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Table 2 Characteristics of included studies

From: Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis

Study Year Country (Province, state, or region) Study design Study objectives Data collection methods Analysis Guidelines and health topic examined Behaviour change framework, model, or theory
Phipps et al. [36] 2019 England (South East) Qualitative study To explore what factors impact the ability of clinicians to manage care home flu outbreaks according to national guidelines and highlight opportunities for change Collected notes written (from discussions) during responses to outbreaks, presentations on influenza at stakeholder engagement events Identified and matched codes to themes—capability, opportunity, and organizational factors from framework National guidelines supporting antiviral use Framework developed by Greenhalgh et al., capability, opportunity, and motivation
Abraham et al. [37] 2019 Germany (Varied) Process evaluation subcomponent of a pragmatic cluster randomized controlled trial To systematically document the implementation process and describe barriers and facilitators Structured interviews and focus groups Not reported IMPRINT—to reduce physical restraint use None
Villarosa et al. [38] 2018 Australia (New South Wales) Exploratory qualitative study To explore the perceptions of care staff towards the provision of oral health care following implementation of a new care model: (1) examine the perceptions of the care staff regarding oral health care practices; (2) ascertain the needs and recommendations of care staff in relation to improving the delivery of oral health care. Focus group Inductive thematic analysis Better oral health in Residential Aged Care programme None
Huhtinen et al. [39] 2018 Australia (Sydney) Mixed method To identify the perceived barriers to the implementation of the Australian guidelines on influenza outbreak management with staff in an inner-city Sydney region Telephone interview using a semi-structured questionnaire Thematic analysis National Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Care Facilities in Australia None
Nilsen et al. [40] 2018 Sweden (Southern region) Qualitative study To identify barriers and facilitators to implementing evidence-based palliative care in the nursing homes Semi-structured interviews Content analysis. Codes were compared with categories outlined in the Organizational Readiness for Change Framework World Health Organization guidelines on palliative care Organizational Readiness for Change
DuBeau et al. [41] 2007 USA (Kansas) Mixed method To survey nursing home staff and state surveyors regarding attitudes about perceived and/or experienced barriers and challenges to implementing F315 compliance Questionnaire survey with Likert type responses and open-ended questions Inductive manifest and latent content analysis based on grounded theory F315 tag: guidance for meeting compliance in managing and evaluating urinary incontinence and urinary catheters None
Birney et al. [42] 2016 Canada (Alberta) Exploratory qualitative study To understand how four LTC facilities in Alberta have implemented medication reviews for the Appropriate Use of Antipsychotic Initiative Semi-structured interviews and observations Thematic analysis Alberta Guideline on the Appropriate Use of Antipsychotic Medications None
Fallon et al. [43] 2006 Australia (City of Toowoomba) Quality improvement study To identify barriers to implementation of evidence-based recommendations and strategies to overcome these barriers Semi-structured focus group Thematic analysis Evidence-based recommendations for oral health None
Baert et al. [44] 2016 Belgium (Flanders) Mixed method To identify barriers as well as motivators for organizing physical activity in LTC homes according to administrators on the different levels of the socioecological model. A secondary goal was examining their knowledge of the guidelines regarding physical activity and to reveal potential motivators and barriers for the implementation of these guidelines Questionnaire and interviews Deductive qualitative content analysis (Interviews) World Health Organization guidelines for physical activity in older adults None
Alamri et al. [45] 2015 Canada (Ontario) Qualitative study To identify potential barriers to evidence-based practices for osteoporosis and fracture prevention in LTC settings Action plan worksheet completed by LTC staff in the control arm of an intervention study Deductive and inductive thematic analysis Clinical practice guidelines for the diagnosis and management of osteoporosis in
Canada
Theoretical Domains Framework
