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

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.