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Step 3: Identify barriers and explore ways to overcome them

Explore ways to improve decision aid use and provision of decision support while overcoming barriers.

3.1 Ask patients and health professionals

  1. What is likely to get in the way of using decision aids and/or providing decision support?
    • Are the barriers specific to the decision aid (e.g., requires computer access, literacy too high, too difficult to use, not accessible)?
    • Are the barriers specific to the patients or health professionals (e.g. lack of awareness, limited knowledge/skills, poor attitudes, concerns, incompatible with current practice, lack of confidence)?
  2. Who will use the decision aids and include them in the process of care?
  3. What can be done to make it easier for decision aids or decision support to be provided?
    • Are there health policy or organization documents to justify implementation?
    • Who needs to ‘approve’ the decision aid?
    • What can be done to overcome identified barriers?

3.2 More formal measures of factors influencing implementation of decision aids and decision support

  1. Survey health professionals to identify barriers and facilitators influencing their use of decision aids and provision of decision support. There is a measurement tool based on the Ottawa Model of Research Use.
  2. Survey health professionals to identify their attitudes, subjective norms, perceived control and intentions to use decision aids and provide decision support. There is a measurement tool based on the Theory of Planned Behavior.
  3. Qualitative interviews or focus groups can be used to explore factors influencing use of decision aids and decision support and obtain feedback on decision aids or decision support tools (positive features, changes needed, relevance, timing for use).


Examples of additional resources

Légaré F, Borduas F, Freitas A, Jacques A, Godin G, Luconi F, Grimshaw J; CPD-KT team. Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PLoS One. 2014 Mar 18;9(3):e91013. doi: 10.1371/journal.pone.0091013. eCollection 2014.

Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals' perceptions. Patient Educ Couns. 2008 Dec;73(3):526-35. doi: 10.1016/j.pec.2008.07.018. Epub 2008 Aug 26.

Logan J, Harrison MB, Graham ID, Dunn K, Bissonnette J. Evidence-based pressure-ulcer practice: The Ottawa Model of Research Use. Can J Nurs Res. 1999 Jun;31(1):37-52.

Last modified: 2014-08-22.