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Assess Barriers to Knowledge Use

Barriers to knowledge use must be considered prior to knowledge implementation. The Clinical Practice Guidelines Framework for Improvement is a useful framework to identify barriers to knowledge use. Methods to access barrier to knowledge use include: 1) the Delphi procedure (to achieve consensus among a panel of experts), 2) qualitative approach such as focus groups, interviews, and questionnaires, 3) statistical analysis on observational dataset by regressing potential determinant on variation in health care delivery, and 4) statistical analysis on multiple studies concerning guideline implementation to determine factors that account for the heterogeneity of effects across studies.

Examples of barriers to knowledge use

  • Knowledge
    • Lack of awareness
    • Lack of familiarity
    • Forgetting
  • Attitudes/Motivation
    • Lack of agreement due to:
      • the scientific value of evidence
      • the rigidity of the guideline
      • the threat to professional autonomy
      • the perceived bias of the author
      • the lack of clarification and impracticality of the guideline in the following
    • Lack of applicability due to:
      • the characteristics of the patient
      • the clinical situation
      • the perception that knowledge implementation is not cost-beneficial
      • the lack of confidence in the individuals who are responsible for developing or presenting knowledge implementation
    • Lack of expectancy due to:
      • the perception that implementation will not lead to improved outcomes for either the patient or the health care process
      • the negative feelings that may be provoked by the new behavior resulted from knowledge implementation, and/or not having taken into account existing feelings around the process of implementation
      • the lack of self-efficacy
      • the lack of motivation to use knowledge or to change one's habits
  • Behavior
  • External barriers
    • Factors associated with patient
      • the inability to reconcile patient preferences with the use of knowledge
    • Factors associated with knowledge use as an innovation
      • the perception that the innovation cannot be experimented with on a limited basis
      • the perception that the innovation is not consistent with one's own approach
      • the perception that the innovation is difficult to understand and to put into use
      • the lack of visible results in using the innovation
      • the perception that the innovation can not be created and shared with one another in order to reach a mutual understanding
      • the perception that the use of the innovation will increase uncertainty (for example, the lack of predictability, of structure, of information)
      • the perception that the innovation lacks flexibility to the extent that it is not changeable or modifiable by a user in the process of its adoption and implementation
    • Factors associated with environmental factors
      • insufficient time to put knowledge into practice
      • insufficient materials or staff to put knowledge into practice
      • insufficient support from the organization
      • inadequate access to actual or alternative health care services to put knowledge into practice
      • insufficient reimbursement for putting knowledge into practice
      • perceived increase in malpractice liability if new knowledge is put into practice