SynthesisHealth research policy and systems2020
Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview.
Synthesis in Health research policy and systems, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 192 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
192 citing papers in PubMed, 12 syntheses or guidelines pooled it.
- Exploring disparities in adherence to colorectal cancer clinical practice guidelines and associated survival outcomes: a systematic review and meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Pooled it
- Implementation research on osteoarthritis in Asia: a systematic review.Frontiers in public health · 2026Pooled it
- Are Canadian Clinical Practice Guidelines Accounting for Adults With Multiple Chronic Diseases? A Systematic Review.Journal of evaluation in clinical practice · 2025Pooled it
- Staff-reported barriers and facilitators to the implementation of healthcare interventions within regional and rural areas: a rapid review.BMC health services research · 2025Pooled it
- Hospital falls clinical practice guidelines: a global analysis and systematic review.Age and ageing · 2024Pooled it
- Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review.BMC health services research · 2024Pooled it
- Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines.Arthritis care & research · 2023Pooled it
- What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines.Clinical rheumatology · 2023Pooled it
- Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review.Orphanet journal of rare diseases · 2023Pooled it
- Identifying strategies for implementing a clinical guideline for cancer-related fatigue: a qualitative study.BMC health services research · 2023Guideline
- Extrinsic and intrinsic factors acting as barriers or facilitators in nurses' implementation of clinical practice guidelines: a mixed-method systematic review.Acta bio-medica : Atenei Parmensis · 2022Pooled it
- A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0-6) weeks of gestation.Systematic reviews · 2021Pooled it
- Exploring Implementation Processes of a Multicomponent Family Support Intervention in Intensive Care Units (FICUS) Study: A Mixed-Methods Process Evaluation.Journal of advanced nursing · 2025Trial
- Barriers and Facilitators-Lessons Learned From a Randomised Trial to Implement Clinical Practice Guidelines for the Prevention of Coercion in Psychiatry.International journal of mental health nursing · 2025Trial
- Effectiveness of an Internet-Based Acceptance and Commitment Therapy Intervention for Reducing Psychological Distress in Health Care Professionals: Randomized Controlled Trial.Journal of medical Internet research · 2024Trial
- Symptom management care pathway adaptation process and specific adaptation decisions.BMC cancer · 2023Trial
- Planning a Clinical Practice Guideline Revision for a Core Set of Outcome Measures in Adults Undergoing Neurologic Physical Therapy, Part 1: Assessing Dissemination and Scholarly Uptake.Clinical and public health guidelines · 2026Article
- Improving Clinical Outcomes Related to Preeclampsia: Real-World Impacts of Implementation of a Redesigned Approach to Antenatal Care-The Initial Maternity Assessment and Planning (IMAP) Service.The Australian & New Zealand journal of obstetrics & gynaecology · 2026Article
- Developing a strategy for identifying recommendations prioritized for implementation in the Colombian health system.Health research policy and systems · 2026Article
- Adapting and implementing health systems guidelines: learning lessons from countries.Health research policy and systems · 2026Article
132 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
introductionClinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs.
methodsA search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients.
resultsOverall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines.
conclusionsThe barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.
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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.