Theories from social and behavioural science can make an important
contribution to the process of developing a conceptual framework for
improving use of clinical practice guidelines and clinician performance. A
conceptual framework for guideline dissemination and implementation is
presented which draws on relevant concepts from diffusion of innovation
theory, the transtheoretical model of behaviour change, health education
theory, social influence theory, and social ecology, as well as evidence
from systematic literature reviews on the effectiveness of various
behaviour change strategies. The framework emphasises the need for
pre-implementation assessment of (a) readiness of clinicians to adopt
guidelines into practice, (b) barriers to change as experienced by
clinicians, and (c) the level at which interventions should be targeted. It
also incorporates the need for multifaceted interventions, identifies the
type of barriers which will be addressed by each strategy, and develops the
concept of progression through stages of guideline adoption by clinicians,
with the use of appropriately targeted support strategies. The potential
value of the model is that it may enable those involved in the process of
guideline dissemination and implementation to direct strategies to target
groups more effectively. Clearly, the effectiveness and utility of the
model in facilitating guideline dissemination and implementation requires
validation by further empirical research. Until such research is available,
it provides a theoretical framework that may assist in the selection of
appropriate guideline dissemination and implementation strategies.