title: Associations between perceptions of evidence and adoption of H1N1 influenza infection prevention strategies among healthcare workers providing care to persons with spinal cord injury.
abstract: OBJECTIVE
  To examine associations between perceptions of evidence (research evidence, clinical expertise, patient preferences) and outcomes of a nationwide programme to implement H1N1 influenza prevention guidelines.
  
  
  BACKGROUND
  Healthcare workers do not consistently adhere to recommended infection control practices and this may be associated with their perceptions of evidence sources.
  
  
  METHODS
  Cross-sectional mailed survey.
  
  
  METHODS
  A survey of healthcare workers was administered in August 2010 after implementation of H1N1 prevention guidelines. Outcomes of interest were ratings of adherence to H1N1 prevention guidelines.
  
  
  RESULTS
  Respondents with complete data (N = 283) were included in analyses. Facility-level adherence to guidelines was associated with opinions of clinical experts. Healthcare workers who rated clinical expertise as aligning with recommendations also rated their facilities as being more adherent to guidelines. Perceptions of research evidence and patient preferences were not associated with facility adherence. Personal adherence was not associated with perceptions of evidence, except among those healthcare workers who rated both clinical experts and patients as unsupportive of guidelines; these practitioners were less likely to adhere to recommended personal hygiene practices.
  
  
  CONCLUSIONS
  Efforts to implement guidelines might be most effective when capitalizing on the influence of clinical experts. To better explain variability in guideline adherence, inclusion of a broader array of variables is recommended for future studies.
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) and VA Puget Sound Healthcare System, Seattle, Washington, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Ullrich
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Lavela
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Scott
authors.initials: S
authors.lastname: Miskevics
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
mesh_terms: D006282:Health Personnel; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*
keywords: adherence; evidence; guideline implementation; influenza prevention; nursing; promoting action on research implementation in health services