Barriers and facilitators to guideline implementation strategies to improve obstetric care in low and middle income countries (LMIC): qualitative evidence synthesis

Tim Stokes, EJ Beth Shaw, Janette Camosso-Stefinovic, Mari Imamura, Lovney Kanguru, Julia Hussein

Research output: Contribution to conferenceAbstract


Background: Clinical guidelines and their implementation strategies are seen as crucial to improving obstetric care in LMIC. For these strategies to be effective we need a better understanding why implementation works in some contexts, and not in others, and how sustainability of quality improvement can be achieved. We aimed to synthesise qualitative research on guideline implementation strategies for LMIC obstetric care to identify barriers and facilitators to successful implementation.

Methods: Systematic review of qualitative evidence using “best fit” framework synthesis. The setting was obstetric health care facilities in LMIC and participants include health professionals and paramedical professionals located in health facilities from tertiary to primary level, and those working in communities. The guideline implementation strategies were: a) distribution of educational materials, b) educational meetings, c) Local consensus processes, d) Educational outreach visits, e) Local opinion leaders, f) Audit and feedback and g) Reminders.

Results: Nine studies were included. The majority (seven) evaluated implementation of audit. The synthesis utilised a “stages of change” conceptual framework to identify barriers and facilitators related to pre-implementation, implementation and institutionalisation of the guideline implementation strategies.

Conclusions: Our set of barriers and facilitators are likely to be transferable to guideline implementation in other LMIC clinical settings.
Original languageEnglish
Publication statusPublished - Nov 2015
EventOIHRN 8th Annual Conference - Dunedin, New Zealand
Duration: 11 Nov 201512 Nov 2015


ConferenceOIHRN 8th Annual Conference
CountryNew Zealand



  • guideline implementation strategies
  • obstetric care
  • maternity care
  • low and middle income countries

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