Enablers and barriers to evidence implementation in complementary medicine: A systematic review

BACKGROUND: Despite the push for complementary medicine (CM) practitioners to engage in evidence implementation, and arguments in support of evidence-based practice (EBP), uptake of EBP amongst most CM professions remains low. This review aimed to synthesise the evidence examining the barriers and enablers to evidence implementation in CM. METHODS: Any primary study examining enablers and barriers to evidence implementation in CM were eligible for inclusion. Eight databases and search engines were searched for eligible studies. Reference lists of included studies were screened, and authors of included studies were contacted to identify current or unpublished studies that met the inclusion criteria. RESULTS: Thirty-nine published and unpublished studies were included in this review. The seven published qualitative studies and 25 published quantitative studies were rated as moderate to high quality. Fifty-two distinct barriers and 62 discrete enablers were identified. Reported barriers were predominantly structural (e.g. limited availability of time and clinical evidence) and cognitive (e.g. skills deficits), with relatively fewer studies reporting cultural (e.g. lack of industry support) or attitudinal barriers (e.g. lack of interest in, or relevance to CM). Enablers of evidence implementation largely focussed on improving access to bibliographic databases and evidence reviews, supporting skills acquisition, and cultivating leadership and interprofessional/interagency collaboration. CONCLUSION: The findings of this review highlight the diverse barriers and enablers to evidence implementation in CM that span multiple dimensions. The interplay between these various factors highlights the complexity of evidence implementation, and the need for a targeted multistakeholder, multidimensional solution to optimise evidence-based practice in CM.