SSM - Health Systems最新文献

{"title":"Performance and challenges of Accredited Social Health Activists (ASHAs) in delivering key Maternal and Newborn Health (MNH) services in India: A systematic review and meta-analyses","authors":"Sukriti Chawla ,&nbsp;Chandan Kumar ,&nbsp;Montu Bose ,&nbsp;Shikha M. Shrivastav","doi":"10.1016/j.ssmhs.2025.100134","DOIUrl":"10.1016/j.ssmhs.2025.100134","url":null,"abstract":"<div><h3>Background</h3><div>Accredited Social Health Activists (ASHAs), a cadre of community health workers in India, have played a significant role in improving key maternal and newborn health (MNH) services since their inception in 2005 under the National Rural Health Mission (NRHM). However, persistent inequalities in the coverage of these health services and the expanding engagement of ASHAs within the health system necessitate a revisit to their performance and the challenges they face. This study synthesizes existing evidence on ASHAs' performance in MNH services.</div></div><div><h3>Methods</h3><div>A comprehensive search of bibliographic databases, including PubMed, Scopus, Embase, and Web of Science, yielded a total of 9140 studies. Of these, 38 studies were included in the systematic review, and 31 in the meta-analyses. Random-effects models were used to estimate the pooled effect size (Relative Risk) of ASHAs in delivering three key MNH services: antenatal care visits, institutional deliveries, and postnatal care.</div></div><div><h3>Findings</h3><div>The meta-analyses suggest that ASHAs have a positive, albeit marginal, impact on improving key MNH services. Qualitative studies revealed both enablers and barriers to ASHA’s performance, which were classified into individual, cultural, and health system-related factors.</div></div><div><h3>Interpretation</h3><div>The study highlights that fostering a supportive environment is crucial for enhancing ASHAs’ impact on MNH service coverage. Given significant interstate disparities, regionally adaptive strategies are required. Additionally, the scope of ASHAs' responsibilities should be periodically reviewed to ensure the provision of holistic and culturally sensitive maternal care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health information sharing between the public and private sectors during Covid in Zambia","authors":"Dell D. Saulnier ,&nbsp;Felix Masiye","doi":"10.1016/j.ssmhs.2025.100136","DOIUrl":"10.1016/j.ssmhs.2025.100136","url":null,"abstract":"<div><div>Information sharing between the public and private sectors of the health system is essential to decision-making during shocks, and understanding the process between sectors can provide information on the health system’s ability to utilize knowledge. The aim of this study was to analyze the process of capturing and registering Covid-19 test information from public and private facilities in Zambia for use in disease surveillance and monitoring. Process mapping was done through document review, key informant interviews, and a workshop to generate information on the process and its challenges. Three pathways for data capture and registration with seven stakeholder groups were identified: tests conducted, test results, and the DHIS2 tracker. The process for sharing information between the public and private sectors was active and functioning, but challenged by fragmentation, limited resources and ownership, and difficulty governing multiple pathways and uses. Unique public-private challenges included an underdefined role for the private sector in public health emergencies and a lack of integration and governance of the private sector in extraordinary circumstances. The findings suggest that implementing a new reporting process for the private sector during a public health crisis was an internal shock itself, which implies that information sharing for decision-making during crises could be improved by engaging and integrating the private sector into emergency preparedness prior to the moment of crisis.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health practitioner regulation and anti-racism: A scoping review","authors":"Patrick Chiu ,&nbsp;Natalie J. Thiessen ,&nbsp;Damilola Iduye ,&nbsp;Samantha Louie-Poon ,&nbsp;Janice Y. Kung ,&nbsp;Kathleen Leslie","doi":"10.1016/j.ssmhs.2025.100108","DOIUrl":"10.1016/j.ssmhs.2025.100108","url":null,"abstract":"<div><h3>Background</h3><div>Racism remains pervasive in healthcare systems, driving inequalities for racialized healthcare professionals and clients. The role of health practitioner regulators is to protect the public; however, their actions or inactions may also perpetuate racism. Though there is increasing recognition of regulators’ role in addressing racism, there is currently no synthesized understanding of existing knowledge on this topic.