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J Clin Epidemiol. 2016 Aug;76:229-37. doi: 10.1016/j.jclinepi.2016.02.017. Epub 2016 Feb 27.

Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

Author information

1
Department of Medicine, University of Toronto, RFE 3-805, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4; Department of Emergency Medicine, University Health Network, RFE GS-480, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. Electronic address: lisa.puchalskiritchie@utoronto.ca.
2
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
3
Dalla Lana School of Public Health, University of Toronto, 155 College St., 6th Floor, Toronto, Ontario, Canada M5T 3M7; Dignitas International, PO Box 1071, Zomba, Malawi.
4
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
5
Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
6
Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, P O Box 7072 Kampala, Uganda.
7
World Health Organization, Pristina Office, Institute of Public Health, University Clinical Centre, St. Nëna Terezë, Rrethi I Spitalit pn, 10000 Pristina, Kosovo.
8
Department of Medicine, University of Toronto, RFE 3-805, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.

Abstract

OBJECTIVES:

To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings.

STUDY DESIGN:

Secondary analysis of qualitative data.

SETTING:

Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis.

RESULTS:

Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products.

CONCLUSION:

By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.

KEYWORDS:

Barriers; Evidence implementation; Evidence tools; Facilitators; Guidelines; Knowledge products

PMID:
26931284
DOI:
10.1016/j.jclinepi.2016.02.017
[Indexed for MEDLINE]
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