BMJ Global Health最新文献

{"title":"Progress in epidemic-ready primary health care: early pilot results from four African countries (Ethiopia, Nigeria, Sierra Leone and Uganda), December 2023 - October 2024.","authors":"Stacey Leanne Mearns, Moreen Kamateeka, Tochi Okwor, Aisha Abba, Celestina Obiekea, Jenom Danjuma, Arone M Haile, Daniel Damtew, Damene Debalke, Joseph Kanu, Ramatu Ngauja, Susan Michaels-Strasser, Abdullah Wailagala, Allan Muruta, Atim Dansan, Amy Elizabeth Barrera-Cancedda, Samantha Kozikott, Justine Landegger, Leena N Patel, Amanda McClelland","doi":"10.1136/bmjgh-2025-019249","DOIUrl":"10.1136/bmjgh-2025-019249","url":null,"abstract":"<p><p>Primary healthcare (PHC) is the first point of contact with communities and essential for epidemic preparedness. The COVID-19 pandemic exposed gaps in PHC resilience. Epidemic Ready Primary Healthcare (ERPHC) was designed to bridge these gaps by strengthening PHC to prevent, detect and respond to outbreaks while maintaining essential services. An ERPHC pilot was initiated in December 2023 in 654 PHC facilities across Ethiopia, Nigeria, Sierra Leone and Uganda. The approach improves connection to local communities, detection and reporting of cases, healthcare worker protection and patient treatment. Interventions include integrating Infection Prevention and Control (IPC), surveillance and case management functions, monthly mentorship visits, data-driven quality improvement assessments and enhanced communication between facilities and public health authorities.After 11 months, facility epidemic readiness scores improved from 55% to 87%. Reports of suspected reportable diseases increased from 184 to 290 per month, with 94% reported within 24 hours. A total of 75 cases of epidemic-prone diseases were detected across 17 facilities, with 99% of cases meeting the 7-1-7 target for detection and 100% meeting the target for notification. IPC scores improved from 56% to 94%, and correct donning and doffing of personal protective equipment by HCWs improved from 34% to 87%. Bottlenecks included inconsistent supply chains and inadequate infrastructure.ERPHC has demonstrated rapid improvements in performance, emphasising the impact of integration across technical disciplines and targeted mentorship in boosting epidemic readiness. Early results of the ERPHC approach show potential to accelerate the detection and reporting of epidemic-prone diseases and improve HCW and patient safety.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The localisation of humanitarian response to conflict and displacement: a scoping review from a health systems perspective.","authors":"Michael McGrath, Gülşah Kurt, Erin Davis, Salah Addin Lekkeh, Ammar Beetar, Muhammad Kamruzzaman Mozumder, Fatema Almeamari, Simon Rosenbaum, Ruth Wells","doi":"10.1136/bmjgh-2024-018331","DOIUrl":"10.1136/bmjgh-2024-018331","url":null,"abstract":"<p><strong>Introduction: </strong>The Grand Bargain Agreement at the 2016 World Humanitarian Summit emphasised the need to reform the humanitarian system. Central to these reforms were commitments to localise humanitarian assistance by increasing funding and decision-making for local and national responders and shifting control away from international actors. Localisation has the potential to improve the operational effectiveness of humanitarian assistance, strengthen local health systems and empower affected communities; however, progress has been slow. We aimed to identify the barriers, facilitators and outcomes of localised humanitarian health response for populations affected by conflict and displacement.</p><p><strong>Methods: </strong>We searched six academic databases for empirical studies published between January 2016 and May 2024 describing localised or locally led health organisations, workers or service delivery for populations affected by conflict and displacement in low- and middle-income countries. We adopt a health systems perspective and results are presented as a narrative summary using the WHO Health System Building Blocks framework.</p><p><strong>Results: </strong>Of the 48 included studies, 32 used qualitative methodologies. Efforts to localise humanitarian responses were hampered by multiple challenges relating to funding, leadership and relationships with international actors. Locally led humanitarian response improved the coverage, reach and responsiveness of health interventions, as well as the speed and efficiency of service delivery in conflict and displacement settings. However, there was little evidence of an increase in the meaningful participation or empowerment of affected communities and other local actors. Instead, international actors leveraged these operational advantages while retaining control over funding and decision-making. This dynamic increased workforce stressors for local staff and undermined local leadership and structures.