Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

Abstract

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.

Relevance and Barriers to Evidence-Based Practice in Zambian Defense Force Medical Services: A Qualitative Analysis of Roundtable Group Discussion by Military Health Personnel

“…The lack of adequate resources and physical facilities for EBP are universal and our finding is consistent with previous research [7,8,17,21,24,26]. In a qualitative study in Latin American hospitals, professional informants reported scarce physical facilities as their main hurdle to change perinatal care practice [21].…”

“…While these barriers are obstructive to EBP and can negatively affect staff morale and motivation. Perhaps, the barriers could be due to communication problems [21] between staffs and managers, administrators' are unaware of their responsibilities or lack EBP knowledge. Findings from a systematic review highlighted that poor institutional support hinders the uptake of EBP [17].…”

“…Okwundu [22] also described 80% of hospital doctors in Nigeria lack access to internet and online databases. Thus, staffs need good infrastructure, reliable internet service and access to online resources to search for evidence to inform practice [21,32].…”

A systematic review on barriers, facilities, knowledge and attitude toward evidence-based medicine in Iran

“…Witches are fits with previous studies in other countries. [53][54][55][56][57] Thus, the results of the present study and similar results obtained from other studies showed that the following cases were inevitable: providing appropriate facilities for implementation of EBM, providing enough time to study, performance based on evidences through workload reduction, increasing human resources, training time management and so on, teaching research method and planning, conducting and using research results, and also training the principles and standards of EBM and establishing legal, political and administrative infrastructures to provide the possibility of making changes and applying research results by health service providers, albeit, with professional, ethical and legal supervision and incentives to increase physicians' cooperation in the field of EBM, and holding courses in order to enhance health providers' ability and English The results indicated Iranian health providers have relatively low awareness of specific terms of EBM (44.2%). The lowest familiarity and understanding were of CI, level of evidence, meta-analysis and OR respectively that matches greatly with results of previous researches.…”

Influencia de la adolescencia y su entorno en la adherencia al control prenatal e impacto sobre la prematuridad, bajo peso al nacer y mortalidad neonatal

“…La propia formación médica intervencionista donde la preparación en la atención básica o de nivel I no es la adecuada o suficiente. Las instituciones de la salud que prestan estos servicios tienen escasez de personal profesional capacitado, de materiales necesarios, e instalaciones físicas no adecuadas para atender a la población adolescente embarazada (32).…”