Background: Tobacco is consumed by two-thirds of individuals with severe mental illness (SMI). Despite a high tobacco-related disease burden, there is a lack of evidence-based cessation interventions for individuals with SMI living in low- and middle-income countries. This study aims to evaluate the feasibility and acceptability of a culturally adapted behavioural intervention for tobacco cessation (SCIMITAR-SA) delivered in mental health services in Bangladesh, India, and Pakistan. Methods: A two-arm, parallel-group, individually randomised, multi-country feasibility trial will be conducted across six mental health facilities in urban centres. All trial participants will receive Very Brief Advice (VBA) and an educational leaflet from their clinical team. Additionally, those in the intervention arm will receive up to seven structured behavioural support sessions. Salivary cotinine and anabasine will be used to biochemically verify abstinence at seven months post-randomisation. Quantitative outcomes will assess feasibility of conducting a definitive trial, including recruitment and retention rates, session attendance, completeness of baseline assessments and outcome measures at four and seven months and use of health resources. An embedded process evaluation will explore the feasibility and acceptability of trial processes, and of the delivery and receipt of the VBA and SCIMITAR-SA interventions. Economic outcomes will assess the feasibility of collecting cost and resource-use data to inform a future definitive trial. Discussion: The SCIMITAR-SA trial will provide essential evidence on the feasibility of delivering culturally adapted cessation support for people with SMI in South Asia and inform scalable integration into routine psychiatric care across low- and middle-income settings. Registration: ISRCTN registry (ISRCTN91038721)

Integrated Behavioural Activation and physical activity interventions have the potential to tackle depression and diabetes multimorbidity. However, such interventions, developed in high-income countries, may need to be adapted and contextualized to be appropriate for use in low and middle-income countries. The objective of this study was to adapt an Integrated Behavioural Activation and physical activity intervention to tailor it for women with depression and type 2 diabetes mellitus living in Pakistan. Two co-design informed workshops with key stakeholders (people with depression and type 2 diabetes mellitus, carers, healthcare workers, and social workers) were conducted. The purpose of workshop 1 was to identify facilitators and barriers to the delivery of the original Integrated Behavioural Activation and physical activity intervention (BAcPAc) intervention as per the domains of the Bernal cultural adaptation framework (language, persons, metaphors, content, concepts, goals, methods, context). Based on the findings of workshop 1, changes were made to the original intervention. Stirman’s adaptation classification was used to map the changes. In workshop 2, participants’ feedback was used to refine the contents of the adapted intervention. A total of 21 participants attended workshop 1, while 16 participants attended workshop 2. Barriers and enablers were identified in all domains of the Bernal’s framework. Changes were made in the language, pictures/illustrations, intervention dose and delivery, training intensity, and evaluation measures. This study produced a theoretically informed, culturally adapted Integrated Behavioural Activation and physical activity intervention for women with depression and type 2 diabetes mellitus (BE-ACTIVE) living in Pakistan.

