title: An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol.
abstract: BACKGROUND
  Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption.
  
  
  METHODS
  The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension) and institutional care (chronic ulcer, chronic heart failure) topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies.
  
  
  CONCLUSIONS
  Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective outcomes reflecting the adoption of processes and associated patient care outcomes could be evaluated.
authors: Toronto General Research Institute, 200 Elizabeth Street, 13EN-235, Toronto, Ontario, M5G2C4, Canada. anna.gagliardi@uhnresearch.ca
authors: Anna R
authors: AR
authors: Gagliardi
authors: Melissa C
authors: MC
authors: Brouwers
authors: Valerie A
authors: VA
authors: Palda
authors: Louise
authors: L
authors: Lemieux-Charles
authors: Jeremy M
authors: JM
authors: Grimshaw