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

Document Type : Systematic Review


1 Bsc in Healthcare Management, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

2 Bsc in Healthcare Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Assistant Professor, Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Evidence-Based Practice (EBP) means combining the best available evidence with clinical experiences, as well as patients’ values and expectations. The findings of our previous systematic review, published in 2014, indicated that EBP faces numerous barriers.
Aim: The present study aimed to update the findings of the previous research by reviewing studies published after 2014.
Method: The data were collected by searching the 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. The data were extracted using a data extraction form consisting of the 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 frequency.
Results: Finally, 77 articles were included in the study. Only 13% of the studies were conducted in low and middle-income countries. The extracted barriers were categorized into five areas of specialized/hospital care, primary health care, rehabilitation care, medical education, and healthcare management and decision making. Based on the content-analysis results, barriers were divided into six main themes: system-level barriers, barriers related to the evidence, individual-related, communicational, resource, patient-related, and 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.