Department of Sociology, Forman Christian College, Lahore, Pakistan
Department of Social Policy, University of Oxford, Oxford, UK.
BMJ Open. 2023 Oct 29;13(10):e076883. doi: 10.1136/bmjopen-2023-076883.
The objective of this review is to (1) identify barriers and facilitators with respect to women's health services at a primary care level based on a systematic review and narrative synthesis and (2) to conclude with recommendations for better services and uptake.
Systematic review and narrative synthesis.
PubMed, BMC Medicine, Medline, CINAHL and the Cochrane Library. Grey literature was also searched.
Qualitative, quantitative and mixed studies were included in the review.
The search took place at the beginning of June 2021 and was completed at the end of August 2021. Studies were included in the review based on the Sample, Phenomenon of Interest, Design, Evaluation, Research type criteria. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Data were synthesised using a narrative synthesis approach.
A total of 33 studies were included in the review. We identified six barriers to the delivery of effective primary healthcare for women's health which have been organised under two core themes of 'service barriers' and 'family/cultural barriers'. Ten barriers to the uptake of primary healthcare for women have been identified, under three core themes of 'perceptions about healthcare service', 'cultural factors' and 'practical issues'. Three facilitators of primary healthcare delivery for women were identified: 'motivating community health workers (CHWs) with continued training, salary, and supervision' and 'selection of CHWs on the basis of certain characteristics'. Five facilitators of the uptake of primary healthcare services for women were identified, under two core themes of 'development of trust and acceptance' and 'use of technology'.
Change is needed not only to address the limitations of the primary healthcare services themselves, but also the cultural practices and limited awareness and literacy that prevent the uptake of healthcare services by women, in addition to the wider infrastructure in terms of the provision of financial support, public transport and child care centres.
CRD42020203472.
本综述旨在：(1) 通过系统评价和叙述性综合，确定初级保健水平妇女健康服务的障碍和促进因素；(2) 为改善服务和利用率提出建议。
系统评价和叙述性综合。
PubMed、BMC 医学、Medline、CINAHL 和 Cochrane 图书馆。还搜索了灰色文献。
纳入的研究包括定性、定量和混合研究。
搜索于 2021 年 6 月初开始，并于 2021 年 8 月底完成。研究是根据样本、感兴趣的现象、设计、评估、研究类型标准纳入综述的。使用混合方法评估工具评估纳入研究的质量。使用叙述性综合方法对数据进行综合。
共纳入 33 项研究。我们确定了有效提供妇女健康初级保健的六项障碍，这些障碍已组织在两个核心主题下：“服务障碍”和“家庭/文化障碍”。确定了妇女接受初级保健的十个障碍，这些障碍分为三个核心主题：“对医疗保健服务的看法”、“文化因素”和“实际问题”。确定了促进妇女初级保健提供的三个因素：“通过持续培训、工资和监督激励社区卫生工作者 (CHWs)”和“根据某些特征选择 CHWs”。确定了促进妇女接受初级保健服务的五个因素，分为两个核心主题：“建立信任和接受”和“使用技术”。
不仅需要改变初级保健服务本身的局限性，还需要改变文化习俗和限制妇女获得保健服务的意识和读写能力，以及在提供财政支持、公共交通和儿童保育中心等方面的更广泛基础设施。
CRD42020203472。
