Discussion
The complexity of classifying individuals into different levels of
readiness to change, indicated the importance of understanding each
participant at their level of readiness to “hear” about CPGs. This
understanding may lead to more targeted interventions to train PTs about
EBP and using CPGs as an efficient source of information, which may in
turn lead to sustainable long-term behaviour change in CPG uptake16. The importance of EBP in clinical practice was
echoed by all the SoC, showing that this is may be a strong motivator
for CPG uptake, if the underlying reasons for a “lack of time” can be
effectively addressed. The fact that both the Pre-contemplation and
Contemplation participants identified logistical issues (“few staff,
high workload”, “accessing CPGs”), links to a limited understanding
of the function and benefit of using CPGs in practice. It is interesting
that the Preparation participants were focused on what the monetary
effect would be to CPG-uptake, possibly indicating that they may benefit
from understanding the domains of healthcare quality to support its use
to improve healthcare outputs 11. The Action
participants may benefit from a deeper understanding to determining the
quality of the CPGs, including the strength of the underlying research
that the CPGs drew from. The Maintenance participants are in a unique
position to become change agents to increase the use of CPGs among
colleagues and the greater healthcare community, as they already
interact with and use CPGs in their daily practice. The five educators
that did not perceive time as a barrier, may think that they are able to
use CPGs easier because they are used to working with research
documents. Conversely, this may also indicate that the educators do not
understand what is expected of clinicians in a daily workload.
The model of time management for better CPG uptake (Figure 3) proposes a
novel approach to assist evidence implementalists and clinicians alike
to determine how to progress through the SoC and barriers to improve CPG
uptake. When clinicians can identify their level of readiness to use
CPGs, then they are able to choose the strategy to enable moving forward
and improve or maintain their CPG-uptake. The strength of the proposed
model is that it provides guidance on how to move an individual through
the different SoC by determining where their SoC lies in relation to
their perceived barriers to CPG uptake, but also considering the
criteria for healthcare quality. This ensures a growing ability of
clinical decision-making in light of the best available research
evidence. A weakness of this model is that it may still not address the
fluidity of readiness to change with regards to individuals moving
forward and backward between SoC, while experiencing different barriers
to optimum CPG uptake.
Table 3 proposes different strategies that may be employed to assist
each SoC level to improve their CPG uptake into clinical practice.
Through the categorisation of clinicians into different SoC, strategies
may be developed to reach each participant at their readiness to
“hear” about CPGs and to start implementing CPGs in daily practice.
The authors developed “framing quotations” as possible ways that
future individuals may explain their experience with and uptake of CPGs.
The authors postulate that, by determining an individual’s SoC and
employing individualised strategies to improve CPG uptake, it will lead
to more efficient and effective patient care, due to better evidence
utilisation through overcoming the barrier of time.
>>Table 3: Strategies for Stages of Change
levels about here>>