A scoping review on barriers to implementation of health education programs in low to middle income countries

Abstract

We aimed to map literature on the barriers to effective implementation of health education programs (HEPs) in low to middle income countries (LMICs) to guide future implementation research. We employed a rigorous scoping review design. Our review was guided by the Arksey and O’Malley framework, 2005, further enhanced by Levac et al. The keyword search was comprehensive for relevant studies presenting evidence on barriers to implementation of HEPs in LMICs from Google Scholar, PubMed, EBSCOHost (CINAHL and Academic Search Complete) databases and grey literature. The first search identified 3,092 articles, of which 1,412 duplicates were eliminated. An additional 1,632, 34 and 7 articles did not meet the inclusion criteria based on sequential title screen, abstract review and full text review respectively. Seven studies met the inclusion criteria for the actual scoping review. Findings of the review revealed three categories of barriers to effective implementation of HEPs in LMICs grouped as individual or patient level, community level and population level barriers. A key barrier to effective implementation of HEPs in LMICs revealed from the review was socio-economic challenges, which result from resource constraints. This calls for adequate allocation of the limited resources toward health education to ensure effective implementation of HEPs in LMICs and improve health outcomes.