Table 2 Characteristics of included studies
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 |