From legalisation to practice: implementation of newly legalised health interventions in healthcare settings - a systematic review.

Clinical Snapshot

Key Findings

• P Value: Not applicable for descriptive analysis

• Effect Size: 880 diverse barriers, facilitators and strategies identified

• Primary Outcome: Implementation factors for newly legalised health interventions

• Nnt Or Sensitivity: 27 barrier themes, 18 facilitator themes, 17 strategy themes across 5 domains

• Confidence Interval: Not applicable for qualitative synthesis

Clinical Application

High feasibility as provides practical framework for implementation planning across system, organisational and individual levels Highly relevant to Australian healthcare given local research team and current policy debates around medical assistance in dying, medical cannabis access, and reproductive health services Healthcare organisations and providers implementing newly legalised interventions including medical assistance in dying, medical abortion, assisted reproduction

Abstract

OBJECTIVES: Over the last decade, a growing number of health interventions (eg, medical assistance in dying and mitochondrial donation) have become legalised or decriminalised globally. Newly legalised health interventions share characteristics that are distinct from other health interventions, making their implementation more challenging. They are often highly emotive, controversial and associated with strong opinions and ethical dilemmas, with some of them being high-stake and irreversible. This study aimed to identify, systematise and map the factors that affect the implementation of health interventions that have recently been legalised. DESIGN: A systematically conducted review. DATA SOURCES: PubMed, Scopus, EMBASE and CINAHL were searched to identify studies published between 2014 and 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies if they evaluated the implementation of health interventions that were newly legalised or newly decriminalised. DATA EXTRACTION AND SYNTHESIS: Data were extracted and synthesised through descriptive analysis. Both deductive and inductive thematic analyses were applied to map the barriers, facilitators and implementing strategies that influence the implementation of newly legalised health interventions in healthcare settings. RESULTS: The search strategy yielded 1510 publications, of which 78 were included in this review. Findings showed that several newly legalised health interventions, including medical assistance in dying (n=56 studies); medical abortion (n=13); assisted human reproduction (n=3); psychedelic-assisted therapies (n=3); use of medical cannabis (n=2) and use of biosimilars (n=1) were addressed. The analysis identified a total of 880 diverse barriers, facilitators and strategies in five domains across system, organisational and individual levels: (1) patients/service users/consumers; (2) healthcare providers; (3) healthcare organisation; (4) legal processes and (5) system. These were further divided into 27 themes of barriers, 18 themes of facilitators and 17 themes of strategies. CONCLUSIONS: Implementing newly legalised health interventions is complex. Our findings can support the development of an implementation plan for the spread and scaling of future health interventions, maximising the impact of interventions and making them accessible to more people and health organisations.

References

1. 1.Vizheh, M., Lamprell, K., Sheriff, S., Cormack, M., Braithwaite, J., Ludlow, K., Mills, C., & Long, J. C. (2026). From legalisation to practice: implementation of newly legalised health interventions in healthcare settings - a systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2025-101271