Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Research

A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping

Authors: Amy E Green, Gregory A Aarons

Published in: Implementation Science | Issue 1/2011

Login to get access

Abstract

Background

The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States.

Methods

Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data.

Results

A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups.

Conclusions

EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.
Appendix
Available only for authorised users
Literature
1.
Hoagwood K, Olin S: The NIMH blueprint for change report: Research priorities in child and adolescent mental health. J Am Acad Child Adolesc Psychiatry. 2002, 41: 760-767. 10.1097/00004583-200207000-00006.CrossRefPubMed
2.
Jensen PS: Commentary: The next generation is overdue. J Am Acad Child Adolesc Psychiatry. 2003, 42: 527-530. 10.1097/01.CHI.0000046837.90931.A0.CrossRefPubMed
3.
Backer TE, David SL, Soucy GE: Reviewing the Behavioral Science Knowledge Base on Technology Transfer (NIDA Research Monograph 155, NIH Publication No. 95-4035). 1995, Rockville, MD: National Institute on Drug Abuse
4.
Ferlie EB, Shortell SM: Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001, 79: 281-315. 10.1111/1468-0009.00206.CrossRefPubMedPubMedCentral
5.
Aarons GA, Hurlburt M, Horwitz S: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011, 38: 4-23. 10.1007/s10488-010-0327-7.CrossRefPubMed
6.
Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004, 180: S57-S60.PubMed
7.
Glisson C: Structure and technology in human service organizations. Human services as complex organizations. Edited by: Hasenfeld Y. 1992, Thousand Oaks, CA: Sage Publications, 184-202.
8.
Lehman WEK, Greener JM, Simpson DD: Assessing organizational readiness for change. J Subst Abuse Treat. 2002, 22: 197-209. 10.1016/S0740-5472(02)00233-7.CrossRefPubMed
9.
Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Adm Policy Ment Health. 2004, 6: 61-74.
10.
Laing A, Hogg G: Political exhortation, patient expectation and professional execution: Perspectives on the consumerization of health care. Brit J Manage. 2002, 13: 173-188. 10.1111/1467-8551.00230.CrossRef
11.
Hermann RC, Chan JA, Zazzali JL, Lerner D: Aligning measurement-based quality improvement with implementation of evidence-based practices. Adm Policy Ment Health. 2006, 33: 636-645. 10.1007/s10488-006-0055-1.CrossRefPubMed
12.
Innvaer S, Vist G, Trommald M, Oxman A: Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002, 7: 239-244. 10.1258/135581902320432778.CrossRefPubMed
13.
Aarons GA: Measuring provider attitudes toward evidence-based practice: Consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am. 2005, 14: 255-271. 10.1016/j.chc.2004.04.008.CrossRefPubMedPubMedCentral
14.
Aarons GA, Wells RS, Zagursky K, Fettes DL, Palinkas LA: Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. Am J Public Health. 2009, 99: 2087-2095. 10.2105/AJPH.2009.161711.CrossRefPubMedPubMedCentral
15.
Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009, 4: 50-10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentral
16.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F: Implementation Research: A synthesis of the literature. 2005, Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231)
17.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral
18.
Dopson S, Fitzgerald L: The role of the middle manager in the implementation of evidence-based health care. J Nurs Manag. 2006, 14: 43-51. 10.1111/j.1365-2934.2005.00612.x.CrossRefPubMed
19.
Dopson S, Locock L, Gabbay J, Ferlie E, Fitzgerald L: Evidence-based medicine and the implementation gap. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. 2003, 7: 311-330. 10.1177/1363459303007003004.
20.
Morgenstern J: Effective technology transfer in alcoholism treatment. Subst Use Misuse. 2000, 35: 1659-1678. 10.3109/10826080009148236.CrossRefPubMed
21.
Frambach RT, Schillewaert N: Organizational innovation adoption: A multi-level framework of determinants and opportunities for future research. J Bus Res Special Issue: Marketing theory in the next millennium. 2002, 55: 163-176.
22.
Klein KJ, Conn AB, Sorra JS: Implementing computerized technology: An organizational analysis. J Appl Psychol. 2001, 86: 811-824.CrossRefPubMed
23.
Davis DA, Thomson MA, Oxman AD, Haynes RB: Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995, 274: 700-10.1001/jama.274.9.700.CrossRefPubMed
24.
Solomon DH, Hashimoto H, Daltroy L, Liang MH: Techniques to improve physicians' use of diagnostic tests: a new conceptual framework. JAMA. 1998, 280: 2020-10.1001/jama.280.23.2020.CrossRefPubMed
25.
Buchanan D, Fitzgerald L, Ketley D, Gollop R, Jones JL, Lamont SS, Neath A, Whitby E: No going back: A review of the literature on sustaining organizational change. Int J of Manage Rev. 2005, 7: 189-205. 10.1111/j.1468-2370.2005.00111.x.CrossRef
26.
Rimmer M, Macneil J, Chenhall R, Langfield-Smith K, Watts L: Reinventing Competitiveness: Achieving Best Practice in Australia. 1996, South Melbourne, Australia: Pitman
