Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs.

This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed.

Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure.

This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support.

The purpose of WHO’s Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons.

This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis.

The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: ‘Embracing life’, ‘Dealing with challenges’ and ‘Considering the future’.

In Australia, around 3.6 million people suffer from hearing loss, more than 1.3 million with preventable hearing conditions. Ear diseases are prevalent in Indigenous populations, particularly children and are associated with poor educational outcomes and subsequent high rates of unemployment and incarceration. In Australia, rural and remote communities have rates of middle ear perforations five times the rate that the World Health Organisation regards to be a significant public health problem.

Barriers to accessing ear health services have been identified including gaps in testing during the ‘early years’ and difficulty in accessing these services. Reducing the risk of hearing loss through improved ear health care can directly impact the ability to learn and develop. Collaboration between community, health providers and government is crucial to ensure necessary support for change. An opportunity presents for rural community pharmacists, who are both qualified and accessible to provide an ear health programme and thus improve health outcomes for both Indigenous and non-Indigenous Australians in their communities.

The aim of this study was to identify published evidence of pharmacists’ involvement in ear health care interventions to inform the development of ear health services able to be delivered in rural community pharmacy in Australia.

The search strategy was applied to the following electronic databases: MEDLINE, Scopus, CINAHL, Emcare, Cochrane, Google Scholar and Google.

Study selection articles were included if they described an ear health intervention in a community pharmacy setting. The interventions reported in the articles were evaluated for their inclusion of effectiveness, whether the service was sustainable, and the inclusion of enablers and barriers to the provision of ear care. The articles were also thematically analysed using the Deadly Ears Deadly Kids Deadly Communities Framework. A total 8427 articles were identified and evaluated against inclusion and exclusion criteria, with eleven eligible articles suitable for inclusion in the review. The articles included were conducted in Australia (n = 4), England (n = 4), United States of America (n = 2) and Brazil (n = 1). The ear health interventions identified included hearing screening (n = 3), otoscopy pilot studies (n = 2), audiometry services (n = 1), specific education for undergraduate pharmacy students (n = 2) and a pharmacy-based clinic (n = 3). Effectiveness and sustainability were not formally reported in any of the included articles. Positive outcomes, funding availability, consumer access to community pharmacy, cost savings for consumers and improved connection to health providers were identified as enablers. Difficulty in attracting funding was the most commonly reported barrier.

Improving ear health of both Indigenous and non-Indigenous peoples through services provided in community pharmacy presents as an important opportunity for rural pharmacists. Pharmacists are accessible and thus well placed to improve ear healthcare and resultant quality of life for these vulnerable populations. This review has identified factors required to effectively develop ear health models of care in community pharmacy including a pharmacist training program, continuous funding to ensure sustainability and support from pharmacy stakeholders and the community.

The aims of this study were to improve responses to students in distress and who are feeling suicidal, to help practitioners to increase their responsiveness to those at high risk of suicide and to develop effective responses to those affected by their deaths. The study sought to build a detailed picture of students’ patterns of service use.

National suicide prevention strategies emphasise that suicide prevention requires the collaboration of a wide range of organisations. Among these, primary care services play a key role in relation to suicide prevention for young people in crisis.

This study, undertaken between 2004 and 2007, focused on 20 case studies of student suicide that took place in the United Kingdom between May 2000 and June 2005. It adopted a psychological autopsy approach to learn from a wide range of informants, including parents, friends, university staff and the records of coroners or procurator fiscals. Twenty families gave permission for their son’s or daughter’s death to be included in the study and agreed to participate in the study. Informants were interviewed in person and the data were analysed thematically. Analysis of the case study data suggested that in a number of cases students had failed to engage with services sufficiently early or in sufficient depth. Primary care practitioners need to be proactive in communicating concerns about vulnerable students to student support services. At local levels, collaboration between student support and National Health Service practitioners varied considerably and channels of communication need to be developed.

To explore parents’ experiences of using child health services for their pre-school children post-migration.

Migrating between countries necessitates movement and adjustment between systems of healthcare. Children of migrants are known to have poorer health than local children on some measures and are less likely to access primary care. In the United Kingdom (UK), children are offered a preventive Healthy Child programme in addition to reactive services; this programme consists of health reviews and immunisations with some contacts delivered in the home by public health nurses.

