Journal of primary health care最新文献

{"title":"Primary care clinicians' perspectives on migraine management in Aotearoa New Zealand: a qualitative study.","authors":"Julia Randerson, Fiona Imlach, Jonathan Kennedy, Susan Garrett","doi":"10.1071/HC25078","DOIUrl":"10.1071/HC25078","url":null,"abstract":"<p><strong>Introduction: </strong>Despite being a common and disabling neurological disease, migraine is often underdiagnosed and undertreated. Although most patients with migraine can be effectively managed in primary care, people with migraine in Aotearoa New Zealand (NZ) report multiple barriers to care and negative impacts of migraine on physical and mental health, work and quality of life.</p><p><strong>Aim: </strong>This study aimed to describe the experience of primary care clinicians with managing migraine disease in NZ and identify enablers and barriers to effective care.</p><p><strong>Methods: </strong>Clinicians were recruited through advertisements in an online newsletter and a regional email network. Semi-structured interviews were completed via phone or Zoom. Inductive thematic analysis was undertaken to identify key themes.</p><p><strong>Results: </strong>Five general practitioners and three nurse practitioners were interviewed. Themes related to the clinician, healthcare system and societal factors were identified across the patient journey of seeking health care (cultural safety, primary care accessibility, awareness and health literacy), diagnosis (diagnostic knowledge, secondary care and diagnostic test accessibility and diagnostic overshadowing) and management (treatment knowledge, communication and patient education, access to ongoing care, role of other health professionals and stigma of chronic disease).</p><p><strong>Discussion: </strong>Significant barriers to migraine health care related to accessibility of primary care, particularly cost, wait times and availability. Advice from neurology was a valued resource, but access to in-person consultations for patients with migraine was limited. Clinician knowledge about migraine diagnosis and treatment was well supported by online and educational resources. Involving the wider primary care team in migraine management could help improve care.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":"247-255"},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355131","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":"Strategies for research capacity building by family physicians in primary care: a scoping review.","authors":"Margarida Gil Conde, Carolina Penedo, Francisco Freitas Barcelos, Raquel Carmona Ramos, Sofia Silvério Serra, Cristina Ribeiro, Paulo Jorge Nicola","doi":"10.1071/HC25042","DOIUrl":"10.1071/HC25042","url":null,"abstract":"<p><strong>Introduction: </strong>Research in primary care (PC) is essential for improving patient outcomes and healthcare systems. However, family physicians often face barriers to conducting research, including limited training, time constraints, and lack of institutional support. Identifying effective strategies to build research capacity can help integrate research into PC practice.</p><p><strong>Aim: </strong>This scoping review identifies and synthesises strategies that strengthen family physicians' research capacity in PC.</p><p><strong>Methods: </strong>The review followed the PRISMA-ScR methodology. We included studies published up to 2023 in English, Portuguese, or Spanish that described relevant research capacity building (RCB) strategies for family physicians in PC, with no restrictions on study design. A comprehensive search in PubMed, Scopus, Web of Science, and the Cochrane Library was conducted. This review protocol was registered in the Open Science Framework (1).</p><p><strong>Results: </strong>We included 19 studies and identified five key strategic approaches to RCB in PC: (1) Training and mentoring programmes - Structured educational initiatives and mentorship developed research skills. (2) Networking - Collaborative research networks fostered engagement. (3) Blueprint development - Frameworks guided research initiatives. (4) Strategic communication interventions - Awareness campaigns promoted a research culture. (5) Knowledge transfer and exchange - Mechanisms facilitated the application and dissemination of research findings.</p><p><strong>Discussion: </strong>Implementing multifaceted strategies enhances family physicians' involvement in research and strengthens the research culture in PC. Combining structured training programmes, professional networking, and strategic communication fosters a more research-friendly environment. Future studies should assess how adaptable these strategies are to different PC settings, evaluate their long-term impact, and integrate other professional groups within PC.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":"256-269"},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355189","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 wholistic approach to patient-empowered care: a quality improvement report.","authors":"Andrew Corin","doi":"10.1071/HC25050","DOIUrl":"10.1071/HC25050","url":null,"abstract":"<p><strong>Introduction: </strong>An updated medical model for wholistic and patient-centred care that adds elements of prevention and management of long-term medical conditions to the old biomedical model is a necessary response to current understanding of health and wellbeing. The capacity to adapt and self-manage is central to health, and important domains or pillars to consider are physical, psychological, social/emotional, and spiritual. The challenge for this model is applying it in a resource-constrained primary care environment.