27.
Kotter JP: Leading Change: Why Transformation Efforts Fail. (Cover story). Harvard Bus Rev. 1995, 73: 59-67.
28.
Lozeau D, Langley A, Denis J-L: The corruption of managerial techniques by organizations. Human Relations. 2002, 55: 537-564. 10.1177/0018726702055005427.CrossRef
29.
Pettigrew AM, Ferlie E, McKee L: Shaping strategic change: Making change in large organizations: The case of the National Health Service. 1992, London: Sage Publications
30.
Hemmelgarn AL, Glisson C, Dukes D: Emergency room culture and the emotional support component of Family-Centered Care. Child Health Care. 2001, 30: 93-110. 10.1207/S15326888CHC3002_2.CrossRef
31.
Diamond MA: Innovation and diffusion of technology: A human process. Consult Psychol J. 1996, 48: 221-229.CrossRef
32.
Dale BG, Boaden RJ, Wilcox M, McQuater RE: Sustaining continuous improvement: What are the key issues?. Quality Engineering. 1999, 11: 369-377. 10.1080/08982119908919253.CrossRef
33.
Rapp CA, Etzel-Wise D, Marty D, Coffman M, Carlson L, Asher D, Callaghan J, Holter M: Barriers to evidence-based practice implementation: results of a qualitative study. Community Ment Health J. 2010, 46: 112-118. 10.1007/s10597-009-9238-z.CrossRefPubMed
34.
Rapp CA, Etzel-Wise D, Marty D, Coffman M, Carlson L, Asher D, Callaghan J, Whitley R: Evidence based practice implementation strategies: Results of a qualitative study. Community Ment Health J. 2008, 44: 213-224. 10.1007/s10597-007-9109-4.CrossRefPubMed
35.
US Census Bureau: State and county quick facts: San Diego County, California. 2010, US Census Bureau
36.
Trochim WM: An introduction to concept mapping for planning and evaluation. Eval Program Plann. 1989, 12: 1-16. 10.1016/0149-7189(89)90016-5.CrossRef
37.
Burke JG, O'Campo P, Peak GL, Gielen AC, McDonnell KA, Trochim WM: An introduction to concept mapping as a participatory public health research methodology. Qual Health Res. 2005, 15: 1392-1410. 10.1177/1049732305278876.CrossRefPubMed
38.
Trochim WM, Cook JA, Setze RJ: Using concept mapping to develop a conceptual framework of staff's views of a supported employment program for individuals with severe mental illness. J Consult Clin Psychol. 1994, 62: 766-775.CrossRefPubMed
39.
Concept Systems: The Concept System software®. Ithaca, NY. 2007, 4.147
40.
Kane M, Trochim W: Concept mapping for planning and evaluation. 2007, Thousand Oaks, CA: Sage Publications, IncCrossRef
41.
Trochim WMK, Stillman FA, Clark PI, Schmitt CL: Development of a model of the tobacco industry's interference with tobacco control programmes. Tob Control. 2003, 12: 140-147. 10.1136/tc.12.2.140.CrossRefPubMedPubMedCentral
42.
Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, NJ: Erlbaum, 2
43.
Aarons G, Sawitzky A: Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Adm Policy Ment Health. 2006, 33: 289-301. 10.1007/s10488-006-0039-1.CrossRefPubMedPubMedCentral
44.
Domino ME, Norton EC, Morrissey JP, Thakur N: Cost Shifting to Jails after a Change to Managed Mental Health Care. Health Serv Res. 2004, 39: 1379-1402. 10.1111/j.1475-6773.2004.00295.x.CrossRefPubMedPubMedCentral
45.
Palinkas LA, Aarons GA, Chorpita BF, Hoagwood K, Landsverk J, Weisz JR: Cultural exchange and implementation of evidence-based practices. Res Social Work Prac. 2009, 19: 602-612. 10.1177/1049731509335529.CrossRef
46.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M: Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research questions. Adm Policy Ment Health. 2011, 38: 65-76. 10.1007/s10488-010-0319-7.CrossRefPubMed
47.
Aarons GA, Brown SA, Hough RL, Garland AF, Wood PA: Prevalence of adolescent substance use disorders across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001, 40: 419-426. 10.1097/00004583-200104000-00010.CrossRefPubMed
48.
Checkland K, Harrison S, Marshall M: Is the metaphor of'barriers to change'useful in understanding implementation? Evidence from general medical practice. J Health Serv Res Policy. 2007, 12: 95-10.1258/135581907780279657.CrossRefPubMed
49.
Checkland K, Coleman A, Harrison S, Hiroeh U: 'We can't get anything done because...': making sense of'barriers' to Practice-based Commissioning. J Health Serv Res Policy. 2009, 14: 20-10.1258/jhsrp.2008.008043.CrossRefPubMed
Metadata
Title
A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping
Authors
Amy E Green
Gregory A Aarons
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-104

Other articles of this Issue 1/2011

Implementation Science 1/2011 Go to the issue

Research

From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

Study protocol

A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial

Systematic review

What is the value and impact of quality and safety teams? A scoping review

Debate

Community-based knowledge translation: unexplored opportunities

Study protocol

Effects of an evidence service on health-system policy makers' use of research evidence: A protocol for a randomised controlled trial

Research

How can we improve guideline use? A conceptual framework of implementability