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\begin{document}

\title{How to contextualise training on guideline-uptake for your setting}



\author[1]{Jessica Stander}%
\author[1]{Karen Grimmer}%
\author[1]{Yolandi Brink}%
\affil[1]{Stellenbosch University Faculty of Medicine and Health Sciences}%


\vspace{-1em}



  
  \date{May 17, 2024}


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\selectlanguage{english}
\begin{abstract}
One knowledge translation method, of putting evidence into practice, is
the use of clinical practice guidelines (CPG). The purpose of this brief
report is to describe an 8-step process of ``how to'' contextualise a
training programme to increase CPG-uptake for a targeted audience in a
clearly defined setting. This process may assist implementalists to
fast-track the development of contextualised training to improve
CPG-uptake.%
\end{abstract}%



\sloppy


\textbf{Keywords}

Clinical practice guidelines; Physiotherapy; Knowledge translation;
Allied health; Contextualisation

\textbf{Brief Report}

Allied health usually comprises physiotherapy, occupational therapy,
speech and language therapy, and clinical nutrition \textsuperscript{1}.
Research into knowledge translation (KT) in allied healthcare has lagged
behind medicine, however KT intervention studies in allied healthcare
generally report significant positive effects for behavioural change.
They unfortunately have low methodological quality and rigor, and are
influenced by outcome reporting bias and poorly described
interventions\textsuperscript{2--5}.

For a successful KT intervention, KT strategies should address local
issues and barriers that may hinder regular application of
evidence-based practice \textsuperscript{6}. Local issues often relate
to the service delivery elements rather than strength of the evidence
(reported by WHO (2010) \textsuperscript{7}. Service delivery elements
include Workforce, Comprehensiveness, Resources, Continuity,
Coordination and Accountability. Therefore contextualised, tailored KT
strategies are needed to translate best-evidence approaches into local
clinical practice \textsuperscript{6}. The aim of this brief report is
to provide simple instructions regarding how to contextualise a training
programme for the uptake of clinical practice guidelines (CPG) for a
targeted audience in a clearly defined setting.

We previously published research on the development and validation
(content and utility validation) of a training programme targeted to
physiotherapists to educate them on the use of CPG in daily
practice\textsuperscript{8}. The development of the programme was
underpinned by the five-step Implementation of Change model
\textsuperscript{9}. Furthermore, it adhered to the template for
intervention description and replication (TIDiER) checklist for
implementation intervention studies to ensure a robust and rigorous
development process\textsuperscript{10}. The TIDiER checklist is an
extension of the CONSORT 2010 statement and included 12 items:
``\emph{brief name, why, what (materials), what (procedure), who
provided, how, where, when and how much, tailoring, modifications, how
well (planned), how well (actual)} '' (p.1) \textsuperscript{10}. This
training programme was developed for a specific purpose, which was to
write optimum content in a way that met end-user-needs. We believe that
the content of the training programme is relevant to other healthcare
professionals in other settings. However, different end-user groups will
have specific needs and contextual factors influencing their
participation in such a training programme. Therefore, we recommend that
the following steps be taken in order to contextualise the training
programme for the intended target audience:

Clearly define the end-user group in terms of:

\begin{itemize}
\tightlist
\item
  What are their needs?
\item
  What is their working environment: do they have internet access;
  ability to take time off work to do the training; restrictions on
  their ability to practice autonomously; high workload; etc.?
\item
  Do they have an interest in CPG-uptake? Is the training important
  enough for them to \emph{make time} to engage with the programme?
\end{itemize}

\begin{enumerate}
\tightlist
\item
  Determine the barriers to CPG-uptake of the end-user group. Research
  shows that most healthcare professionals have similar barriers to
  CPG-uptake \textsuperscript{11,12}. However, it is the underlying
  reasons for the barriers that need to be determined to ensure that
  each barrier is carefully addressed during
  training\textsuperscript{13,14}. It is only when actionable strategies
  to overcome barriers are put into place, that these barriers will be
  effectively addressed \textsuperscript{8}.
\item
  What is the preferred learning style of the target audience? Specific
  healthcare professionals have specific learning styles, for instance
  nurses seem to learn by gathering and organising information and
  through experiencing then reflecting on the
  situation\textsuperscript{15}. Furthermore, occupational therapists
  also learn through experiencing and reflecting on the situation and
  through hands-on experiences \textsuperscript{15,16}. It is important
  to design teaching programs using strategies that appropriately
  address different learning styles. We have previously reported on the
  preferred learning style of physiotherapists being active participants
  in the learning activity that is underpinned with a strong theoretical
  basis \textsuperscript{17}. This assisted us in determining which KT
  strategies would be appropriate to ensure optimum learning of
  PTs\textsuperscript{17}. Determining the preferred learning style of
  the target audience, and tailoring training to it, will assist in
  increasing the chances of successful implementation of CPG-uptake.
\item
  Search for existing training programmes that conform to the TIDiER
  recommendations, including whether the chosen training programme
  material is readily available \textsuperscript{10}. Considering the
  previously described steps, will you be able to use the programme in
  its existing form, or can you `unpick' the programme elements to
  address most of your target audience's needs?
\end{enumerate}

