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Multilevel barriers to guideline implementation - a nationwide multi- professional cross- sectional study within child and adolescent psychiatry

Santesson, Anna LU ; Holmberg, Robert LU ; Bäckström, Martin LU ; Gustafsson, Peik LU orcid ; Perrin, Sean LU orcid and Jarbin, Håkan LU (2024) In Child and Adolescent Psychiatry and Mental Health
Abstract
Background: Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods: 440 CAMHS clinicians across Sweden (52%)... (More)
Background: Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods: 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. Results: Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption abilityies. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. Conclusion: This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Children and adolescents, Depression, Treatment guidelines, Implementation, Barriers and facilitators, Needs Assessment, Multiprofessional
in
Child and Adolescent Psychiatry and Mental Health
publisher
BioMed Central (BMC)
ISSN
1753-2000
language
English
LU publication?
yes
id
cab7c971-b553-448c-9941-f52675221705
date added to LUP
2024-08-28 11:09:48
date last changed
2024-08-29 10:34:35
@article{cab7c971-b553-448c-9941-f52675221705,
  abstract     = {{Background:  Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods: 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. Results: Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption abilityies. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. Conclusion: This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.}},
  author       = {{Santesson, Anna and Holmberg, Robert and Bäckström, Martin and Gustafsson, Peik and Perrin, Sean and Jarbin, Håkan}},
  issn         = {{1753-2000}},
  keywords     = {{Children and adolescents; Depression; Treatment guidelines; Implementation; Barriers and facilitators; Needs Assessment; Multiprofessional}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Child and Adolescent Psychiatry and Mental Health}},
  title        = {{Multilevel barriers to guideline implementation - a nationwide multi- professional cross- sectional study within child and adolescent psychiatry}},
  year         = {{2024}},
}