BackgroundContinuous Professional Development is essential for maintaining competency among physical therapists in evolving healthcare systems. Identifying clinicians perceived training needs is crucial for targeted educational programs; however, evidence on factors influencing these needs across professional domains remains limited.ObjectiveThis study was conducted to assess the perceived training needs of physical therapists across multiple professional domains and examine whether demographic and professional characteristics predict these needs.MethodsA cross-sectional survey was conducted among practicing physical therapists from two major provinces of Pakistan. Training needs across research, communication, administration, management, and clinical tasks were assessed using the Hennessy-Hicks Training Needs Analysis questionnaire. Responses were classified as Not Required, No Need, or Need. Multinomial logistic regression examined the effects of gender, experience, position, and specialty, with odds ratios (OR) and 95% confidence intervals (CI) reported.ResultsImportance scores (5.02-6.28) were high, while performance scores (1.91-4.81) were lower, producing notable gaps (0.26-4.37). High training needs were identified in research appraisal, amputation management, health promotion, wheelchair prescription, gait training, and administrative tasks, with the largest gap in administration (4.37). Most competencies showed low gaps, while ICU management was borderline; IPA confirmed priority areas in the "Concentrate Here" quadrant. Regression analysis showed limited predictive effects (p > 0.05), except senior position reducing research training need (OR = 0.111, p = 0.040). Less experienced therapists showed higher need in administration and management domains.ConclusionTraining needs vary across domains and are primarily influenced by experience and role. Early-career therapists require greater support, highlighting the need for targeted professional development and leadership training. HighlightsIn Pakistan, eight out of 30 physical therapy competencies were found to have high training needs.Therapists working with patients, gaps were found in evaluating research, amputees care and clubfoot management, analyzing gait, wheelchairs prescriptions, and administrative skills.Borderline training was needed for skills related to the ICU.Less experienced therapist's revealed greater training requirements in administrative and management domains.The findings revealed necessity for professional growth, curriculum reforms, and national frameworks to standardize competencies and enhance rehabilitation services.

BackgroundIntermittent Hypoxia-Hyperoxia Therapy (IHHT) is a recent, non-invasive method proposed to enhance physiological adaptations and promote recovery in musculoskeletal dysfunctions. However, evidence to guide practice remains limited. This systematic review aims to evaluate the therapeutic effects of IHHT on pain and health outcomes in patients with musculoskeletal dysfunctions.MethodsA systematic search was conducted following PRISMA guidelines across MEDLINE, EMCARE, CINAHL, Embase, Scopus, Google Scholar, and Semantic Scholar. Eligible studies included patients with musculoskeletal disorders receiving IHHT compared to usual care or no intervention, with outcomes assessing pain and general health. Cochrane RoB 2.0 tool and the PEDro scale evaluated methodological quality, while certainty of the evidence was assessed using the GRADE criteria and review quality with AMSTAR tool.ResultsIn seven trials, recruiting 321 participants, IHHT demonstrated significant improvements in pain (SMD = -0.5, 95% CI = -1.14 to -0.13, p < 0.0001), and general health (MD = -12.06, 95% CI = -16.73 to -7.39, p < 0.00001), reduction in psychological parameters (p < 0.00001), and improved functional mobility (p < 0.006). Moderate heterogeneity was reported across outcomes. Sensitivity and subgroup analysis clarified effect directions. Limitations included small sample size, short follow-up durations, and moderate to high methodological quality across included trials.ConclusionIHHT appears to be well-tolerated and effective intervention for improving pain, general health, severity of dysfunction, and psychological parameters, with no major adverse events reported in the included trials. However, overall certainty remains moderate, highlighting the need for future trials to monitor and report safety outcomes.

Background Integrated Behavioural Activation and physical activity interventions (BAcPAc) have the potential to tackle depression and type 2 diabetes mellitus (T2DM) multimorbidity. However, such interventions, developed in high-income countries, may need to be adapted and contextualized to be appropriate for use in low and middle-income countries. The objective of this study was to adapt a BAcPAc intervention to tailor it for women with depression and T2DM living in Pakistan. Methods Two co-design informed workshops with key stakeholders (people with depression and T2DM, carers, healthcare workers, and social workers) were conducted. The purpose of workshop 1 was to identify facilitators and barriers to the delivery of the original BAcPAc intervention as per the domains of the Bernal cultural adaptation framework (language, persons, metaphors, content, concepts, goals, methods, context). Based on the findings of workshop 1, changes were made to the original intervention. Stirman’s adaptation classification was used to map the changes. In workshop 2, participants’ feedback was used to refine and finalise the contents of the adapted intervention. Results A total of 21 participants attended workshop 1, while 16 participants attended workshop 2. Barriers and enablers were identified in all domains of the Bernal’s framework. Changes were made in the language, pictures/illustrations, intervention dose and delivery, training intensity, and evaluation measures. Conclusion This study produced a theoretically informed, culturally adapted BAcPAc intervention for women with depression and T2DM living in Pakistan.

