Table 1 Summary of included studies
From: Barriers for conducting clinical trials in developing countries- a systematic review
Author, location | Subjects (n) | Type | Focus | Main findings |
|---|---|---|---|---|
Seruga, Africa: 4 countries, Asia: 5 countries, Central/ South America: six countries and 8 developed countries [40] | Oncologists with clinical trial experience (39 from LMICs and 41 from HICs) | Quantitative/Web based survey | Barriers | Lack of funding, lack of competent authorities and ethical procedures, lack of research materials, lack of time or competing priorities, concerns about insurance/indemnification coverage, lack of trained personnel, lack of patients/patient accrual |
Schlaff, Latin America (Chile), the Middle East (Egypt), Europe (Greece), China, India, Australia, and the, United States [41,42,43,44,45] | Senior and accomplished investigators (7 participants, one from each country) | Qualitative | Barriers | India: Funding is limited, regulation impediments, misinformation about research Egypt: lack of funding, lack of a scientific atmosphere, and “brain drain” of scientists China: Combine the clinical with basic research Latin America: Less value for scientific research, insufficient allocation of human and economic resources. |
Siegfried, South Africa [46] | Investigators and other clinical stakeholders (19) | Qualitative/ Key informant interviews | Barriers and need for additional training | Impediments in ethics processes, high cost of trials, the potential burden of trial conduct on clinical care, insufficient skilled researchers |
Ranasinghe, China [47] | Health professionals conducted (40) | Qualitative/in-depth interviews | Barriers | Lack of leadership support for implementing quality improvement, lack of resources, fears of patient disputes and litigation, healthcare funding constraints, high out-of-pocket expenses, and patients’ refusal to participate |
Franzen, Ethiopia [48] | Health researchers and stakeholders with research interest (20) | Qualitative/ in-depth interviews (n = 7) and focus group discussions (n = 3). | Barriers and facilitators | Barriers: Human and material capacity, regulatory and other administrative bottlenecks, operational hurdles, awareness, confidence and motivation |
Franzen, Ethiopia and Cameroon [49] | Local health-researchers, senior stakeholders and regulators (72) | Qualitative/ in-depth interviews (n = 22), focus group discussions (n = 9), and process mapping exercises (n = 7) | Barriers and facilitators | Shared barriers: System and organisational barriers like low resources, weak regulatory and administrative systems, few learning opportunities, little human and material capacity, and few incentives for doing research. Ethiopia: lack of awareness, confidence, and motivation to undertake trials Cameroon: environments that discourage personal initiative were more problematic. |
Cardoso, Sub-Saharan Africa (n = 46) [50] | 303 key-informant interviews (clinical researchers and other clinical trial stakeholders) | Qualitative/key informant interview and literature review | Status and barriers | Levels/sustainability of funding, policymakers’ understanding of the importance of research, infrastructure in research institutions and Human resources available. |
Gomez, Latin America countries (n = 15) [51] | 92 medical oncologists | Quantitative/Survey | Barriers | Complex regulatory process, low budgets, high costs, poor financial management, and time constraint. |
Sulthan, Saudi Arabia [52] | 100 clinical researchers | Quantitative/Survey | Perception and barriers | Long approval process, shortage of human resource and lack of the institutional support, lack of encouragement, lack of awareness among the research professionals and the general public |
Al-Dorzi, Saudi Arabia [53] | 186 medical staff | Quantitative/Survey | Interest and barriers | lack of time, financial compensation and encouragement and lack of training of research |