title: Barriers to and facilitators for the use of an evidence-based occupational therapy guideline for older people with dementia and their carers.
abstract: OBJECTIVE
  Implementing evidence-based guidelines is not a simple task. This study aimed to define barriers to and facilitators for implementing the proven and effective Community Occupational Therapy in Dementia (COTiD) guideline for older people with dementia and their carers.
  
  
  METHODS
  The qualitative method we used was the grounded theory. We collected data from focus group interviews with 17 occupational therapists (OTs) and telephone interviews with 10 physicians and 4 managers. We analysed the data with the constant comparative method by identifying codes, categories, and main themes.
  
  
  RESULTS
  The main themes in barriers that OTs encountered were that they did not feel competent in treating older people with dementia at home according to the guideline; they had difficulties prioritising in this complex treatment, both for the client and themselves; and they were unsure about the minimal criteria for guideline adherence. The intensity of this programme was the main barrier. The barriers that confronted physicians and managers were lack of knowledge about occupational therapy and its reimbursement and lack of available trained OTs. For the OTs, the guideline's content and focus, evidence, and external support facilitated the use of the guideline. For physicians and managers, the guideline's evidence base and its benefits for clients and carers were the main facilitators.
  
  
  CONCLUSIONS
  This study generates knowledge for applying innovations in health care settings. Improvement of the OTs' knowledge and self-confidence is needed for using the guideline. We expect that more competent OTs will motivate their physicians and managers to use this successful COTiD intervention.
authors.affiliation: Radboud University Nijmegen Medical Centre, Department IQ Healthcare, Nijmegen Centre for Evidence-Based Practice, Nijmegen, the Netherlands. m.a.van.t.leven@hr.nl
authors.forename: Netta
authors.initials: N
authors.lastname: Van't Leven
authors.forename: Maud J L
authors.initials: MJ
authors.lastname: Graff
authors.forename: Marleen
authors.initials: M
authors.lastname: Kaijen
authors.forename: Bert J M
authors.initials: BJ
authors.lastname: de Swart
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.forename: Myrra J M
authors.initials: MJ
authors.lastname: Vernooij-Dassen
mesh_terms: D000328:Adult; D017028:Caregivers; D003704:Dementia / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011795:Surveys and Questionnaires