Community Health Nurses in Low‐ and Middle‐Income Countries: A Systematic Integrative Review of Roles, Barriers, and Improvement Perspectives

AIM: This review identifies the roles, barriers, and improvement strategies for community health nurses in low- and middle-income countries. BACKGROUND: Community health nurses play a vital role in strengthening primary health care. Their contribution to improving health systems is crucial in countries where access to care remains a significant challenge, particularly in remote areas. Nevertheless, their practices are often hampered by systemic barriers that diminish the effectiveness and recognition of their contributions. METHODS: A systematic integrative review using the Whittemore and Knafl approach and conforming to PRISMA guidelines was conducted using the PubMed, Scopus, Web of Science, and CINAHL databases for studies published from 2014 to March 2025. Methodological quality was assessed with design-appropriate checklists. The research protocol was registered in PROSPERO (CRD420251069882). RESULTS: Out of 1047 records screened, 22 studies met the inclusion criteria. A thematic synthesis revealed three main themes relating to community health nurses: areas of practice (health promotion and prevention, clinical/supportive care, coordination, and community empowerment); barriers at organizational, sociocultural, and policy levels. DISCUSSION: They face multifaceted constraints that limit their effectiveness, yet evidence shows that targeted investments in training, infrastructure, and community collaboration can enhance their role in delivering equitable healthcare CONCLUSION: Community health nurses are critical actors in the health system but are often underrecognized due to structural, educational, cultural, and policy-related barriers. IMPLICATIONS FOR NURSING: Investing in community health nurses' capacity and visibility can improve care access and continuity, especially in underserved areas. IMPLICATIONS FOR HEALTH POLICY: National policies should define community health nurses' roles, improve working conditions, and promote leadership and regulatory recognition to advance universal health coverage goals.