Results
Participants: Thirty-one PTs participated in the study: 10
participants in private and public practices each, and 11 participants
from the education sector.
SoC classification: Table 1 outlines the classification of study
participants into their appropriate SoC and includes illustrative
quotations in relation to their appropriate SoC. Some participants did
not have a clear understanding of CPGs, and of those that did, not all
were ready to implement CPGs into practice. Conversely, of those
individuals who were unclear about CPGs, there were some who wanted to
apply best evidence to their practice and were unsure about doing this.
Years in practice were not an indicator to whether the person was more
or less likely to implement CPGs in their practice.
>>Table 1: Classification of study
participants into Stages of Change about
here>>
To be classified at the Pre-contemplation stage, participants must have
provided evidence that they were not ready to explore the use of CPGs in
clinical practice. If participants provided evidence that they were
considering the possibilities of implementing CPGs, then they were
classified as in the Contemplation stage. If participants noted the
benefits of using CPGs in clinical practice, or if they understood what
CPGs entailed, or had previously used them, they were assigned into the
Action stage. P6 and P11 did not see accessing of CPGs as a barrier to
CPG uptake, but rather assisting them due to it being readily available
to them via online sources. They may be classified at the Action stage
of the SoC, as they can already see ways to incorporate CPGs as part of
their clinical load. They will need assistance with choosing a CPG and
prioritising conditions seen in practice for application of CPGs.
To be classified at the Maintenance stage, the participants must have
provided evidence that they have successfully used CPGs and are
continuing to use it.
However, when assigning participants into the TTM SoCs, there were
complexities in the classification process. Considering the quotations
related to whether “time due to workload” was an issue for CPG uptake,
the answers were initially divided into “yes “, “no” and “do not
know” groups. In the “yes” group there were five private, two public
and two educators that indicated time as a barrier. These participants
were classified in the lower SoC (Pre-contemplation (n=5) and
Contemplation (n=3)), except one participant who was classified as
Maintenance. One private PT, two public PTs and five educators did not
think that time was a barrier to CPG uptake. All but one of the PTs that
did not identify time as a barrier were classified in the higher SoC,
Action (n=6) or Maintenance (n=1). The one participant (P07) that was
ultimately classified as “Preparation” reflected more on the view of
the public sector PT than their own position. In the “do not know”
group four private, six public and four educators were identified.
When comparing the different SoC levels to the subthemes relating to the
concept of “lack of time” (Figure 2), all participants identified
“EBP as priority in practice” as a factor, while certain SoC levels
were more likely to identify other subthemes of the “lack of time”.
For example, the participants in the pre-contemplation stage, were more
likely to identify “Few staff, high workload” as barriers to CPG
uptake. In addition to above, participants in the contemplation stage
identified “accessing CPGs” as another barrier. Whereas, participants
in the preparation stage, identified “Time is money” as barrier to CPG
uptake. Participants in the action stage identified “knowledge on CPG
use” as a barrier. The maintenance stage had no barriers apart from
“EBP as priority in practice”, being cited more as a factor
influencing rather than a barrier to CPG uptake.
The authors conceptualised a model of time management for better CPG
uptake (Figure 3). This model combines the barriers of time, the
different SoC 17 and the six domains of healthcare
quality 11. This model gives researchers a way of
categorising individuals into different SoC to assist clinicians in CPG
uptake to ultimately align clinical practice to evidence-informed
practice. Central to the model is the barrier of time, with the first
circle providing underlying challenges to the concept of “lack of
time” for evidence uptake. The following circle deals with a clinician
moving through the different SoC (from Pre-contemplation to Maintenance)
to reaching the criteria for healthcare quality. The model is
encompassed by the clinician determining the importance of the outer
circle, “EBP as priority”, to their own clinical decision-making
process. Each circle within the wheel model is a moving part, with the
circles’ parts aligning and interacting with each other at different
stages of their process toward optimum usage of evidence as part of
their decision-making process.
The authors mapped the constructs of the wheel model (Figure 3) to the
Theoretical Domains Framework of behaviour change (TDF) (Table 2) to
support its design and applicability to addressing the lack-of-time
barrier to CPG uptake 22. The updated TDF
“provides a method for theoretically assessing implementation
problems, as well as professional and other health-related behaviours as
a basis for intervention development ” 23. The TDF
has previously been used to investigate influences on health and
clinical behaviours, developing and evaluating implementation
intervention designs and guiding appropriate behaviour change technique
identification 22.
>>Figure 3: Wheel model of time management for
better CPG-uptake about here>>
>>Table 2: Mapping of wheel model to
Theoretical Domains Framework 22 about
here>>