</p><p><strong>Assessment of problem: </strong>The value of an enhanced model of care in a general practice setting was tested. Elements of the model were relevance and applicability to New Zealand general practice, equity considerations, and validated tools for delivering messages and measuring outcomes. Components were facilitated group video modules to educate and support participants in self-efficacy within domains of physical, psychological, emotional, and spiritual wellbeing, followed by extended one-on-one consultations between participants and their GP at 6-monthly intervals for 1 year.</p><p><strong>Results: </strong>Self-Efficacy and Patient Activation Measure scores increased throughout the study. Quality of Life scores and consideration of the four domains of wellbeing indicate patient ability for self-management and adaptability in the face of changing medical conditions, without decline in wellbeing.</p><p><strong>Summary: </strong>A shift in locus of control favouring the patient, with use of validated tools to enhance a wholistic approach in patient-clinician interactions, results in meaningful health improvements. Such tools and education resources are accessible and can be incorporated into existing systems of care without substantial disruption and offers a realistic opportunity for positive change.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":"278-286"},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355225","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":"Adaptation of a maternal and child mHealth programme: an example from Aotearoa New Zealand.","authors":"Rosie Dobson, Amanda Uri, Melanie Stowell, Hayden McRobbie, Karen Evison, Elaine Umali, Robyn Whittaker","doi":"10.1071/HC26124","DOIUrl":"https://doi.org/10.1071/HC26124","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence for mHealth in the delivery of public health messages is growing. Cultural adaptations of existing mHealth programmes may be an efficient way to extend their reach to new target populations, but best practices for such adaptations are unclear.</p><p><strong>Aim: </strong>This paper describes the process of culturally adapting an existing parental and child health text messaging programme in a region of Aotearoa New Zealand in which there is a high proportion of Māori, a population that continues to experience systemic inequities in child health outcomes.</p><p><strong>Methods: </strong>An adapted mHealth Development and Evaluation Framework informed the three-stage cultural adaptation process. Consultation with a local governance group and end-users established important factors in adapting and rebranding the programme. The adapted content was reviewed by local and external experts. The final messages underwent local translation into Te Reo Māori (Māori language), and all versions were pre-tested before rollout.</p><p><strong>Results: </strong>The resultant intervention, txtpēpi, provides free information and support to families during pregnancy through the child's first two years. The programme is available in four versions: Te Reo Māori or English for parents or family members. The personalised messages are designed to support and enable end-users to engage with local services and essential health behaviours (e.g. immunisation).</p><p><strong>Discussion: </strong>Cultural adaptations of existing mHealth programmes are a resource-intensive process but contribute vital information about how to develop culturally safe support for new populations.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016625","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":"Can a mindful medicine workshop improve healthcare professional well-being? A quasi-experimental study.","authors":"Kendall Crossen, Brigitte Eastwood, Jeremy Rossaak","doi":"10.1071/HC26126","DOIUrl":"https://doi.org/10.1071/HC26126","url":null,"abstract":"<p><strong>Introduction: </strong>Burnout and psychological distress are common among healthcare professionals. Mindfulness-based strategies delivered over several weeks have been shown to improve well-being and reduce burnout.</p><p><strong>Aim: </strong>This study aimed to assess whether a brief mindfulness intervention could improve well-being in a heterogeneous healthcare workforce across primary and secondary care settings.</p><p><strong>Method: </strong>Healthcare professionals attending a 3-day Mindful Medicine Workshop (teaching participants to apply mindfulness principles to medicine) were invited to complete an online survey 1 week before the workshop and 3 months afterwards. Well-being was assessed using the Perceived Stress Scale (PSS) and Maslach Burnout Inventory (MBI). Participants were also asked about engagement in mindfulness practices.</p><p><strong>Results: </strong>At baseline, 80% of participants reported moderate to high stress, with a mean PSS score of 19.6. This decreased to 14.0 at 3 months (P < 0.001). Baseline MBI scores indicated high emotional exhaustion (EE) (21.2) and depersonalisation (DP) (12.4). At 3 months, EE decreased to 16.4 (P = 0.036) and DP to 9.9 (P = 0.20). Personal accomplishment increased from 37.5 to 40.6 (P = 0.033). Participants engaging in mindfulness practices weekly or more frequently increased from 43% at baseline to 71% at 3 months (P = 0.012).</p><p><strong>Discussion: </strong>Participation in a 3-day Mindful Medicine Workshop was associated with reduced perceived stress and emotional exhaustion, and increased personal accomplishment and engagement in mindfulness practices at 3 months. These findings suggest that a brief, intensive mindfulness-based intervention may be a feasible approach to supporting the well-being of healthcare professionals working across primary and secondary care in Aotearoa New Zealand.