{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:36:34Z","timestamp":1785418594983,"version":"3.56.0"},"reference-count":45,"publisher":"AOSIS","issue":"2","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Despite the effectiveness of personal protective equipment (PPE) and physical distancing interventions for COVID-19 infection prevention and control (IPC), low uptake among health and care workers persists.\n\nAim:\u00a0To synthesise evidence from primary qualitative research exploring the perceptions and experiences of health and care workers on the use of PPE and physical distancing in the context of COVID-19.\n\nSetting:\u00a0Healthcare settings including care homes.\n\nMethod:\u00a0An electronic database search was conducted using search terms based on the inclusion criteria, and the search strategy was peer-reviewed by a team of information scientists. Thirty qualitative studies were sampled after eligibility screening independently by two review authors. Synthesis was performed using the thematic synthesis approach. The confidence in each review finding was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations; Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach.\n\nResults:\u00a0Fifteen analytical themes were identified. Health and care workers valued the use of PPE in patient care. The sense of value was heightened by perceived susceptibility to infection with COVID-19, the need to deliver optimal patient care and the desire to protect family members. Service delivery, clinical workflows, the absence of visual cues for spatial separation and physical infrastructure hindered adherence to physical distancing guidelines.\n\nConclusion:\u00a0The gap between IPC guidelines and their implementation is an important health system barrier to PPE use and physical distancing in healthcare settings.\n\nContribution:\u00a0This review provides useful insights on key considerations for planning and implementing IPC in healthcare settings.<\/jats:p>","DOI":"10.4102\/jphia.v16i2.621","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T05:20:36Z","timestamp":1744694436000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Health and care workers\u2019 perceptions of PPE and physical distancing for COVID-19: A qualitative evidence synthesis"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9035-9193","authenticated-orcid":false,"given":"Dachi I.","family":"Arikpo","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qderh61","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Calabar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3231-2821","authenticated-orcid":false,"given":"Afiong O.","family":"Oku","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qderh61","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Calabar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-3570","authenticated-orcid":false,"given":"Okwu A.","family":"Onyema","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qderh61","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Calabar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2406-360X","authenticated-orcid":false,"given":"Edward O.","family":"Odey","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qderh61","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Calabar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0753-3400","authenticated-orcid":false,"given":"Hannah H.","family":"Hurwitz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8458-1794","authenticated-orcid":false,"given":"Jo\u00e3o P.","family":"Toledo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8921-3712","authenticated-orcid":false,"given":"Kathleen","family":"Dunn","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8207-8423","authenticated-orcid":false,"given":"April","family":"Baller","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6252-3793","authenticated-orcid":false,"given":"Helen J.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6144-9413","authenticated-orcid":false,"given":"Martin M.","family":"Meremikwu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qderh61","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Calabar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"ref0","unstructured":"World Health Organization. Infection prevention and control in the context of COVID-19: A guideline [homepage on the Internet]. Geneva: World Health Organization; 2023 [cited 2024 Apr 01]. Available from: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-IPC-guideline-2023.3"},{"key":"ref1","unstructured":"World Health Organization. Infection prevention and control during health care when COVID-19 is suspected [homepage on the Internet]. Interim guidance. 2020 [cited 2024 Apr 01]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/331495\/WHO-2019-nCoV-IPC-2020.3-eng.pdf?sequence=1"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Mutambudzi M, Niedzwiedz C, Macdonald EB, et al. Occupation and risk of severe COVID-19: Prospective cohort study of 120 075 UK Biobank participants. Occup Environ Med. 2021;78(5):307. https:\/\/doi.org\/10.1136\/oemed-2020-106731","DOI":"10.1136\/oemed-2020-106731"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Stephen RI, Olumoh J, Tyndall J, Adegboye O. Risk factors for COVID-19 infection among healthcare workers in North-East Nigeria. Healthcare. 