Factors affecting speech pathologists’ implementation of stroke management guidelines: a thematic analysis

Abstract

Purpose: Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. Methods: A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Results: Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Conclusions: Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended.

Implications for Rehabilitation

• In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities.

• Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood.

• This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care.

• Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

• Clinical practice guidelines
• evidence-base practice
• implementation science
• knowledge translation
• qualitative research
• speech pathologists
• stroke rehabilitation

Acknowledgements

We would like to thank Dr Angela Dew and Dr Belinda Kenny from the University of Sydney for their advice on earlier versions of this paper, and Professor Leanne Togher from the University of Sydney for her advice in the early stages of research design and writing.

Declaration of interest

The third author was an employee of the CCRE in Aphasia Rehabilitation at the time of this study. The authors report no other conflicts of interest.