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016871","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":"Hapū māmā experiences of the Whanganui Best Start Model of Care in primary care: a qualitative study.","authors":"Katie E McMenamin, Emma Davey, Heather Gifford, John P McMenamin","doi":"10.1071/HC25210","DOIUrl":"https://doi.org/10.1071/HC25210","url":null,"abstract":"<p><strong>Introduction: </strong>Early pregnancy engagement is important for maternal and infant wellbeing, yet Māori continue to experience inequities in access to timely and culturally responsive care. The Whanganui Best Start Model of Care was developed to strengthen equitable, culturally grounded, early pregnancy support within primary care.</p><p><strong>Aim: </strong>This study aimed to explore hapū māmā (pregnant women) experiences of early pregnancy care delivered through the Whanganui Best Start Model of Care, with a focus on equity, cultural acceptability, relational safety, and systems implications for primary care.</p><p><strong>Method: </strong>A qualitative study guided by Kaupapa Māori research (KMR) principles was conducted with nine hapū māmā who received a Best Start assessment in a very low cost access clinic or iwi-owned practice. Semi-structured interviews were analysed using reflexive thematic analysis, with cultural review by a senior Māori researcher (HG).</p><p><strong>Results: </strong>Māmā described Best Start as a valuable entry into maternity care when delivered with whakawhanaungatanga, clear communication, and responsive follow-up. Positive experiences included feeling heard, supported, and connected to community, mental health, and Kaupapa Māori services. Challenges included variable introduction to Best Start, inconsistent follow-up, difficulties accessing midwifery care, and assessments that felt overly checklist-driven. Kaupapa Māori and/or relaxed assessment environments enhanced safety and reduced anxiety.</p><p><strong>Conclusion: </strong>The Best Start Model of Care can strengthen early pregnancy engagement and support equity for Māori when delivered consistently. System improvements are needed to ensure relationally grounded communication, standardised follow-up pathways, reliable midwifery navigation, and ongoing collaboration with Kaupapa Māori services.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977107","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":"Developing practice-led solutions for intergenerational diabetes in Pacific populations: a participatory action research project in general practice.","authors":"Christine Barthow, Erin Millar, Bryan Betty, Hansa Patel, Eileen McKinlay","doi":"10.1071/HC26076","DOIUrl":"https://doi.org/10.1071/HC26076","url":null,"abstract":"<p><strong>Introduction: </strong>Addressing complex clinical and service delivery challenges in general practice, such as managing type 2 diabetes (T2D) in Pacific families experiencing intergenerational diabetes, is difficult.</p><p><strong>Aim: </strong>This study used participatory action research (PAR) to identify initial steps toward a new model of T2D care for Pacific peoples, to disrupt the cycle of intergenerational diabetes.</p><p><strong>Methods: </strong>A modified PAR process was undertaken in a very low-cost access general practice serving a predominantly Pacific population. Six sequential focus groups (FGs) were held with clinical, support, and management staff. Each FG built on the previous one through iterative member checking, with analysis informing subsequent discussions. Framework analysis was used to synthesise data and identify areas for action.</p><p><strong>Results: </strong>Twenty-one staff from a wide range of disciplines participated in six FGs. Staff identified challenges in current care and generated ideas for improving service delivery. Through iterative discussion, the team identified potential next steps, including a focus on Pacific people under 40 years of age with T2D, developing a wider range of literacy and communication tools, and exploring more empowering approaches to discussing diabetes. Staff also identified areas requiring support from the Primary Health Organisation, the community, and wider public health initiatives.</p><p><strong>Discussion: </strong>PAR, informed by appreciative inquiry, provided a structured, collaborative process that supported staff to reflect on practice, consider alternative approaches, and clarify priorities for future development. Although the longer-term impact is not known, the process fostered engagement, strengthened the research-practice partnership, and generated feasible directions for enhancing care for Pacific families experiencing intergenerational diabetes.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963375","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":"Safety as a precondition for participation: rethinking physical activity for transgender people in primary care contexts.","authors":"Katie E McMenamin, Kelvin Sasse, Cyn Willis, Eden Sibbald","doi":"10.1071/HC26158","DOIUrl":"https://doi.org/10.1071/HC26158","url":null,"abstract":"<p><strong>Background: </strong>Transgender people in Aotearoa New Zealand experience inequitable health outcomes. Although physical activity supports wellbeing, participation is often limited by safety concerns and a lack of affirming environments. Primary care providers recognise low engagement but have limited pathways to support safe participation.