2022;10(10):1919. https:\/\/doi.org\/10.3390\/healthcare10101919","DOI":"10.3390\/healthcare10101919"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Neuwirth MM, Mattner F, Otchwemah R. Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients. Antimicrob Resist Infect Control. 2020;9(1):199. https:\/\/doi.org\/10.1186\/s13756-020-00864-w","DOI":"10.1186\/s13756-020-00864-w"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Abed Alah M, Abdeen S, Selim N, et al. Compliance and barriers to the use of infection prevention and control measures among health care workers during COVID-19 pandemic in Qatar: A national survey. J Nurs Manag. 2021;29(8):2401\u20132411. https:\/\/doi.org\/10.1111\/jonm.13440","DOI":"10.1111\/jonm.13440"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Mohamad N, Pahrol MA, Shaharudin R, et al. Compliance to infection prevention and control practices among healthcare workers during COVID-19 pandemic in Malaysia. Front Public Health. 2022;10:878396. https:\/\/doi.org\/10.3389\/fpubh.2022.878396","DOI":"10.3389\/fpubh.2022.878396"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Biesty L, Meskell P, Glenton C, et al. A QuESt for speed: Rapid qualitative evidence syntheses as a response to the COVID-19 pandemic. Syst Rev. 2020;9(1):256. https:\/\/doi.org\/10.1186\/s13643-020-01512-5","DOI":"10.1186\/s13643-020-01512-5"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Garritty C, Gartlehner G, Nussbaumer-Streit B, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol. 2021;130:13\u201322. https:\/\/doi.org\/10.1016\/j.jclinepi.2020.10.007","DOI":"10.1016\/j.jclinepi.2020.10.007"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Houghton C, Meskell P, Delaney H, et al. Barriers and facilitators to healthcare workers\u2019 adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582. https:\/\/doi.org\/10.1002\/14651858.CD013582","DOI":"10.1002\/14651858.CD013582"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):181. https:\/\/doi.org\/10.1186\/1471-2288-12-181","DOI":"10.1186\/1471-2288-12-181"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71","DOI":"10.1136\/bmj.n71"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Booth A. Clear and present questions: Formulating questions for evidence based practice. Libr Hi Tech. 2006;24(3):355\u2013368. https:\/\/doi.org\/10.1108\/07378830610692127","DOI":"10.1108\/07378830610692127"},{"key":"ref13","unstructured":"The EndNote Team. EndNote (Version EndNote X9) [64 bit]. Philadelphia, PA: Clarivate; 2013."},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Suri H. Purposeful sampling in qualitative research synthesis. Qual Res J. 2011;11(2):63\u201375. https:\/\/doi.org\/10.3316\/QRJ1102063","DOI":"10.3316\/QRJ1102063"},{"key":"ref15","unstructured":"EPOC. EPOC Qualitative Evidence Synthesis guidance on when to sample and how to develop a purposive sampling frame. EPOC resources for review authors [homepage on the Internet]. Cochrane Effective Practice and Organisation of Care (EPOC). [cited 2024 Apr 01]. Available from: https:\/\/epoc.cochrane.org\/sites\/epoc.cochrane.org\/files\/public\/uploads\/Resources-forauthors2017\/qes_guidance_on_sampling.pdf"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Ames H, Glenton C, Lewin S. Purposive sampling in a qualitative evidence synthesis: A worked example from a synthesis on parental perceptions of vaccination communication. BMC Med Res Methodol. 2019;19(1):26. https:\/\/doi.org\/10.1186\/s12874-019-0665-4","DOI":"10.1186\/s12874-019-0665-4"},{"key":"ref17","unstructured":"Critical Appraisal Skills Programme. Critical Appraisal Skills Programme (CASP) \u2013 Qualitative studies checklist [homepage on the Internet]. 2018 [cited 2024 Apr 05]. Available from: https:\/\/casp-uk.net\/checklists\/casp-qualitative-studies-checklist.pdf"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):45. https:\/\/doi.org\/10.1186\/1471-2288-8-45","DOI":"10.1186\/1471-2288-8-45"},{"key":"ref19","unstructured":"Miles MB, Huberman AM, Salda\u00f1a J. Qualitative data analysis: A methods sourcebook. 3rd ed. Thousand Oaks, CA: Sage; 2014."},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Harden A. Applying systematic review methods to studies of people\u2019s views: An example from public health research. J Epidemiol Community Health. 2004;58(9):794\u2013800. https:\/\/doi.org\/10.1136\/jech.2003.014829","DOI":"10.1136\/jech.2003.014829"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Noyes J, Booth A, Flemming K, et al. Cochrane Qualitative and Implementation Methods Group guidance series \u2013 Paper 3: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. J Clin Epidemiol. 2018;97:49\u201358. https:\/\/doi.org\/10.1016\/j.jclinepi.2017.06.020","DOI":"10.1016\/j.jclinepi.2017.06.020"},{"key":"ref22","unstructured":"The SURE Collaboration. SURE guides for preparing and using evidence-based policy briefs 5. Identifying and addressing barriers to implementing policy options. Version 2.1 [homepage on the Internet]. 2011 [cited 2024 Apr 05]. 