Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature

Abstract

ObjectiveTo identify factors associated with accessing and utilisation of healthcare and provision of health services in slums.DesignA scoping review incorporating a conceptual framework for configuring reported factors.Data sourcesMEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December 2021 using slum-related terms.Eligibility criteriaEmpirical studies of all designs reporting relevant factors in slums in low and middle-income countries.Data extraction and synthesisStudies were categorised and data were charted according to a preliminary conceptual framework refined by emerging findings. Results were tabulated and narratively summarised.ResultsOf the 15 469 records retrieved from all years, 4368 records dated between 2016 and 2021 were screened by two independent reviewers and 111 studies were included. The majority (63 studies, 57%) were conducted in Asia, predominantly in India. In total, 104 studies examined healthcare access and utilisation from slum residents’ perspective while only 10 studies explored provision of health services from providers/planners’ perspective (three studies included both). A multitude of factors are associated with accessing, using and providing healthcare in slums, including recent migration to slums; knowledge, perception and past experience of illness, healthcare needs and health services; financial constraint and competing priorities between health and making a living; lacking social support; unfavourable physical environment and locality; sociocultural expectations and stigma; lack of official recognition; and existing problems in the health system.ConclusionThe scoping review identified a significant body of recent literature reporting factors associated with accessing, utilisation and provision of healthcare services in slums. We classified the diverse factors under seven broad categories. The findings can inform a holistic approach to improving health services in slums by tackling barriers at different levels, taking into account local context and geospatial features of individual slums.Systematic review registration numberhttps://osf.io/694t2.

Barriers and facilitators to type 2 diabetes management among slum‐dwellers: A systematic review and qualitative meta‐synthesis

“…We identified several factors that are particularly pertinent in slum settings, such as difficulty in dietary adherence, adherence medication, 15–18,26 lifestyle changes/behavior, 15,16,18,22,23,26 literacy and knowledge about the disease and diet, 14,15,17–19,26,30,35 costs and financial issues, 14,17–19,21–25,27,29,35 family/social/friends support, 14,25,26,29 availability/accessibility of healthcare services, the costs of health services, 15,17–20,23 patients‐providers interaction 14,24,25,29,30 . In line with our study, a previous scoping review suggested that factors such as knowledge, perception (including misconception and distrust), financial issues, stigma, healthcare needs and health services, competing priorities and inadequacy of social support, and so on, in the existing health system all contribute to the challenges faced by slum‐dwellers 39 …”

“…14,24,25,29,30 In line with our study, a previous scoping review suggested that factors such as knowledge, perception (including misconception and distrust), financial issues, stigma, healthcare needs and health services, competing priorities and inadequacy of social support, and so on, in the existing health system all contribute to the challenges faced by slum-dwellers. 39 Costs and financial issues were frequently reported in studies as factors affecting healthcare-seeking behaviors, disease management, and also as a barrier to dietary adherence and eating healthy food, adherence to medication, and diabetes self-management. 14,[17][18][19][21][22][23][24][25]27,29,35 These barriers were also reported in previous studies.…”

“…Previous studies reported lack of time and competing priorities as factors affecting healthcare-seeking behavior [55][56][57] and health service utilization. [58][59][60] A scoping review demonstrated that slum residents have to strike when making decisions on healthcare seeking and utilization, 39 lack of health insurance coverage, expensive co-payments, and mistrust of the medical system is a barrier for low-income populations with diabetes. 14,61 Poor information, lack of skills, poor communication skills, and high workload in delivering care to patients by healthcare systems lead to poor quality of care and poor T2D management among slum-dwellers.…”

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers

“…It is a commonly held assumption that the health conditions of urban populations are superior to their rural counterparts due to greater healthcare availability and economic opportunities [ 9 , 10 ]. Evidence from urban poor communities across Asia and Africa, however, show that poor and marginalized urban populations have worse access to ANC and facility childbirth compared to the non-poor, and often have maternal, newborn, and child mortality rates as high as or higher than those in rural areas [ 7 , 10 – 14 ]. In Kampala slums, for example, the estimated stillbirth rate is 43 deaths per 1000 live births which is more than double the 19 deaths per 1000 live births in rural areas of the country.…”

Socioeconomic Determinants of Maternal and Child Healthcare Utilization and Infant Survival: A Case Study of Kijumo Village, Uganda

“…In Kijumo Village, Uganda, a rural community characterized by limited resources and infrastructure, accessing timely and quality maternal and child healthcare services poses significant challenges for many residents [21][22][23][24]. Limited financial resources, inadequate transportation infrastructure, and cultural norms that prioritize traditional healing practices may deter mothers from seeking essential healthcare services during pregnancy, childbirth, and the postnatal period [25][26]. Consequently, preventable maternal and infant deaths continue to occur, highlighting the urgent need for targeted interventions to address existing disparities and improve health outcomes in the community [27][28][29][30].…”