Experiences of health professionals towards using mobile electrocardiogram (ECG) technology: A qualitative systematic review.

OBJECTIVES: To identify and explore the experiences of health professionals towards using mobile electrocardiogram (ECG) technology. INTRODUCTION: Mobile technology is increasingly being incorporated into healthcare systems, and when implemented well, has the potential to revolutionise the way in which care is delivered. The uptake of mobile ECG technology enables health professionals to record and transmit ECGs electronically, at the point of care. It is important to explore both the impact of this technology and staff experiences to help understand how readily it is accepted and how effectively it is used in practice. There is a paucity of knowledge and understanding from primary healthcare providers and a lack of qualitative evidence offering insight into the monitoring and use of mobile ECG technology. Therefore, this review adds to the available body of knowledge by giving insight from the perspectives of health professionals on its use. METHODS: TRIP, CINAHL, MEDLINE, Scopus and sources of grey literature were searched for eligible studies. Databases were searched from their inception dates, with a restriction on studies written in English. The results of the search are presented in a PRISMA flow diagram. Two reviewers independently screened studies and assessed methodological quality in accordance with JBI methodology for systematic reviews of qualitative evidence. Data were extracted from the included studies and meta-aggregation methodology adopted to identify categories and create synthesised findings related to the healthcare professionals' experiences. RESULTS: A total of six studies were included, which resulted in 18 findings and five categories. Three synthesised findings were generated: Quick, easy and feasible in both urban and remote settings; Increased accessibility of AF screening opportunities for all; Enhanced support in staff resources, time and technology are required. The level of confidence of synthesised findings varied from low to moderate according to ConQual. CONCLUSIONS: This systematic review synthesised the experiences of healthcare professionals using mobile ECG technology. The methodological quality of the included studies was high, and findings indicated healthcare professionals (HCPs) generally found mobile ECG technology simple, quick, easy to use and non-invasive. Enablers regarding mobile ECG technology were time, workload, and remuneration for improved interoperability with current systems and sustainability for screening long term. Data on the experiences of HCPs came from studies capturing mainly proactive, lower-risk patients; therefore, this review was unable to demonstrate if there are any differences between the experiences of HCPs working in primary care settings, such as GP practices/pharmacies, and those working remotely in the community. This highlights a gap in provision for those patients requiring HCPs to record an ECG in their own home. RELEVANCE TO CLINICAL PRACTICE: The experiences of HCPs towards using Mobile ECG technology in practice is quick, easy and feasible in both urban and remote settings. HCPs and organisations should consider identifying key staff as "change champions" and use change/leadership models to support the integration (with current workflows), transformation, and evaluation of mobile ECG technology in their practice setting. HCPs and providers using mobile ECG technology should ensure it prioritises at-risk individuals and includes the "housebound" population.

Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review.

INTRODUCTION: People who experience homelessness face disproportionately poor reproductive health and adverse pregnancy outcomes, including but not limited to unintended pregnancy, abortion, low birth weight and preterm birth, as well as a higher risk of sexually transmitted infections (STIs). Precarious living conditions are known to contribute to poor uptake and engagement with sexual and reproductive healthcare (SRH) for this population. AIM: To identify and understand the perceived barriers and facilitators for accessing and utilising SRH for people who experience homelessness from their perspective, and the perspective of support staff/volunteers and healthcare professionals. METHODS: Electronic databases and online sources were searched. Two reviewers independently carried out the screening, data extraction, critical appraisal, data synthesis and thematic analysis of findings. RESULTS: Following deduplication and screening, 23 papers/reports were considered eligible for the review. Barriers for people experiencing homelessness to accessing and utilising SRH were identified within the themes of complexity, feelings and knowledge (ie, individual-level factors), as well as patient/provider interaction and healthcare system (ie, organisational factors). Facilitators were identified within all of the above themes except for complexity. CONCLUSIONS: Both population characteristics and attributes of the healthcare system influence access and utilisation of SRH by people experiencing homelessness. Given the complexity of living conditions associated with homelessness, greater efforts to improve access should be placed on healthcare systems and aspects of care delivery. This systematic review highlights current gaps in the literature and provides recommendations for enhancing future research and practice to meet the needs of this vulnerable group more effectively.

Understanding processes of risk and protection that shape the sexual and reproductive health of young women affected by conflict: the price of protection.

BACKGROUND: It is assumed that knowing what puts young women at risk of poor sexual health outcomes and, in turn, what protects them against these outcomes, will enable greater targeted protection as well as help in designing more effective programmes. Accordingly, efforts have been directed towards mapping risk and protective factors onto general ecological frameworks, but these currently do not take into account the context of modern armed conflict. A literature overview approach was used to identify SRH related risk and protective factors specifically for young women affected by modern armed conflict. PROCESSES OF RISK AND PROTECTION: A range of keywords were used to identify academic articles which explored the sexual and reproductive health needs of young women affected by modern armed conflict. Selected articles were read to identify risk and protective factors in relation to sexual and reproductive health. While no articles explicitly identified 'risk' or 'protective' factors, we were able to extrapolate these through a thorough engagement with the text. However, we found that it was difficult to identify factors as either 'risky' or 'protective', with many having the capacity to be both risky and protective (i.e. refugee camps or family). Therefore, using an ecological model, six environments that impact upon young women's lives in contexts of modern armed conflict are used to illustrate the dynamic and complex operation of risk and protection - highlighting processes of protection and the 'trade-offs' between risks. CONCLUSION: We conclude that there are no simple formulaic risk/protection patterns to be applied in every conflict and post-conflict context. Instead, there needs to be greater recognition of the 'processes' of protection, including the role of 'trade-offs' (what we term as 'protection at a price'), in order to further effective policy and practical responses to improve sexual and reproductive health outcomes during or following armed conflict. Focus on specific 'factors' (such as 'female headed household') takes attention away from the processes through which factors manifest themselves and which often determine whether the factor will later be considered 'risk inducing' or protective.