BMC primary care最新文献

{"title":"U.S. and Swedish primary care physicians' views on promoting healthy lifestyles: a qualitative study.","authors":"Helene Johansson, Lars Weinehall, James Dalton, Julie Sorensen, Paul Jenkins, Lars Jerdén","doi":"10.1186/s12875-026-03407-1","DOIUrl":"10.1186/s12875-026-03407-1","url":null,"abstract":"<p><strong>Background: </strong>Primary care patients can benefit from counseling to address unhealthy lifestyle habits. Despite this, evaluations most often note that primary care facilities are not using the full potential of healthy lifestyle counseling methods. Studies comparing prevention efforts in different countries generally find substantial differences between countries. Quantitative studies carried out in a project targeting health professionals and patients in the U.S. and Sweden have demonstrated considerable differences between the two countries. In particular, U.S. health care professionals were found to be more engaged in lifestyle counseling than their Swedish counterparts. The aim of this qualitative study was to more fully explore and compare U.S. and Swedish primary care physician's views on and involvement in promoting healthy lifestyles.</p><p><strong>Methods: </strong>In total, 28 tape-recorded, semi-structured interviews were carried out with Swedish and U.S. primary care physicians. Data were analyzed using a combination of inductive and deductive qualitative content analysis approaches.</p><p><strong>Results: </strong>Primary care physicians in both countries viewed addressing lifestyle habits like smoking, lack of physical activity and poor diet as important, but their level of commitment ranged \"from dedicated to merely doing one's duty\". This overarching theme was reflected across categories concerning role responsibility, client receptiveness and perceived impact, self-efficacy, supporting mechanisms, and working conditions. U.S. physicians were generally more engaged in promoting healthy lifestyles and described more structured routines and greater personal responsibility, whereas Swedish physicians more often relied on referral options and shared responsibility across professional groups. In both countries, lifestyle change was seen as difficult, and physicians' involvement was shaped by confidence, skills, time, and available support. Limited resources and constrained working conditions, particularly lack of time, were barriers contributing to doubts about the effectiveness of counseling efforts.</p><p><strong>Conclusions: </strong>There was consensus in both countries about addressing lifestyle habits as an integrated part of their role as primary care physicians. The study suggests that physicians were uncertain about the effectiveness of their interventions concerning unhealthy lifestyles, implying a need for further dissemination of the latest evidence for such interventions. Physicians requested a team approach for promoting healthy lifestyles with a clearly defined role for physicians in these efforts.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and evaluation of an implementation strategy of a diabetic foot program in primary care: study protocol for a cluster randomized controlled trial (iMplanta study).","authors":"Irene de-Castro-López, Blanca Riquelme-Gallego, Isabel M Socias, Miquel Colom-Rosselló, Miquel Bennasar-Veny, Aina M Yañez","doi":"10.1186/s12875-026-03415-1","DOIUrl":"10.1186/s12875-026-03415-1","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot is one of the most severe complications of diabetes mellitus, with physical, psychological, social, and economic consequences. Evidence suggests that up to 75-80% of diabetic foot complications are preventable through appropriate preventive care. Although structured preventive protocols, such as the Diabetic Foot Program, have been adapted for the primary care in Spain, their integration into routine clinical practice remains suboptimal. This paper describes the protocol for the iMplanta study, which aims to evaluate the effectiveness of an implementation strategy for the Diabetic Foot Program in primary care.</p><p><strong>Methods: </strong>The iMplanta study is a two-arm cluster randomized controlled trial to be conducted in 20 primary care centres (PCCs) in Mallorca (Balearic Islands, Spain). PCCs will be randomly allocated (1:1) to either an intervention group or a control group. The intervention group will receive a structured implementation strategy for the Diabetic Foot Program developed using the Implementation Mapping framework, while the control group will continue with usual care, applying the Diabetic Foot Program without additional implementation support. Data will be collected at three time points: baseline (covering the 12 months prior to study initiation) and 6 and 12 months post-implementation. Implementation outcomes will be evaluated using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), complemented by Proctor et al. implementation outcomes (acceptability, feasibility, and appropriateness).