Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review
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Date
2017
Authors
Baatiema, L.
Otim, M.E.
Mnatzaganian, G.
de-Graft Aikins, A.
Coombes, J.
Somerset, S.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Adoption of contemporary evidence-based guidelines for acute stroke management is often delayed
due to a range of key enablers and barriers. Recent reviews on such barriers focus mainly on specific acute stroke
therapies or generalised stroke care guidelines. This review examined the overall barriers and enablers, as perceived
by health professionals which affect how evidence-based practice guidelines (stroke unit care, thrombolysis
administration, aspirin usage and decompressive surgery) for acute stroke care are adopted in hospital settings.
Methodology: A systematic search of databases was conducted using MEDLINE, Cumulative Index to Nursing and
Allied Health Literature (CINAHL), Embase, PsycINFO, Cochrane Library and AMED (Allied and Complementary Medicine
Database from 1990 to 2016. The population of interest included health professionals working clinically or in roles
responsible for acute stroke care. There were no restrictions to the study designs. A quality appraisal tool for qualitative
studies by the Joanna Briggs Institute and another for quantitative studies by the Centre for Evidence-Based Management
were used in the present study. A recent checklist to classify barriers and enablers to health professionals’ adherence to
evidence-based practice was also used.
Results: Ten studies met the inclusion criteria out of a total of 9832 search results. The main barriers or enablers identified
included poor organisational or institutional level support, health professionals’ limited skills or competence to use a
particular therapy, low level of awareness, familiarity or confidence in the effectiveness of a particular evidence-based
therapy, limited medical facilities to support evidence uptake, inadequate peer support among health professionals’,
complex nature of some stroke care therapies or guidelines and patient level barriers.
Conclusions: Despite considerable evidence supporting various specific therapies for stroke care, uptake of these
therapies is compromised by barriers across organisational, patients, guideline interventions and health professionals’
domains. As a result, we recommend that future interventions and health policy directions should be informed by these
findings in order to optimise uptake of best practice acute stroke care. Further studies from low- to middle-income
countries are needed to understand the barriers and enablers in such settings.
Trial registration: The review protocol was registered in the international prospective register of systematic reviews,
PROSPERO 2015 (Registration Number: CRD42015023481)
Description
Keywords
Acute stroke, Evidence-based practice, Therapies, Services, Barriers, Enablers
Citation
Baatiema, L., Otim, M. E., Mnatzaganian, G., de-Graft Aikins, A., Coombes, J., & Somerset, S. (2017). Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implementation science : IS, 12(1), 74. doi:10.1186/s13012-017-0599-3