Changing clinical behaviour by making guidelines specific

doi:10.1136/bmj.328.7435.343

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Susan Michie, reader in clinical health psychology (s.michie@ucl.ac.uk)1,
Marie Johnston, professor of psychology2

¹Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, London WC1E 7HB
²School of Psychology, King's College, University of Aberdeen, Aberdeen, AB24 2UB

Correspondence to: S Michie

Accepted 8 December 2003

The problems of getting people to act on evidence based guidelines are widely recognised.1 An overview of 41 systematic reviews found that the most promising approach was to use a variety of interventions including audit and feedback, reminders, and educational outreach.1 The effective interventions often involved complicated procedures and were always an addition to the provision of guidelines. None of the studies used the simplest intervention—that is, changing the wording of the guidelines. We examine the importance of precise behavioural recommendations and suggest how some current guidelines could be improved.

Importance of wording

The wording of a behavioural instruction affects the likelihood that it will be followed, by influencing comprehension, recall, planning, and behaviour. For example, work by Philip Ley shows that using specific concrete statements increases the extent to which information is both understood and remembered.2 3 Individuals who intend to change behaviour are more successful if they have a specific behavioural plan.4 A recognised technique of behaviour modification is to define the target behaviour in specific and concrete terms.5

In a study of attributes of 10 national clinical guidelines, general practitioners followed the guidelines on 67% of occasions if they were concrete and precise but on only 36% of occasions when they were vague and non-specific.6 Implementation of guidelines …