</p><p><strong>Conclusion: </strong>For genuine localisation to be achieved, the humanitarian system must foster equitable partnerships and funding mechanisms that empower local organisations and address the structural barriers that perpetuate their exclusion.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the feasibility of partner-implemented digital payment systems for health workers: stakeholder perspectives from Uganda's yellow fever mass vaccination campaign - a qualitative study.","authors":"Michael Ediau, Elizabeth Ekirapa Kiracho, Juliet Aweko, Charles Opio, Maggie Ssekitto Ashaba, Peter Waiswa","doi":"10.1136/bmjgh-2024-017472","DOIUrl":"10.1136/bmjgh-2024-017472","url":null,"abstract":"<p><strong>Background: </strong>The heightening of efforts to eradicate vaccine-preventable diseases through mass vaccination campaigns has contributed to a growing demand for effective and efficient payment mechanisms for frontline vaccination workers in large-scale campaigns. Subsequently, the Uganda Ministry of Health (MoH) adopted digital payments for campaign workers, which were either implemented by the government or partners. We specifically explored stakeholder perspectives on the feasibility of partner-implemented digital payment to front-line health workers in phase one of the yellow fever mass vaccination campaign in Uganda.</p><p><strong>Methods: </strong>We employed a cross-sectional qualitative study. The study area comprised four districts (Amuru, Lira, Hoima and Kikuuba) purposively selected from 51 phase one yellow fever vaccination campaign districts. We collected data through 37 qualitative interviews (25 key informant interviews (KIIs) and 12 in-depth interviews (IDIs)). IDI participants included vaccination health workers (n=12). KII interview participants included district technical officials (n=14), representatives of digital payment implementing partners at district and national levels (n=7) and MoH staff (n=4). All interviews were audio-recorded and later transcribed and analysed using thematic analysis.</p><p><strong>Results: </strong>The partner-implemented payment system was linked with perceived improvements in timeliness and the increased likelihood of beneficiaries receiving complete payment. Despite these benefits, some payment delays were reported. These delays were mainly attributed to incomplete and inaccurate participant payment information. Health workers said they were more motivated because they felt assured of being paid and receiving the full amount.</p><p><strong>Conclusions: </strong>Despite drawbacks, partner-led digital payment of health workers was perceived as a feasible strategy promoting timely, complete payments. Relevant stakeholders should ensure accurate, complete and timely capture and verification of health workers' payment details to counter payment delays. We recommend more rigorous evaluations to determine whether a partner-implementation of digital payment is more effective than government-led payment in different settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis at the crossroads: urgent actions for migrant and refugee health in a turbulent era.","authors":"Tereza Kasaeva, Kerri Viney, Hannah Monica Dias, Martin van den Boom, Santino Severoni, Josette Najjar-Pellet, Diana Abou Ismail, Sanaa T Al-Harahsheh, Allen Gidraf Kahindo Maina, Poonam Dhavan, Farai Mavhunga","doi":"10.1136/bmjgh-2024-017621","DOIUrl":"10.1136/bmjgh-2024-017621","url":null,"abstract":"<p><p>Tuberculosis (TB) remains the world's deadliest infectious disease kiler, affecting the most vulnerable, including refugees and migrants. Their vulnerability is intensified by structural and social barriers that hinder diagnosis and treatment and restrict healthcare access. To put a spotlight on this issue, the WHO in collaboration with the Qatar Foundation launched a technical report on innovative solutions for TB elimination among refugees and migrants at the Seventh World Innovation Summit for Health (WISH) in November 2024. The report proposes 10 policy options and includes seven illustrative case studies to address the issue of TB among refugees and migrants. The global public health landscape has shifted dramatically since the report's release. Widespread funding cuts for health and