A multi-methods approach to explore the organisational level barriers and facilitators to the implementation of evidence-based guidance in primary care.

  • Heather Camille Cassie

Student thesis: Doctoral ThesisDoctor of Philosophy


Aim: To investigate which characteristics of primary care organisations influence the translation of guidance into practice.

Methods: A three phase multi-method design. (1) A literature review exploring organisational change in primary healthcare organisations, focusing on knowledge translation; (2) Development of a dental team questionnaire measuring structure, culture and management; (3) A dental team questionnaire and case studies, to collect data on the structure, culture and management of dental practices along with self-report compliance data exploring the relationship between organisational characteristics and guidance compliance.

Key Results: A ‘best-fit’ framework approach was undertaken for the literature review. This identified the barriers and facilitators to the translation of guidance in primary care organisations. These were communication, team work, flexibility, prioritisation, collaboration, dissemination and expectations. Preliminary interviews with dental team members supported these findings and identified further practice characteristics to explore in the questionnaire. These additional themes were leadership, context and practice systems and learning.

A dental team questionnaire, incorporating the Dental Practice Organisational Measure (DPOM), along with questions to determine practice characteristics and compliance with key dental recommendations was developed, piloted and then disseminated to 400 dental practices. Questionnaire findings revealed no significant relationship between practice characteristics and compliance with Emergency Dental Care (EDC) or Drug Prescribing recommendations. However positive associations were observed between compliance with Oral Health Assessment and Review (OHAR) recommendations and having a Practice Manager as well as with whether a practice is fully NHS, fully private or offers a mixture of treatments. These findings were supported by case study data that identified leadership and context as key drivers in the translation of guidance. Regression models to explore the relationship between the variables in the DPOM tool compliance with EDC and OHAR recommendations also revealed some associations.

Conclusions: A multi-method approach, set within the context of General Dental Practice, was undertaken to explore which characteristics of primary healthcare organisations influence the translation of guidance. Integration of the findings suggest the emergence of two conceptual themes around the relationships and the structural and administrative aspects that exist within healthcare organisations. It may be that new guidance and recommendations should be tailored to incorporate these factors in order to facilitate knowledge translation and hence improve compliance with best practice recommendations.
Date of Award2016
Original languageEnglish
SponsorsScottish Dental Clinical Effectiveness Programme & Scottish Dental Practice Based Research Network
SupervisorJanet Clarkson (Supervisor), Shaun Treweek (Supervisor), Lorna McKee (Supervisor), Craig R. Ramsay (Supervisor) & Linda Young (Supervisor)

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