Barriers and Facilitators to the Rapid Adaptations of Healthcare Service Delivery during Public Health Emergencies: A Systematic Integrative Review of Literature

Abstract Rapid adaptation of healthcare services during public health emergencies is key in ensuring continuous delivery of essential healthcare services. However, challenges associated with rapid adaptation can lead to disruptions in care delivery, impacting responses to population healthcare needs. To prepare for a prompt future response, it is important to identify and understand the barriers and facilitators influencing rapid adaptation efforts. A systematic integrative review was conducted between March and October 2022, with five healthcare-related databases searched from 2012. Weekly auto-alerts continued until March 2023. The Mixed-Methods Appraisal Tool was used for quality assessment and data extraction conducted using the Consolidated Framework for Implementation Research. Seventeen eligible studies utilised quantitative (10/17, 59%), mixed-methods (4/17, 23%) or qualitative designs (3/17, 18%). Most rapid adaptation in healthcare service delivery happened within 3 months after the World Health Organisation declared Coronavirus disease a pandemic (13/17, 76%), with telehealth being the key rapid adaptation that occurred. Inner setting and process factors served as both barriers and facilitators. Two additional factors not present in the consolidated framework, namely: (1) emergency command and control at the healthcare level and (2) acceptability and resilience, were identified as facilitators to rapid adaptation. This systematic integrative review underscores that while healthcare services rapidly adapted within the initial 3 months of the pandemic, inadequate readiness may have hindered their capacity to respond inclusively, potentially impacting on the sustainability of adapted services. Addressing these issues will support greater preparation for public health emergencies.