Five focus groups were held in a city in South West England. Participants were parents of pre-school children (n = 28) who had migrated to the UK from Romania, Poland, Pakistan or Somalia within the last 10 years. Groups selected included both ‘new migrants’ (from countries which acceded to the European Union in the 2000s) and those from communities long-established in the UK (Somali and Pakistani). One focus group consisted of parents of Roma ethnicity. Interpreters co-facilitated focus groups.

Participants described profound differences between child health services in the UK and in their country of origin, with the extent of difference varying according to nationality and ethnic group. All appreciated services free at the point of delivery and an equitable service offered to all children. Primary care services such as treatment of minor illness and immunisation were familiar, but most parents expected doctors rather than nurses to deliver these. Proactive child health promotion was unfamiliar, and some perceived this service as intruding on parental autonomy. Migrants are not a homogenous group, but there are commonalities in migrant parents’ experiences of UK child health services. When adjusting to a new healthcare system, migrants negotiate differences in service provision and also a changing relationship between family and state.

Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access.

Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services.

A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 – August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach.

Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers – transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.

This study analyzed the management of intestinal parasitic infections in the Family Health Strategy covering Brazilian urban slums.

The Family Health Strategy is the preferred strategy for providing public, community-based primary health care in the Brazilian Unified Health System (SUS). Through this strategy, Family Health teams are responsible for the health of residents of a defined territory, including health promotion, health education and control of neglected tropical diseases such as intestinal parasitic infections.

Knowledge, attitudes and practices surveys were applied with Family Health team members (n=58) and patients (n=571) of an agglomeration of Brazilian urban slums in Rio de Janeiro.

The management of intestinal parasitic infections and health promotion were limited. Health education was not considered an essential aspect of team members’ work and did not include environmental or social determinants of health. Community health workers and urban slum residents presented similar knowledge, attitudes and practices regarding intestinal parasitic infections.

Multiple, competing demands promote prioritization of the aspects of care where curative, biomedical activities predominate over prevention and an integral approach to health. However, the complex processes involving the cycle of poverty and disease go beyond the biomedical, limiting the potential for health in urban slums. Implications include a need to better prepare health professionals for primary health care services through reflection on local concerns and the social determinants of health, highlighting the importance of territorialized care and permanent education.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may have a negative impact on both patients’ quality of life and survival. Patients with COPD frequently suffer from heart failure (HF), likely owing to several shared risk factors.

To evaluate the differences in treatment of COPD with and without HF comorbidity according to COPD severity in the general practitioner setting.

We conducted an observational, retrospective study using data obtained from the Italian Health Search Database, which collects information generated by the routine activity of general practitioners. The study sample included 225 patients with COPD, alone or combined with HF.

It has been found that the prevalence of some comorbidities such as diabetes and HF significantly increases with the severity of COPD. Regarding pharmacological treatment, a reduction in the prescription of individually administered long-acting β 2-agonists (LABAs) and long-acting anticholinergics (LAMAs) has been observed with increasing severity of the disease. Moreover, an increase in the prescription of both the combination of the two bronchodilators (LABA + LAMA) and their association with inhaled corticosteroids has been observed with increasing severity of COPD. The prescription of β-blockers in patients with COPD suffering from HF comorbidity decreases from 100% in stage I to less than 50% in the other stages of COPD. This study shows that general practitioners do not follow the guidelines recommendations for the management of patients with COPD in the different stages of the disease, with and without HF comorbidity, as well as in the management of HF. Further efforts must be made to ensure adequate treatment for these patients.

This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy.

PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailand's health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established.

A primary care service of one educational institution was a study site. Eight common illnesses were emphasised. Patient visits were observed, prospectively at community pharmacy and retrospectively at PCU, during August to October 2013. Labour and material costs related to management of common illnesses were recorded. Total cost divided by total patient visits determined the unit cost. For the community pharmacy, patients were followed up after 3–14 days of visit to evaluate the effectiveness. Sensitivity analysis was performed by varying direct medical cost at ±10–30%.

