Table 2.
Barriers to use of systematic reviews by policy makers and health care managers
| Attitudes | Knowledge | Skills | Behaviour | |||
|---|---|---|---|---|---|---|
| Lack of agreement | Lack of outcome expectancy | Inertia of previous or actual practice/lack of motivation | Lack of awareness/familiarity | Lack of skills | SRs/intrinsic factors | Extrinsic factors |
| Limited quantity of research on topics of importance to them, e.g. economic impact, emerging technologies [21, 44, 50] | Avoid providing specific recommendations for action based on SR; do not believe in causal linkage [45] | Lack of motivation to use reviews will require changing policy makers’ attitudes [51] | Administrators’ limited understanding of the function of SRs [44] | Participants’ poor conceptual understanding of systematic reviews [47] | The review itself did not appear to be user-friendly due to inaccessible language and dense layout [39] | Policy inconsistency within health care system (differing interests, different policies run in parallel, performance based incentives) [48] |
| Systematic reviews do not necessarily frame the existing evidence in terms of their policy applications [44] | Information overload leads to lack of awareness of a particular systematic review [24, 43] | The health agency staff had not been taught “to continue to use research to inform their decisions, to inform their practice. They therefore made decisions based on “common sense”, “gut level”, “standards of practice”, and comparative convenience and awareness of available data, rather than based on systematic reviews of research.” [44, 52] | Accessibility: within a systematic review, have difficulty identifying key messages [44] | Attacks on an evidence-based approach. Several officials also discussed instances in which the whole notion of evidence-based health care had come under direct attack, usually by pharmaceutical companies, sometimes in collaboration with advocacy groups, some of which hid their involvement with industry [44]. | ||
| Lack of or unknown credibility of authors of the research [21] | No policy makers mentioned having utilised information from systematic reviews, and most seemed unaware of their existence [38] | Lack features that would make them easier for government officials to evaluate. For example, the quality of studies is often difficult for non-experts to interpret because the explanation of research methods is long and complicated [44] | Concepts presented in tables, including those that showed the GRADE assessment and different levels of risk, were not clear [47] | Accessibility. Even when evidence is available, policymakers may have problems obtaining it [44] | ||
| Ethical disagreement [21] | Appraising and synthesising the evidence was seen as an even bigger challenge [40] | Tables running over 2 pages were cumbersome to read [47] | Lack of availability of research results [21] | |||
| Research information not valued at community level [21] | Difficult to understand by people not trained in evidence-based medicine [21, 47] | Abbreviations caused confusion [47] | Lack of resources to implement research [21] | |||
| Policy decisions are made based on other factors like cost and equity considerations, particularly if evidence base is frail [52] | Words like “sample size” and “relative risk” would be difficult to interpret [47] | Use of jargon and/or unfamiliar vocabulary [47] | Policy climate—provincial/regional not conducive to use [21] | |||
| Mismatch between the type of content offered and their information needs [47] | Lack of expertise in evaluating SRs [44] | Numbers in the text and those in the tables do not correspond precisely [47] | Lack of timely completion of review [21] | |||
| Translating evidence to the local context (including sub groups of patients): individuals frequently had to make independent decisions about how to relate evidence to the needs of their local context, discuss and debate the evidence with local stakeholders and take decisions about its usein practice [48] | Appraising and synthesising the evidence was seen as an even bigger challenge [40] | Current practice patterns lead policy makers and managers reluctant to use reviews [21] | ||||
| Policymakers expected content lying outside the scope of a review: recommendations, outcome measurements not usually included in a review, detailed information about local applicability or costs, and a broader framing of the research enquiry [47] | Wanted a shorter, clearer presentation [47] | Cost of retrieving information prohibitive [21] | ||||
| Reviews covered issues at a more complex level than required [52] | Insufficient authority to implement research results [21] | |||||
| Lack of detail on how to use strategies, tools, processes that would lead to successful integration (i.e. guidance on breaking down systems barriers or how to achieve integration in the context of big, complex system) [49] | Policy makers had difficulty finding brief research summaries and systematic reviews when they were needed (i.e. difficulty accessing SRs) [42] | |||||
| Tended not to use the full report instead referring to the less dense, more accessible articles [49] | Limited time to find, retrieve, read, and translate research [21, 24, 47] | |||||
| Wanted a shorter, clearer presentation [47] | Research often published in academic sources, poorly accessible to policy makers, LMIC policy makers have limited access to subscription-based K or the internet [47] | |||||
| Lack of indexing local journals in international databases, harmonised reporting criteria, editorial processes and presentation of local journals, minimum standards for reporting of research for all local journals. Coverage and searching quality of databases of papers published in local language needs improvement, single national database for research registration, technical and professional support for current databases [51] | ||||||
| If department within commissioning organisation is not in a position of strength, unlikely that evidence will be used for decision-making [52] | ||||||
| Lack of time to find or discuss evidence, usually need an answer to a problem on the same day [52] | ||||||
| Finding the evidence was described as problematic. Several fellows called for greater access to systematic reviews; this was a resource they wanted to see augmented through the desktop [40] | ||||||
| Policy makers’ belief that searching, accessing, and reviewing research findings are highly time consuming is perhaps a good argument for the increased production, promotion, and dissemination of systematic reviews [38] | ||||||
| Limited time to read full study reports (of a SR) [43] | ||||||
SR systematic review