Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis

Implementation Science

Caitlin McArthur¹  Yuxin Bai²  Alexandra Papaioannou²  Patricia Hewston²  Sharon Straus³  Lora Giangregorio⁴ 

[1] Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, Nova Scotia, Canada;GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9, Hamilton, Ontario, Canada;GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9, Hamilton, Ontario, Canada;Master University, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada;University of Toronto, 27 King’s College Circle, M5S 1A4, Toronto, Ontario, Canada;University of Waterloo, 200 University Avenue West, N2L 3G1, Waterloo, Ontario, Canada;Schlegel-UW Research Institute for Aging, 150 Laurelwood Drive, N2J 0E2, Waterloo, Ontario, Canada;

关键词: Long-term care;    Barriers;    Facilitators;    Evidence-based;    Guidelines;    Knowledge translation;   

DOI  :  10.1186/s13012-021-01140-0

来源: Springer

【 摘 要 】

BackgroundThe long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies.MethodsFollowing the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach.FindingsAfter screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings.ConclusionsFuture knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.

【 授权许可】

CC BY