Table 1 Behavioural theories applied in the development and dissemination of CPGs
Theory/conceptAssumptionApplication in the development and dissemination of CPGs
Behavioural change model28Moving through the stages of readiness to change requires changing knowledge and attitudes, encouraging positive beliefs about one’s ability to enact change, and adapting the environment where changes take placeKnowledge transfer in didactic sessions, emphasis on optimising basic, achievable forms of care through repeated interactive learning sessions. Sharing the results and processes of hospital surveys to allow reflection on current practice and indicate the need for change
Adult learning theories29Adults change practice by learning rather than being taught.Active participatory learning, small group interactive sessions, multi-method training
Social influence theory27 44An individual’s belief and behaviour are influenced by persons in their social network and society at large.Involvement of local experts in development of the CPGs. Weight of evidence. Institutional/governmental endorsement and dissemination of guidelines. Use of facilitators with credible backgrounds
Diffusion of innovation theory23 4547Individuals adopt change at different speeds. InnovatorsInstitutional dissemination of guidelines. Mass training to create a corps of people
and early adopters will encourage others in changingsupporting new practices
practice. Some features of innovation modify itsSimplified guidelines with clear and definite messages, repeated series of skill practice and
adoption, including complexity, advantage over existing practicescase scenarios. New guidelines were adapted from existing guidelines (ETAT, PALS, IMCI,
and procedures, compatibility with guidelines in use,national HIV and malaria guidelines).
“trialability”, and observability of results beforeIntroduction of time-saving job aides
adopting the innovation
Health education model25 33 48Behaviour change depends on predisposing, enablingPredisposing strategies: lectures, emphasis on best practice, credible lecturers and CPGs
and reinforcing factors. Predisposing factors are lessbased on available resources
likely to change physicians’ behaviour compared toEnabling strategies: job aides, practice of skills
enabling and reinforcing elements, but behaviourReinforcing strategies: immediate feedback on personal performance, audit/reflection on
change cannot take place without addressing gapscurrent practice, end of course test and evaluation, hospital survey and feedback
in knowledge and skill.
Reflection26Reflection is integral to knowledge translation and enhances the capacity to visualise new realities and outcomesProblem based audit, hospital survey and feedback, small group learning, role play, case scenarios with team of hospital colleagues emphasising successful performance and post course evaluation
  • CPG, clinical practice guideline; ETAT, emergency triage, assessment and treatment.