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




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Implementation Science

, 11:144

First Online: 22 October 2016Received: 19 May 2016Accepted: 10 October 2016DOI: 10.1186-s13012-016-0508-1

Cite this article as: Stokes, T., Shaw, E.J., Camosso-Stefinovic, J. et al. Implementation Sci 2016 11: 144. doi:10.1186-s13012-016-0508-1

Abstract

BackgroundMaternal mortality remains a major international health problem in low- and middle-income countries LMIC, and most could have been prevented by quality improvement interventions already demonstrated to be effective, such as clinical guideline implementation strategies. The aim of this systematic review was to synthesise qualitative evidence on guideline implementation strategies to improve obstetric care practice in LMIC in order to identify barriers and enablers to their successful implementation.

MethodsWe searched MEDLINE and CINAHL databases for articles reporting research findings on barriers and enablers to guideline implementation strategies in obstetric care practice in LMIC. We conducted a -best fit- framework synthesis of the included studies. We used an organisational -stages of change- model as our a priori framework for the synthesis.

ResultsNine studies were included: all were based in Sub-Saharan Africa and in hospital health care facilities. The majority of studies seven evaluated one particular guideline implementation strategy: clinical audit and feedback both criterion-based audit and maternal death reviews, and a minority two evaluated educational interventions. A range of barriers and enablers to successful guideline implementation was identified. A key finding of the framework synthesis was that -high- and -low- intrinsic health care professional motivation are overall enablers and barriers, respectively, of successful guideline implementation. We developed a modified -stages of change- model to take account of these findings.

ConclusionWe have identified a number of quality improvement processes that are amenable to change at limited or no additional cost, although some identified barriers may be difficult to address without increased resources. We note the pathways to implementation may be complex and require further research to develop our understanding of individual and organisational behaviours and motivation in LMIC settings.

Trial registrationPROSPERO CRD42015016062

KeywordsSystematic review Qualitative synthesis Framework synthesis Guideline implementation Obstetrics Low- and middle-income countries AbbreviationsLMICLow- and middle-income countries

Electronic supplementary materialThe online version of this article doi:10.1186-s13012-016-0508-1 contains supplementary material, which is available to authorized users.

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Autor: Tim Stokes - Elizabeth J. Shaw - Janette Camosso-Stefinovic - Mari Imamura - Lovney Kanguru - Julia Hussein

Fuente: https://link.springer.com/







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