Evidence synthesis methodology for questions relating to barriers and enablers in health care: a scoping review

Objective: The objective of this scoping review was to map the range of methodologies and methods used to undertake evidence synthesis aimed at determining barriers and/or enablers in health care, and to inform further research relevant to synthesis methodology in this area. Introduction: Questions related to identifying and exploring barriers and/or enablers within health care are becoming increasingly popular. Currently, there are multiple approaches to synthesizing this evidence, and it is unclear whether a more consistent approach is warranted. Eligibility criteria: Evidence synthesis on barriers and/or enablers (facilitators) that included interest-holders at different levels of the health system were considered. Evidence synthesis projects had to include primary research studies and were published from 2010 to 2021. Literature reviews, narrative reviews, and umbrella reviews were excluded, as were reviews published in languages other than English. Methods: This scoping review followed JBI methodology and was based on a published a priori protocol and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A 3-step search strategy using a combination of key terms and index headings was undertaken in October 2021 via the following databases/resources: PubMed, Embase, CINAHL (EBSCOhost), PsycINFO (Ovid), Cochrane Database of Systematic Reviews, JBI Evidence Synthesis , and EPPI-Centre Systematic Reviews. An extensive piloting process for screening and selection, and data extraction was undertaken due to the large number of reviewers involved. All records were screened independently by 2 reviewers, and any disagreements were resolved through either a third reviewer or discussion with a panel of reviewers. Extraction was undertaken using a customized form, and data were analyzed using descriptive statistics. Data are presented via tables, figures, a word cloud, and an infographic, supplemented with a narrative synthesis. Results: Following completion of the search, 22,308 records were screened and 774 reviews were included in the scoping review. Systematic reviews were the most commonly used methodology (68%) to synthesize barrier and/or enabler questions. Reviews often included diverse types of evidence and involved an assessment of methodological quality (70%). Findings related to barriers and/or enablers were usually grouped and organized into categories, often by thematic methods (33%) or a narrative approach (20%). Incongruencies related to nomenclature, missing information, and methods used were evident across the large dataset. Conclusions: A variety of methodological approaches are being followed to undertake reviews focused on barriers and/or enablers in health care. The current state of the literature indicates that most authors answer these questions via the conduct of a systematic review and include diverse types of evidence. Further work is needed to determine whether authors are unclear when deciding on methodology and whether guidance is required.