scholarly journals A scoping review on barriers to implementation of health education programs in low to middle income countries

Author(s):  
Gashema Pierre ◽  
Tafadzwa Dzinamarira

We aimed to map literature on the barriers to effective implementation of health education programs (HEPs) in low to middle income countries (LMICs) to guide future implementation research. We employed a rigorous scoping review design. Our review was guided by the Arksey and O’Malley framework, 2005, further enhanced by Levac et al. The keyword search was comprehensive for relevant studies presenting evidence on barriers to implementation of HEPs in LMICs from Google Scholar, PubMed, EBSCOHost (CINAHL and Academic Search Complete) databases and grey literature. The first search identified 3,092 articles, of which 1,412 duplicates were eliminated. An additional 1,632, 34 and 7 articles did not meet the inclusion criteria based on sequential title screen, abstract review and full text review respectively. Seven studies met the inclusion criteria for the actual scoping review. Findings of the review revealed three categories of barriers to effective implementation of HEPs in LMICs grouped as individual or patient level, community level and population level barriers. A key barrier to effective implementation of HEPs in LMICs revealed from the review was socio-economic challenges, which result from resource constraints. This calls for adequate allocation of the limited resources toward health education to ensure effective implementation of HEPs in LMICs and improve health outcomes.

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030814
Author(s):  
Moreblessing Chipo Mashora ◽  
Tafadzwa Dzinamarira ◽  
Claude Mambo Muvunyi

IntroductionHealth education programmes (HEPs) have been associated with a number of benefits. These include providing individuals with information on matters related to their mental, social, physical as well as emotional health. HEPs also play a major role in preventing diseases and reducing the level of engagement of individuals in risky behaviours. While this is the case, there are barriers to the effective implementation of HEPs, especially in low-income and middle-income countries (LMICs) where resources are scarce. Available evidence has revealed socioeconomic challenges ranging from literacy issues, discomfort about issues of sexuality, and cultural barriers to financial constraints as key barriers to the implementation of sexual and reproductive health HEPs in LMICs. We will focus on HEPs related to sexual and reproductive health; all age groups will be considered with no restrictions on geographical setting nor model of HEP delivery. This review will map literature on the barriers to the effective implementation of HEPs in LMICs to guide future implementation research.MethodsArksey and O’Malley’s 2005 scoping methodological framework will act as the guide for this review. We will search the following electronic databases: EBSCOhost (Academic search complete, PsycINFO, Health Sources, CINAHL and MEDLINE with full text), Google Scholar, PubMed, SCOPUS, Science Direct and Web of Science. Grey literature from Mount Kenya University theses and dissertations, governments’ as well as international organisations’ reports, such as WHO, and reference lists of included studies will be searched for eligible studies. We will limit our search to publications from 1 January 2000 to 30 September 2019. Using thematic content analysis, we will employ NVivo V.12 to extract the relevant outcomes from the included articles. We will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) version 2018.Ethics and disseminationNo ethical approval is needed for the study as it will not include animal nor human participants. The results of the proposed scoping review will be disseminated electronically, in print and through conference presentation as well as at key stakeholder meetings.


2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Tafadzwa Dzinamarira ◽  
Desmond Kuupiel ◽  
Tivani Phosa Mashamba-Thompson

Abstract Background Health education programs (HEPs) have been documented to increase individuals’ awareness toward their health and improve health outcomes. Given the reported poor health seeking behavior among men in low- to middle-income countries (LMICs), it is crucial for HEPs to be targeted toward men in order to improve health outcomes. Here, we outline a protocol for a scoping review aimed at mapping literature on HEPs for men in LMICs in order to reveal gaps to guide future research and practice. Methods We will conduct a scoping review with guidance from the Arksey and O’Malley framework (Journal of Social Research Methodology 8(1):19–32, 2005), further enhanced by Levac et al. (Implementation Science 5(1):69, 2010). We will conduct a comprehensive keyword search for relevant studies presenting evidence on HEP for men in LMICs from PubMed, Google Scholar, EBSCOhost, and WEB of Science databases. In addition, we will search for relevant gray literature, dissertations, and theses from university repositories as well as international organizations such as the World Health Organization (WHO). We will include articles reporting evidence on health education programs for men in LMICs and published between January 2000 and March 2019. We will employ NVIVO version 12 software package to extract the relevant outcomes from the included articles using content thematic analysis. We will conduct quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) 2018 version. Discussion We anticipate to find relevant studies reporting on health education programs for men in LMICs. The findings of this review will guide further implementation research on health education programs for men in LMICs. The results of the proposed scoping review will be disseminated electronically, in print, and through conference presentation as well as key stakeholder meetings.


BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033320 ◽  
Author(s):  
Fantu Abebe Eyowas ◽  
Marguerite Schneider ◽  
Biksegn Asrat Yirdaw ◽  
Fentie Ambaw Getahun

IntroductionMultimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs.MethodsPubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using key terms, including comorbidity, co-morbidity, multimorbidity, multiple chronic conditions and model of care. Relevant articles will be screened by two independent reviewers and data will be charted accordingly. The result of this scoping review will be presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline.Ethics and disseminationThis scoping review does not require ethical approval. Findings will be published in peer-reviewed journal and presented at scientific conferences.


2020 ◽  
Vol 5 (11) ◽  
pp. e003471
Author(s):  
Ayden Scheim ◽  
Vibhuti Kacholia ◽  
Carmen Logie ◽  
Venkatesan Chakrapani ◽  
Ketki Ranade ◽  
...  

IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.


2020 ◽  
Vol 4 ◽  
pp. 18 ◽  
Author(s):  
Mabel Berrueta ◽  
Ariel Bardach ◽  
Agustin Ciaponni ◽  
Xu Xiong ◽  
Andy Stergachis ◽  
...  

Background: Pregnant women and neonates represent one of the most vulnerable groups, especially in low- and middle-income countries (LMICs). A recent analysis reported that most vaccine pharmacovigilance systems in LMICs consist of spontaneous (passive) adverse event reporting. Thus, LMICs need effective active surveillance approaches, such as pregnancy registries. We intend to identify currently active maternal and neonatal data collection systems in LMICs, with the potential to inform active safety electronic surveillance for novel vaccines using standardized definitions. Methods: A scoping review will be conducted based on established methodology. Multiple databases of indexed and grey literature will be searched with a specific focus on existing electronic and paper-electronic systems in LMICs that collect continuous, prospective, and individual-level data from antenatal care, delivery, neonatal care (up to 28 days), and postpartum (up to 42 days) at the facility and community level, at the national and district level, and at large hospitals. Also, experts will be contacted to identify unpublished information on relevant data collection systems. General and specific descriptions of Health Information Systems (HIS) extracted from the different sources will be combined and duplicated HIS will be removed, producing a list of unique statements. We will present a final list of Maternal, Newborn, and Child Health systems considered flexible enough to be updated with necessary improvements to detect, assess and respond to safety concerns during the introduction of vaccines and other maternal health interventions. Selected experts will participate in an in-person consultation meeting to select up to three systems to be further explored in situ. Results and knowledge gaps will be synthesized after expert consultation.


PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253423
Author(s):  
Oghenebrume Wariri ◽  
Uduak Okomo ◽  
Yakubu Kevin Kwarshak ◽  
Kris A. Murray ◽  
Chris Grundy ◽  
...  

The literature on the timeliness of childhood vaccination (i.e. vaccination at the earliest appropriate age) in low-and middle-income countries has important measurement and methodological issues that may limit their usefulness and cross comparison. We aim to conduct a comprehensive scoping review to map the existing literature with a key focus on how the literature on vaccination timeliness has evolved, how it has been defined or measured, and what determinants have been explored in the period spanning the last four decades. This scoping review protocol was developed based on the guidance for scoping reviews from the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on the timeliness of routine childhood vaccination in low-and middle-income countries published between January 1978 through to 2021. A three-step search strategy that involves an initial search of two databases to refine the keywords, a full search of all included electronic databases, and screening of references of previous studies for relevant articles missing from our full search will be employed. The search will be conducted in five electronic databases: MEDLINE, EMBASE, Global Health, CINAHL and Web of Science. Google search will also be conducted to identify relevant grey literature on vaccination timeliness. All retrieved titles from the search will be imported into Endnote X9.3.3 (Clarivate Analytics) and deduplicated. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility using Rayyan–the web based application for screening articles for systematic reviews. Using a tailored data extraction template, we will extract relevant information from eligible studies. The study team will analyse the extracted data using descriptive statistical methods and thematic analysis. The results will be presented using tables, while charts and maps will be used to aid the visualisation of the key findings and themes. The proposed review will generate evidence on key methodological gaps in the literature on timeliness of childhood vaccination. Such evidence would shape the direction of future research, and assist immunisation programme managers and country-level stakeholders to address the needs of their national immunisation system.


PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250434
Author(s):  
Adovich S. Rivera ◽  
Ralph Hernandez ◽  
Regiel Mag-usara ◽  
Karen Nicole Sy ◽  
Allan R. Ulitin ◽  
...  

Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.


BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e051908
Author(s):  
Isobel Sharpe ◽  
Colleen M Davison

IntroductionClimate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature.MethodsThis review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised.ResultsFifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure–outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure–outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage.ConclusionTo our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.


2020 ◽  
Author(s):  
Md Zabir Hasan ◽  
Shalini Singh ◽  
Dinesh Arora ◽  
Nishant Jain ◽  
Shivam Gupta

Abstract Background: Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs – including India – have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of Primary-Secondary care Integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. Methods: The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000-2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms. Discussion: No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs.Scoping review registration: https://osf.io/kjhzt


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