</p><p><strong>Discussion: </strong>This study will generate evidence on how to effectively implement a preventive Diabetic Foot Program in real-world primary care. By applying implementation science principles, iMplanta aims to inform sustainable and transferable implementation strategies to increase uptake of evidence-based diabetic foot prevention and improve care delivery for people living with diabetes.</p><p><strong>Trial registration: </strong>Prospectively registered on ClinicalTrials.gov, no. NCT07004179. Date of registration February 20, 2025.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring factors associated with autism spectrum disorder diagnosis among children in primary care clinics in Kelantan, Malaysia.","authors":"Farah Munirah Mior Mazlan, Raishan Shafini Bakar, Suhaily Mohd Hairon, Masliza Yusoff, Nik Normanieza Nik Man","doi":"10.1186/s12875-026-03424-0","DOIUrl":"10.1186/s12875-026-03424-0","url":null,"abstract":"<p><strong>Background: </strong>Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by impairments in social communication and restricted or repetitive behaviors. In Malaysia, timely identification within routine primary care services remains challenging, particularly outside major urban centres. This study examined factors associated with ASD diagnosis among children attending government primary care clinics in Kelantan to inform strategies for strengthening primary care developmental surveillance.</p><p><strong>Methods: </strong>A clinic-based cross-sectional study was conducted from March to September 2025 in five districts. Using purposive sampling, 207 children aged 18 months to 12 years were recruited during routine clinic visits, developmental presentations and primary care visits. Sociodemographic and clinical data were captured via a structured proforma. All enrolled children underwent Sensory-Behavior Profile screening followed by clinical assessment utilizing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria regardless of screening result. Simple and multiple logistic regression were applied to examine associations between child and parental characteristics and ASD diagnosis.</p><p><strong>Results: </strong>Of the 207 children analysed, 29 were newly diagnosed with ASD during the study assessment and 178 were classified as non-ASD. In the multivariable analysis, two factors remained independently associated with ASD diagnosis. Older age at assessment was associated with higher odds of ASD diagnosis (aOR 1.30, 95% CI 1.10,1.55; p = 0.003), a finding that likely reflects later recognition, presentation, referral, or diagnostic confirmation within primary care pathways rather than an etiologic risk factor. First-born children were more likely to have an ASD diagnosis than second- or later-born children (aOR 2.48, 95% CI 1.08,5.71; p = 0.033).</p><p><strong>Conclusions: </strong>These findings support the strengthening of primary care developmental surveillance through consistent routine screening, improved clinician competency in developmental surveillance, increased parent awareness, and clear, time-bound referral pathways linked to timely assessment capacity within routine child health services.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient capacity and constraints in managing multimorbidity: a qualitative study in primary care settings in Kerala, India.","authors":"Selvarajan Valsa Shiby Kripa, Sandhya Kizhakke Neelamana, Athira Krishnan, Priya Babu, Balasankar Jayapal Mini, Thoniparambil Ravindranathanpillai Lekha, Linju Joseph, Panniyammakal Jeemon","doi":"10.1186/s12875-026-03402-6","DOIUrl":"10.1186/s12875-026-03402-6","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity, the coexistence of multiple chronic conditions, poses significant challenges to patients, particularly in low- and middle-income countries (LMICs) like India. Limited research has been done to understand the patient treatment burden and capacity from India, which is essential to design and implement effective interventions for managing multimorbidity. We explored the barriers and facilitators to patient capacity for managing multimorbidity in primary care settings in Kerala, India.</p><p><strong>Methods: </strong>We conducted a qualitative study using semi-structured interviews with patients diagnosed with two or more chronic conditions (n = 42) seeking care in primary care settings in Kerala. Data were analysed thematically using two conceptual frameworks of treatment burden and patient capacity: Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) as theoretical lenses.</p><p><strong>Findings: </strong>Our findings show that the complexity of conditions, financial constraints, and cultural practices were barriers to patient capacity. Facilitators that contributed to patient capacity were social support, accessible healthcare, and a positive attitude towards health. Primary care services provide selective care for patients with multimorbidity, leading to treatment burdens outweighing patient capacity. Financial constraints further impacted participants' ability to access out-of-pocket medications.