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Putting Culture into Prehospital Emergency Care: A Systematic Narrative Review of Literature from Lower Middle-Income Countries

Published online by Cambridge University Press:  27 August 2019

Thanh Tam Tran Open the ORCID record for Thanh Tam Tran [Opens in a new window] ,
Janice Lee ,
Adrian Sleigh  and
Cathy Banwell
Thanh Tam Tran*
Affiliation:
National Centre for Epidemiology & Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
Janice Lee
Affiliation:
School of Regulation and Global Governance (RegNet), ANU College of Asia & the Pacific, The Australian National University, Canberra, ACT, Australia
Adrian Sleigh
Affiliation:
National Centre for Epidemiology & Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
Cathy Banwell
Affiliation:
National Centre for Epidemiology & Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
*
Correspondence: Thanh Tam Tran National Centre for Epidemiology & Population Health Building 62 Mills Road Canberra ACT 2601, Australia E-mail: tam.tran@anu.edu.au
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Abstract

Background:

Prehospital emergency care is cost-effective for improving morbidity and mortality of emergency conditions. However, such care has been discounted in the public health system of many lower middle-income countries (LMICs). Where it exists, the Emergency Medical Service (EMS) system is grossly inadequate, unpopular, and misrepresented. Many EMS reviews in developing countries have identified systemic problems with infrastructure and human resources, but they neglected impacts of sociocultural factors. This study examines the sociocultural dimensions of LMICs’ prehospital emergency systems in order to improve the quality and impact of emergency care in those countries.

Methods:

Qualitative studies on EMS systems in LMICs were systematically reviewed and analyzed using Kleinman’s health system theory of folk, popular, and professional health sectors. Also, the three-delay model of emergency care – seeking, reaching, and receiving – provided a guiding framework.

Results:

The search yielded over 3,000 papers and the inclusion criteria eventually selected 14, with duplicates and irrelevant papers as the most frequent exclusion. Both user and provider experiences with emergency conditions and the processes of prehospital care were described. Sociocultural factors such as trust and beliefs underlay the way emergency care was experienced. Attitudes of family and community shaped service-seeking behaviors. Traditional medicine was often the first point of care. Private vehicles were the main transportation for accessing care due to distrust and misunderstanding of ambulance services.

Conclusion:

The findings led to the discussion on how culture is woven into the patients’ pathway to care, and the recommendation for any future development to place a far greater emphasis on this aspect. Instead of relying purely on the biomedical sector, the health system should acknowledge and show respect for popular knowledge and folk belief. Such strategies will improve trust, facilitate information exchange, and enable stronger healer-patient relationships.

Keywords

EMSLMICsprehospital carequalitative reviewsystematic review
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 5 , October 2019 , pp. 510 - 520
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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