{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:01:14Z","timestamp":1782907274796,"version":"3.54.5"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,3,10]],"date-time":"2016-03-10T00:00:00Z","timestamp":1457568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Cure International UK"},{"name":"UK Department for International Development"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To conduct a systematic synthesis of previous research to identify factors that affect treatment\u2010seeking for clubfoot and community\u2010level interventions to improve engagement in low\u2010 and middle\u2010income counties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search of five databases was conducted, and articles screened using six criteria. Quality was appraised using the Critical Appraisal Skills Programme checklist. Eleven studies were identified for inclusion. Analysis was informed by a social ecological model, which specifies five inter\u2010related factors that may affect treatment\u2010seeking: intrapersonal, interpersonal, institutional, community or socio\u2010cultural factors and public policy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intrapersonal barriers experienced were a lack of income and additional responsibilities. At the interpersonal level, support from fathers, the extended family and wider community affected on treatment\u2010seeking. Institutional or organisational factors included long distances to treatment centres, insufficient information about treatments and challenges following treatment. Guardians\u2019 beliefs about the causes of clubfoot shaped behaviour. At the level of public policy, two\u2010tiered healthcare systems made it difficult for some groups to access timely care. Interventions to address these challenges included counselling sessions, outreach clinics, brace recycling and a range of education programmes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study identifies factors that affect access and engagement with clubfoot treatment across diverse settings and strategies to address them.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12684","type":"journal-article","created":{"date-parts":[[2016,2,20]],"date-time":"2016-02-20T15:32:01Z","timestamp":1455982321000},"page":"570-589","source":"Crossref","is-referenced-by-count":22,"title":["What factors affect patient access and engagement with clubfoot treatment in low\u2010 and middle\u2010income countries? Meta\u2010synthesis of existing qualitative studies using a social ecological model"],"prefix":"10.1111","volume":"21","author":[{"given":"Sarah","family":"Drew","sequence":"first","affiliation":[{"name":"Oxford NIHR Musculoskeletal Biomedical Research Unit University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Lavy","sequence":"additional","affiliation":[{"name":"Oxford NIHR Musculoskeletal Biomedical Research Unit University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Gooberman\u2010Hill","sequence":"additional","affiliation":[{"name":"School of Clinical Sciences University of Bristol Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2318-9"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.662260"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.2106\/00004623-198567070-00008","article-title":"Complete subtalar release in club feet. 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