Objective: To determine the immediate effects of muscle energy technique and conventional physical therapy compared to conventional physical therapy alone on pain and range of motion (ROM) in patients with chronic mechanical neck pain. Methods: A randomized controlled trial (RCT) was conducted at Physical Therapy Department Hayatabad Medical Complex Peshawar from March 2022 to August 2022. A total of 50 subjects, aged 18 to 50 years with non-specific neck pain for ≥ 3 months were included. Participants were randomly assigned to two groups through lottery approach. Participants in experimental group (n=25) received muscle energy technique along with conventional physical therapy while participants in control group (n=25) received conventional physical therapy. Baseline and post-intervention (immediately after the session) neck pain intensity and neck ranges were measured by Numeric Pain Rating Scale and goniometer respectively. Results: Mean age of participants was 32.30 ± 7.75. Of the 50 participants, 36 (72%) were male while the remaining 14 (28%) participants were female. At baseline, there were no significant differences (P>0.05) between experimental and control groups. However, at post-intervention, there were significant differences in pain intensity (p=0.024), cervical flexion (p<0.001), extension (p=0.003), left rotation (p<0.001), right rotation (p<0.001), left lateral flexion (p=0.027) and right lateral flexion (p<0.001) ROMs between experimental and control groups. Conclusion: Muscle energy technique along with conventional physical therapy is more effective in decreasing neck pain and improving cervical ROM compared to conventional physical therapy alone in individuals with chronic mechanical neck pain. Trial Registration: Iranian Registry of Clinical Trials (Reference No.: IRCT20220209053976N1). doi: https://doi.org/10.12669/pjms.41.5.9601 How to cite this: Hussain G, Arsh A, Rehman F, Khan S. Immediate effects of muscle energy technique on pain and range of motion in patients with chronic non-specific neck pain: A randomized controlled trial. Pak J Med Sci. 2025;41(5):1365-1369. doi: https://doi.org/10.12669/pjms.41.5.9601 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Occupational drivers are at higher risk of psychological distress and musculoskeletal disorders (MSDs) due to their sedentary jobs. However, limited evidence shows how barriers and facilitators affect drivers' physical activity (PA) and how these factors are associated with psychological outcomes and MSDs. This study assessed PA profiles, sitting time, PA-related barriers and facilitators, psychological outcomes, and MSDs among Pakistani drivers and examined associations between these factors. Methods: A cross-sectional study recruited 300 occupational drivers in Pakistan. Data were collected through Qualtrics using validated questionnaires, including the short-form International Physical Activity Questionnaire, Barriers to Being Physically Active Quiz, Physical Activity and Leisure Motivation Scale, Depression Anxiety Stress Scale, and specific disability questionnaires. Descriptive statistics, correlation analyses, and multivariable regression were performed. Results: Findings showed that 5 % had low, 63 % had moderate, and 32 % had high PA levels. Participants engaged in 7.5 +/- 5.8 h of light PA, 3.3 +/- 4.3 h of moderate-to-vigorous PA, and 103.0 +/- 50.8 h of sitting per week. PA barriers (lack of energy, time, and resources) were negatively correlated with PA (r = -0.16 to -0.21, p < 0.01), while physical and psychological conditions were reported as facilitators. Moderate to extremely severe depression (53 %), anxiety (58 %), and stress (41 %) were prevalent, but regression showed no associations with PA. MSD prevalence was 65 %, with low back pain (41 %) being the most common. PA showed a protective effect on overall MSDs and low back pain. Conclusions: Despite moderate to high PA levels, drivers remained sedentary and faced various barriers to PA participation. Workplace interventions addressing PA barriers, mental health, and MSD are needed.

