Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diVusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the eVectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies.The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more eVectively. Clearly, the eVectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies. (Quality in Health Care 1999;8:177-183) Keywords: guidelines; behaviour change theory; conceptual framework Until recently, there has been little research on the relative merits of dissemination and implementation strategies used to encourage adoption of clinical practice guidelines. However, evidence now exists that use of an appropriate range of strategies, beyond simple information provision through publication in journals or general mailings, can significantly increase rates of guideline adoption by clinicians.

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Objective To pilot a clinical information service for general practitioners. Methods A representative sample of 31 GPs was invited to submit clinical questions to a local academic department of general practice. Their views on the service and the usefulness of the information were obtained by telephone interview. Results Over one month, nine GPs (29% of the sample, 45% of those stating an interest), submitted 20 enquiries comprising 45 discrete clinical questions. The median time to search for evidence, appraise it and write answers to each enquiry was 2.5 hours (range, 1.0–7.4 hours). The median interval between receipt of questions and dispatch of answers was 3 days (range, 1–12 days). Conclusions The GPs found the answers useful in clinical decision making; in four out of 20 cases patient management was altered.