title: Implementation of a Multidisciplinary Guideline for Low Back Pain: Process-Evaluation Among Health Care Professionals.
abstract: Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other's disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Arnela
authors.initials: A
authors.lastname: Suman
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. f.schaafsma@vumc.nl.|Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Department of Public and Occupational Health, VU University Medical Centre, PO Box 7067, 1007 MB, Amsterdam, The Netherlands. f.schaafsma@vumc.nl.
authors.forename: Frederieke G
authors.initials: FG
authors.lastname: Schaafsma
authors.affiliation: Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, Monash University, Suite 41, Cabrini Medical Centre, 183 Wattletree Rd, Melbourne, VIC, 3144, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: Department of Health Sciences, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Department of Public and Occupational Health, VU University Medical Centre, PO Box 7067, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence / Q000191:economics; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000191:economics; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Guideline implementation; Healthcare professionals; Low back pain; Multifaceted implementation strategy; Process evaluation