Kaasalainen et al. [46] 2014 Canada (Ontario) Exploratory, multiple-case study What barriers and facilitators are encountered by the clinical nurse specialists and nurse practitioners in changing team practice related to implementing a pain protocol? Diaries recording strategies, barriers, facilitators; participant observation and field notes by research assistant; interviews and focus groups Thematic analysis Interdisciplinary pain protocol by Kaasalainen et al. 2012 None
Vikstrom et al. [47] 2015 Sweden (Stockholm) Implementation study To outline the nursing home staff experiences during the first year of implementation of guidelines for care of people with dementia Reflective seminars—detailed notes with experiential data relating to participant experiences in 4 discussions and written content/illustrations from posters Inductive and deductive qualitative content analysis Sweden's national evidence-based guidelines for care of people with dementia None
Strachan et al. [48] 2014 Canada (Ontario) Descriptive qualitative study nested in phase 2 of a three-phase mixed methods protocol To explore LTC nurses’ experiences in managing heart failure Focus group Manifest content analysis Canadian Cardiovascular Society Heart Failure guidelines in LTC None
Lim et al. [49] 2014 Australia (Victoria) Not reported To explore the attitudes and perceptions of key healthcare providers towards antimicrobial stewardship interventions in Australian residential aged care facilities Interviews and focus groups Thematic analysis using the framework approach International guidelines for infection control and prevention None
Dellefield et al. [50] 2014 USA (California) Exploratory qualitative interview To describe nurses’ perceptions of individual and organization-level factors influencing performance of pressure ulcer prevention care in 2 VHA Nursing Home Community Living Centers to help identify existing factors perceived as facilitators and barriers to delivering pressure ulcer prevention care Semi-structured interviews Content analysis Evidence-based guidelines for prevention of pressure ulcers None
Berta et al. [28] 2013 Canada (Ontario) Survey To better understand how care protocols are implemented in LTC homes operating in Ontario, and to learn what processes, structural mechanisms, and knowledge sources are relevant to their implementation Pen and paper survey Mean score of importance Clinical practice guidelines for either preventative skin care, wound/ulcer care, restraint use, management of incontinence, management of difficult behaviours, and antimicrobial resistance Organizational learning theory
Bamford et al. [51] 2012 England (Not reported) Process evaluation To explore facilitators and barriers to the use of nutrition guidelines in residential care homes Semi-structured interviews, informal discussions, nonparticipant observation Thematic analysis, themes then mapped onto the Normalization Process Framework UK Food Standards Agency nutrient and food-based guidance for older people in residential care Normalization Process Theory
Kaasalainen et al. [52] 2012 Canada (Ontario) Mixed method To evaluate dissemination strategies in improving clinical practice behaviours (e.g., documentation of pain assessments, use of pain medications and non-pharmacological interventions) among health care team members, and the effectiveness of the pain protocol in reducing pain in LTC residents Focus group and interviews Thematic content analysis The American Medical Directors’ Association and American Geriatrics Society best practice guidelines for pain None
Verkaik et al. [53] 2011 Netherlands (Not reported) Multiple case study Which factors facilitate or inhibit successful introduction of the guideline in psychogeriatric nursing home wards? Which factors facilitate or inhibit the successful application of the guideline by CNAs in their support of residents with comorbid depression? Semi-structured interviews, memos, evaluation forms, activity plan forms, training reports observations Qualitative data analysis Depression in Dementia None
Berta et al. [54] 2010 Canada (Ontario) Multiple case study To explore the translational process that emerges within Ontario long-term care homes with the adoption and implementation of evidence-based clinical practice guidelines Semi-structured interviews, focus groups Template analysis via constant comparative analysis Clinical practice guidelines for either preventative skin care, wound/ulcer care, restraint use, management of incontinence, management of difficult behaviours, and antimicrobial resistance Organizational learning theory
McConigley et al. [55] 2008 Australia (Perth) Qualitative study Identify barriers and facilitators to guideline implementation and strengths that could assist in the implementation process Focus groups and interviews Thematic analysis Australian Pain Society for residents in residential aged care facilities None
