What factors affect patient access and engagement with clubfoot treatment in low‐ and middle‐income countries? Meta‐synthesis of existing qualitative studies using a social ecological model

Abstract

Abstractobjectives To conduct a systematic synthesis of previous research to identify factors that affect treatment-seeking for clubfoot and community-level interventions to improve engagement in low-and middle-income counties.methods A search of five databases was conducted, and articles screened using six criteria. Quality was appraised using the Critical Appraisal Skills Programme checklist. Eleven studies were identified for inclusion. Analysis was informed by a social ecological model, which specifies five inter-related factors that may affect treatment-seeking: intrapersonal, interpersonal, institutional, community or socio-cultural factors and public policy.results Intrapersonal barriers experienced were a lack of income and additional responsibilities. At the interpersonal level, support from fathers, the extended family and wider community affected on treatment-seeking. Institutional or organisational factors included long distances to treatment centres, insufficient information about treatments and challenges following treatment. Guardians' beliefs about the causes of clubfoot shaped behaviour. At the level of public policy, two-tiered healthcare systems made it difficult for some groups to access timely care. Interventions to address these challenges included counselling sessions, outreach clinics, brace recycling and a range of education programmes.conclusions This study identifies factors that affect access and engagement with clubfoot treatment across diverse settings and strategies to address them.

Health workers’ perspectives on the outcomes, enablers, and barriers to the implementation of HIV “Treat All” guidelines in Abuja Nigeria

“…Focusing specifically on patient poverty as a main barrier to Treat All implementation, the study revealed that patients’ lack of capacity to pay for baseline investigation or transport services to clinics limited their ability to access treatment services. The results re-affirms the concept of a wider set of determinants for health and the important effect of socioeconomic factors in determining the health of individuals [33-35].…”

What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: a narrative synthesis of existing qualitative studies

“…A narrative synthesis was conducted in four stages: identifying studies for inclusion, appraising quality, data extraction and synthesis and reporting findings. Methods correspond to our previous meta-synthesis exploring treatment-seeking behaviour for clubfoot [ 11 ].…”

“…Articles were then categorised into three groups. These were: ‘fully addresses CASP items’, ‘mainly addresses CASP items’ or ‘partially addresses CASP items’ [ 11 ].…”

“…It has been suggested that a high proportion of children in LMICs fail to present at clinics and of those that do, many do not complete treatment [ 8 – 10 ]. Reasons for this have been explored in a recent meta-synthesis exploring treatment seeking behavior for clubfoot in LMICs [ 11 ]. Research has also highlighted a number of challenges to service delivery, including a lack of resources [ 9 , 12 , 13 ] and insufficient training for service providers [ 8 , 12 , 14 ].…”

“…The aim of this study is to use a narrative synthesis to synthesise findings from existing qualitative research to explore factors that impact on the implementation of clubfoot services in LMICs and strategies to address them. This is intended to complement existing work that explores factors that impact on patient access to services across a range of LMICs, along with strategies to address them [ 11 ]. It is hoped that this will provide further information to healthcare professionals about how to develop services to better meet the needs of patients.…”