Facilitators of, barriers to and strategies for health-system guidance implementation: a critical interpretive synthesis

This study aims to develop a theoretical framework to support the implementation of health-system guidance, contributing to broader efforts to promote evidence-informed policymaking in health systems. A critical interpretive synthesis was conducted to identify relevant literature from 11 databases and gray literature sources. The documents were assessed for relevance and quality, and data were extracted and synthesized using an interpretive analytic method. Based on the synthesized data, the framework was developed and subsequently refined by the authors. A total of 21 documents published from 2004 to 2024 were included, with 15 (71%) empirical studies and six (29%) non-empirical. The resulting theoretical framework for supporting health-system guidance implementation identified 10 facilitators, 10 barriers, nine combined facilitators and barriers, and 11 strategies across six levels: political system, health system, community, organizational, providers and patients/public. This framework offers a structured approach to comprehensively understanding the various factors and levels involved in health-system guidance implementation. With further development into a practical tool, it may help inform implementation efforts across diverse topics and contexts.