Words matter: increasing the implementation of clinical guidelines

OBJECTIVES: To determine whether writing clinical guideline recommendations in behaviourally specified "plain English" language increases the likelihood of their implementation by service users (patients). DESIGN: Randomised controlled trial in which participants received either the original text of the National Institute for Clinical Excellence (NICE) public guidelines for the management of schizophrenia or a behaviourally specified text with the same content. SETTING: Mental health service user networks and voluntary sector organisations within two inner London boroughs. PARTICIPANTS: Eighty four mental health service users recruited by post or face to face contact at service user meetings. INTERVENTION: The section of the NICE public guidelines for schizophrenia concerning psychological and pharmacological treatments was rewritten to improve style and behavioural specificity by applying evidence-based and psychologically informed principles of good written communication. OUTCOME MEASURES: Cognitive predictors of behaviour, as specified by the evidence based theory of planned behaviour, constituted the primary outcome as it was not possible to measure the actual behaviour of guideline implementation. The predictors were behavioural intentions to implement the guidelines, attitudes towards implementation, and perceived behavioural control over implementation. Satisfaction with the guidelines and perceived comprehension were also measured. RESULTS: Behaviourally specified "plain English" guidelines led to stronger intentions to implement the guidelines, more positive attitudes towards them, and greater perceived behavioural control over using them. There was no difference in satisfaction or perceived comprehension. CONCLUSIONS: Writing guidelines with high behavioural specificity in conjunction with the use of "plain English" may be a simple and effective method of increasing their implementation. Evaluation with a behavioural outcome is now needed.