If viable policy options are not properly implemented they are unlikely to be effective. It is therefore important to consider what potential barriers there may be to the implementation of policy options and how to address these. Identifying and addressing barriers to implementing policy options entails the following steps: identifying potential barriers; identifying strategies to address them; finding and appraising evidence of the effects of those strategies; and summarising what is known. These processes often depend on brainstorming. Frameworks and structured processes can help to ensure that important barriers are identified and addressed. Evidence of the importance of potential barriers can come from qualitative studies (including case studies, interview and focus group studies), surveys, or structured processes. Systematic reviews should be used, as far as possible, as a means to identify barriers to implementing a policy option and for describing the likely impacts of implementation strategies.
Implementing policy options may require changes at various levels, including changes in the behaviours of the recipients and providers of healthcare, organisational changes, and changes in the governance and financing of healthcare. The methods used to identify barriers to implementing policy options, and to tailoring interventions to address them are not well developed and it is often unclear which methods are most appropriate. Tailored interventions, for example, have been found to be more effective than having no intervention for implementing clinical practice guidelines. But little is known about the effectiveness and efficiency of the different methods for identifying barriers and tailoring interventions to address them.1
Evidence of the effects of implementation strategies is often limited, particularly evidence from low- and middle-income countries. Consequently, decisions frequently need to be made based on low-quality evidence. Despite this, descriptions of implementation strategies to address important barriers should include a summary of the available evidence, as well as the logic used to identify specific strategies for further consideration in the policy brief. Performing only a cursory review of the evidence entails risks, including: unreliable descriptions of implementation strategies, a loss of credibility, the introduction of biased assessments, and overstating or understating the degree of confidence that can be placed in estimates or assumptions about the effects of implementation strategies. An investment of time in order to ensure systematic and transparent processes is likely to be warranted both in terms of the specific policy brief and as a way to ensure, as far as possible, that the decisions about how to implement policy options are well-informed by the best available research evidence. Systematic reviews should be used as a basis for describing the likely impacts of implementation strategies as far as possible.
The methods used to find, appraise, and summarise evidence about the effects of implementation strategies are similar to those described in Guide 4. Deciding and describing policy options.