APPLICATION OF THE READY, WILLING, AND ABLE MODEL TO DECISION AID IMPLEMENTATION

Purpose:  While patient decision aids can promote patients’ participation in healthcare, they remain underutilized. Theory-based models describing prerequisites to sustained decision aid use are needed. The ready, willing, and able (RWA) model specifies 3 preconditions for adopting a new behavior. Using this model as an overarching framework, the literature describing primary care providers’ perspectives about decision aids was reviewed. 

Method:  An OvidSP Medline^®search from January 2004 through March 2014 was employed using strategic keyword combinations. Reference lists of relevant articles were examined to identify additional sources. Articles were limited to those focusing on patient decision aids, the experience of health care providers, and the primary care setting. The main outcome of interest was to assess the utility of the RWA model as a means to effectively categorize barriers and facilitators to decision aid use in the primary care setting. Secondary outcomes were to enumerate barriers and facilitators, and propose a research agenda based on the model. 

Result:  The search identified 135 non-duplicative articles. Twenty-one articles met inclusion criteria. The RWA model provided a simple yet practical framework for thinking about the precise mechanisms that facilitate (or work against) the widespread adoption of patient decision aids within primary care. While lack of time was a prominent barrier, additional barriers such as perceived legitimacy, clinic capacity, structures and processes of care, and the overarching health care environment were frequently noted. 

Conclusion:  The RWA model suggests that multiple preconditions must be satisfied before sustained use of patient decision aids can take hold. By identifying precise bottlenecks, the model can inform specific policies and tailored interventions to target the problem. Using the model to troubleshoot for problems prior to implementing a decision aid will likely help to improve uptake and sustain use over time.