</div></div><div><h3>Methods</h3><div>A scoping review following JBI guidelines explored the literature on racism and health practitioner regulation. Six databases were searched: Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and ProQuest Dissertations and Theses Citation Index. Leading global regulatory organizations were searched for grey literature.</div></div><div><h3>Findings</h3><div>Fifty-four sources were included in the review, with 57 % categorized as scholarly literature and 43 % as grey literature. While underdeveloped, this scholarship has grown consistently since 2020. Sources were predominantly from the United Kingdom and the United States, followed by Canada, Australia, and New Zealand. Racism and/or racial discrimination can be manifested and perpetuated within regulators’ organizational practices, complaints and conduct processes, licensure requirements, practice standards or guidelines, education program approval or accreditation processes, and continuing competence programs. Health practitioner regulators can create anti-racist healthcare systems by addressing their organizational governance structures and processes and attending to their core regulatory functions.</div></div><div><h3>Conclusions</h3><div>While progress has been made toward anti-racist health practitioner regulation, further critical analysis and empirical evidence are needed to inform effective strategies. Clarifying concepts, collecting race-based data, partnering with racialized groups, and integrating anti-racism into regulatory performance frameworks can drive impactful reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Violence against women is not a public health problem’: Barriers and facilitators to providing health care for survivors of intimate partner violence in Mexico City","authors":"Sophie M. Morse ,&nbsp;Daniela C. Rodríguez ,&nbsp;Erin C. Lentz ,&nbsp;Carolina Dotoreo Soriano ,&nbsp;Ana Jocelyn Mejía Morales ,&nbsp;Claudia Diaz Olavarrieta ,&nbsp;Manuela Colombini","doi":"10.1016/j.ssmhs.2025.100094","DOIUrl":"10.1016/j.ssmhs.2025.100094","url":null,"abstract":"<div><div>Violence against women (VAW) remains an urgent public health crisis globally. In Mexico, 39.9 % of women over age 15 have reported experiencing intimate partner violence (IPV) in their current or past relationships. Although Mexico has made significant progress toward addressing this issue through numerous policies and regulations, the status of implementing those policies is unknown. This study identifies the facilitators of and barriers to providing health services for survivors of IPV in Mexico City at the policy, facility, and individual health care worker (HCW) levels. Seventy-six qualitative interviews were conducted with key informants, including policymakers, facility managers, and health care workers. Data were analyzed thematically and organized across health system levels. We found that the Federal Ministry of Health was not considered a leader in VAW response, and facility managers displayed limited prioritization of VAW. The greatest facilitator of care was having a Specialized Service unit with dedicated staff to support IPV survivors. HCWs reported some knowledge and skills for addressing IPV in patients, but many did not feel prepared, especially for the emotional aspects of care, and burnout was common. A significant barrier to care was HCW’s reluctance to engage with IPV patients or their cases for reasons such as the normalization of violence or hesitance to participate in the justice system. Despite progress towards addressing IPV in Mexico, addressing barriers to service delivery would improve the effectiveness of the health system's response to IPV, ultimately improving health outcomes for survivors of violence.