\begin{itemize}
\tightlist
\item
  What will be the KT strategies that you will implement with your
  chosen end-user group?
\item
  Are you travelling to the group?
\item
  What is the length of the training, content presentation? Will there
  be online versus face-to-face sessions or both?
\end{itemize}

When determining the elements of potentially-relevant training
programme, start by identifying which components are fixed and which are
variable \textsuperscript{18}. Our published programme consisted of an
online and one-day face-to-face training -- this constituted the fixed
component of the programme \textsuperscript{8}. The variable component
consisted of email support, a social media group with regular
interaction for a 2-month period post-training, and the use of a 2-page
printed summary CPG for daily referral \textsuperscript{19}.

\begin{enumerate}
\tightlist
\item
  Identify a condition that is relevant to your target audience. The
  search for current, quality CPGs addressing the identified condition.
  During our study, we used a condition, commonly treated by PT: acute
  and subacute low back pain. We searched for a CPG for this condition
  to be used as a vehicle to teach the PTs how to implement CPG
  recommendations into daily practice. After completing a comprehensive
  online search, there was no contextualised CPG found for the South
  African population. However, we identified three current, high quality
  CPGs with which we developed a summary CPG document as a user-friendly
  document to use as part of the training programme\textsuperscript{19}.
  Whether you are adapting, adopting or contextualising an existing CPG,
  it should fit the purpose of providing a vehicle to show your audience
  where and how to source it and how to use the document to increase
  evidence-based practice behaviour \textsuperscript{8}.
\item
  Finally, determine whether your training program is feasible for your
  audience regarding cost, acceptability of the programme content,
  likelihood that practice behaviour will change, and value placed on
  the time spent completing the programme \textsuperscript{8,20}. This
  may be achieved by piloting the programme on a small group of your
  proposed target audience. Once the training programme is piloted, the
  programme can be finalised for the full target audience.
\item
  When determining which outcome measures to use, the implementalists
  need to distinguish between implementation effectiveness and outcomes
  (i.e. ``\emph{the effects of deliberate and purposive actions to
  implement new treatments, practices, and services} '' (p.65)) from
  treatment effectiveness and service outcomes (quality criteria of
  healthcare: efficiency, safety, effectiveness, equity,
  patient-centredness, timeliness) \textsuperscript{21,22}. As with most
  KT intervention studies, ensure that you evaluate the programme for a
  change in knowledge, skill and practice behaviour of the
  participants\textsuperscript{2--4}. Furthermore, using mixed methods
  designs may assist in understanding the participants' perspective on
  the training and how it influences their practice in addition to
  implementation effectiveness \textsuperscript{8,23}.
\item
  Ongoing training need to be considered to ensure continued
  professional behaviour change \textsuperscript{13}. Ongoing training
  may include social media groups for support and further research
  evidence dissemination \textsuperscript{24}, activity behaviour
  diaries \textsuperscript{18}, audit and feedback and journal
  clubs\textsuperscript{25}.
\end{enumerate}

\textbf{List of abbreviations}

CPGs: Clinical practice guidelines

CONSORT: Consolidated Standards of Reporting Trials

KT: Knowledge translation

PT: Physiotherapy/ Physiotherapists

TIDiER: Template for intervention description and replication

WHO: World Health Organization

\textbf{Declarations}

Conflict of interest

The authors have no conflicts of interest to declare.

Authors' contributions

JS, YB, KG collaborated on the planning and conceptualisation of the
study. JS performed the data collection. JS, YB and KG analysed the
data. All authors read and approved the final manuscript.

Acknowledgements

We would like to thank all the participants of this study for
participating and helping to build the field of knowledge translation in
physiotherapy. This study was funded by Stellenbosch University (55956;
K1811).

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