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

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


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / statistics & numerical data*
  • Developed Countries / statistics & numerical data
  • Developing Countries / statistics & numerical data
  • Evidence-Based Practice / organization & administration*
  • Evidence-Based Practice / statistics & numerical data
  • Female
  • Health Services Accessibility / organization & administration*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Kosovo
  • Malawi
  • Maternal Health Services / organization & administration*
  • Maternal Health Services / statistics & numerical data*
  • Middle Aged
  • Myanmar
  • Tanzania
  • Uganda
  • Young Adult