Instruments to identify risk factors associated with adverse childhood experiences for vulnerable children in primary care in low- and middle-income countries: A systematic review and narrative synthesis.
Instruments to identify risk factors associated with adverse childhood experiences for vulnerable children in primary care in low- and middle-income countries: A systematic review and narrative synthesis.
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DOI：
10.1371/journal.pgph.0000967
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Chamberlain, Diane
中科院分区：
文献类型：
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作者：
Mwashala, Winfrida;Saikia, Udoy;Chamberlain, Diane
暴露于不良童年经历的弱势儿童在医疗保健和社会福利支持系统中缺乏可见度，特别是在将生物心理社会护理纳入传统医疗护理方面存在延误的国家。本综述旨在识别、评估和总结现有的筛查工具，这些工具用于测量低收入和中等收入国家（LMICs）初级卫生保健（PHC）环境中弱势儿童与不良童年经历（ACE）相关的风险因素。本研究的目标人群是生活贫困和处于极端社会劣势的儿童（05-18岁）。首先，使用系统性综述和荟萃分析首选报告项目（PRISMA）方法进行系统性综述。混合方法的叙述合成分析了用于评估暴露于ACE的弱势儿童的研究和工具。每种工具的质量，有效性和可行性进行了审查，用于与脆弱的儿童在一线临床设置。缺乏合适的风险评估工具来识别LMIC初级卫生保健环境中弱势儿童暴露于ACE的生物心理社会风险因素。在九个确定的工具，从审查的研究，没有发现适合快速识别ACE的影响。这是由于审查的工具存在问题，可能会阻碍其在一线临床环境中快速筛查ACE的应用。这包括工具的追溯性、评估者的决策能力、执行工具的机构能力以及评估生物心理社会层面的个人风险因素的工具能力。因此，目前，缺乏工具，可用于确定生物心理社会风险因素的ACE在脆弱的儿童在初级保健资源有限的设置。需要进一步开发一种快速识别弱势儿童ACE的工具，以便及早识别并转介预防护理、治疗和社会支持服务。
Vulnerable children exposed to Adverse Childhood Experiences (ACEs) are lacking visibility in healthcare and social welfare support systems, particularly in countries where there are delays in integrating biopsychosocial care into traditional medical care. This review seeks to identify, evaluate, and summarise existing screening instruments used in measuring risks factors related to Adverse Childhood Experiences (ACEs) in vulnerable children in Primary Health Care (PHC) settings in low- and middle-income countries (LMICs). The target population in this research is children from age (05–18 years) living in poverty and extreme social disadvantage. First, a systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A mixed-methods narrative synthesis analyzed the studies and instruments used to assess vulnerable children exposed to ACEs. Each instrument was scrutinized for quality, validity, and feasibility for use with vulnerable children in frontline clinical settings. There is a lack of suitable risk assessment instruments to identify biopsychosocial risk factors from exposure to ACEs in vulnerable children in LMIC primary healthcare settings. Among nine identified instruments from the reviewed studies, none were found suitable for rapidly identifying the effects of ACEs. This was due to issues on the reviewed instruments which could hinder their application in the rapid screening of ACEs in frontline clinical settings. This included the, retrospective nature of the instruments, decisional capacity of the rater, institutional capacity in implementation of the instruments and instruments capacity to assess individual risk factors in biopsychosocial dimensions. Therefore, currently, there is lack of instruments that can be used to identify biopsychosocial risk factors of ACEs in vulnerable children in primary care in limited-resource settings. Further development of an instrument for the rapid identification of ACEs in vulnerable children is required for an early recognition and referred for preventive care, treatment, and social support services.