Factors influencing HPV vaccine implementation in South Asia: a scoping review protocol.

INTRODUCTION: The HPV vaccine is characterized by its significant effectiveness in preventing the occurrence of cervical cancer. However, the South Asian countries face multiple challenges in implementing the human papillomavirus vaccine (HPV) at scale. Implementation of human papillomavirus vaccination for eliminating cervical cancer necessitates investigating the factors that impact the health system of these nations. Hence, this review will map the evidence on factors influencing the scaling up of human papillomavirus vaccination in South Asia. METHODS: The proposed scoping review will follow the steps given by Arksey and O'Malley and Levac et al. The search approach will follow McGowan et al. (14) evidence-based manual for Peer Analysis of Electronic Search Strategies (PRESS 2015) for systematic searches. Using a comprehensive search, the literature from 2006 onward will be identified from PubMed, CINAHL, EMBASE, Web of Science, and Scopus. The search strategy will include terms relating to the HPV vaccine and implementation. A predefined criterion for the inclusion and exclusion of studies will be adopted by three review authors independently to determine the eligible studies. The results will be narratively synthesized and examined in addition to being quantitatively presented to provide an outline. The review will be presented per the "Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR)" guidelines. CONCLUSIONS/DISCUSSION: The evaluation is anticipated to map the barriers and enablers influencing the rollout of the human papillomavirus vaccine. Lessons learned from the South Asian countries, where the vaccine has been implemented, may contribute to aiding the implementation of the vaccine in countries with similar health systems in an effective manner. SYSTEMATIC REVIEW REGISTRATION: The protocol was prospectively registered on the "open science framework". The registration DOI is https://doi.org/10.17605/OSF.IO/T5SW9 .

Evidence on factors influencing HPV vaccine implementation in South Asia: A scoping review.

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.

Barriers and Facilitators for the Donation and Acceptance of Human Breast milk: A Scoping Review.

PURPOSE OF REVIEW: Human milk is the best source of nutrients for all infants. When a mother's own milk is unavailable, the World Health Organization suggests using donor human milk for premature neonates with or without medical complications. Exploring the barriers and facilitators for breast milk donation and its acceptability is essential for developing this intervention. A scoping review was conducted based on a methodological framework developed by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). A search was conducted in PubMed (NCBI), CINAHL (EBSCO), and Web of Science (Elsevier). A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form. RECENT FINDINGS: We included 20 articles for narrative synthesis. Barriers and facilitators for donating and accepting breast milk were categorized under six themes: individual, family, community, workplace, health system, and policy-related. The common individual barriers were time requirements for BMD, personal dislike of the process, lack of knowledge, insufficient milk, negative opinions, and lack of information. Family stigma, negative rumors, less educated family members, and illness of a family member were identified as family-related barriers. Community-related barriers include cultural or religious unacceptable practices, societal taboos, and distance to milk banks. The major barriers identified in relation to the health system were lack of practical and psychological support, lack of information, storing and transportation issues, lack of knowledge among HCWs, and logistical challenges of creating a milk lab. The common work-related barriers were the lack of adequate time, philosophical objections, and incomprehension at returning to work. Policy-related barriers identified include the need for hygiene requirements, donation costs, and lack of standardized guidelines. Making the donation process faster, providing pick-up services for donors, and community education and male partner engagement regarding breast milk donation could help to boost the acceptability of breast milk donation.

Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India.

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes.

Contextual factors influencing the urban mobility infrastructure interventions and policies for older adults in low- and middle-income countries: a realist review.

Transportation is among the key aspects that influence active ageing. This realist review intends to understand the mechanisms of urban mobility infrastructure interventions and policies in low- and middle-income countries for older adults and to identify factors, which influenced the success or failure of interventions. We followed the steps suggested by Pawson and colleagues for a realist review. Electronic databases were searched from inception until August 2020. Studies were screened based on titles, abstracts and full text. The quality of included studies was assessed based on rigour and relevance. The evidence was obtained from 36 articles with diverse study designs conducted in 36 low- and middle-income countries. Findings were validated through stakeholder consultations from three low- and middle-income countries. Of the various individual factors identified, behaviour change communication interventions were low-cost, had a long-term impact and were efficient in increasing awareness among users to improve safety, social inclusion and about transport schemes for older adults. Improved transport infrastructure resulted in a shift from private to public transportation. For a sustainable urban transport infrastructure, good governance and involvement of stakeholders for planning and implementing transport interventions were considered necessary. Lack of evaluation, experience of transport planners, and inter-sectoral coordination were key challenges to successful interventions. The review highlighted a lack of older adult-specific transportation policies, and gender-targeted interventions for older women, suggesting a need for interventions and policies based on the contextual factors existing in a region.

A mixed-methods systematic review on barriers to exclusive breastfeeding.

INTRODUCTION: The World Health Organization recommends exclusive breastfeeding for every newborn during the first 6 months of life, yet women come across various challenges to continuing it. AIM: This systematic review was intended to identify barriers to exclusive breastfeeding among mothers. METHODS: MEDLINE, Cumulative Index to Nursing and Allied health literature, ProQuest, Web of Science and Scopus databases were searched from January 1990 to October 2017. The systematic review included quantitative, qualitative and mixed-methods studies to identify barriers to exclusive breastfeeding among mothers of reproductive age with an infant aged between 0 and 12 months. All studies were screened based on titles, abstracts and full text by two reviewers independently. The methodological quality of included studies was assessed using appropriate tools. Of the 9737 eligible records, 44 studies were included for analysis. Classification of barriers to exclusive breastfeeding was adopted from the conceptual framework of factors affecting breastfeeding practices given by Hector and colleagues. RESULTS: In total 32 barriers were grouped under individual, group and society level factors. Meta-analysis indicated that mothers who smoked had 2.49 times more odds of not exclusively breastfeeding than non-smoking mothers and mothers who had undergone caesarean section had 1.69 times more risk of cessation of exclusive breastfeeding than mothers who have had a vaginal childbirth. CONCLUSION: The systematic review revealed a complex interplay of various barriers related to exclusive breastfeeding. It is recommended that context-specific strategies should be designed in accordance with barriers existing in a region or country.

Developing an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries: a protocol for realist synthesis.

BACKGROUND: Mobility, one of the basic daily activities, helps in carrying out routine work, which contributes to people's well-being. A lack of friendly and accessible infrastructure may act as a barrier, which limits older adults' contributions and participation in society. Hence, it is important to have an enabling environment for older adults to carry out their activities independently at ease. There is ample research evidence about effective interventions on urban mobility infrastructures, but there is a lack of evidence regarding what works, for whom, and in what circumstances. Hence, there is a need to identify the contextual factors for different regions to design region-specific interventions. The aim of this realist synthesis is to develop an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries. METHODS: A realist review will be undertaken using the following process: (1) development of a program theory, (2) search strategy and information sources, (3) study selection and appraisal, (4) data extraction, and (5) data synthesis. In addition to searching grey literature and contacting authors, we will search (since inception) multiple electronic databases such as PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Studies will be included based on their ability to provide data that evaluates some aspect of the program theory. Two independent reviewers will screen and extract data from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome that explains how safe and accessible urban mobility infrastructures for older adults implemented in low- and middle-income countries translate to better health outcomes. The findings will be reported according to Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidelines. DISCUSSION: This realist review will help to develop a framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries. The results of this study will support evidence-based decision-making on urban mobility systems and will be of interest to various stakeholders. Dissemination will be done through conference presentations, policy briefs, media, and peer-reviewed journals. Implications for future research will be discussed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020168020.