scholarly journals Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

2021 ◽  
Vol 6 (2) ◽  
pp. e004213
Author(s):  
Grace McCutchan ◽  
Bahr Weiss ◽  
Harriet Quinn-Scoggins ◽  
Anh Dao ◽  
Tom Downs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Cancer Treatment ◽  
Help Seeking ◽  
Middle Income ◽  
Cancer Symptoms ◽  
Middle Income Countries ◽  
Help Seeking Behaviour ◽  
Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

scholarly journals Psychosocial Influences on Medical Help Seeking for Cancer Symptoms and Treatment in Low- and Middle-Income Countries: A Meta-Analysis and Mixed Methods Systematic Review

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 33-33
Author(s):  
Grace McCutchan ◽  
Kate Brain ◽  
Harriet Quinn-Scoggins ◽  
Anh Dao ◽  
Tom Downs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Help Seeking ◽  
Meta Analysis ◽  
Traditional Healers ◽  
High Income ◽  
Middle Income ◽  
Cancer Symptoms ◽  
Middle Income Countries ◽  
Psychosocial Influences

PURPOSE Cancer disproportionately affects people living in low- and middle-income countries (LMICs), partly because of delayed medical help-seeking behavior (HSB). Our mixed-methods systematic review synthesized existing studies in LMICs to understand psychosocial influences on cancer-related medical HSB to inform the development of effective interventions to promote earlier HSB for cancer. METHODS We searched peer-reviewed literature databases for quantitative, qualitative, and mixed-methods studies exploring barriers/facilitators to medical HSB for cancer symptoms in adults living in LMICs. Study exclusion criteria were low methodologic quality, non-English language publication, non–peer-reviewed publication, and studies conducted in high-income countries. Study findings were synthesized using meta-analysis, meta-ethnography, and narrative synthesis methods, according to individual study design. RESULTS Fifty studies were included. Many studies used nonstandardized measures/designs, which increased the difficulty integrating findings. Preliminary findings indicate that the use of traditional healers is a key barrier to prompt medical HSB in LMICs. Use of traditional healers for cancer symptoms/treatment was influenced by causal beliefs about symptoms, familial pressure, ease of access, affordability, and a preference to avoid biomedical treatment, which was perceived as invasive, ineffective, and expensive. Additional psychosocial barriers included shame and stigma associated with cancer, such as fear of marital rejection/divorce; limited knowledge of cancer and associated symptoms; financial and access barriers associated with travel and appointments; and cultural barriers, such as women needing permission from the family network. CONCLUSION Such barriers as low symptom knowledge and negative beliefs about cancer are universal barriers to cancer HSB in high-income countries and LMICs, whereas the use of traditional healers and women needing permission to seek medical help seem to be unique to LMICs. Intervention developers should work with local communities to appropriately tailor cancer awareness interventions in LMICs, taking into account cultural influences on HSB. Future evaluations would benefit from using validated measures and robust study designs.

scholarly journals Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

2021 ◽  
pp. BJGP.2021.0345
Author(s):  
Hassan Awan ◽  
Faraz Mughal ◽  
Tom Kingstone ◽  
Carolyn A Chew-Graham ◽  
Nadia Corp
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Emotional Distress ◽  
Help Seeking ◽  
South Asians ◽  
Qualitative Studies ◽  
Long Term Conditions ◽  
Help Seeking Behaviour

People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality compared to people with physical conditions alone. South Asians (SAs) are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. SAs are less likely to recognise symptoms which may represent mental health problems. To explore how people of SA origin with LTCs understand, experience and seek help for emotional distress, depression and anxiety. Systematic review of qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. Comprehensive searches of eight electronic databases from inception to 1st September 2021. Data extracted included study characteristics, and understanding, experience and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The CASP checklist for qualitative studies was used to assess quality of papers, and GRADE-CERQual used to determine the overall strength of evidence. Twenty one studies from 3,165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension,’ and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and gender differences. Help-seeking behaviour: self-management, seeking help from family, friends, and faith, and inadequate clinical support. This review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of LTCs, to support improvement in its recognition and management.

scholarly journals Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-And- Lower Middle-Income Countries

2021 ◽  
Author(s):  
Giuliano Russo ◽  
Tiago Silva Jesus ◽  
Kevin Deane ◽  
Abdinasir Yusuf Osman ◽  
David McCoy
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Premature Deaths ◽  
Trade Offs ◽  
Mother And Child ◽  
New Research ◽  
The Impact

Background: The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children’s health in low-and-lower-middle-income countries. Methods: A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between November 1st-10th 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on low-and-lower-middle-income countries, addressed impacts on women and child’s health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute’s critical appraisal tools were used to assess the quality of the studies, and the PRISMA guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design. Results: The review process identified 46 papers meeting the inclusion criteria from 17 countries whichall focussed on the COVID-19 and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women is well-established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods are disrupted, and poverty levels increase. Conclusion: Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

To explore the barriers to and facilitators of adolescents in Low-Middle-Income- Countries (LMICs) seeking mental health care: Protocol for a Mixed-Methods Systematic Review

