Table 2

Groups of barriers and facilitators independently associated with implementation and de-implementation

Groups of barriers and facilitatorsImplementation of medication guidelines OR (95% CI)Implementation of referral guidelines OR (95% CI)De-implementation of low value blood management practices OR (95% CI)
Innovation*1.83 (0.49 to 6.75)0.74 (0.38 to 1.42)
Professional—outcome expectancy†2.73 (1.46 to 5.08)‡1.56 (0.73 to 3.30)0.30 (0.13 to 0.71)‡
Professional—motivation§0.28 (0.11 to 0.70) ‡
Social context**1.22 (0.49 to 3.02)
Organisational context††1.39 (0.84 to 2.30)2.54 (1.06 to 6.05)‡
Economic and political context‡‡0.43 (0.19 to 0.98)‡
  • *Innovation: characteristics of the practice to be implemented or de-implemented, for example, attractiveness.

  • †Professional—outcome expectancy: the perceived net benefit of the practice to be implemented or de-implemented to patients by the orthopaedic surgeons. ‡p<0.05, factors significantly associated in multivariate analyses (independent associations).

  • §Professional—motivation: motivational factors for orthopaedic surgeons to implement or de-implement the practice in question, for example, own or department priorities.

  • ¶Patient: patient-related factors, for example, patient pressure, comorbidities.

  • **Social context: factors related to the social context of the professional, for example, opinion of colleagues, leadership.

  • ††Organisational context: factors related to the organisation of care processes, for example, staff capacities, structures.

  • ‡‡Economic and political context: factors related to economic and political context, for example, financial arrangements, regulations and policies.