Mapping of person-centred sexual and reproductive health interventions at primary healthcare settings: An umbrella review

This umbrella review synthesizes findings from 21 global reviews to map person-centred sexual and reproductive health interventions in primary care, identifying five key thematic strategies that primarily enhance autonomy, dignity, and communication while highlighting the need for more explicit evaluation and holistic integration of person-centred components in future initiatives.

The Gist

Imagine your local primary healthcare clinic as a busy train station. For a long time, the trains (medical services) ran on a strict, rigid schedule. If you needed to go to a specific destination (like family planning or cancer screening), you had to follow the exact path the station master told you, often without much say in the route or the stops you made.

This paper is like a super-map created by a team of explorers who gathered 21 different travel guides (research reviews) from around the world between 2016 and 2024. Their goal? To see how we can turn that rigid train station into a personalized concierge service where every passenger (woman or girl) feels respected, heard, and in control of their own journey.

Here is what they found, broken down into simple ideas:

1. The Big Picture: What is "Person-Centred" Care?

Think of "person-centred" care as the difference between a fast-food drive-thru and a chef cooking a custom meal.

• The Old Way (Drive-thru): "Here is your standard burger. Eat it quickly. Next!" (This is just treating the illness).
• The New Way (Custom Chef): "What do you feel like? Do you have allergies? How do you want it prepared? Let's make this meal work for your life." (This is respecting your autonomy and dignity).

The researchers looked at how clinics are trying to become more like that custom chef.

2. The Five Tools in the Toolkit

The map revealed five main "tools" or strategies that clinics are using to make care more personal:

• 🛠️ Interactive Decision Tools (The GPS Navigator): Instead of a doctor just pointing at a map, these are digital tools or counseling sessions that help patients plot their own course. It's like having a GPS that asks, "Do you want the scenic route or the fast route?" and lets you choose.
• 📋 Provider Prompts (The Friendly Reminder): These are little checklists or digital nudges for the doctors. Imagine a waiter who remembers you always order water with your meal, not because they are forced to, but because they are programmed to care about your specific needs.
• 📱 Remote/Digital Channels (The Delivery App): Getting health info or advice through your phone or computer, so you don't have to stand in a long line at the station. It brings the care to your living room.
• 🤝 Integrated Services (The All-in-One Travel Hub): Instead of having to take three different buses to see three different specialists, this strategy puts everything (family planning, cancer checks, HIV support) in one friendly building so you don't get lost.
• 🗣️ Peer Navigation (The Local Guide): Using people from the community who have been through similar experiences to guide others. It's like having a local tour guide who knows all the shortcuts and makes you feel safe because they've walked the path before.

3. What's Working and What's Missing

The explorers found that these new tools are great at boosting Autonomy (giving you the steering wheel), Dignity (treating you with respect), and Communication (talking with you, not at you).

However, they noticed some parts of the journey were still a bit rough:

• Trust: Sometimes, the relationship between the passenger and the driver still feels a bit shaky.
• Social Support: The station doesn't always have enough "travel buddies" to help you along the way.
• The Environment: Sometimes the waiting room still feels cold and clinical, rather than warm and welcoming.

The Bottom Line

The paper concludes that while clinics are starting to build these amazing "custom meal" experiences and are using cool new tech and community guides, they aren't quite there yet.

To truly succeed, future clinics need to make sure that every single step of the journey—from the moment you walk in to the moment you leave—is designed around you, the person. It's about shifting from a system that just treats bodies to a system that cares for whole human beings, ensuring women and girls feel safe, respected, and in the driver's seat of their own health.

Technical Summary

Technical Summary: Mapping of Person-Centred Sexual and Reproductive Health Interventions at Primary Healthcare Settings

1. Problem Statement
Sexual and reproductive health (SRH) is a fundamental pillar of primary healthcare (PHC). However, there is a critical need to advance person-centred SRH to ensure gender equality, uphold women's autonomy, and guarantee high-quality care that respects individual needs. While various interventions exist globally, there is a lack of synthesized evidence regarding how these interventions are currently mapped, implemented, and evaluated specifically within PHC settings. The challenge lies in identifying which interventions effectively promote person-centredness (defined by domains such as autonomy, dignity, and communication) and recognizing gaps where these core values are under-addressed.

2. Methodology
This study employed an umbrella review design to synthesize existing systematic and other types of reviews.

• Search Strategy: A comprehensive search was conducted across five bibliometric databases covering the period from 2016 to 2024.
• Inclusion Criteria: Reviews were selected if they focused on SRH interventions in PHC settings that aimed to enhance women's autonomy and referred to (either explicitly or implicitly) person-centred care.
• Selection Process: Two researchers independently performed screening, data extraction, and quality appraisal of eligible reviews to minimize bias.
• Data Synthesis: Thematic analysis was used to identify patterns in intervention types and their alignment with person-centred care domains.

3. Key Contributions

• Comprehensive Synthesis: The review consolidates findings from 21 eligible reviews (comprising 12 scoping, 7 systematic, 1 integrative, and 1 narrative review) out of an initial pool of 1,300 identified studies.
• Geographic and Thematic Scope: It provides a global perspective, covering interventions in high-income countries (7 reviews), low- and middle-income countries (6 reviews), and global contexts (8 reviews). It addresses diverse SRH topics including family planning, STIs/HIV, and breast/cervical cancer.
• Thematic Framework: The study establishes a five-theme framework for categorizing person-centred SRH interventions, offering a structured way to understand current delivery modes.
• Gap Identification: It critically highlights the discrepancy between interventions that claim to be person-centred and those that explicitly measure or evaluate person-centredness, noting that most reviews only inferred person-centredness rather than explicitly referring to it.

4. Results
The synthesis identified five primary themes characterizing current interventions:

1. Interactive decision- and counselling-support tools: Mechanisms to facilitate shared decision-making.
2. Provider-initiated clinical prompts/support: Systems to guide healthcare workers in delivering person-centred care.
3. Remote/digital information channels: Utilization of technology to disseminate information and support.
4. Integrated service delivery and accessibility strategies: Approaches to streamline services and reduce barriers to access.
5. Social/peer-led navigation: Community-based support systems to guide patients through the healthcare system.

Alignment with Person-Centred Domains:

• Well-Addressed: The interventions predominantly focused on autonomy, dignity, and communication.
• Under-Addressed: Significant gaps were found regarding trust, social support, and the facility environment, indicating these areas require more attention in future designs.

5. Significance
This paper underscores a positive shift in SRH care towards models that are more responsive, accessible, and respectful. It demonstrates that innovation in delivery modes is occurring globally. However, the review concludes that the field is hindered by a lack of explicit evaluation of person-centredness. To achieve truly holistic care for women and girls, future interventions must move beyond implicit assumptions and intentionally incorporate, measure, and optimize person-centred components. This study serves as a foundational map for policymakers and researchers to prioritize under-served domains (trust, environment) and standardize the evaluation of person-centred outcomes in PHC.