2021 ◽  
Author(s):  
Sudha Subhadra Kallakuri ◽  
Pallab K Maulik ◽  
Prachi Kaistha ◽  
Maree Hackett
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mixed Methods ◽  
Study Design ◽  
Critical Appraisal ◽  
Mental Illnesses ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Abstract Background: Adolescence is a very important transitional phase for an individual as they move from childhood to adulthood. In 2007, the World Health Organization reported that 16% of the global burden of disease and injuries occur among adolescents i.e. those aged between 10 and 19 years, most of them starting by the age of 14 years and usually become serious; if left unrecognised or unattended at that point in time. Several risk factors are associated with increases in the mental health disorders. It is pertinent to promote interventions which teach life skills like regulating one’s emotions, building resilience, and dealing with difficult situations with confidence and strength. This mixed-methods systematic review aims to synthesise best available evidence on the barriers and facilitators to help seeking for mental illnesses among adolescents in Low-Middle-Income Countries Methods and Analyses: The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be carried out in electronic databases like PubMed,EMBASE, PsychINFO, Sociofile, CINAHL to identify studies relevant to the review question. At the first stage, titles and abstracts of articles retrieved through the searches will be examined against the eligibility criteria. The second stage will involve independent full-text screening of included articles by two reviewers. All qualitative, quantitative, and mixed method research studies which explicitly answer the research questions will be considered in this review. Methodological appraisal (Risk of Bias) will be conducted using the Joanna Briggs Institute's standardized critical appraisal tools or other standardized critical appraisal tools contingent on the study design by two reviewers. Data will be extracted on the aims/purpose, study design, geographical location, study population, study duration, interventions (if applicable) outcomes, and results of included studies. Data analyses will be conducted using the convergent approach to analysis of mixed methods research using JBI guidance. Discussion: The research will help to identify gaps in knowledge and generate evidence for health departments to look more specifically at the mental health of adolescents and challenges of addressing them. Systematic Review Registration: PROSPERO: CRD42020214349

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

scholarly journals Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review

2019 ◽  
Vol 20 (6) ◽  
pp. 266-273
Author(s):  
Pushpa Udayangani Gamalathge ◽  
Sanjeewa Kularatna ◽  
Hannah E Carter ◽  
Sameera Senanayake ◽  
Nicholous Graves
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Use Of Resources ◽  
The Cost

Background: Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim: To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods: A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results: Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions: The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.

scholarly journals Effectiveness of Interventions To Enable Hypertension Medication Adherence In Low-And Middle-Income Countries: A Systematic Review And Meta-analysis

2021 ◽  
Author(s):  
Olivia Nakwafila ◽  
Benn Sartorius ◽  
Sphamandla Josias Nkambule ◽  
Tivani Mashamba Thompson
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Meta Analysis ◽  
Pharmacological Interventions ◽  
Middle Income ◽  
Quality Of Evidence ◽  
Middle Income Countries ◽  
Secondary Outcomes

Abstract Background: In recent decades low- and middle-income countries (LMICs) are witnessing an increase in hypertension and thus becoming a significant public health issue due to associated Cardiovascular disease (CVD) outcomes. Antihypertensive medication adherence is crucial to controlling blood pressure; therefore, this systematic review aimed to evaluate the effectiveness of non-pharmacological interventions on improving blood pressure control and medication adherence in patients with hypertension in LMICs.Methods: We searched the following databases for relevant literature published between Jan 2005 – Dec 2020: PubMed, EBSCOhost included Academic Search; CINAHL and MEDLINE complete; PubMed; WEB of Science; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews and Google Scholar. Cochrane risk of bias tool (RoB 2) was used to appraise included studies critically, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to measure the quality of evidence. We conducted a meta‑analysis using DrSimonian-Laid's random-effect model at 95% confidence intervals (CIs). The secondary outcomes of interests were synthesised descriptively as changes in BP adherence outcomes. Results: We identified 14 eligible randomised controlled trials that presented blood pressure (BP) effectiveness and medication adherence among BP patients aged between 18-75 years. The overall quality of evidence with the majority of trials was moderate. Meta weighed effect (SBP) for 12/14 studies was -4.74 (95% CI:-6.07 to -3.47) and I2 = 57%. Out of 14 eligible studies, (86%) suggested a significant improvement in the proportion of patients with controlled blood pressure (BP < 140/90mmHG) with a positive effect on secondary outcomes such as quality of life.Conclusion: Non-pharmacological interventions could be effective in managing hypertension. In recommending the need to investigate the feasibility of non-pharmacological evidence in specific LMIC settings, focus should be on an intervention strategy consisting of an educational intervention directed toward the patients, health professionals and organisation. Considering heterogeneity, randomised trials that are well-designed with larger sample sizes are encouraged in LMICs` to help policymakers make well-informed decisions on hypertension management.Systematic review Registration: PROSPERO registration number: CRD42020172954

scholarly journals Quality of stroke guidelines in low- and middle-income countries: a systematic review

2021 ◽  
Vol 99 (09) ◽  
pp. 640-652E
Author(s):  
Joseph Yaria ◽  
Artyom Gil ◽  
Akintomiwa Makanjuola ◽  
Richard Oguntoye ◽  
Jaime Miranda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income
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