Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

Stokes, Tim; Shaw, Elizabeth; Camosso‐Stefinovic, Janette; Imamura, Mari; Kanguru, Lovney; Hussein, Julia

doi:10.1186/s13012-016-0508-1

Cited by 56 publications

(74 citation statements)

References 39 publications

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“…This finding could be consistent with previous reports of low availability of equipment and supplies in the national healthcare service in Mozambique [30,31]. The unreliability of resources for maternal care has also been observed in previous studies from LMICs, such as Tanzania, Uganda and Nepal [32–34], and this has been recognized as a barrier to implement strategies for the improvement of obstetric care [35]. Furthermore, as reported in Tanzania, inadequately stocked and equipped facilities undermine the ability of the health system to provide optimal maternal care [36].…”

Section: Discussionsupporting

confidence: 91%

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Mocumbi

McKee

Munguambe

et al. 2018

Global Health Action

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Background: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence. Objectives: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. Methods: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach’s α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Results: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed. Conclusions: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants’ responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.

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Section: Discussionsupporting

confidence: 91%

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Mocumbi

McKee

Munguambe

et al. 2018

Global Health Action

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“…Only a few facilitators were identified in the implementation reports; key enablers were positive attitudes towards change and support from the organization's management, which are consistent in studies involving low‐ and middle‐income countries (Dizon et al., ; Stokes et al., ). It appears that majority of implementation projects in this study focused on identifying barriers and overlooked the value of facilitators.…”

Section: Discussionsupporting

confidence: 66%

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

Lizarondo

Lockwood

McArthur

2019

Worldviews Ev Based Nurs

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Background: Culture-and context-specific issues in African countries such as those related to language, resources, technology, infrastructure and access to available research may confound evidence implementation efforts. Understanding the factors that support or inhibit the implementation of strategies aimed at improving care and health outcomes specific to their context is important.Aims: The aim of this study was to determine barriers and facilitators to evidence implementation in African healthcare settings, based on implementation projects undertaken as part of the Joanna Briggs Institute (JBI) Clinical Fellowship program.Methods: Reports of implementation projects conducted in Africa were obtained from the JBI database and printed monographs associated with the fellowship program. A purpose-built data extraction form was used to collect data from individual reports. Data were analysed using content analysis.Results: Eleven published and nine unpublished implementation reports were reviewed. The most frequently reported barriers to evidence implementation operate at the health organization or health practitioner level. Health organization-level barriers relate to human resources, material resources and policy issues. Health practitioner-level barriers relate to practitioners' knowledge and skills around evidence-based practice, and attitudes to change. Barriers at the government and consumer levels were uncommon. Only a few facilitators were identified and were related to health practitioners' attitudes or support from the organization's management.Linking Evidence to Action: The study identified a core set of barriers and facilitators in African healthcare settings, which are common to other low-and middle-income countries. These can be used to develop a method by which implementation programs can systematically undertake barrier or facilitator analysis. Future research should aim to develop a process by which these barriers and facilitators can be prioritised so that a structured decision support procedure can be established.

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“…In using the 'best fit' framework synthesis approach [41], an adapted CFIR framework will be developed which goes beyond listing determinants to illustrate the relationships between factors. This approach, adopted by other recently published reviews [42][43][44][45], may help advance the a priori framework towards being more testable. For example, the adapted CFIR framework can be used to generate a hypothesis, specifically in the context of menu labelling, to be tested in empirical research.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review

Kerins

McHugh

McSharry

et al. 2020

Int J Behav Nutr Phys Act

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Background: Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry.Methods: Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR).

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Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

Cited by 56 publications

References 39 publications

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review

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