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Barriers to using personal protective equipment by healthcare staff during the COVID-19 outbreak in China. Medicine (Baltimore). 2020;99(48):e23310. https:\/\/doi.org\/10.1097\/MD.0000000000023310","DOI":"10.1097\/MD.0000000000023310"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Sivaraman G, Lakshmanan J, Paul B, et al. \u2018Shifting from anxiety to the new normal\u2019: A qualitative exploration on personal protective equipment use by otorhinolaryngology health-care professionals during COVID-19 pandemic. Niger Postgrad Med J. 2022;29(2):110\u2013115. https:\/\/doi.org\/10.4103\/npmj.npmj_10_22","DOI":"10.4103\/npmj.npmj_10_22"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Sharma M, Sharma D, Sharma AK, Mohanty A, Khapre M, Kalyani CV. Barriers faced by health-care workers in use of personal protective equipment during COVID pandemic at tertiary care hospital Uttarakhand, India: A qualitative study. J Educ Health Promot. 2022;11:74. https:\/\/doi.org\/10.4103\/jehp.jehp_406_21","DOI":"10.4103\/jehp.jehp_406_21"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Setiawan HW, Pratiwi IN, Nimah L, et al. Challenges for healthcare workers caring for COVID-19 patients in Indonesia: A qualitative study. Inq J Health Care Organ Provis Financ. 2021;58:004695802110602. https:\/\/doi.org\/10.1177\/00469580211060291","DOI":"10.1177\/00469580211060291"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Goodarzi A, Khodaveisi M, Abdi A, Salimi R, Oshvandi K. Healthcare providers\u2019 experiences in hospital resuscitation of patients with COVID-19: A qualitative study. BMC Nurs. 2022;21(1):238. https:\/\/doi.org\/10.1186\/s12912-022-01020-y","DOI":"10.1186\/s12912-022-01020-y"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Venesoja A, Gr\u00f6nman K, Tella S, et al. Healthcare workers\u2019 experiences and views of using surgical masks and respirators, and their attitudes on the sustainability: A semi-structured survey study during COVID-19. Nurs Rep. 2021;11(3):615\u2013628. https:\/\/doi.org\/10.3390\/nursrep11030059","DOI":"10.3390\/nursrep11030059"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Ribeiro E, Ferreira \u00c2, Cardoso C, Queiroz R, Silva V. Face-to-face clinical practice under COVID-19 pandemic: How psychotherapists describe their experiences. Front Psychol. 2021;12:726439. https:\/\/doi.org\/10.3389\/fpsyg.2021.726439","DOI":"10.3389\/fpsyg.2021.726439"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Ferrari G, Dobrina R, Buchini S, Rudan I, Schreiber S, Bicego L. The impact of personal protective equipment and social distancing on communication and relation between nurses, caregivers and children: A descriptive qualitative study in a maternal and child health hospital. J Clin Nurs. 2021;00:1\u201312. https:\/\/doi.org\/10.1111\/jocn.15857","DOI":"10.1111\/jocn.15857"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Romeu-Labayen M, Tort-Nasarre G, Alvarez B, et al. Spanish nurses\u2019 experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal. J Clin Nurs. 2021;31(15\u201316):2154\u20132166. https:\/\/doi.org\/10.1111\/jocn.16031","DOI":"10.1111\/jocn.16031"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Ozdemir Koken Z, Savas H, Gul S. Cardiovascular nurses\u2019 experiences of working in the COVID-19 intensive care unit: A qualitative study. Intensive Crit Care Nurs. 2022;69:103181. https:\/\/doi.org\/10.1016\/j.iccn.2021.103181","DOI":"10.1016\/j.iccn.2021.103181"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Hayirli TC, Stark N, Bhanja A, Hardy J, Peabody CR, Kerrissey MJ. Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care. Int J Qual Health Care. 2021;33(2):mzab069. https:\/\/doi.org\/10.1093\/intqhc\/mzab069","DOI":"10.1093\/intqhc\/mzab069"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Hoernke K, Djellouli N, Andrews L, et al. Frontline healthcare workers\u2019 experiences with personal protective equipment during the COVID-19 pandemic in the UK: A rapid qualitative appraisal. BMJ Open. 2021;11(1):e046199. https:\/\/doi.org\/10.1136\/bmjopen-2020-046199","DOI":"10.1136\/bmjopen-2020-046199"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Markkanen P, Brouillette N, Quinn M, et al. \u2018It changed everything\u2019: The safe home care qualitative study of the COVID-19 pandemic\u2019s impact on home care aides, clients, and managers. 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Infect Control Hosp Epidemiol. 2021;43(4):474\u2013480. https:\/\/doi.org\/10.1017\/ice.2021.154","DOI":"10.1017\/ice.2021.154"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Arikpo DI, Onyema AO, Oku AO, et al. Perceptions and factors influencing uptake of mask and physical distancing in community settings in the context of coronavirus disease 2019: A rapid qualitative evidence synthesis. J Public Health Africa. 2025;16(2), a614. https:\/\/doi.org\/10.4102\/jphia.v16i2.614","DOI":"10.4102\/jphia.v16i2.614"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"LaRue RJ, Morkus P, Laengert S, et al. Navigating performance standards for face mask materials: A custom-built apparatus for measuring particle filtration efficiency. 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