Authors' objectives:

This bulletin aims to summarise the available evidence on changing professional practice, and to give a range of helpful and relevant advice to those involved in changing practice.

Authors' recommendations: This overview of empirical research, theoretical perspectives and insights from practical experience offers guidance on bringing about change. Whilst the research base is incomplete, it is possible to make informed judgements on how best to influence the behaviour of health professionals. It is clear that any attempt to change should use a systematic approach and involve strategic planning. Any proposed change - for example, the implementation of a clinical guideline - would first involve a period of 'information and diagnostic analysis' to inform the development of an appropriate dissemination and implementation strategy. The methods used to undertake a 'diagnostic analysis' are likely to vary according to prevailing circumstances but they involve a combination of routine data analysis, specific surveys and interviews and informed judgement. From material presented in this bulletin such an analysis might include: 1. identification of all groups involved in, affected by or influencing the proposed change(s) in practice 2. assessment of the characteristics of the proposed change that might influence its adoption 3. assessment of the preparedness of the health professionals to change and other potentially relevant internal factors within the target group 4. identification of potential external barriers to change 5. identification of likely enabling factors, including resources and skills. Once completed the results of the 'diagnostic analysis' can be used to inform the design and content of the dissemination/implementation strategy. The choice of appropriate dissemination and implementation interventions should also be guided by knowledge of relevant research. Once chosen, dissemination and implementation interventions should be fully co-ordinated. Dissemination activities by themselves are unlikely to lead to changes in behaviour. However, this should not be taken to mean that raising awareness of the messages underpinning proposed changes is unimportant. Whilst the relationship between knowledge and behaviour is rarely linear, awareness of 'the message' still plays an important part in the process. Behaviour change is complex and, whilst dissemination and implementation strategies may draw upon interventions that have been evaluated in empirical research (e.g. reminders, educational outreach), other more diffuse interventions which have yet to be evaluated may also be necessary. Successful strategies are likely to be broad-based and multi-faceted. They are also likely to have significant costs attached to them and will need to be adequately resourced. In the course of changing behaviour, a wide range of people may be involved, including health professionals, managers, policy makers and the public. The roles of various participants should be identified and steps taken to ensure that appropriate training is provided. Successful change is unlikely to occur unless people with necessary skills and knowledge exist to lead and apply all components of dissemination and implementation strategies. Finally, any systematic approach to changing behaviour should include plans to monitor and evaluate the degree to which the proposed change is achieved, together with methods to maintain and reinforce any change.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination