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低收入和中等收入国家在实施孕产妇健康证据产品方面面临许多共同障碍。

Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

作者信息

Puchalski Ritchie Lisa M, Khan Sobia, Moore Julia E, Timmings Caitlyn, van Lettow Monique, Vogel Joshua P, Khan Dina N, Mbaruku Godfrey, Mrisho Mwifadhi, Mugerwa Kidza, Uka Sami, Gülmezoglu A Metin, Straus Sharon E

机构信息

Department of Medicine, University of Toronto, RFE 3-805, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4; Department of Emergency Medicine, University Health Network, RFE GS-480, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.

Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.

出版信息

J Clin Epidemiol. 2016 Aug;76:229-37. doi: 10.1016/j.jclinepi.2016.02.017. Epub 2016 Feb 27.

Abstract

OBJECTIVES

To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings.

STUDY DESIGN

Secondary analysis of qualitative data.

SETTING

Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis.

RESULTS

Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products.

CONCLUSION

By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.

摘要

目标

探讨几个低收入和中等收入国家(LMICs)在孕产妇健康挑战及证据应用方面的异同,并确定代表LMICs卫生保健环境中证据应用的障碍和促进因素的共同和独特主题。

研究设计

定性数据的二次分析。

研究背景

分析了描述作者在三大洲五个LMICs开展的项目的会议报告和文章。项目重点是确定证据产品应用的障碍和促进因素:五项世界卫生组织孕产妇健康指南,以及一项提高结核病治疗依从性的知识转化策略。采用主题内容分析法对数据进行分析。

结果

在已确定的证据应用障碍中,各国和各临床领域存在高度共性,其中资金、物资和人力资源短缺最为突出。相比之下,确定的促进因素很少,且各国和证据应用产品之间差异很大。

结论

通过确定共同障碍和需要额外关注以确保捕捉独特障碍和促进因素的领域,这些发现为制定一个框架提供了起点,该框架可指导对孕产妇健康证据应用障碍和促进因素的评估,并可能更广泛地指导LMICs中的证据应用评估。

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