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.