Patient and family engagement in patient safety efforts in low-resource settings: a scoping review

Patient and family engagement in patient safety in low- and lower-middle-income countries (LLMICs) is not well described. This scoping review synthesised the literature to identify key strategies, barriers and enablers of engagement and to explain how patients and families contribute to safety efforts in healthcare settings.

Scoping review following Arksey-O'Malley and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

PubMed, Medline, CINAHL, PsycINFO, Scopus and Web of Science were searched from inception to April 2024.

We included qualitative, quantitative and mixed-methods studies, published in English across all healthcare settings, that met the following criteria: (1) explored the attitudes, perceptions and experiences of patients, families or healthcare providers (HCPs) regarding patient engagement in safety activities; (2) described the participation of patients, caregivers or families in the design, delivery or evaluation of interventions aimed at promoting patient safety in healthcare facilities.

Data were extracted using a standardised charting form, and a narrative synthe.sis was conducted to identify key themes. The National Health Service (NHS) framework for patient engagement in patient safety was applied to categorise forms of engagement (information, involvement and partnership) and levels of engagement (own care, service provider and system) among included studies.

Of 7709 records screened, 36 studies met inclusion criteria. Twenty-three studies explored the perspectives of patients, families and HCPs on patient engagement in safety. Key findings revealed that while patients and families recognised the importance of their roles in safety, unclear role definitions, lack of training and communication barriers limited their participation. HCPs acknowledged the value of patient involvement but identified challenges such as knowledge gaps, time constraints and lack of institutional support. Thirteen studies involved patients and family caregivers in safety improvement initiatives. Most interventions were limited to information sharing, with only two achieving partnership-level engagement. Engagement primarily occurred at the individual and provider levels, with no studies addressing the policy level. Factors influencing engagement were identified at four levels: patient, HCP, system and community.

Despite its potential benefits, the implementation and impact of patient and family engagement in patient safety efforts in LLMICs remain largely unexplored. Most efforts focus on information sharing through educational interventions at the direct care level, with limited involvement of patients and families at the partnership level. To enhance safety outcomes, future initiatives must adopt context-specific strategies that empower patients and families as active partners. Drawing lessons from high-income countries and adapting them to the socio-cultural and infrastructural realities of LLMICs will be crucial for developing scalable, cost-effective and sustainable engagement practices.