title: What drives junior doctors to use clinical practice guidelines? A national cross-sectional survey of foundation doctors in England & Wales.
abstract: BACKGROUND
  Clinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.
  
  
  METHODS
  A self-completed, anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.
  
  
  RESULTS
  A total of 13,138 doctors were invited of which 1693 [corrected] (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2-3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence. Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: "confidence", "familiarity", "commitment and duty", "time" and "perceived benefits". Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.
  
  
  CONCLUSIONS
  In this large survey of newly qualified doctors, "confidence", "familiarity" and "commitment and duty" were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence. Our findings suggest a number of approaches that may be taken to improve junior doctors' commitment to CPGs through processes that increase their confidence and familiarity in using CPGs. Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.
authors.forename: Logan
authors.initials: L
authors.lastname: Manikam
authors.affiliation: Population, Policy and Practice, UCL Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK. logan.manikam.10@ucl.ac.uk.|National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK. logan.manikam.10@ucl.ac.uk.
authors.forename: L
authors.initials: L
authors.lastname: Manikam
authors.forename: Andrew
authors.initials: A
authors.lastname: Hoy
authors.affiliation: National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK. andrewrh.work@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Hoy
authors.forename: Hannah
authors.initials: H
authors.lastname: Fosker
authors.affiliation: University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK. hannahfosker@nhs.net.
authors.forename: H
authors.initials: H
authors.lastname: Fosker
authors.affiliation: University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK. martin.wong@doctors.org.uk.
authors.forename: Martin Ho Yin
authors.initials: MH
authors.lastname: Wong
authors.forename: Jay
authors.initials: J
authors.lastname: Banerjee
authors.affiliation: University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK. jb234@le.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Banerjee
authors.forename: Monica
authors.initials: M
authors.lastname: Lakhanpaul
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, Addison House, London, SE1 IUL, UK. m.lakhanpaul@ucl.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Lakhanpaul
authors.forename: Alec
authors.initials: A
authors.lastname: Knight
authors.affiliation: King's Improvement Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addison House, London, SE1 IUL, UK. alec.knight@kcl.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Knight
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, Addison House, London, SE1 IUL, UK. peter.littlejohns@kcl.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Littlejohns
authors.forename: P
authors.initials: P
authors.lastname: Littlejohns
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004739:England; D055317:Evidence-Based Practice / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014852:Wales