在中低收入国家（LMICs）中绘制临床障碍和基于证据的实施策略图。
Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs).
机构信息
JBI, The University of Adelaide, Adelaide, SA, Australia.
Department of Nursing, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.
出版信息
Worldviews Evid Based Nurs. 2021 Jun;18(3):190-200. doi: 10.1111/wvn.12503. Epub 2021 May 10.
BACKGROUND
Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice.
AIM
To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies.
METHODS
A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy.
RESULTS
A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers.
LINKING EVIDENCE TO ACTION
Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.
背景
中低收入国家（LMICs）面临着非传染性和传染性疾病的双重疾病负担。解决这些公共卫生问题需要有效的实施策略，并将知识转化为实践。
目的
从已发表的证据实施研究中，确定并分类中低收入国家实施证据的障碍和策略。
方法
对在中低收入国家完成并发表在 JBI 系统评价和实施报告数据库中的为期 6 个月、多阶段、强化循证临床奖学金项目的关键特征进行描述性分析。根据 Donabedian 护理维度（结构、过程和结果）识别和分类障碍，并将策略映射到 Cochrane 有效实践和护理组织分类法。
结果
2010 年至 2018 年期间，共发表了 60 个实施项目，报告了来自中低收入国家的 58 个基于证据的临床审计主题。这些项目涉及不同的人群，主要在三级保健机构进行。共确定了 279 个实施障碍。最常见的障碍分组与过程有关，主要与员工知识有关。共使用了 565 种策略，每个项目都采用了多种策略来解决实施循证实践的障碍；大多数策略被归类为医疗保健工作者的教育会议。
将证据付诸行动
中低收入国家需要针对具体情况的策略来成功实施证据，并且可以使用当地可用的低成本资源来解决一些常见的障碍。在中低收入国家对医疗保健工作者进行教育是一种有效的提高认识、改变工作场所文化和实施证据转化的策略。
Zotero 插件