Objective: To determine the effects of submaximal interval training on anthropometric measurements, endurance, and flexibility of lower back and hamstrings in people with sedentary lifestyle. Methods: A quasi-experimental design was employed in this study involving 20 sedentary participants (12 females and eight males mean age: 27.20±8.48. The study conducted at Physical Therapy gym Khyber Medical University Peshawar from January 2019 to June 2019. Over four weeks, participants underwent a submaximal interval training program, comprising treadmill walking or running at 70-80% of their maximum heart rate for one minute, followed by one minute of active recovery conducted three time weekly. Assessments comprised of endurance VO2 max using the Bruce Protocol, flexibility of the lower back extensors and hamstring muscles through the Young Man Christian Association (YMCA) sit and reach test, body mass index (BMI) and waist-hip ratio (WHR). Results: The submaximal interval training intervention yielded significant improvements in endurance VO2 max, (p=0.001), flexibility (p=0.001) and BMI (p=0.016). However, the waist-hip ratio did not show any significant changes, mean pre-score (0.83±0.95) remaining the same in the post-score (0.83±0.93) (p=0.64). Conclusion: The submaximal interval training intervention demonstrated a high level of tolerance, as evidenced by a remarkable adherence rate of 91% among participants. Moreover, this training approach exhibited significant enhancements in various physical parameters. doi: https://doi.org/10.12669/pjms.41.4.10163 How to cite this: Ali I, Darain H, Khan MI, Khattak MI, Arsh A. Effects of submaximal interval training on anthropometric measurements, endurance, and flexibility of lower back and hamstrings in healthy individuals with a sedentary lifestyle. Pak J Med Sci. 2025;41(4):1132-1137. doi: https://doi.org/10.12669/pjms.41.4.10163 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Wheelchair users with poor trunk control and postural abnormalities require additional posture support devices and wheelchair modifications to sit upright. Therefore, this study was conducted to observe the function of wheelchair users in the modified wheelchair and their satisfaction with both the modified wheelchair and intermediate wheelchair service. A descriptive study was conducted, and 14 participants were recruited through consecutive sampling. Post-intervention data were collected from these wheelchair users using the Functioning Every Day with a Wheelchair (FEW) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) questionnaires. The data were analyzed through frequency tables and a two-sample t-test. The scores indicated that wheelchair users functioned well in the modified wheelchairs. The range of FEW was 4.8 to 5.6, respectively, with a mean of 5.15 +/- 0.227, out of a maximum possible score of 6. The QUEST device sub-score was 4.514 +/- 0.2381 and the service sub-score was 4.550 out of a maximum possible score of 5 (SD = 0.3716) indicating that the users were highly satisfied with both the modified wheelchairs and intermediate service provided. Wheelchair users functioned well in the modified wheelchair and expressed a high level of satisfaction with both the modified wheelchair and intermediate wheelchair service provided.

OBJECTIVES:To describe the employment of people with spinal cord injury/disease (SCI/D) and identify employment-associated factors among participating countries in the International Spinal Cord Injury 2024. DESIGN:Cross-sectional, multinational, observational cohort study. SETTING:Community setting with participants from 31 countries representing all 6 World Health Organization regions. PARTICIPANTS:A total of 11,170 working age people (N=11,170) with SCI/D were analyzed. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:International Spinal Cord Injury (InSCI) Community Survey. RESULTS:The majority were men (72.4%), most persons had paraplegia (65.6%), incomplete (57.2%), and traumatic as cause of injury (77.5%). The median age was 45.5 years, the median time since injury was 11 years, and the median total years of education was 12 years. A third of the respondents were engaged in paid work (33.1%). Participants from lower middle-income countries had 59% lower odds (OR=0.413; 95% CI, 0.363-0.469; P<.001) of employment compared with high-income countries. Modifiable factors that positively influence employment included education and receiving vocational rehabilitation. CONCLUSIONS:A major finding of this study is the difference in employment rates and employment factors for people with an SCI/D in high-income countries versus low income countries. Although employment can powerfully facilitate wellbeing in this population, it is heavily influenced by broader socioeconomic factors that vary across countries. Efforts can be targeted toward addressing education and vocational rehabilitation to improve employment of people post-SCI/D.

