title: Implementing clinical guidelines in stroke: a qualitative study of perceived facilitators and barriers.
abstract: BACKGROUND
  Clinical guidelines are frequently used as a mechanism for implementing evidence-based practice. However research indicates that health professionals vary in the extent to which they adhere to these guidelines. This study aimed to study the perceptions of stakeholders and health professionals on the facilitators and barriers to implementing national stroke guidelines in Ireland.
  
  
  METHODS
  Qualitative interviews using focus groups were conducted with stakeholders (n=3) and multidisciplinary team members from hospitals involved in stroke care (n=7). All focus group interviews were semi-structured, using open-ended questions. Data was managed and analysed using NVivo 9 software.
  
  
  RESULTS
  The main themes to emerge from the focus groups with stakeholders and hospital multidisciplinary teams were very similar in terms of topics discussed. These were resources, national stroke guidelines as a tool for change, characteristics of national stroke guidelines, advocacy at local level and community stroke care challenges. Facilitators perceived by stakeholders and health professionals included having dedicated resources, user-friendly guidelines relevant at local level and having supportive advocates on the ground. Barriers were inadequate resources, poor guideline characteristics and insufficient training and education.
  
  
  CONCLUSIONS
  This study highlights health professionals' perspectives regarding many key concepts which may affect the implementation of stroke care guidelines. The introduction of stroke clinical guidelines at a national level is not sufficient to improve health care quality as they should be incorporated in a quality assurance cycle with education programmes and feedback from surveys of clinical practice.
authors: School of Nursing and Midwifery, Trinity College Dublin, Ireland. cdonnel@tcd.i
authors: Claire
authors: C
authors: Donnellan
authors: S
authors: S
authors: Sweetman
authors: E
authors: E
authors: Shelley
mesh_terms: D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D007494:Ireland; D008505:Medical Staff, Hospital; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D020521:Stroke / Q000628:therapy
keywords: Barriers; Clinical guidelines; Facilitators; Implementation; Stroke