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Guideline developers in Low- and Middle-Income Countries want to develop and use living guidelines, but are currently limited by important barriers: Findings from a Qualitative Study

Meteku BT 1 , De Silva K 2 , Green SE 3 , Turner T 4

Affiliations 

  • 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia; Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara, 269, Ethiopia
  • 2 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
  • 3 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia; Cochrane Australia, Monash University, Melbourne, Victoria, 3004, Australia
  • 4 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia; Cochrane Australia, Monash University, Melbourne, Victoria, 3004, Australia. Electronic address: -Tari.Turner@monash.edu
J Clin Epidemiol, 2025 Jan 30.
PMID: 39892522 DOI: 10.1016/j.jclinepi.2025.111707

Abstract

OBJECTIVE: Evidence-based clinical guidelines have the potential to improve health care and health outcomes. Living guidelines methods provide an approach to ensuring guidelines are always up-to-date, maximizing this potential. However, to date, most work on living guidelines has been conducted in high income countries. The objective of this study is to explore the barriers and facilitators to the development, adaptation, and use of living guidelines among evidence-based guideline developers in low- and middle-income countries (LMICs).

STUDY DESIGN AND SETTING: We used a descriptive qualitative study design. We employed purposive and snowball sampling techniques to recruit guideline developers from LMICs and World Health Organisation offices to participate in online, semi-structured interviews. Data were analysed using a thematic approach with NVivo 20 software. Ethics approval was granted by Monash University.

RESULTS: We interviewed 18 participants from LMICs, (Colombia, India, Iran, Indonesia, Argentina, and Malaysia), and WHO offices (including headquarters, regional offices, and country offices). Two main themes emerged, along with six associated subthemes. The main themes were: (1) People in LMICs want living guidelines and (2) Resource limitations and their implications for living guidelines in LMICs.

CONCLUSION: Our research identified that guideline developers in LMICs have a strong desire to both develop and use living guidelines, but are currently limited by important barriers. Initiatives to support development, adaptation, and use of living guidelines in LMICs may help overcome barriers and meet the need for living guidelines in LMICs. It is also essential to design strategies that overcome identified barriers to developing, adapting, and implementing living guidelines, such as a lack of resources, delays in updates, and limited accessibility.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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