Understanding What Works in Disseminating Clinical Practice Guidelines – A Qualitative Evidence Synthesis

Abstract

AIM OF THE REVIEW: To identify the barriers and facilitators that influence the dissemination of clinical practice guidelines, and to explore the perceived usefulness, practical utility, expectations and unmet needs of end-users in relation to current dissemination strategies. METHODS: This qualitative evidence synthesis is a part of mixed-methods evidence synthesis. We searched literature from MEDLINE, Embase, CINAHL, Web of Science, Scopus, Epistemonikos, Agency for Healthcare Research and Quality and Medical Guidelines Clearing house on 30th January 2025. Screening, data extraction and quality appraisal of the included studies were done by at least two authors independently and in duplicate. We performed reflexive thematic analysis of the data related to barriers, facilitators, usefulness, utility and unmet needs of dissemination products and channels. We assessed the confidence of evidence following the GRADE CERQual methods. RESULTS: We screened 31,853 titles and abstracts and found 40 eligible studies to be included in this qualitative evidence synthesis. We identified themes related to barriers and facilitators, practical utility and usefulness, unmet needs of dissemination products and unmet needs of dissemination channels. Key barriers were weak institutional support, language barriers, scepticism, low awareness and lack of training programmes. Main facilitators were related to leadership and institutional support, consumer and stakeholder involvement, training and multichannel dissemination. We identified the dissemination strategies that were perceived as useful when focused on improving clinical decision making and encouraging organisation adoption. Key aspects related to practical utility were the improved communication between healthcare professionals and patients or carers and better understandability of the guidelines when presented using simple layouts, visual features and multiple channels including social media. Unmet needs related to dissemination products included a demand for cultural and linguistic inclusivity, active promotion of guidelines, easier navigation through digital formats and training support for implementation. The key unmet need related to dissemination channels was the visibility and awareness of channels. CONCLUSION: This qualitative evidence synthesis identified key barriers and facilitators of dissemination strategies including unmet needs regarding the products and channels used in these strategies. The results can further inform organisations that develop and disseminate clinical practice guidelines.