At the community pharmacy, community pharmacists performed multiple tasks including interviewing and assessing patients, choosing an appropriate treatment and dispensing. Of 9141 visits, 775 (8.5%) with common illnesses were included. Upper respiratory disorder was found the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (£1.18) for pain to 82.71 baht (£1.80) for skin disorder. Two-thirds of pharmacy visits (77.9%, 539/692) reported complete recovery. Managing common illnesses at the PCU was performed by nurse assistants, nurses, doctors and pharmacists. Of 6701 patient visits to the PCU, 1545 (23.1%) visits were at least one of the eight illnesses. Upper respiratory disorder was the majority, 53.0% (771/1454). Unit cost of treatment ranged from 85.39 baht (£1.86) for eye/ear to 245.93 baht (£5.36) for sexual health. Managing common illness at a community pharmacy shows satisfactory effectiveness with lower unit cost.

An exploratory study of the Cardiff Bangladeshi community in a primary care setting, prior to the development of culturally appropriate diabetes health education.

British Bangladeshis are one of the most economically deprived communities in Britain, with high morbidity and mortality rates from chronic illness. Access and use of their services is perceived by Primary Health Care Teams (PHCTs) to be difficult, due to communication and cultural barriers.

One-to-one tape-recorded interviews were held in Sylheti, Bengali or English with an age-stratified sample from the community registered with a practice in central Cardiff. The N*DIST package was used to analyse data, with ongoing discussion of emerging themes. The topics explored in these interviews were family structure and decision making within families, meal patterns, health beliefs, experiences of primary care and barriers to engaging with the outside world.

Family structure and social patterns had many similarities with those of the local community, and dietary and health beliefs also followed ‘Western’ concepts. People were anxious to be healthy, but often did not know about core primary care services. The community places value on the opinion and support of primary care professionals. However, a major cross-cutting theme was difficulty in accessing health care (especially for women), and reasons for this are discussed in the paper. With this information, the PHCT can now consider adapting itself to improve access and communication. We suggest that our methodological approach is both relevant and achievable for those working in primary care settings in our increasingly multi-cultural, ethnically mixed communities, and is not purely the province of sociologists or academics (important learning points have been identified and highlighted).

Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled.

CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed.

In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down – exploring the chaos experienced by patients as they seek help; (2) negative cycle – highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle – validating patient–doctor relationships underpinned by clear communication can help break the negative cycle.

Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient–doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.

To explore parents’ perceptions of environmental household risks to their child’s asthma and to identify the strategies they adopt in relation to these perceived risks.

The prevalence of childhood asthma is increasing worldwide and especially in the UK. Asthma is more common in areas of socio-economic disadvantage. Household environmental factors have been implicated in some of this increase. A number of factors in the home environment have been found to act as triggers to asthma symptoms, including high humidity levels, poor ventilation, mould, second-hand tobacco smoke and pet allergens. Little is known about how parents, as the main care-givers and decision makers in the home, perceive and cope with the risks posed by these triggers.

Semi-structured interviews were conducted with a purposive sample of parents of 32 children with asthma aged 4 to 16 years and living in a socio-economically disadvantaged urban community in the North East of England. Interviews were audiotaped, transcribed verbatim and analysed using constant comparison techniques.

All parents were aware of some of the risks their children faced at home. Some appeared to know more than others and coping styles varied. A typology of three groups of parents was identified: those who actively seek advice and adopt clear preventative strategies (preventers); those who minimize the risks and only react when things go wrong (reactors); and those who engage in compensatory activities in an attempt to trade-off between harms and benefits (compensators). The unifying themes underpinning these different styles are that all parents are motivated to maintain normal family life but that they adopt different strategies to achieve this.

The aim of this study was to conduct a comparative follow-up assessment of clients with depressive symptoms attending monk healers or primary care clinics in Thailand.

Consecutively attending clients of three monk healing and three primary care centres who screened positive (a score of 9 or more) on the Primary Health Questionnaire (PHQ)-9 at the study site were followed up at 3 months after baseline assessment.

In 3 monk healer sites, 448 clients agreed to be screened with the PHQ-9 for depression, and 94 screened positive, and in 3 health centres 582 clients agreed to be screened, and 92 screened positive for depressive symptoms on the PHQ-9. In 2 monk healing sites, 79 clients (84%) were followed up at 3 months, and in 3 health centres, 79 clients (85.9%) were followed up at 3 months. At 3-month follow-up, mixed modelling found significant interaction effects (a time-by-condition interaction, i.e., between-group changes) on depression scores (P = <0.001). Depressive symptoms significantly decreased over time, but there was no significant difference in decline between the two groups.

Clients attending monk healers decreased more in depressive scores compared to clients attending primary care centres, though there was no group effect with respect to number of depressed clients.