Development of a theoretical framework to support health-system guidance implementation using a critical interpretive synthesis approach

Session Type
Synthesis of evidence without meta-analysis
Wang Q1, Chen Y2, Yang K3, Sch√ľnemann HJ4, Wilson MG1, Lavis JN1
1Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, and McMaster Health Forum, McMaster University, Canada
2WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, China
3Evidence-Based Medicine Center, and Evidence Based Social Science Research Center, Lanzhou University, China
4Department of Health Research Methods, Evidence and Impact, Michael G DeGroote Cochrane Canada and GRADE Centres, McMaster University, Canada

Background: As systematically developed statements regarding possible courses of action, health system guidance (HSG) can assist policymakers with developing or adjusting policies, just as physicians modify their practice based on clinical guidelines. However, there are conceptual and methodological challenges in HSG implementation due to the complexity of health-system policymaking and vast differences in contexts. Therefore, there is a need for a comprehensive and well-organized theoretical framework to support HSG implementation.
Objectives: To develop a theoretical framework concerning the facilitators of, barriers to and strategies for HSG implementation at the individual, organizational, community and system levels.
Methods: We applied a critical interpretive synthesis (CIS) approach to synthesize the findings from a range of relevant literature. We searched 11 electronic databases and seven organizational websites. Also, purposively sampling of the literature was conducted to fill the identified conceptual gaps. The included papers were assessed by relevance and five quality criteria. We developed a standardized form for extracting information and used an interpretive analytic approach to synthesize the findings. (Registration PROSPERO CRD42020214072)
Results: A total of 159,983 documents were retrieved, with 90,597 unique documents after the removal of duplicates. After the independent two-phase screening, a total of 15 documents published between 2009 and 2020 were finally included for analysis. In terms of study type, 11 (73%) were empirical studies (e.g., interviews, before-and-after study), while the remaining four (27%) were non-empirical studies (e.g., handbooks, theory papers). The theoretical framework included the facilitators, barriers and strategies for HSG implementation at the individual (including provider and patient/public), organizational, community and system (including health and political systems) levels (Figure 1). Detailed tables about specific themes will be presented at the conference.
Conclusions: A new theoretical framework about facilitators, barriers and strategies for HSG implementation was developed using a CIS approach. The HSG implementation framework could be widely used for supporting the implementation of HSG covering varied topics and in different contexts.
Patient, public and/or healthcare consumer involvement: As for the individual level in the theoretical framework, we summarized the factors and strategies at the patient/public level since they are the important stakeholder during the HSG implementation process.

Figure 1 Framework for supporting HSG implementation.png