Background:Within every clinical setting, various challenges are experienced in implementing evidence into practice. However, low and lower-middle income countries have unique healthcare features that may further add complexity to implementation efforts. It is therefore important to understand the barriers and facilitators specific to their context so that targeted strategies can be incorporated in the implementation plan.
Objectives: The objective of this study was to determine the barriers and facilitators to evidence implementation in Africa across various health settings. Barriers and facilitators that cut across or vary between countries and settings were also identified.
Methods: Twenty published and unpublished reports of implementation projects undertaken by the Joanna Briggs Institute’s clinical fellows from seven countries in Africa were reviewed. Clinical fellows consisted of health practitioners from different disciplines including dentistry, pharmacy, nursing and medicine. Data on barriers and facilitators were extracted and analysed using content analysis.
Results: Barriers at the health system and practitioner levels were identified including inadequate physical structure, equipment and resources, lack of policies to support best practice, high workload, lack of training and access to evidence-based information, and lack of knowledge and skills relevant to evidence-based practice. There was a high degree of similarity across countries and settings in terms of the identified barriers. Positive staff attitude and knowledge about best practice were the most common facilitators described in the implementation reports.
Conclusions: The findings of this study are useful not only in providing guidance to the assessment of barriers and enablers but also for mapping strategies that can be introduced in clinical settings in Africa. Effective and sustainable implementation of best practice in African healthcare settings requires a targeted and multifaceted approach that takes into account both health system issues and practitioner challenges.