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.
Puchalski Ritchie, L. M., Khan, S., Moore, J. E., Timmings, C., van Lettow, M., Vogel, J. P., … Straus, S. E. (2016). Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. Journal of Clinical Epidemiology, 76, 229–237. https://doi.org/10.1016/j.jclinepi.2016.02.017