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Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

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Abstract

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Background

In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain.

Objectives

To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes.

Search methods

For this update, in addition to the EPOC Register and pending files, we searched the following databases without language restrictions, from inception until August 2007: MEDLINE, EMBASE, CINAHL, BNI and HMIC. We searched the National Research Register to November 2007.  We undertook further searches to October 2009 to identify potentially eligible published or ongoing trials.

Selection criteria

Randomised controlled trials (RCTs) of interventions tailored to address prospectively identified barriers to change that reported objectively measured professional practice or healthcare outcomes in which at least one group received an intervention designed to address prospectively identified barriers to change.

Data collection and analysis

Two reviewers independently assessed quality and extracted data. We undertook quantitative and qualitative analyses. The quantitative analyses had two elements.

1. We carried out a meta‐regression to compare interventions tailored to address identified barriers to change with either no interventions or an intervention(s) not tailored to the barriers.

2. We carried out heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, concealment of allocation, rigour of barrier analysis, use of theory, complexity of interventions, and the reported presence of administrative constraints.

Main results

We included 26 studies comparing an intervention tailored to address identified barriers to change to no intervention or an intervention(s) not tailored to the barriers. The effect sizes of these studies varied both across and within studies.

Twelve studies provided enough data to be included in the quantitative analysis. A meta‐regression model was fitted adjusting for baseline odds by fitting it as a covariate, to obtain the pooled odds ratio of 1.54 (95% CI, 1.16 to 2.01) from Bayesian analysis and 1.52 (95% CI, 1.27 to 1.82, P < 0.001) from classical analysis. The heterogeneity analyses found that no study attributes investigated were significantly associated with effectiveness of the interventions.

Authors' conclusions

Interventions tailored to prospectively identified barriers are more likely to improve professional practice than no intervention or dissemination of guidelines. However, the methods used to identify barriers and tailor interventions to address them need further development. Research is required to determine the effectiveness of tailored interventions in comparison with other interventions.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Tailored interventions to overcome identified barriers to change effects on professional practice and health care outcomes

Tailored interventions to change professional practice are interventions planned following an investigation into the factors that explain current professional practice and any reasons for resisting new practice. These factors are referred to as barriers to change. The barriers may vary in different healthcare settings, groups of healthcare professionals or clinical tasks. It is widely assumed that efforts to change professional practice have a lower likelihood of success unless these barriers are identified and taken into account.

In a previous review that was able to include only 15 studies, we were unable to conclude that tailoring was effective. However, more studies of tailoring have been published and therefore we have incorporated the new studies into an update of the review.

We have included 26 studies in the new review. The findings indicate that tailored interventions can change professional practice. As yet, there is insufficient evidence on the most effective approaches to tailoring, including how barriers should be identified and how interventions should be selected to address the barriers. In addition, there is no evidence about the cost‐effectiveness of tailored interventions compared to other interventions to change professional practice. Consequently, it is reasonable to employ low‐cost tailored interventions in practice, but evidence on the cost‐effectiveness of the alternative methods of tailoring is required before use of more costly tailored approaches can be justified.