development coupled with escalating geopolitical tensions now threaten hard-won public health gains. On the back of an already chronically underfunded TB response, where only 26% of the needed funds were available, both global and local responses to TB are faltering-putting lives, equity and elimination goals at serious risk. While the 2024 WISH report outlined policy actions to address TB among refugees and migrants, shrinking funding for health and development now threatens implementation. Therefore, in this analysis piece, we examine the current and urgent challenge of addressing TB among migrants and refugees framed in the context of three policy actions in the WISH report-namely, political commitment, adequate resourcing and equitable access to healthcare. We argue that sustaining and scaling up efforts to end TB is not optional-it is imperative.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.","authors":"Ruvandhi R Nathavitharana, Abarna Pearl, Matthew O'Bryan, Matthew Edwards, Helene-Mari van der Westhuizen, Bruna Voldman, Advaith Subramanian, Naveed Delrooz, Omolayo Anjorin, Amanda Biewer, Carl-Michael Nathanson, Nora Engel, Nazir Ismail, Andrew McDowell, Karen Steingart","doi":"10.1136/bmjgh-2024-018700","DOIUrl":"10.1136/bmjgh-2024-018700","url":null,"abstract":"<p><strong>Introduction: </strong>Fewer than 50% of people with tuberculosis receive a molecular WHO-recommended rapid diagnostic test (mWRD). We performed a mixed-methods systematic review to categorise barriers and enablers that affect mWRD use and impact and evaluate mWRD implementation strategies. Parts of this review informed the WHO standard: Universal Access to Tuberculosis Diagnostics.</p><p><strong>Methods: </strong>We searched multiple databases without language restrictions until 29 July 2022. We included studies that used qualitative, quantitative or mixed methods study designs. Four reviewers independently screened studies and extracted data. We categorised studies as thick or thin depending on whether authors analysed findings beyond a descriptive list of barriers or enablers and demonstrated insights into participants' perspectives. We appraised study quality by adapting the Standards for Reporting Implementation Studies statement. We synthesised data using a thematic approach and used GRADE-CERQual to assess confidence in the findings.</p><p><strong>Results: </strong>We identified 54 high-thickness studies from 18 countries, including public and private healthcare settings. Implementation strategies included engaging patients, training and supporting clinicians, building infrastructure and interactive assistance. Examples included remote outreach programmes, community testing, longitudinal clinician engagement, auxiliary workers, multicomponent strategies, performance feedback, improving health information management to strengthen care linkage and diagnostic network improvement. We had high or moderate confidence in our findings.</p><p><strong>Conclusion: </strong>Innovative and contextually relevant implementation strategies are needed for tuberculosis programmes to realise the benefits of improved accuracy and diagnostic expediency that mWRDs offer. Multicomponent strategies that centre equity and longitudinal health worker training across the diagnostic cascade must be prioritised.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of person-centred maternity care service in humanitarian and fragile settings.","authors":"Wubshet D Negash, Asmamaw Atnafu, Robera Olana Fite, Kamalini Lokuge","doi":"10.1136/bmjgh-2025-020696","DOIUrl":"10.1136/bmjgh-2025-020696","url":null,"abstract":"<p><strong>Introduction: </strong>Women who live in humanitarian settings are three times more likely to die than those who live in peaceful environments. Person-centred maternity care (PCMC) is a fundamental human right for every woman, yet it is often overlooked in humanitarian contexts. This scoping review aims to summarise person-centred maternity healthcare in fragile and humanitarian contexts.</p><p><strong>Methods: </strong>A scoping review of quantitative and/or qualitative approach was conducted to assess person-centred maternity care in humanitarian settings. Research that assessed dimensions of PCMC such as autonomy, dignity, privacy, communication, confidentiality and supportive care was included. Electronic database searches of PubMed, MEDLINE, EMBASE, PsycINFO, Scopus and generic web searches (Google Scholar) were used to search for available evidence. