title: The development of guideline implementation tools: a qualitative study.
abstract: BACKGROUND
  Research shows that guidelines featuring implementation tools (GItools) are more likely to be used than those without GItools, however few guidelines offer GItools and guidance on developing GItools is lacking. The objective of this study was to identify common processes and considerations for developing GItools.
  
  
  METHODS
  Interviews were conducted with developers of 4 types of GItools (implementation, patient engagement, point-of-care decision-making and evaluation) accompanying guidelines on various topics created in 2008 or later identified in the National Guideline Clearinghouse. Participants were asked to describe the GItool development process and related considerations. A descriptive qualitative approach was used to collect and analyze data.
  
  
  RESULTS
  Interviews were conducted with 26 GItool developers in 9 countries. Participants largely agreed on 11 broad steps, each with several tasks and considerations. Response variations identified issues lacking uniform approaches that may require further research including timing of GItool development relative to guideline development; decisions about GItool type, format and content; and whether and how to engage stakeholders. Although developers possessed few dedicated resources, they relied on partnerships to develop, implement and evaluate GItools.
  
  
  CONCLUSIONS
  GItool developers employed fairly uniform and rigorous processes for developing GItools. By supporting GItool development, the GItool methods identified here may improve guideline implementation and use.
authors.affiliation: University Health Network, Toronto, Ont.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.affiliation: McMaster University, Hamilton, Ont.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.affiliation: Women's College Hospital, Toronto, Ont.
authors.forename: Onil K
authors.initials: OK
authors.lastname: Bhattacharyya
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