SynthesisImplementation science : IS2016
Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence.
Synthesis in Implementation science : IS, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 5 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 5 syntheses or guidelines pooled it, 90 citations in OpenAlex.
- Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review.Health policy and planning · 2020Pooled it
- Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview.Health research policy and systems · 2020Pooled it
- Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review.The international journal of behavioral nutrition and physical activity · 2020Pooled it
- Pooled it
- Pooled it
- Impact of reliable light and electricity on job satisfaction among maternity health workers in Uganda: A cluster randomized trial.Human resources for health · 2022Trial
- The FemTech revolution: Unlocking the potential of new technology for optimizing pregnancy outcomes in low- and middle-income countries and remote areas.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Guideline adherence to aspirin prophylaxis use for preeclampsia among healthcare providers in Northwest Ethiopia: an explanatory sequential mixed-methods study.AJOG global reports · 2026Article
- Fifty years of maternal mortality research in sub-Saharan Africa: a bibliometric analysis of trends, gaps, and opportunities for health equity.Frontiers in global women's health · 2026Review
- Healthcare Workers' Perspectives on the E-MOTIVE Postpartum Haemorrhage Bundle in Tanzania: A Qualitative Study of Implementation Facilitators and Challenges.International journal of women's health · 2026Article
- Implementing the WHO's Emergency Care Systems toolkit: a qualitative study for facilitators and barriers.Emergency medicine journal : EMJ · 2025Article
- Landscape analyses of gaps in reproductive, maternal, newborn, child, and adolescent health policies and guidelines to catalyse policy implementation improvement in Uganda.Health research policy and systems · 2025Article
- Context matters: examining factors influencing the implementation of evidence-based family systems care for small and sick newborns across the care continuum.Frontiers in health services · 2025Article
- Article
- Global variation in antibiotic prescribing guidelines and the implications for decreasing AMR in the future.Frontiers in pharmacology · 2025Review
- Effectiveness of dissemination strategies of maternal clinical guidelines: A narrative review.African journal of primary health care & family medicine · 2024Review
- Midwives' experiences regarding recordkeeping during intrapartum care in Limpopo Province healthcare facilities.Curationis · 2024Article
- Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries.SSM - population health · 2024Review
- The Outcomes, Barriers, and Facilitators of Implementing Clinical Practice Guidelines in Iran: A Comprehensive Review.Iranian journal of public health · 2024Review
- Exploring variations in the implementation of a health system level policy intervention to improve maternal and child health outcomes in resource limited settings: A qualitative multiple case study from Uganda.PLOS global public health · 2024Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.