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses criteria for scoping review statement. The data from the final selected articles were extracted into an Excel spreadsheet. Finally, we described the study characteristics and summarised the concept of person-centred care.</p><p><strong>Result: </strong>A total of 889 articles were identified. After exclusion by title and abstract, 71 articles were eligible for full-text review, and finally 16 articles were eligible for data extraction. Our findings revealed low respect and supportive care, poor communication and autonomy, and breach of privacy. Resource constraints, protracted insecurity, cultural and language barriers were attributed to poor person-centred sexual and reproductive health. The review identified several implemented interventions, including training for healthcare providers, access to language translators, social and cultural support programmes, free healthcare services and community engagement initiatives.</p><p><strong>Conclusion: </strong>There are significantly more reports of negative experiences of maternity healthcare services than positive ones. Prioritising culturally appropriate approach, simulation-based training for healthcare providers on person-centred care, community engagement and the integration of PCMC domains into existing health services are essential to improve quality maternal health.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of measures taken by governments to support hand hygiene in community settings: a systematic review.","authors":"Jedidiah S Snyder, Erika Canda, Jordan Honeycutt, Lilly A O'Brien, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Marlene K Wolfe, Bethany A Caruso, Matthew C Freeman","doi":"10.1136/bmjgh-2025-018929","DOIUrl":"10.1136/bmjgh-2025-018929","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review aimed to identify and evaluate the implementation of government measures that support equitable and sustained hand hygiene practices in community settings.</p><p><strong>Methods: </strong>We systematically searched 12 databases, including PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary for peer-reviewed and grey literature published through late March 2023. Additional sources were identified through expert consultations and manual reference list checks of related reviews. Studies employing quantitative, qualitative or mixed-methods designs were eligible. Study quality was assessed using the Mixed Method Appraisal Tool. Government measures were categorised according to the Sanitation and Water for All Building Blocks framework: sector policy strategy; institutional arrangements; sector financing; planning, monitoring, review; and capacity development. Hand hygiene outcomes were classified as access, behaviour change or enabling environment and impact as positive, null or not evaluated.</p><p><strong>Results: </strong>Thirty-one studies (24 journal articles and 7 grey literature) from 19 countries-mostly middle income (71%)-were included. Most focused on household (58%), schools (19%) or both (13%). A total of 75 government measures were identified, with sector policy strategy and capacity development being the most common (each 31%), followed by institutional arrangements (17%), planning, monitoring, review (13%) and sector financing (8%). Positive impacts were linked to 45 measures across all five Building Blocks in 17 studies.</p><p><strong>Conclusion: </strong>This systematic review highlights diverse government measures supporting hand hygiene in community settings, with sector policy strategy and capacity development being the most frequently reported. While many government measures showed positive impacts, gaps remain in financing, implementation and sustainability beyond households and schools. Strengthening governance, increasing investment and expanding research on cost-effectiveness and implementation barriers are essential to improve hygiene initiatives and ensure equitable access.