Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review

Abstract

Background: Women with abnormal uterine bleeding (AUB) experience barriers to accessing healthcare services. Objectives: To identify and describe the evidence on interventions to improve healthcare access of women with AUB. Search strategy: A systematic search of databases including Medline, CINAHL, EMBASE, Scopus, and Cochrane register for clinical trials on February 26, 2021. Selection criteria: Studies including women with AUB and investigating an intervention to improve access at the levels of individual patient, community, organization, health system, or medical education. Data collection and analysis: Data extraction and descriptive analysis of the country, study design, settings, participant characteristics, intervention, outcome measures, and key findings. Main results: We identified 20 studies and most interventions (13 studies) targeted organizational changes. Creating a multidisciplinary team, bringing services together and developing a care pathway improved the availability of services. Management of AUB in an outpatient setting improved the affordability. The use of decision aids improved patient engagement in consultations. There is a lack of interventions at an individual or community level targeting health literacy, health beliefs, social acceptability, and opportunity to reach and pay for services. Conclusions: Community-based culturally-adapted interventions focusing on access to women with different socio-economic and cultural backgrounds should be investigated.