Introduction

Every day, research findings are being produced, however, their uptake in real-world practice remains a challenge. It has been reported that it takes an estimated 17 years for research findings to be translated into clinical practice [1–3], although in recent time, this delay has improved from 9 to 13 years in the field of mental health and cardiovascular diseases [4]. Delays in translation has raised concerns in view of waste of expensive resources, and a sacrifice of potential patient benefit [5]. Research cannot contribute to effective and efficient healthcare unless it reaches its intended users and are routinely adopted into practice.

Implementation science (IS) is a field of study that can help to bridge the knowledge-practice gap. It is defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services” [6]. In the last decade, the field has advanced rapidly and a wide range of research studies have been conducted including exploring barriers and facilitators to implementation, exploring influences on the provider, patient, and organizational behaviours, testing implementation strategies’ effectiveness, developing theories and frameworks to support implementation, and developing and validating measures to assess implementation outcomes [7]. However, most of the IS literature are from Western high-income countries such as the USA, UK, Australia, and Canada [8–10]. Nevertheless, some IS work has been observed in low- and middle-income countries particularly from the Africa region including the adaption of IS frameworks, and the selection and application of implementation strategies [11,12]. The advancement of IS research in the African region can be attributed to the support by Western-country partners or international organisation, which provided funding, and cross-country learning opportunities for IS training and capacity building in the region [13,14], although the lack of funding, collaborators and mentorship prevailed as main barriers to engage in IS research [14].

IS has particular importance in Asian settings as it is the region where many low- and middle-income countries reside. The region experiences higher mortality and poor health outcomes when face with global health burdens due to limited resources as compared to high-income countries [15]. Improving the time and effective delivery of evidence-based interventions can help to bridge disease prevention and management gaps. IS provides approaches and tools to develop strategies that can generate and/or maximize resources to facilitate the implementation of evidence-based interventions in resource-constrained settings [16].

It has been 17 years since IS emerged, with the launch of the first dedicated specialist scientific journal, Implementation Science in 2006 [6]. However, although IS research in Asia is still limited, it is gradually gaining traction [17]. Based on narrative reviews and commentaries, the slow adoption of IS research in Asia is said to be attributed to the lack of emphasis by policymakers in setting research agendas or fund implementation research, the lack of applicability of IS theory/model/framework in low and middle resource settings, the monopoly of knowledge sharing by high-income countries, the lack of emphasis of equity and community participation in the implementation research agenda, and the lack of IS expertise and basic understanding of IS [18,19]. While there has been a call for increasing IS research in the Asia [18], there is a lack of initiatives in advancing the field in the region. Hence, understanding barriers to conducting IS research can increase awareness, and help to identify potential strategies to promote the conduct of IS research further. Currently, understanding of barriers to IS research in the Asian settings has not been empirically studied. Therefore, this study aims to assess barriers to conducting IS research in Asia.

Methodology

Participants

Researchers who had conducted IS research in Asian settings were invited to participate in this study. These participants were identified from implementation science studies that were published, whereby the corresponding authors of the studies were invited to participate. The study sampling frame was obtained via an online literature search on IS research conducted in Asian settings using the PubMed, EMBASE, CINAHL, and PsycINFO databases. More information on the search process and strategy can be found in S1 File.

The inclusion criteria for the articles were:

• study that use an implementation theory, model, framework in guiding the implementation effort [20], perform a process or implementation evaluation, or described use of any of the 73 implementation strategies (ERIC), or presented findings on implementation outcomes (i.e., acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration and sustainability) [21]
• conducted in Asian settings
• studies conducted by non-Asian researchers, but the study was conducted in an Asian setting
• original research (rather than a letter, commentary, protocol, editorial, review)
• was authored by a named (rather than an anonymous) author
• published from 2006 onwards
• published in English

The exclusion criteria were:

• studies conducted in multi-countries (including both Asian and non-Asian countries).
• studies conducted by Asian researchers but in non-Asian settings.

