22 Chapter 2 The secondary outcomes were the number and types of implementation strategies per study. The different strategies used were categorized according to the Cochrane Effective Practice and Organisation of Care taxonomy [19]. The Effective Practice and Organisation of Care taxonomy includes four domains of interventions: Implementation strategies, Delivery arrangements, Financial arrangements and Governance arrangements. Data extraction Relevant information from the included articles was extracted in a data abstraction form. This form was piloted for the first five studies and finalized after discussion (DS, TR, EI). Data included country of origin, setting, type of guideline, participants, implementation strategies, barrier assessment, use of implementation theory or framework, and outcomes. Depending on the measurements performed in the included studies, both or either of the primary outcomes (i.e. patient-related nursing outcomes or adherence to the guideline) were collected. All data abstraction forms were initially completed by DS and checked by either TR or EI. Differences were discussed when necessary. Risk of bias assessment The risk of bias of the included studies was assessed with two tools. The Cochrane risk of bias tool was used for the controlled studies [20]. This tool consists of nine items, of which each is scored high, low or unclear risk of bias. The ‘Newcastle-Ottawa Quality Assessment form for Cohort studies’ was used for cohort before-after studies [21]. The Newcastle-Ottawa Quality Assessment consists of three parts; selection, comparison and outcome. For each part a number of stars can be assigned, resulting in an overall score (good, fair or poor). Both risk of bias tools were included in the data abstraction form, initially completed by DS and checked by either TR or EI. Discrepancies were resolved by discussion. The Newcastle-Ottawa Quality Assessment form for Cohort Studies contains a question on whether the follow-up was long enough for the outcome to appear [21]. In line with recommendations of the World Health Organisation (WHO) on implementation research, we took it that a period of at least of 3 months, for baseline and after measurement each, was sufficient [22]. After discussion DS, TR, and EI jointly decided that a three-month period was sufficient. Regarding the before-after studies, a follow-up period less than three months therefore resulted in poor scores on the outcome part of the Newcastle-Ottawa Quality Assessment form for Cohort Studies. The Cochrane tool does not contain such a parameter.
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