03512nas a2200385   4500000000100000008004100001260001200042653003300054653001800087653001900105653002700124653001900151100001400170700001300184700001300197700001400210700001400224700001100238700001500249700001300264700001400277700001400291700001400305700001400319700001300333700002000346700001600366700001900382245010200401856009300503300000700596490000700603520250200610022001403112       2022                            d  c06/202210aEvidence-informed guidelines10aGlobal health10aHealth systems10aImplementation science10aScoping review1 aBreneol S1 aCurran J1 aMarten R1 aMinocha K1 aJohnson C1 aWong H1 aLanglois E1 aWozney L1 aVélez MC1 aCassidy C1 aJuvekar S1 aRothfus M1 aAziato L1 aKeeping-Burke L1 aAdjorlolo S1 aPatiño-Lugo D00aStrategies to adapt and implement health system guidelines and recommendations: a scoping review.  uhttps://health-policy-systems.biomedcentral.com/track/pdf/10.1186/s12961-022-00865-8.pdf  a640 v203 a<p><strong>BACKGROUND: </strong>Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries.</p>

<p><strong>METHODS: </strong>We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.</p>

<p><strong>RESULTS: </strong>A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level.</p>

<p><strong>CONCLUSIONS: </strong>The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.</p>
  a1478-4505