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Physicians and Nurses Focus on Different Aspects of Guidelines When Deciding Whether to Adopt Them: An Application of Conjoint Analysis

Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands, a.goossens{at}amc.uva.nl.

Patrick M. M. Bossuyt, PhD

Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands

Rob J. de Haan, PhD

Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center at the University of Amsterdam, the Netherlands

Objectives. The objectives of this study are to determine the relative importance of 6 guideline features for physicians' and nurses' willingness to adopt practice guidelines, to examine whether physicians and nurses focus on the same or on different aspects of guidelines, and to test whether professionals' learning preference influences their willingness to adopt guidelines. Methods. An orthogonal main effects design was used to develop 16 written guideline descriptions, which varied on 6 characteristics: 1) benefit for the professional, 2) source, 3) support by management, 4) scientific basis, 5) costs, and 6) subject. These descriptions were presented to 251 physicians and 110 nurses working at the Academic Medical Center in Amsterdam, the Netherlands. They indicated their willingness to adopt each guideline on a 7-point scale and completed Kolb's Learning Style Inventory to determine their preferred learning style. Results. The response rate was 55% for physicians and 66% for nurses. The mean age was 40 years; 55% and 25% of the respondents were male. The mean adoption score was 5.26 for physicians and 5.00 for nurses. Of the 6 characteristics, ``scientific basis'' was found to be the strongest determinant for physicians, and the factor ``interesting subject'' was the strongest for nurses. The other characteristics had a limited effect. Theoretically oriented physicians had a significantly lower average score compared with those who preferred active experimentation. No such effects were observed with nurses. Conclusions. Adherence to guidelines is influenced by internal as well as contextual attributes of guidelines. Physicians and nurses focus on different aspects, which is partly influenced by their preferred learning style. This difference in focus should be taken into account when developing an implementation strategy.

Key Words: guidelines • conjoint analyses • adherence • implementation • nurses. (Med Decis Making 2008;28:138—145)

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