title: Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.
abstract: 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.
  
  
  
  Secondary analysis of qualitative data.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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. Electronic address: lisa.puchalskiritchie@utoronto.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Puchalski Ritchie
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
authors.forename: Sobia
authors.initials: S
authors.lastname: Khan
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Moore
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Timmings
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College St., 6th Floor, Toronto, Ontario, Canada M5T 3M7; Dignitas International, PO Box 1071, Zomba, Malawi.
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
authors.forename: Dina N
authors.initials: DN
authors.lastname: Khan
authors.affiliation: Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.affiliation: Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
authors.forename: Mwifadhi
authors.initials: M
authors.lastname: Mrisho
authors.affiliation: Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, P O Box 7072 Kampala, Uganda.
authors.forename: Kidza
authors.initials: K
authors.lastname: Mugerwa
authors.affiliation: World Health Organization, Pristina Office, Institute of Public Health, University Clinical Centre, St. Nëna Terezë, Rrethi I Spitalit pn, 10000 Pristina, Kosovo.
authors.forename: Sami
authors.initials: S
authors.lastname: Uka
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gülmezoglu
authors.affiliation: Department of Medicine, University of Toronto, RFE 3-805, 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.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D063826:Kosovo; D008295:Malawi; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008875:Middle Aged; D002052:Myanmar; D013636:Tanzania; D014454:Uganda; D055815:Young Adult
keywords: Barriers; Evidence implementation; Evidence tools; Facilitators; Guidelines; Knowledge products