Understanding how an integrated rehabilitation workforce can be supported and strengthened is crucial to address gaps in access and quality of rehabilitation below tertiary hospitals. We explored how physiotherapists in two provinces in Pakistan perceive enablers and constraints to their rehabilitation performance at individual, workplace, health systems, socio-cultural, and political levels. Using a qualitative approach based on social ecological theories of health-worker performance and semi-structured interviews, 31 in-depth interviews with physiotherapists were conducted at secondary care hospitals in Khyber Pakhtunkhwa and Sindh provinces. Four intersecting themes were generated. (i) The capacity to perform as a rehabilitation professional is mediated by factors operating at different levels of the worker ecology. The experience of these factors has implications for (ii) the livelihoods and wellbeing of rehabilitation workers and (iii) the quality of care these workers perceive is delivered. (iv) Respondents' insightful and diverse suggestions for positive opportunities for change, towards strengthening and expanding integration of rehabilitation services within the health system, have policy and practice implications. Findings suggest an interdependence between context, rehabilitation workers, and the quality of care they deliver. The perspectives of these workers draw attention, beyond staff numbers and distribution, to the real-world challenges of practicing effectively in the context of local and systemic constraints and facilitators. These insights will be valuable to current efforts to integrate rehabilitation into health care settings beyond tertiary hospitals.

Background: Clubfoot or congenital talipes equino varus (CTEV) is a common orthopedic abnormality that is successfully treated by the Ponseti method all over the world. However, the foremost challenging problem to the Ponseti method is relapse. This study aimed to find out prevalence and factors associated with relapse clubfoot treated by the Ponseti technique in Peshawar.

We investigated the effectiveness of interventions provided by traditional healers for common mental disorders (CMDs) together with associated barriers and facilitators. Electronic databases including MEDLINE, APA Psych Info, Allied and Complementary Medicine, Embase, CINAHL, Social Science Citation Index, and Scopus were searched from inception until October 2021. Randomised controlled trials (RCTs) assessing interventions by traditional healers for CMDs and qualitative and mixed-methods studies examining traditional healers and their attendees’ views about the treatment of CMDs by traditional healers were included. Cochrane Risk of Bias Assessment tool (RoB-1) and Critical Appraisal Skills Programme (CASP) were used for the quality assessment of studies. A meta-analysis and thematic synthesis were conducted. Sixteen RCTs (1,132 participants) and 17 qualitative or mixed-methods studies (380 participants) were included. Improvement in symptoms was greater for interventions by traditional healers compared to control groups for both depression and anxiety. Subgroup analyses indicated that only “spiritual passe” interventions showed improvement in depression and anxiety, and participants with co-morbid anxiety and physical conditions showed improvement in anxiety. Facilitators to engaging with interventions by traditional healers were shared faith-based worldview exhibited by traditional healers and their attendees and perceived effectiveness of traditional healing. Stigma and concealing mental illness were found to be barriers not only to formal healthcare but also to traditional healers’ services. Interventions by traditional healers such as “spiritual passe” are effective in improving CMDs. However, evidence is still limited due to the low quality of studies and lack of long-term evidence.

OBJECTIVE To determine the sensitivity and specificity of the clinical diagnostic tests of subacromial impingement syndrome. METHODS The systematic review comprised search on PubMed, PEDro, Cochrane Library and Google Scholar databases. For prospective cohort studies published in peer-reviewed English-language journals without any time limit, at least fully describing one clinical test. Only studies with free full text available were included. Data extracted included sensitivity and specificity for each clinical test, and variations were sorted out by the 3 reviewers by discussion. RESULTS Of the 4137 studies identified, 2951(71.3%) were on PubMed, 119(2.9%) PEDro, 5(0.1%) Cochrane Library and 1062(25.7%) Google Scholar. After screening out all the studies that did not match the detailed inclusion criterion, 3(0.07%) studies were selected for review; 1(33.3%) each done in Spain, Turkey and France. Overall, there were 181 aged 15-82 years; 85(47%) males and 96(53%) females. Supraspinatus palpation test had a sensitivity of 92%, while the modified Neer test had specificity of 95.56% in terms of ruling out subacromial impingement syndrome. CONCLUSIONS Supraspinatus palpation and modified Neer tests were found to be the most effective in the diagnosis of subacromial impingement syndrome.

