title: Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.
abstract: OBJECTIVE
  Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines.
  
  
  METHODS
  A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified.
  
  
  RESULTS
  Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice.
  
  
  CONCLUSIONS
  Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended.
  
  
  CONCLUSIONS
  In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.
authors.affiliation: Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney , Cumberland Campus C43S, Lidcombe New South Wales , Australia .
authors.forename: Melissa
authors.initials: M
authors.lastname: Miao
authors.forename: Emma
authors.initials: E
authors.lastname: Power
authors.forename: Robyn
authors.initials: R
authors.lastname: O'Halloran
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D019468:Disease Management; D055317:Evidence-Based Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D013066:Speech-Language Pathology; D000071939:Stroke Rehabilitation; D057170:Translational Research, Biomedical
keywords: Clinical practice guidelines; evidence-base practice; implementation science; knowledge translation; qualitative research; speech pathologists; stroke rehabilitation