</p><p><strong>Aim: </strong>This study aimed to explore how safety in physical activity is understood by transgender people and identify the conditions required to enable participation, with relevance for primary care.</p><p><strong>Method: </strong>A qualitative co-design approach was undertaken with a working group comprising transgender people from the Whanganui community, grounded in lived experience. Six facilitated sessions were conducted and analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four interconnected themes were identified. Safety was understood as multi-dimensional, encompassing physical, personal, and practical domains. Participation was conditional, shaped by the interaction between individual needs and environmental factors. Safety was relational, developing through trust, connection, and consistency over time. Visibility of safe, affirming physical activity opportunities was necessary but required careful management to support privacy and autonomy.</p><p><strong>Conclusion: </strong>Supporting safe participation in physical activity requires attention to the conditions that enable engagement. For primary care, this reframes physical activity from a simple recommendation to a supportive, relational process.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929798","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":"Does a free optometry service address barriers to eye care? An analysis of routinely collected data.","authors":"Rebecca Pettitt, Elisabeth Moore, Pauline Norris, Shirley Keown","doi":"10.1071/HC26096","DOIUrl":"https://doi.org/10.1071/HC26096","url":null,"abstract":"<p><strong>Introduction: </strong>The lack of public funding for optometry services has resulted in a high unmet need for vision aids for many of Aotearoa New Zealand's population, particularly those living in areas of socio-economic deprivation, older persons, and Māori and Pacific people.</p><p><strong>Aim: </strong>This paper assesses whether a free optometry service provided by Tūranga Health (an iwi-based healthcare provider in Gisborne), OneSight EssilorLuxottica Foundation, and a Gisborne-based private optometry service (OPSM) effectively addresses barriers to optometry care for people facing disadvantage.</p><p><strong>Methods: </strong>We used data routinely collected by Tūranga Health, including short interviews with a small number of patients and staff, to describe the service and explore whether and how it addressed unmet need.</p><p><strong>Results: </strong>The high use of the service (698 eye tests performed over five days) and the very high proportion of interventions delivered (621 pairs of prescription glasses provided, 56 referrals for further optometry services, and 12 referrals for cataracts) suggest high unmet need. Patients and staff reported cost and physical access/transport barriers as the most common reason for lack of previous engagement with optometry services.</p><p><strong>Discussion: </strong>This study highlights the importance of accessible ocular health care and suggests the Tūranga Health model addresses access barriers.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929869","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":"'Apply caution' Medical educator perspectives on undergraduate students using AI in reflection: a qualitative study.","authors":"Shabana Bharmal, Erik Blair, Michael Page","doi":"10.1071/HC26070","DOIUrl":"https://doi.org/10.1071/HC26070","url":null,"abstract":"<p><strong>Introduction: </strong>Reflection, a cornerstone of professional development and a core component of medical education, is increasingly challenged by the emergence of generative artificial intelligence (AI). AI's capability to mimic human behaviour through real-time feedback, content generation, and conversational interfaces presents pressing ethical and pedagogical concerns regarding its use in reflection.</p><p><strong>Aim: </strong>This qualitative study sought to explore the perspectives of educators on undergraduate medical students using AI in reflection.</p><p><strong>Methods: </strong>Data were generated through two online focus groups with general practitioners in the role of expert participants, each lasting around one hour and including three participants. All six participants were academic undergraduate primary care educators who teach reflection skills to students.</p><p><strong>Results: </strong>Five themes were conceptualised by reflexive thematic analysis: questioning assessment of reflection; professionalism in jeopardy; acceptability of using AI in learning; digital divide and educational equity; and institutional and educator readiness for AI. Educators faced complex tensions between embracing technological progress and protecting the relational and ethical foundations of medical education.</p><p><strong>Discussion: </strong>Although there was cautious optimism about AI's role as a facilitative tool, participants uniformly emphasised that its educational value depends on critical, transparent, and ethically grounded implementation. This study highlights how undergraduate primary care educators should be cautious of the heightened challenges to academic integrity posed by AI. Uncertainty around fostering authentic student engagement in reflection suggests the need for further exploration in partnership with students. These findings highlight key areas for medical educators to support learners' early engagement with AI.</p>","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900852","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}