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the concept of access as a critical dimension of universal health coverage in the context of rural communities of Western Province, Zambia","authors":"Cameron B. Chiarot ,&nbsp;Craig R. Janes ,&nbsp;Abu Yousuf Md Abdullah ,&nbsp;Fastone Goma ,&nbsp;Massauso Phiri ,&nbsp;Douglas Singini ,&nbsp;Richard Zulu ,&nbsp;Zahid A. Butt","doi":"10.1016/j.ssmhs.2025.100106","DOIUrl":"10.1016/j.ssmhs.2025.100106","url":null,"abstract":"<div><div>The concept of access is critical for the operationalization of universal health coverage (UHC), which is especially relevant in rural and remote communities of lower-income countries (LICs) to lower-middle-income counties (LMICs) where high-priority health needs are in great demand. The objective of the present study was to empirically evaluate the concept of access in one such context. To gain insights on the health systems approach to the concept of access, a cross-sectional study design using a health facility questionnaire was conducted in eleven study districts of Western Province, Zambia. Additional variables were extracted from the Zambia Master Facility List. Using a combination of descriptive statistics, geospatial analysis, and modelling, we evaluated population growth, health facilities (n = 220), travel time, and highly qualified personnel (HQP). Our projections indicate a 48.59 % decline in total health facilities per 10,000 population by 2032, suggesting demand is outpacing supply. Estimated average walk times from a central business district to a health facility ranged from 6.64 to 13.9 h. Analysis of HQP revealed that Community Health Workers and nurses were the most common providers, with only two doctors available across the study districts. We summarized numerous concept of access frameworks into three distinct approaches in the context of space and time. The health systems approach was the most comprehensive, and findings from our study underscore the importance of crucial explanatory variables that may be used to empirically measure health service utilization as a critical dimension of UHC.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USAID withdrawal and the erosion of development assistance for health: Considerations for health system leadership in LMICs","authors":"Kabir Sheikh ,&nbsp;Helen Schneider","doi":"10.1016/j.ssmhs.2025.100107","DOIUrl":"10.1016/j.ssmhs.2025.100107","url":null,"abstract":"<div><div>Development assistance for health (DAH) is entering a period of retrenchment, exemplified by the withdrawal of USAID from global health. This commentary examines, the implications of a declining DAH landscape for health systems in low- and middleincome, countries (LMICs). The loss of donor support not only creates significant funding gaps but also removes certain benefits that donors have provided - such as sustained financing for high-impact vertical programs (e.g. immunization and disease control) and coordination functions. At the same time, the reduction in DAH may alleviate some longstanding distortions, including the fragmentation caused by vertical initiatives and the internal “brain drain” of talent into donor-funded projects, opening opportunities for countries to reclaim leadership. The immediate challenge for health system leaders is to mitigate service disruptions through short-term measures, while pursuing long-term strategies to increase domestic health investment and strengthen system-wide capacities. We emphasize the need for renewed commitment to the principles of country ownership and alignment - now driven by domestic stewardship rather than donor conditionality. In a changing global context, new arrangements that complement national efforts are needed to ensure that global solidarity and support for shared health goals persist despite a reduced role for traditional aid.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical assessment of strategic health purchasing in Benin's health financing schemes and the implications for universal health coverage","authors":"Cossi Xavier Agbeto ,&nbsp;Christelle Boyi ,&nbsp;Noudéhouénou Credo Adelphe Ahissou ,&nbsp;Hashim Hounkpatin ,&nbsp;Nihad Jessica Eyitayo Agoligan Tometin ,&nbsp;Arsène Yades ,&nbsp;Agnes Gatome-Munya ,&nbsp;Jean-Paul Dossou","doi":"10.1016/j.ssmhs.2025.100152","DOIUrl":"10.1016/j.ssmhs.2025.100152","url":null,"abstract":"<div><div>Several reforms are underway in Benin to improve strategic health purchasing. This study examines th⁠e extent to which purchasing mechanisms in Benin are strategic, highlighting pr⁠ogress made, persistent challenges, and implications for achieving universal health coverage (UHC) in the context of national health financing reforms. We emplo⁠yed a single embedded case study design, collecting data through document rev⁠iew and informal interviews conducted between⁠ September⁠ 2019 and March 2020. Three major schemes w⁠ere assessed: the health insurance component of the Human Cap⁠ital Strengthening Insurance (AM-ARCH)⁠, the Special Regime for Civil S⁠ervants, and the National C⁠esarean-Section Exemption Scheme.