title: Addressing implementation challenges during guideline development - a case study of Swedish national guidelines for methods of preventing disease.
abstract: BACKGROUND
  Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.
  
  
  METHODS
  Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.
  
  
  RESULTS
  The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.
  
  
  CONCLUSIONS
  This case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 90185, Umeå, Sweden. linda.sundberg@epiph.umu.se.|Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 17177, Stockholm, Sweden. linda.sundberg@epiph.umu.se.
authors.forename: Linda
authors.initials: L
authors.lastname: Richter-Sundberg
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 90185, Umeå, Sweden. therese.kardakis@ki.se.|Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 17177, Stockholm, Sweden. therese.kardakis@ki.se.
authors.forename: Therese
authors.initials: T
authors.lastname: Kardakis
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 90185, Umeå, Sweden. lars.weinehall@epiph.umu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
authors.affiliation: Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, SE 971 87, Luleå, Sweden. rickard.garvare@ltu.se.
authors.forename: Rickard
authors.initials: R
authors.lastname: Garvare
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 90185, Umeå, Sweden. monica.nystrom@ki.se.|Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 17177, Stockholm, Sweden. monica.nystrom@ki.se.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Nyström
mesh_terms: D000328:Adult; D032921:Consensus; D055317:Evidence-Based Practice / Q000458:organization & administration / Q000592:standards; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D040242:Risk Reduction Behavior; D013548:Sweden