From the literature search, a total of 2295 articles were retrieved. These articles were screened by title and abstract by the two researchers of this study (WTT, CYO). Articles assessed were included or excluded according to the inclusion and exclusion criteria. Once the researchers finished their screening, they cross-checked each other’s assessment for correctness. Discrepancies were resolved through discussions. From the 2295 articles, 2013 articles were removed as they did not fit the study inclusion criteria. The final number of articles included in this study were 282, and the corresponding authors’ email addresses were extracted. Fig 1 illustrates the process of participant identification and the data collection process of this study.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 1. Study data collection process.

https://doi.org/10.1371/journal.pone.0325372.g001

Ethics considerations

The study protocol was approved by the Universiti Malaya Research Ethics Committee (UMREC): UM.TNC2/UMREC_2989. Informed consent was obtained from all individual participants included in the study.

Results

IS research practice

Majority of the participants reported that they have performed or collaborated on a study examining the translation of an intervention into routine settings in the past 5 years (85.8%, n = 97). Among those who have applied for funding for implementation research (n = 80), 78.8% (n = 63) were successful.

Among the countries within Asia, the most common country where IS research was conducted was in India (19.5%, n = 22), followed by Bangladesh (12.4%, n = 14), Nepal (10.6%, n = 12), and Indonesia (8.8%, n = 10). However, the most common country where the participants reported to have obtained funding for IS research was the US (15.9%, n = 18), followed by UK (9.7%, n = 8), India (7.1%, n = 8), Australia (5.3%, n = 6), China (5.3%, n = 6), Bangladesh (5.3%, n = 6), and Singapore (5.3%, n = 6) (Fig 2). Other funders (4.4%, n = 5) that were reported were Sexual Violence Research Initiative (SVRI), the Joint United Nations Programme on HIV/AIDS (UNAIDS), ViiV Healthcare, the International Association of Providers of AIDS Care (IAPAC), Gilead, the United States Agency for International Development (USAID), and the World Health Organization (WHO).

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 2. The number of participants who reported the country in which they conducted IS research, and countries where they received funding from.

https://doi.org/10.1371/journal.pone.0325372.g002

Barriers to conducting IS research

The most common barrier to conducting IS research was the lack of funding (86.7%, n = 98) followed by the lack of awareness (59.5%, n = 67), the lack of time (56.6%, n = 64), and the lack of organisational support (48.7%, n = 55), and Others (3.5%, n = 4) (Table 1). Findings from Others were incorporated together with comments from the open-ended question.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Barriers to conducting IS research and socio-demographic characteristics and IS practice.

https://doi.org/10.1371/journal.pone.0325372.t001

Analysis of the open-ended responses

In addition to the commonly recognized barriers to conducting IS research—such as limited funding, awareness, time, and organizational support—open-ended responses revealed six additional challenges. These include insufficient commitment and engagement from stakeholders beyond researchers, a perceived lack of value attributed to IS research, concerns about the field’s scientific rigour, challenges arising from existing knowledge, systems, and practices, inadequate capacity or training opportunities, and the absence of clear indicators for academic progression within the field (Table 2).

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. Additional barriers (n = 52).

https://doi.org/10.1371/journal.pone.0325372.t002

Discussions

To our knowledge, this is the first study that assessed the barriers to conducting IS research in Asia. The study findings indicate that IS research is gaining momentum in the Asian region as many of the participants reported to have perform or collaborated on a study examining the translation of an intervention into routine settings in the past five years. Nevertheless, there was a high proportion who reported barriers to performing IS research. The prevalence of barriers reported in this study are higher compared to other studies conducted in the Western countries where the most prevalent barrier reported was the lack of funding (Asia: 86.7%; USA: 82.7%; multicountry study (Australia, Netherlands, Canada, USA, and the UK): 17.3%) followed by the lack of awareness (Asia: 59.5%; USA: 50.9%; multicountry study (Australia, Netherlands, Canada, USA, and the UK): 0.8%), and the lack of organisational support (Asia: 48.7%; USA: 28.9%; multicountry study (Australia, Netherlands, Canada, USA, and the UK): 9%) [22,24]. These barriers were also echoed in another study conducted in Western Europe countries namely Germany, Austria and Switzerland [25]. This study also found that many of the IS research was conducted among countries in South Asia specifically India, Bangladesh, and Nepal, while many reported to received funding from non-Asian countries such as from the UK and US.

