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Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2\u20135 provinces were selected from each region. 2\u20133 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; the west\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02; the middle\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001 compared with the east), hospital grades (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028), length of practitioners\u2019 practice (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006), education background (Ph.D.,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.027; Master,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), evidence-based medicine skills acquired in work unit (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012), and medical specialty of practitioner (General Practice,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006; Surgery,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.043).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12911-020-01382-w","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T07:04:27Z","timestamp":1610607867000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Determinants of successful guideline implementation: a national cross-sectional survey"],"prefix":"10.1186","volume":"21","author":[{"given":"Ying-hui","family":"Jin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Ming","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid S.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tong","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan-qi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xian-tao","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4725-9581","authenticated-orcid":false,"given":"Xing-huan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,14]]},"reference":[{"key":"1382_CR1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/1748-5908-7-67","volume":"7","author":"AR Gagliardi","year":"2012","unstructured":"Gagliardi AR, Brouwers MC. 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Verbal Informed consent was obtained before the questionnaires were distributed, and this was approved by the ethics committee.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All the authors (Ying-hui Jin, Li-Ming Tan, Khalid S. Khan, Tong Deng, Chao Huang, Fei Han, Jing Zhang, Qiao Huang, Di Huang, Dan-qi Wang, Yu Wang, Xian-tao Zeng, Qiang Wang, Xing-huan Wang) declare no competing financial interests. Ying-hui Jin, Xian-tao Zeng, Qiang Wang and Xing-huan Wang have conducted several clinical practice guidelines.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19"}}