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidance and ablutions: optimising hand hygiene in public health.","authors":"Mohammed Sani, Suwaiba Yusuf","doi":"10.1136/bmjgh-2025-022009","DOIUrl":"10.1136/bmjgh-2025-022009","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia.","authors":"Wen-Chien Yang, Theodros Getachew, Emily R Smith, Delayehu Bekele, Sofanit Haile, Gesit Metaferia, Zelalem Birhan Tilahun, Catherine Arsenault","doi":"10.1136/bmjgh-2025-019102","DOIUrl":"10.1136/bmjgh-2025-019102","url":null,"abstract":"<p><p>Ethiopia has prioritised high-impact interventions to reduce neonatal deaths, including antenatal corticosteroids (ACS) utilisation. However, effective ACS use has faced various challenges. We used multiple data sources to examine the current landscape of ACS use in Ethiopia and to elucidate barriers to effective ACS utilisation, including a review of national obstetric guidelines over the past decade, a review of literature, and a descriptive analysis of health facility data.National obstetric protocols recommend administering ACS in both hospitals and health centres. However, ACS remains substantially underused. The 2016 Ethiopian Emergency Obstetric and Newborn Care Assessment reported that only 5% of preterm infants were born to women who had received corticosteroids before delivery. At the health facility level, the 2021 Ethiopian Service Provision Assessment survey showed that only 22.1% of facilities providing antenatal care and delivery services had administered ACS in the past 3 months, and 44.7% of facilities had injectable corticosteroids in stock at the time of the survey. Notably, private clinics had both the lowest corticosteroid availability (16.9%) and utilisation rate (2.8%).We identified several barriers to effective ACS use, including healthcare service delivery organisation, gaps in healthcare providers' knowledge and skills (particularly at the primary healthcare level and in private facilities), challenges in accurate gestational age assessment resulting from limited access to early ultrasound and late initiation of antenatal care, and insufficient corticosteroid availability. Increasing ACS uptake alone is unlikely to have the desired population benefits without considering health service delivery redesign and integration with other life-saving maternal and newborn health interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioural factors influencing hand hygiene practices across domestic, institutional and public community settings: a systematic review and qualitative meta-synthesis.","authors":"Bethany A Caruso, Jedidiah S Snyder, Lilly A O'Brien, Erin LaFon, Kennedy Files, Dewan Muhammad Shoaib, Sridevi K Prasad, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Marlene K Wolfe, Matthew C Freeman","doi":"10.1136/bmjgh-2025-018927","DOIUrl":"10.1136/bmjgh-2025-018927","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review sought to understand barriers and enablers to hand hygiene in community settings.</p><p><strong>Methods: </strong>Eligible studies addressed hand hygiene in a community setting, included a qualitative component, and were published in English between 1 January 1980 and 29 March 2023. Studies were excluded if in healthcare settings or were animal research. We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, Public Affairs Information Service Index, WHO Institutional Repository for Information Sharing, UN Digital Library and World Bank eLibrary, manually searched relevant systematic reviews' reference lists, and consulted experts. We used MaxQDA software to code papers, using the COM-B (Capability, Opportunity, Motivation and Behaviour) framework to classify barriers and enablers. We used thematic analysis to describe each COM-B subtheme identified, GRADE-CERQual to assess confidence in evidence for thematic findings and the Mixed Method Appraisal Tool (MMAT) to assess risk of study bias.</p><p><strong>Results: </strong>80 studies were included; most took place in Africa (31; 39%), South-East Asia (31; 39%) and domestic settings (54; 68%). The mean MMAT score was 4.86 (good quality). Barriers and/or enablers were reported across all COM-B constructs and subconstructs. The most reported barriers aligned with Physical Opportunity (eg, soap availability), Reflective Motivation (eg, hand hygiene not prioritised) and Automatic Motivation (eg, no habit). In contrast, the most reported enablers aligned with Automatic Motivation (ie, habit) and Reflective Motivation (ie, perception of health risk).</p><p><strong>Conclusion: </strong>Findings confirm that a lack of necessary resources for hand hygiene hinders practice, even when people are motivated. Results may explain why hand hygiene increases when there are acute health risks (eg, COVID-19), but decreases when risks are perceived to fade. The qualitative methodology used among the studies may have revealed a broader array of barriers and enablers than what might have been found by quantitative, researcher-driven studies, but representativeness may be limited. Evidence was also limited on alcohol-based hand rubs. Findings can inform the design of future hand hygiene initiatives.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}