Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

OBJECTIVES: Lay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs. DESIGN: Mixed-method systematic review. DATA SOURCES: Six key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles. ELIGIBILITY CRITERIA: Papers that described discussions with lay informal social network members during symptoms or illness experiences. DATA ANALYSIS AND SYNTHESIS: Quality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies. RESULTS: 13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice. CONCLUSION: Lay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours. PROSPERO REGISTRATION NUMBER: CRD42020205196.