Changing clinical practice: Facilitators and barriers to the implementation of a nationwide videofluoroscopy evidence-based guideline

Abstract

Purpose: To explore speech-language therapists’ (SLT) perceptions of the facilitators and barriers to implementation of a nationwide evidence-based guideline for videofluoroscopic study of swallowing in New Zealand.

Method: A questionnaire was developed and administered online using a cross-sectional study design targeting SLT leaders and guideline auditors from 20 health authorities in New Zealand. A mixed-method approach to data analysis was implemented through descriptive statistics and qualitative description.

Results: Eighteen SLT leaders and guideline auditors from 12 health authorities responded. Analysis revealed five facilitator categories: communication, documentation, education, evaluation, and resources, and five barrier categories: communication, change, leadership, resources, and time. When presented with a list of strategies and barriers, over 80% reported that changing their authority's VFSS standard operating procedures and having interactive small group sessions were effective facilitators. While over 60% reported time and financial constraints as barriers.

Conclusions: This is the first study in New Zealand to report the perceptions of SLTs in implementing a nationwide evidence-based guideline. It highlights the perceived facilitators and barriers to guideline implementation for New Zealand SLTs. Future successful guideline implementation would benefit from the findings of this study.

Keywords:

• Best practice guideline
• Changing practice
• Implementation
• Facilitators
• Barriers
• Videofluoroscopy

Acknowledgements

Arianne Mendoza completed her Masters of Speech-Language Therapy Practice at The University of Auckland in 2014. This manuscript is the product of her final year research project. Arianne is currently practicing as a speech-language therapist in the USA. Dr Anna Miles and Dr Clare McCann are faculty members of the Discipline of Speech Science at The University of Auckland.

Disclaimer statements

Contributors A.M.L. contributed to study design, ethics approval, data collection, data analysis, interpretation, and manuscript preparation. A.M. contributed to study design, ethics approval, data collection, data analysis, interpretation, manuscript preparation, and overall supervision of the study. C.M.M. contributed to study design, ethics approval, data analysis, interpretation, and manuscript preparation.

Funding None.

Conflicts of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethics approval This study received appropriate regional ethics approval (UAHPEC/9405).