Barriers to Evidence-Based Practice in Health System: A Systematic Review

Abstract

Background: Evidence-Based Practice (EBP) means combining the best available evidence with clinical experiences, patients’ values and expectations. The findings of our previous systematic review, published in 2014, indicated that EBP faces numerous barriers.Aim: This study aims to update prior study findings by reviewing studies published after 2014.Method: The data was gathered by searching relevant keywords in PubMed, Cochrane, Scopus, and Google Scholar between 2014 and 2021. The articles were screened based on their titles, abstracts and full texts, respectively, considering the inclusion criteria. The data was extracted using a data extraction form consisting of author, year, country, type of study, area of study, list of barriers, and their number in each study. Finally, the data was analyzed, summarized, and reported using content-analysis by descriptive statistics such as percentage and frequencyResults: Finally, 77 articles were included in the study. Only 13% of the studies were conducted in low and middle-income countries. Extracted barriers were categorized into five areas of specialized / hospital care (50 studies and 67% of the barriers), primary health care (5 studies and 6% of the barriers), rehabilitation care (11 studies and 11% of the barriers), medical education (5 studies and 5% of the barriers), and healthcare management and decision making (6 studies and 12% of the barriers). Based on the content-analysis results, barriers were divided into six main themes: system-level barriers, barriers related to the evidence, individual-related barriers, communicational barriers, barriers related to the resources, patient-related barriers, external barriers. Lack of time, support, and skills had the highest repetition, respectively.Implications for Practice: The results of our previous study were updated, and further barriers were identified and reported. Policymakers and managers can use the results as a practical guide to expand and improve EBP and remove barriers