</div><div>Our findings show that while mandates for pur⁠chasers are defined, overlaps per⁠sist. Publi⁠c providers⁠ have limited autonomy in decision-making and financial management. Benefits packages are specified but no⁠t aligned with service delivery guidelines, and contrac⁠ting is largely non-selective, involving mainly public and⁠ faith-based facilities. Provider payment remains predominantly fee-for-service, and performance monit⁠ori⁠ng is fragmented with minimal automation.</div><div>Overall, evid⁠ence⁠ of strategic purchasing in Ben⁠in rem⁠ains limited despite ongoing reforms. To advance progress, Benin should prioritize the d⁠evelopment of a coherent health financing strategy supported by clear legal and regulatory frameworks. Key a⁠ctions i⁠nclude promoting community participation in defining benefit packages, redesigning provider pay⁠ment mechanisms beyond open-ended fee-for-service, an⁠d strengthening contracting with both public and private providers. Incorp⁠orating performance⁠-based elements into payment systems w⁠ill be crucial for enhancing accountability and incentivizing the quality of care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The regulation-practice gap, regulatory relationships, and quality improvement in resource-constrained health systems: Findings from a study of professional regulation for doctors and nurses in Uganda","authors":"Gloria Seruwagi ,&nbsp;Catherine Nakidde ,&nbsp;Peter Waiswa ,&nbsp;Francis Wafula ,&nbsp;Anita Musiega ,&nbsp;Dosila Ogira ,&nbsp;Tina Kiefer ,&nbsp;Michael J. Gill ,&nbsp;Mike English ,&nbsp;Gerry McGivern","doi":"10.1016/j.ssmhs.2025.100149","DOIUrl":"10.1016/j.ssmhs.2025.100149","url":null,"abstract":"<div><h3>Background</h3><div>Regulation is a core mechanism for maintaining the availability and quality of the health workforce, underpinning a WHO building block for health system improvement, but often fails in resource-constrained health systems in the Global South. This paper examines views and experiences of professional regulation for doctors and nurses/midwives in Uganda, regulatory problems and opportunities for improvement.</div></div><div><h3>Methods</h3><div>We conducted focus groups, 60 interviews with Ugandan national regulatory stakeholders, doctors, and nurses/midwives, and a national survey completed by 2213 Ugandan doctors and nurses/midwives.</div></div><div><h3>Results</h3><div>With limited resources, staff, and significant responsibilities, Ugandan health regulators were perceived as focusing on collecting fees, registering, and licensing health practitioners, rather than ensuring high-quality professional practice. While Ugandan doctors, nurses and midwives support regulation in principle, they reported limited engagement with distant regulators, who rarely noticed or addressed malpractice. However, we found one positive case where nurses described good personal relationships with a local regulator, who supported, mentored and explained to nurses what regulation and compliance meant in practice, and here nurses viewed regulation as working well. Thus, we explain how regulatory relationships can bridge the geographical gap between regulators and health professionals and the interpretive gap between written standards and practice.</div></div><div><h3>Conclusion</h3><div>Improving relationships between regulators and regulated health workers holds potential to address the regulation-practice gap, which is generally undermining regulation and professionals’ practice in resource-constrained countries in the Global South. However, regulatory relationships must be supported by adequate resources and transparent mechanisms to prevent local-level regulatory capture, politics, and corruption.