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Table 3 Description of barriers (facilitators) mentioned by the key informants

From: Impact of clinical and health services research projects on decision-making: a qualitative study

Classification of barriers Specific barriers Examples
Organizational barriers/facilitators Difficulties in relationships between different levels of care, or, in other words, the lack of coordination between them (non-integrated care) ‘Yes, because we must put primary pharmacologists and hospital specialists on the same wavelength, and so far this task has not been easy. The primary care professional’s perspective doesn’t exactly match the specialist’s; the latter has many more nuances, higher costs and clashes with primary care structures.’ (decision-maker; P4)
  Lack of institutional involvement ‘It depends on who is involved in the study. If the Catalan Health Service is involved, it should have been willing to offer recommendations that could have subsequently modified or changed clinical practice guidelines…’ (researcher; P4)
  The non-support of clinical managers and planners ‘The primary care director, the regional management, the primary care division of the Catalan Health Institute and the Foundation for Primary Care Research (Jordi Gol i Gurina Foundation) granted us their support.’ (researcher; P1)
  The frequent changes of managers ‘Because hospital directors and general managers change frequently, or because this issue is not deemed to be as important as it should be…’ (researcher; P5)
  Lack of channels for the translation of research ‘The main barrier is that there are no well-established channels for the translation of research. And when researchers finish a study and publish it, there are no other channels, only those created by scientific societies and congresses. This is the main problem. I also think that there are increasing numbers of tools, such as the Health Plan… the Master Plans, which include contact with researchers. More tools like these should be strengthened and developed.’ (researcher; P2)
  Prioritization of research conducted by large groups or centres or the limited opportunities for the promotion of research in primary care centres ‘I think that healthcare policy is focused on large hospitals and strong research groups, etc., but these clinical aspects of immediate protection, immediate social repercussion, in which the patient is the beneficiary, are somewhat unattended…’ (researcher; P5)
  Previous opportunity in research ‘Having had the opportunity to receive a first grant, for sure. Having started to think at a good time…’ (researcher; P1)
Barriers/facilitator related with the nature of the research Difficulties in the dissemination of results due to interdisciplinary reasons. ‘Clinical journals refused to publish it because they claimed it was too complicated and that clinicians would not understand it… we preach multidisciplinary research but in practice this is more complicated. You can find economists working with clinicians and clinicians working with economists, but a clinical article will rarely be included in an economic journal and vice-versa…’ (researcher, P4).
  Lack of interrelationship between research and industry ‘First, there have been basic initial research projects with first tests, and then it is crucial that industries have manufactured marketable devices. Therefore, I would say there are two pillars: one, basic research and, the other, the fact that this research has been carried out by industries.’ (researcher; P3)
Barriers/facilitator derived from cultural and individual factors Reluctance to change ‘When the idea of change is raised inside a hospital, in the sense of opening up the hospital, having closer ties with primary care, performing interventions outside the hospital, etc., it clashes a bit with the culture of doctors and specialists, but overall when we have carried it out and explained its benefits, we have gotten the approval and participation of many people’ (decision-maker; P4)
  The researcher does not self-attribute the role of disseminating research to managers ‘Overall, I would say that researchers are forced to take on many roles. I am ready to be a researcher, but not to make an election pamphlet. In this regard, I think the relationship between healthcare policies and health plans is not as it should be.’ (researcher; P6)
  Direct participation of the decision-maker in the project ‘… because we participated during the time of elaboration, meaning in the meetings prior to starting the project’ (decision-maker; P6 and P2)
  (No) awareness of decision-makers ‘Directly from the respiratory diseases team I was aware of these projects because I worked in management or in the Drug Commission, and through some of the commissions I was made aware that the project was going ahead…’ (decision-maker; P3 and P1)