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

Journal article

Objectives

Annually around 100,000 babies are born with feet twisted inwards, a condition known as ‘clubfoot’, which limits participation in everyday life. Clubfoot can be treated using non-surgical manipulation, but many guardians in low and middle - income countries (LMICs) do not present for treatment. The Social Ecological Model specifies five inter-related factors that may impact on this: intrapersonal, interpersonal, institutional, community or socio-cultural factors and public policy. Using this model, we conducted a systematic synthesis of previous research to identify factors that impact on treatment seeking for clubfoot and community level interventions to improve engagement in LMICs.

Methods

A search of five databases was conducted and articles screened using six criteria. Quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Eleven studies were identified for inclusion. Analysis was informed by a Social Ecological Model.

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 impacted on treatment seeking. Institutional or organisational factors included long distances to treatment centres, insufficient information about treatments and ch allenges 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 identified factors that impact on access and engagement with clubfoot treatment across diverse settings and strategies to address them.

Authors: Drew, S; Lavy, C; Gooberman-Hill, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Tropical Medicine and International Health
• Volume: 21
• Issue: 5
• Pages: 570-589
• Publication date: 2016-02-19
• Acceptance date: 2016-02-19
• DOI: 10.1111/tmi.12684
• EISSN: 1365-3156
• ISSN: 1360-2276
• Language: English
• Keywords: meta-synthesis; qualitative research; clubfoot; paediatric orthopaedics; Social Ecological Model; low and middle-income countries