Background
Lack of time has consistently been reported as a major barrier to
effective uptake of research evidence into clinical practice1–5. Despite this body of evidence, the concept of a
“lack of time” is not well understood, as there are few effective
strategies available for clinicians to assist them to decrease time-use
barriers to evidence uptake 5,6.
Clinical practice guidelines (CPGs) are defined as “a convenient way of
packaging evidence and presenting recommendations to healthcare decision
makers” (p.6) 7. Thus CPGs, in theory, should provide
busy physiotherapists (PTs) with easy-to-use tools that support
efficient access to current best evidence in ways that inform their
daily clinical practice decisions. However, CPG uptake rarely occurs at
the speed of evidence production 8. Knowledge
translation strategies, specifically training programmes about
evidence-based practice (EBP) and CPGs, aim to support PTs’
evidence-uptake behaviours and their use of CPGs to leverage effective
and efficient practices 9,10. This aligns with the six
domains of healthcare quality: safe, effective, patient-centred, timely,
efficient and equitable 11. These six domains ensure
optimal patient management.
Prochaska and DiClemente’s Transtheoretical Model (TTM) of Stages of
Change (SoC) is one of the oldest behaviour change frameworks, developed
to describe health choices and stages of health behaviour change (Figure
1) 12. The TTM was initially developed for managing
substance abuse, specifically smoking cessation 13,
and it has since been applied to changing dietary behaviours14 and physical activity 15. The TTM
has more recently been applied to investigations into the effectiveness
of interventions into healthcare professionals’ (physicians, nurses,
allied health practitioners) uptake of evidence into practice (in this
case healthcare worker’s hand hygiene), with greater compliance with
uptake of evidence being related to higher levels of SoC16.The authors indicated that to understand the
complexity of behaviour change related to CPG uptake, the healthcare
professionals’ readiness to change needs to be considered, as it cannot
be assumed that all healthcare providers are similarly motivated to
embrace EBP 16. SoC comprise pre-contemplation (no
recognition of need for or interest in change); contemplation (thinking
of changing); preparation (intention and first steps towards taking
action to change); action (adopting new behaviours); and maintenance
(ongoing practice of new behaviours) 17. There is also
a “termination” phase that is used in substance abuse literature that
is usually not referred to in implementation science, as it is not
relevant due to the focus of continual quality improvement in EBP uptake
practices 13,16.
>>Figure 1: Prochaska & DiClemente’s Stages
of Change (adapted with permission) about
here>>
There has been no research to our knowledge that explores time as a
barrier within the SoC framework, to better understand the processes of
PTs’ uptake of CPGs. We postulate that understanding barriers to CPG
uptake within the context of changing EBP behaviours is a ‘chicken and
egg’ situation, where barriers to behaviour change, and PTs’ SoC are
related to their understanding of CPGs. If the PTs understand how to use
CPGs in practice, they may be more inclined to overcome barriers to CPG
uptake. This paper explores the concept of lack of time as a barrier for
CPG uptake for PTs at different SoC.