Barriers and enablers to conducting cluster randomized control trials in hospitals: A theory-informed scoping review

By: Arielle Weir, Simon Kitto, Jennifer Smith, Justin Presseau, Ian Colman & Simon Hatcher

Cluster randomized control trials (CRCTs) are essential for evaluating interventions in hospital settings, but their implementation can be complex. This study aimed to identify the barriers and enablers to conducting CRCTs in hospitals through a theory-informed scoping review.

By systematically examining existing literature, the study identified key factors that hinder or facilitate the successful implementation of CRCTs in hospital settings. The review utilized a theory-informed approach, incorporating established frameworks and theories to provide a comprehensive understanding of the identified barriers and enablers.

The findings highlight the challenges faced during the planning, execution, and evaluation phases of CRCTs in hospitals. Barriers included issues related to organizational structures and culture, such as the resistance to change, inadequate resources, and limited leadership support. Methodological challenges, such as recruitment and retention of participants, randomization procedures, and data collection, were also identified as significant barriers.

However, the study also highlighted several enablers that can support the successful implementation of CRCTs in hospitals. Collaborative partnerships among researchers, clinicians, and administrators emerged as a crucial factor in overcoming barriers. Adequate training and capacity-building initiatives for research staff were found to enhance the feasibility and quality of CRCTs. Additionally, the use of tailored implementation strategies, stakeholder engagement, and clear communication channels were identified as enablers to facilitate the smooth execution of CRCTs.

Understanding the barriers and enablers identified in this review is crucial for researchers, policymakers, and hospital administrators. By recognizing the challenges and opportunities associated with conducting CRCTs in hospital settings, stakeholders can implement strategies to overcome barriers and optimize the implementation of evidence-based interventions. This review serves as a valuable resource for improving the design and execution of future CRCTs in hospitals, ultimately enhancing the quality of healthcare services and patient outcomes.

To read the full article, visit: https://doi.org/10.1016/j.evalprogplan.2020.101815.