Funding availability is a common challenge to conducting research in Asia. In majority of the Asian countries, the ratio of research and development expenditure to GDP is less than 1%, while more developed countries such as South Korea and China spent only about 4.5% and 2.1% respectively [22,30]. In this study, it was found that many participants received their funding to conduct IS research from the US and the UK. This is not surprising given that these countries have a longer IS history, and funding scheme to support dissemination and implementation research [31]. Some have also reported to receive funding from global organisation such as WHO, and other discipline-specific organisations such as UNAIDS. While these fundings support international research, this also meant that IS researchers in Asia are competing with researchers from other parts of the world on the pool of funding available to conduct IS research. Currently, dedicated funding for IS research in Asia is scarce. Much of the research funding in Asia prioritise basic science or research that produce commercialised innovations [32], as these types of research are deemed more prestigious and valuable [25]. To increase the availability of funding to conduct IS research in Asia, this will require priority shifting at the governmental level to set implementation research priorities. This can be observed in Singapore, and Hong Kong where IS is a priority area in their national research award and grant [33,34]. Apart from setting up dedicated fundings for IS, providing flexibility in the use of other discipline-specific research funding to support IS research, for example, as a secondary research question should be considered by funders [25].

The availability of funding will not increase IS research unless researchers have knowledge and skills to conduct IS research. Currently, IS training in the Asian region are scarce and sporadic, and this has impact on the ability of healthcare researchers in the region to effectively conduct implementation research [35]. Even when trainings are available locally, they are often conducted on ad hoc basis in the form of talks, or a few-days workshop, by inviting IS expert from the Western countries. Indeed, international network is a good first step in terms of IS training provision, but such can only be afforded by higher income countries in the region for example in Singapore, Hong Kong, and Malaysia. While there are online trainings on IS that can be accessible for free [36,37], these resources rely on self-study which may not be adequate to provide the necessary skills to design and perform high quality IS research [25]. There is a need to increase IS capacity building so that more training can be conducted locally. Another way to increase visibility and training especially among early career researchers is the incorporation of IS into the academic curricula [25]. Several master programme for IS has been developed in the region [38,39]. Conference offers another avenue for IS training, however, there is a lack of IS conference in Asia. Regional conferences that focus on implementation-related topic such as health systems and services (often under public health) do not include specific session on implementation science [40]. Cost is an issue for researchers from developing Asian countries to travel to the western counterparts [25] to attend IS conferences or to receive more formal IS trainings such as in the US, Canada or the UK [41]. Having an IS conference or event that specifically caters to the Asian community can increase IS visibility and understanding in the region, enable context specific topics to be discussed, formulation of agenda for establishing IS in the region [25].

One of the key approaches for effective and sustainable IS research is the involvement of stakeholders at the beginning and throughout the entire research [32]. However, this study revealed the lack of support and commitment from stakeholders (i.e., government stakeholders, senior leaders, or clinicians) as another barrier to conducting IS research. This barrier has also been expressed to be the biggest challenge for IS research as compared to other types of research as IS research requires willing practice partners from the implementation setting for the implementation to happen [42]. This barrier stemmed from the lack of awareness, perceived low value of the activity, and even hierarchical culture [43]. Building constructive long-term collaborations requires strategic approach, and this may not be something that many IS researchers are equipped with [25,26]. Strategies to increase the support and commitment from stakeholders in IS research that can be considered are: to have frequent communications with them to highlight the importance of IS research, making them feel exclusive by inviting them as expert panel rather as a participant, provide training to enhance their skills for effective participation, or publishing in peer-reviewed journals to show case credibility [43,44].

Conclusion

This study sheds light on the multifaceted barriers hindering the conduct of IS research in Asia, revealing a pressing need for systemic change to enable its advancement. The findings highlight that while IS research is gradually gaining traction in the region, it remains significantly constrained by limited funding, low awareness, insufficient training opportunities, and inadequate stakeholder engagement. Additionally, challenges such as the perceived low value of IS, lack of academic incentives, and systemic rigidity further impede progress. These barriers suggest that to advance IS in Asia, concerted efforts are required to establish dedicated funding streams, embed IS education within academic curricula, develop regional training programmes, and foster strategic, long-term collaborations with key stakeholders. Addressing these issues will not only build research capacity but also enable the generation of contextually relevant evidence to improve health outcomes and bridge the research-to-practice gap in diverse Asian healthcare settings.

Supporting information

Acknowledgments

The authors of this study would like to thank Dr Elizabeth R Stevens, Dr Donna Shelley, and Dr Bernadette Boden-Albala for their permission to adapt their questionnaire for this study. We are also thankful to Universiti Malaysia Sarawak for their financial support towards the Article Processing Charges (APC), which made the publication of this research possible.