Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes.
BACKGROUND
In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain.


OBJECTIVE
To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes.


METHODS
For this update, in addition to the EPOC Register and pending files, we searched the following databases without language restrictions, from inception until August 2007: MEDLINE, EMBASE, CINAHL, BNI and HMIC. We searched the National Research Register to November 2007. We undertook further searches to October 2009 to identify potentially eligible published or ongoing trials.


METHODS
Randomised controlled trials (RCTs) of interventions tailored to address prospectively identified barriers to change that reported objectively measured professional practice or healthcare outcomes in which at least one group received an intervention designed to address prospectively identified barriers to change.


METHODS
Two reviewers independently assessed quality and extracted data. We undertook quantitative and qualitative analyses. The quantitative analyses had two elements.1. We carried out a meta-regression to compare interventions tailored to address identified barriers to change with either no interventions or an intervention(s) not tailored to the barriers.2. We carried out heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, concealment of allocation, rigour of barrier analysis, use of theory, complexity of interventions, and the reported presence of administrative constraints.


RESULTS
We included 26 studies comparing an intervention tailored to address identified barriers to change to no intervention or an intervention(s) not tailored to the barriers. The effect sizes of these studies varied both across and within studies.Twelve studies provided enough data to be included in the quantitative analysis. A meta-regression model was fitted adjusting for baseline odds by fitting it as a covariate, to obtain the pooled odds ratio of 1.54 (95% CI, 1.16 to 2.01) from Bayesian analysis and 1.52 (95% CI, 1.27 to 1.82, P < 0.001) from classical analysis. The heterogeneity analyses found that no study attributes investigated were significantly associated with effectiveness of the interventions.


CONCLUSIONS
Interventions tailored to prospectively identified barriers are more likely to improve professional practice than no intervention or dissemination of guidelines. However, the methods used to identify barriers and tailor interventions to address them need further development. Research is required to determine the effectiveness of tailored interventions in comparison with other interventions.
Baker
Richard
R
Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester, Leicestershire, UK, LE1 6TP.
Camosso-Stefinovic
Janette
J
Gillies
Clare
C
Shaw
Elizabeth J
EJ
Cheater
Francine
F
Flottorp
Signe
S
Robertson
Noelle
N
D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D016032:Randomized Controlled Trials as Topic