Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study

Background and Purpose: Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work. Methods: Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients. Results: Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted. Discussion and Conclusions: Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship. Video Abstract available for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).