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Breneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, Langlois EV, Wozney L, Vélez CM, Cassidy C, Juvekar S, Rothfus M, Aziato L, Keeping-Burke L, Adjorlolo S, Patiño-Lugo DF. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Health Res Policy Syst 2022; 20:64. [PMID: 35706039 PMCID: PMC9202131 DOI: 10.1186/s12961-022-00865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada.
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Kirti Minocha
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Catie Johnson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Helen Wong
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Lori Wozney
- Nova Scotia Health Authority Policy and Planning, Dartmouth, Canada
| | - C Marcela Vélez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Melissa Rothfus
- W.K. Kellogg Health Science Library, Dalhousie University, Halifax, Canada
| | - Lydia Aziato
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, St. John, Canada
| | - Samuel Adjorlolo
- Department of Mental Health Nursing, University of Ghana, Legon, Accra, Ghana
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