Cheek et al. [56] 2004 Australia (South) Descriptive/exploratory multimethod multilayered design To investigate the factors that influence the implementation of best practice guidelines with respect to quality use of medicines in residential aged care facilities Critical Incident Technique, focus groups, and nominal groups Not reported Nursing Guidelines for Medication Management in Nursing Homes and Hostels, Guidelines for Medical Care of Older Persons in Nursing Homes and Hostels, Best Practice Model for the Supply of Pharmacy Services to Residential Care Facilities None
Hilton et al. [57] 2016 Australia (not reported) Mixed method To determine the views and experiences of nurses and care staff in residential care settings in relation to (a) implementing best practice oral care guidelines with residents of long-term care setting who have chronic disabling health conditions and (b) the barriers and facilitators to the implementation of common oral care practices included in clinical guidelines Online survey and focus group Thematic content analysis Several oral care guidelines None
Lau et al. [58] 2007 USA (Michigan) Not reported To examine the importance of work-related factors such as interprofessional communication, participation in decision making, and relationships among clinical staff members, for the adoption of guidelines in nursing homes Semi-structured interviews Thematic analysis Federal guidelines on medication delivery CMS-mandated drug regimen review quality indicators, modified Beers criteria, and other practice guidelines, such as those issued by the American Medical Directors Association None
Buss et al. [59] 2004 Netherlands (Limburg, Noord-Brabant) Qualitative study To elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention Interviews, written pressure prevention protocols Thematic analysis Dutch National Guidelines for Pressure Ulcer Prevention None
Van der Maaden et al. [60] 2017 Netherlands (Not reported) Process evaluation To provide further understanding on the lack on an intervention effect in the cluster randomized trial. Observation, interviews, survey Content analysis Practice guidelines for optimal symptom relief of pneumonia for residents with dementia None
Kong et al. [61] 2021 South Korea (Seoul Special City, Gtyeonggi-do, Incheon Metropolitan City, Gangwon-do) Qualitative descriptive study To describe nursing home staff's perceptions of the barriers and needs in implementing care for people with dementia in Korean nursing homes Semi-structured interviews Qualitative content analysis Person-centred dementia care None
Jeong et al. [62] 2020 South Korea (Not reported) Mixed methods study To identify the barriers to implementation of a CPG perceived by healthcare professionals Semi-structured interviews Thematic analysis Clinical practice guidelines for management of delirium None
Eldh et al. [63] 2020 England, Ireland, Netherlands, Sweden (Not reported) Cluster randomized controlled trial with embedded realist evaluation To demonstrate the added and unique contribution observations made in comparison with survey and stakeholder interviews in a mixed method implementation study Non-participant observations, survey, and interviews Content analysis Continence Management Guidelines Promoting Action on Research Implementation in Health Services Framework
Cossette et al. [64] 2020 Canada (Quebec) Prospective closed cohort supplemented by a development evaluation To identify barriers and enablers in relation to the long-term integration of the OPUS-AP strategy in routine care Semi-structured interviews Semi-inductive thematic analysis Appropriate use of anti-psychotics for behavioural and psychological symptoms of dementia None
Surr et al. [65] 2020 England (West Yorkshire, Oxfordshire, South London) Pragmatic cluster randomized controlled trial with a process evaluation To examine the perceived barriers to and facilitators of intervention implementation, the mechanisms of impact and the perceived impacts from the perspective of mappers, expert mappers, managers, staff, residents and relatives Semi-structured interviews Framework analysis Dementia Care Mapping None
Desveaux et al. [66] 2019 Canada (Ontario) Qualitative process evaluation To examine whether, how, and why an academic detailing intervention could improve evidence uptake and (2) identify perceived changes that occurred to inform outcomes appropriate for quantitative evaluation. Semi-structured interviews Inductive approach within the framework method Fall prevention guideline None
Walker [67] 2019 Australia (Not reported) Process evaluation To report on process outcomes of the ViDAus study evaluating the feasibility of this multifaceted, interdisciplinary knowledge translation intervention for the implementation of vitamin D supplement use in residential aged care facilities Unclear Not reported Vitamin D supplementation guidelines Promoting Action on Research Implementation in Health Services Framework
  1. LTC long-term care