Implementation of healthcare guidelines in public health: an umbrella review

Healthcare guidelines are intended to standardize health practitioners' practice and improve patient outcomes, yet their implementation in public health is often inconsistent. This umbrella review aimed to identify barriers and facilitators influencing guideline implementation and to provide an overview of effective strategies to enhance guideline adherence in public health.

Systematic reviews and meta-analyses, published between 2014 and 2024, were identified through searches in PubMed (Q4 2024) and Scopus, CINAHL, and the Cochrane Database (Q2 2026). After applying the inclusion criteria, these were assessed for methodological quality using the AMSTAR-2 tool. Barriers, facilitators, and strategies were categorized using the Measurement Instrument for Determinants of Innovations (MIDI) framework to provide a comprehensive overview.

Thirteen systematic reviews were included, most of which conducted qualitative syntheses, with only one meta-analysis identified. Organizational determinants were the most frequently reported barriers, including limited resources, insufficient coordination, and lack of management support. Factors related to healthcare professionals, such as perceived relevance of guidelines and alignment with practice, also influenced implementation. Facilitators included perceived usefulness of guidelines, professional engagement, and social support. A wide range of implementation strategies was identified, targeting organizational structures, end-users, and guideline characteristics. Educational approaches were the most applied but showed inconsistent effectiveness, especially when used in isolation. Evidence on the added value of multi-component strategies was mixed, with no single approach consistently associated with successful implementation.

Effective implementation of healthcare guidelines in public health requires a comprehensive approach addressing context-specific determinants. Although implementation challenges are shared across healthcare, the structural characteristics of public health often amplify organizational and end-user barriers. No single strategy ensures consistent success; instead, effectiveness depends on tailoring implementation efforts to specific settings and determinants. Further high-quality research is needed to identify effective implementation strategies and bridge the gap between evidence and daily public health practice.

This umbrella review was not registered in a publicly accessible database prior to its conduct.