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflicts and complexities around intellectual property and value sharing of artificial intelligence healthcare solutions in public-private partnerships: A qualitative study","authors":"Hassane Alami ,&nbsp;Lysanne Rivard ,&nbsp;Pascale Lehoux ,&nbsp;Mohamed Ali Ag Ahmed ,&nbsp;Racha Soubra ,&nbsp;Ronan Rouquet ,&nbsp;Richard Fleet ,&nbsp;Jean-Paul Fortin","doi":"10.1016/j.ssmhs.2025.100093","DOIUrl":"10.1016/j.ssmhs.2025.100093","url":null,"abstract":"<div><h3>Background</h3><div>Public healthcare systems are increasingly relying on artificial intelligence (AI) technologies to meet growing healthcare needs. Because AI technologies are complex and costly to develop, public-private partnerships (PPPs) between digital companies and university hospital centres are being promoted as a key for the successful development and implementation of AI solutions. This article aims to shed light on stakeholders’ perspectives on the intellectual property (IP) and value sharing of AI technologies developed by PPPs and how their practical experiences can affect the success or failure of such PPPs.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 29 stakeholders concerned with and/or involved in digital health technologies in a large Canadian university hospital centre. Data were collected and analysed through a mixed deductive-inductive approach.</div></div><div><h3>Results</h3><div>The analysis revealed three key themes highlighting AI IP issues of concern for PPP stakeholders. First, the collaborations and contributions required from all stakeholders to develop AI technologies of clinical and commercial value are highly complex and often unclear. Second, the lack of institutional and commercial recognition of clinicians’ essential contributions to AI solution development results in competing academic and business imperatives that hinder their engagement in PPPs. Finally, public healthcare systems’ strategic use of AI requires new policies adapted to the digital economy where IP plays a central role in value generation and sharing.</div></div><div><h3>Conclusion</h3><div>For PPPs developing AI healthcare technologies to be successful, updated policies clarifying public healthcare systems’ strategic use of AI are required as well as clear value-sharing frameworks between stakeholders.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity, diet, medication adherence, blood glucose monitoring and foot care in people with type 2 diabetes in Nepal","authors":"Grish Paudel ,&nbsp;Corneel Vandelanotte ,&nbsp;Padam Kanta Dahal ,&nbsp;Abha Shrestha ,&nbsp;Biraj Karmacharya ,&nbsp;Tomohiko Sugishita ,&nbsp;Lal Rawal","doi":"10.1016/j.ssmhs.2025.100083","DOIUrl":"10.1016/j.ssmhs.2025.100083","url":null,"abstract":"<div><h3>Introduction</h3><div>Type 2 diabetes mellitus (T2DM) is among the most common Noncommunicable diseases (NCDs), responsible for an estimated 2 million deaths in 2019. The prevalence of T2DM is increasing in low- and middle-income countries including Nepal. The practice of good self-care behaviours (i.e., physical activity, dietary habits, adherence to medication, blood glucose monitoring, and foot care) plays a vital role in managing disease conditions. This study aims to assess the practice of self-care behaviours and their associated factors among people with T2DM in Nepal.</div></div><div><h3>Methods</h3><div>Data on self-care behaviours were assessed from 481 adults (aged 30–70 years) with T2DM from two districts (Kavrepalanchowk and Nuwakot) in Nepal. Self-care behaviours (dietary habits, physical activity, medication adherence, blood glucose monitoring, and foot care) were assessed using pre-tested and interviewer-administered questionnaires. Multiple logistic regression analysis was used to determine the factors associated with self-care behaviours.</div></div><div><h3>Results</h3><div>Physical activity (80 %) was the most practiced self-care behaviour followed by a healthy diet (49.9 %), medication adherence (48.2 %), blood glucose monitoring (32.2 %), and foot care (1.7 %). Significant associations for age and area of residence were observed for physical activity. Religion and not using tobacco were associated with a healthy diet. Educational status and blood glucose level were associated with blood glucose monitoring. Alcohol use and comorbid conditions were associated with medication adherence.</div></div><div><h3>Conclusion</h3><div>Adherence to a healthy diet, medication, blood glucose monitoring, and foot care were still inadequate among the people with T2DM in Nepal. This implies the need for designing and implementing socially and culturally accepted diabetes self-management programs to empower and motivate people with T2DM to self-manage their disease conditions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}