Background: Physical activity may be effective in alleviating depressive symptoms and improving glycaemic control; however, evidence to guide practice is limited. The current review was conducted to assess the effects of physical activity on depression and glycaemic control in people with type 2 diabetes mellitus.Methods: Randomized controlled clinical trials, from the earliest record to October 2021, which recruited adults with the diagnosis of type 2 diabetes mellitus and compared physical activity with no interventions or usual care for the management of depression were included. The outcomes were change in depression severity and gly-caemic control.Results: In 17 trials, including 1362 participants, physical activity was effective in reducing the severity of depressive symptoms (SMD =-057; 95%CI =-0.80,-0.34). However, physical activity did not have a sig-nificant effect in improving markers of glycaemic control (SMD =-0.18; 95%CI =-0.46, 0.10). Limitations: There was substantial heterogeneity in the included studies. Furthermore, risk of bias assessment showed that most of the included studies were of low quality.Conclusions: Physical activity can effectively reduce the severity of depressive symptoms, nonetheless, it appears that physical activity is not significantly effective in improving glycaemic control in adults who have both type 2 diabetes mellitus and depressive symptoms. The latter finding is surprising, however, given the limited evidence on which this is based, future research on the effectiveness of physical activity for depression in this population should include high quality trials with glycaemic control as an outcome.

Background: The health benefits of physical activity in adults with depression and type 2 diabetes mellitus (T2DM) are well established, however people with depression and T2DM do not generally reach recommended levels of physical activity. Evidence on how to support physical activity in this group is limited; this is particularly the case in low- and middle-income countries. To develop interventions to promote physical activity, it is important first to understand the barriers and facilitators in this population. Methods: A qualitative study was conducted in Pakistan using semi-structured individual interviews. Adults diagnosed with depression and T2DM, their carers, and healthcare staff were included. Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was used to identify themes. Results: Twenty-three participants (12 male; 11 female) were recruited. Five themes were generated from the data: 1) Cultural and religious norms and practices influence physical activity behaviours 2) Availability of resources and the potential for incorporating physical activity into routine life determine physical activity behaviours 3) Available healthcare resources can be used to promote physical activity 4) Patients' individual-level characteristics affect their physical activity behaviours 5) Technology-based interventions may be used to promote physical activity. Conclusion: Individual, cultural, and healthcare system level barriers and facilitators can affect the participation of people with depression and T2DM in physical activity. Religious, social, cultural, domestic, and occupational activities provide opportunities to perform physical activities. Furthermore, harnessing routinely available healthcare resources and the use of technology-based interventions can facilitate the promotion of physical activity.

We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was -2.31 (95% CI, -4.16 to -0.45; p = .015, I-2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.

