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Qual Saf Health Care 13:355 doi:10.1136/qhc.13.5.355
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Changing clinical behaviour by making guidelines specific

The uptake of guidelines could be improved simply by changing their wording, suggest clinical psychologists. The more precisely behaviours are specified, they argue, the more likely they are to be carried out. Their advice is to use language that is behaviourally precise and to use active verbs, avoiding general exhortations (should) and general descriptions (may).

As an example, the researchers looked at guidelines from the National Institute for Clinical Excellence for the management of schizophrenia. The recommendations from these guidelines, like many, are at risk of being buried and not implemented. The researchers reworded the recommendations using behavioural terms such as what and who, adding that when, where and how could equally be used. Rewording the recommendations in this way they were able to identify areas of uncertainty in their implementation.

The researchers also showed that specifying behaviour precisely allows the barriers or facilitators to change to be looked at, so that future guidelines can be adapted accordingly. Known as ABC (antecedents, behaviour and consequences) it allows for the systematic investigation into the way that behaviour is linked to what occurs before the implementation of a guideline (the antecedents) and what occurs afterwards (the consequences).

Future research is now needed to support these views, and suggestions include a comparison of the implementation of guidelines before and after they have been rewritten in behaviourally specific terms.

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