title: Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review.
abstract: OBJECTIVE
  This systematic review aims (1) to identify barriers and facilitators during implementation of primary preventive interventions on patient handling in healthcare, and (2) to assess their influence on the effectiveness of these interventions.
  
  
  METHODS
  PubMed and Web of Science were searched from January 1988 to July 2007. Study inclusion criteria included evaluation of a primary preventive intervention on patient handling, quantitative assessment of the effect of the intervention on physical load or musculoskeletal disorders or sick leave, and information on barriers or facilitators in the implementation of the intervention. 19 studies were included, comprising engineering (n = 10), personal (n = 6) and multiple interventions (n = 3). Barriers and facilitators were classified into individual and environmental categories of factors that hampered or enhanced the appropriate implementation of the intervention.
  
  
  RESULTS
  16 individual and 45 environmental barriers and facilitators were identified. The most important environmental categories were "convenience and easy accessibility" (56%), "supportive management climate" (18%) and "patient-related factors" (11%). An important individual category was motivation (63%). None of the studies quantified their impact on effectiveness nor on compliance and adherence to the intervention.
  
  
  CONCLUSIONS
  Various factors may influence the appropriate implementation of primary preventive interventions, but their impact on the effectiveness of the interventions was not evaluated. Since barriers in implementation are often acknowledged as the cause of the ineffectiveness of patient handling devices, there is a clear need to quantify the influence of these barriers on the effectiveness of primary preventive interventions in healthcare.
authors.affiliation: Erasmus MC, Department of Public Health, University Medical Center Rotterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Koppelaar
authors.forename: J J
authors.initials: JJ
authors.lastname: Knibbe
authors.forename: H S
authors.initials: HS
authors.lastname: Miedema
authors.forename: A
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D006266:Health Education; D006282:Health Personnel; D006801:Humans; D013677:Medical Laboratory Science; D055805:Moving and Lifting Patients / Q000295:instrumentation / Q000379:methods*; D009140:Musculoskeletal Diseases / Q000517:prevention & control*; D009784:Occupational Diseases / Q000473:pathology*; D011322:Primary Prevention / Q000295:instrumentation / Q000379:methods