Objectives: To review published clinical trials which assessed the effects of deep transverse friction massage on pain and range of motion in patients with adhesive capsulitis. Methods: A systematic review was conducted according to PRISMA guidelines. Literature search was performed in MEDLINE, AMED, EMBASE, HMIC, CINAHL, PEDRO, and SPORTDiscus. Two independent reviewers performed screening of the articles retrieved from different databases. Clinical trials published in English language from the earliest record to March 2022 that reported effects of deep transverse friction massage/Cyriax's friction massage on pain and/or range of motion in patients with diagnosis of adhesive capsulitis were included. The Critical Appraisal Skills Programme was used for quality assessment of the included studies. Results: A total of six studies reporting on 226 adhesive capsulitis patients were included in the systematic review. All the six studies were randomized controlled clinical trials. On the Critical Appraisal Skills Programme tool, four of the six studies had a score of 8/11, while the other two studies received a score of 7/11 and 6/11. Out of these six trials, four reported that pain was significantly (P<0.05) improved in the deep transverse friction massage group as compared to the control group. Regarding range of motion outcome, five studies showed that range of motion was significantly (P<0.05) improved in the deep transverse friction massage group while only one study showed non-significant results. Conclusion: It can be concluded that deep transverse friction massage significantly relieves pain and improves the range of motion in individuals with adhesive capsulitis.

BACKGROUND:Low- and middle-income countries (LMICs) are experiencing growing demand for healthcare services yet face a persistent shortage in access to specialist health workers (SHWs). Task shifting is an approach used to address this gap in service provision. Specific healthcare tasks are shifted to other, larger cadres of non-specialist health workers (NSHWs), including lay health workers with SHWs potentially taking on supervisory roles. Previous studies demonstrate that task shifting is both clinically and economically effective, however the impact of task shifting on health workers (HWs) is not fully understood.OBJECTIVE:The aim of this synthesis is to generate new knowledge about what influences HWs perspectives of benefits and costs of engaging in task shifting.METHODS:A qualitative evidence synthesis (QES) of peer-reviewed literature using databases CINAHL, the Cochrane Database of Systematic Reviews, Psych INFO, MEDLINE, EMBASE, Epistimonikos, Web of Science (science and social science citation index), Scopus LILACS, the African Index Medicus and Google Scholar. Eligible studies were those that included qualitative data about HWs perspectives of task shifting in LMICs. Information from eligible studies was extracted into a Google Sheet, and the data gathered were analysed thematically.RESULTS:Fifty-four studies were included in the QES. Results were organised under three themes, 'the cultural environment in which task shifting is employed', 'access to resources for task shifting' and 'alignment with personal values and beliefs, self-efficacy and personal emotional resilience'.CONCLUSION:This is the first review bringing together views about task shifting from the perspective of different cadres of HWs drawn from diverse healthcare, geographical and country settings in LMICs. Task shifting is a complex process which relies upon the active engagement of HWs. Taking into consideration factors that influence HWs perspectives, such as their personal characteristics, preparatory training, and ongoing access to resources, is important for informing how task shifted healthcare initiatives are designed and delivered to successfully widen access to healthcare in LMICs.

Gender inequalities in accessing healthcare services, particularly in low- and middle-income countries (LMICs) are consistently reported in the literature. Financial constraints and greater distance from healthcare facilities are the most reported barriers to the limited accessibility of women to healthcare services in these countries. However, these two barriers are not specific to women as men living in these countries also face these barriers, then why do gender disparities exist in accessing healthcare services? Objective: To explore this question, we conducted this study to identify factors influencing women’s access to healthcare services in LMICs. Methods: A review article was conducted in September 2023. PubMed, CINHAL, EMBASE and HMIC databases were searched. Additional searching was performed in Google Scholar. Qualitative studies published from the earliest record to August 2023 which reported barriers to women’s access to healthcare services in LMICs were included. Results: Results showed that individual-level factors that influence women’s access to healthcare services in LMICs include economic status and knowledge and beliefs, inter-personal level factors include social norms and support from family and friends, community-level factors include support from community members and transportation facilities while system-level factors that influence women’s access to healthcare services include the availability of healthcare services and providers, the role of the medical fraternity, health insurance coverage, availability and implementation of effective policies and evidence-based practice and research. Conclusion: The review identified a wide range of individual, interpersonal, community and system-level barriers that hinder women residing in LMICs from accessing appropriate healthcare services. There is a need to develop cost-effective, culturally appropriate approaches, guidelines, and policies to improve women’s access to healthcare services in LMICs.