title: Knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings: a systematic review.
abstract: BACKGROUND
  Adopting technologies such as injection safety devices in healthcare settings can enhance injection safety. Developing guidelines for appropriate adoption of such technologies need to consider factors beyond evidence for their health effects. The objective of this study is to systematically review the published literature for evidence among healthcare workers and patients about knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings.
  
  
  METHODS
  We included both qualitative and quantitative studies conducted with the general public, patients, and healthcare workers, administrators, or policy makers. We searched MEDLINE, EMBASE, CINHAL and CENTRAL. We used a duplicate and independent approach to title and abstract screening, full text screening, data abstraction and risk of bias assessment.
  
  
  RESULTS
  Out of a total of 6568 identified citations, we judged fourteen studies as eligible for this systematic review. All these studies were surveys, conducted with healthcare workers in high-income countries. We did not identify any qualitative study, or a study of the general public, patients, healthcare administrators or policy makers. We did not identify any study assessing knowledge, or values assigned to outcomes relevant to injection safety devices. Each of the included studies suffered from methodological limitations, which lowers our confidence in their findings. Based on the findings of six studies, the injection safety devices were generally perceived as easy to use and as an improvement compared with conventional syringes. Some of these studies reported few technical problems while using the devices. In three studies assessing perceived safety, the majority of participants judged the devices as safe. Two studies reported positive perceptions of healthcare workers regarding patient tolerance of these injection safety devices. One study found that less than half the nurses felt comfortable using the insulin pens. Findings from four studies assessing preference and satisfaction were not consistent.
  
  
  CONCLUSIONS
  This systematic review identified evidence that injection safety devices are generally perceived as easy to use, safe, and tolerated by patients. There were few reports of technical problems while using the devices and some discomfort by nurses using the insulin pens.
authors.affiliation: Lebanese University, Beirut, Lebanon.
authors.forename: Rami
authors.initials: R
authors.lastname: Tarabay
authors.affiliation: American University of Beirut, Beirut, Lebanon.
authors.forename: Rola
authors.initials: R
authors.lastname: El Rassi
authors.affiliation: American University of Beirut, Beirut, Lebanon.
authors.forename: Abeer
authors.initials: A
authors.lastname: Dakik
authors.affiliation: Lebanese University, Beirut, Lebanon.
authors.forename: Alain
authors.initials: A
authors.lastname: Harb
authors.affiliation: Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Rami A
authors.initials: RA
authors.lastname: Ballout
authors.affiliation: Lebanese University, Beirut, Lebanon.
authors.forename: Batoul
authors.initials: B
authors.lastname: Diab
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Selma
authors.initials: S
authors.lastname: Khamassi
authors.affiliation: Department of Internal Medicine, American University of Beirut, Beirut, Lebanon. ea32@aub.edu.lb.|Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, 1107 2020, Beirut, Lebanon. ea32@aub.edu.lb.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ea32@aub.edu.lb.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
mesh_terms: D001291:Attitude of Health Personnel; D005240:Feasibility Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007267:Injections; D057240:Patient Preference; D017060:Patient Satisfaction; D011482:Protective Devices; D036301:Qualitative Research
keywords: Acceptance; HCW; Injection safety devices; Injections; Preferences; Satisfaction