Community Health Nurses in Low- and Middle-Income Countries: A Systematic Integrative Review of Roles, Barriers, and...

Area of Science:

• Global Health
• Nursing Practice
• Health Systems Strengthening

Background:

• Community health nurses are essential for primary healthcare, especially in resource-limited settings.
• Their roles are critical for improving health system access in remote areas.
• Systemic barriers often hinder the effectiveness and recognition of community health nurses' contributions.

Purpose of the Study:

• To identify the roles of community health nurses in low- and middle-income countries.
• To explore the barriers encountered by these nurses.
• To determine strategies for enhancing their practice and impact.

Main Methods:

• A systematic integrative review following PRISMA guidelines.
• Searched PubMed, Scopus, Web of Science, and CINAHL databases (2014-March 2025).
• Included 22 studies after screening 1047 records; assessed methodological quality.

Main Results:

• Community health nurses engage in health promotion, prevention, clinical care, coordination, and community empowerment.
• Identified barriers exist at organizational, sociocultural, and policy levels.
• Thematic synthesis revealed multifaceted constraints impacting their effectiveness.

Conclusions:

• Community health nurses are crucial but often underrecognized due to various barriers.
• Targeted investments in training, infrastructure, and collaboration can enhance their role.
• Improving capacity and visibility of these nurses can advance healthcare access and continuity, particularly in underserved regions.