• Monika Kastner, Onil Bhattacharyya, Leigh Hayden, Julie Makarski, Elizabeth Estey, Lisa Durocher, Ananda Chatterjee, Laure Perrier, Ian D Graham, Sharon E Straus, Merrick Zwarenstein, and Melissa Brouwers.
• Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8. Electronic address: monika.kastner@utoronto.ca.
• J Clin Epidemiol. 2015 May 1; 68 (5): 498-509.

ObjectivesTo identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake.Study Design And SettingWe conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies. Analysis involved the development of a codebook of definitions, validation of data, and development of hierarchical narratives to explain guideline implementability.ResultsWe found that guideline implementability is associated with two broad goals in guideline development: (1) creation of guideline content, which involves addressing the domains of stakeholder involvement in CPGs, evidence synthesis, considered judgment (eg, clinical applicability), and implementation feasibility and (2) the effective communication of this content, which involves domains related to fine-tuning the CPG's message (using simple, clear, and persuasive language) and format.ConclusionOur work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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