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>>