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

ABSTRACT

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 RESULTS: Eleven published and nine unpublished implementation reports were reviewed.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.