</p><p><strong>Conclusion: </strong>This study highlights how the complexity of multimorbidity and financial constraints in primary care settings in Kerala influences patient capacity. Understanding how treatment burden and patient capacity influence patients in India and similar LMIC settings will enable the design of interventions that enhance patient capacity and reduce treatment burden within the cultural and health system context.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators for optimal perinatal primary care in low-risk pregnancies: an interview study with parents and healthcare professionals.","authors":"Maëlle De Coninck, Sophie Albrecht, Arno Maetens, Joni Gilissen, Liesbeth Van Kelst","doi":"10.1186/s12875-026-03397-0","DOIUrl":"10.1186/s12875-026-03397-0","url":null,"abstract":"<p><strong>Background: </strong>Shortened postpartum hospital stays have shifted perinatal care to primary care settings, potentially expanding the role of primary care midwives. However, specialist care remains prevalent during perinatal stages and the role of midwives in primary care is undefined. We aim to investigate current barriers to optimal organization of perinatal care at the primary care level for low-risk pregnancies in Flanders, Belgium, focusing on organization, accessibility, and quality of care. In addition, we explore what inhibits or can facilitate the expansion of the role of primary care midwives herein.</p><p><strong>Methods: </strong>We conducted interviews with thirteen parents and nineteen healthcare providers. Parents had experienced parenthood within the past year, and healthcare providers had at least one year of experience in primary care. Participants were recruited through professional associations and regional primary care zones in the city of Antwerp. We applied a qualitative inductive content analysis.</p><p><strong>Results: </strong>Seven barriers emerged, highlighting areas for improvement in perinatal primary care and the potential role of midwives. Findings underscore the need for increased awareness of preconception care, enhanced psychosocial follow-up, streamlined role distribution among healthcare providers, integrated offer of prenatal care, clarity about the value of postpartum care early on, and improved access to medical records.</p><p><strong>Conclusions: </strong>The study identifies key opportunities for optimizing perinatal primary care. Coordinated care pathways, clear role distribution, and a unified patient record offer opportunities to enhance interprofessional collaboration in primary care. Continued dialogue and further research are recommended to develop an effective perinatal primary care model.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that influence access to primary healthcare services for migrants with a pre-existing mental ill-health diagnosis: a scoping review.","authors":"Norma Houlihan, Annmarie Grealish, Luca Greenan, Kathleen Markey","doi":"10.1186/s12875-026-03375-6","DOIUrl":"10.1186/s12875-026-03375-6","url":null,"abstract":"<p><strong>Background: </strong>Migrants frequently encounter significant stressors during their migration journey, which can adversely affect their mental health. The rising prevalence of mental ill-health among migrant populations is an increasing public health concern. Primary healthcare services are crucial in addressing both the physical and mental health needs of migrants with pre-existing mental ill-health diagnoses. However, it is essential to understand the factors that facilitate and hinder access to primary healthcare services for this population.</p><p><strong>Aim: </strong>This scoping review sought to identify factors that enable and hinder migrants with pre-existing mental ill-health diagnoses when accessing primary healthcare services.</p><p><strong>Methods: </strong>This scoping review followed the Joanna Briggs Institute methodology as it facilitates the inclusion of all relevant information that has not previously been combined and helps to identify gaps in existing literature as a means of informing future research. A systematic search of five electronic databases, Medline, CINAHL, PsycINFO, ASSIA, and Web of Science, was conducted between 2014-2024.</p><p><strong>Results: </strong>Thirteen studies met the eligibility criteria and were synthesised using narrative synthesis. The findings reveal that migrants with pre-existing mental ill health diagnoses face significantly more barriers than enablers when accessing primary healthcare services. Notably, the interrelated barriers illuminate a lack of culturally appropriate alignment of primary healthcare services to address the diverse range of physical and mental healthcare needs of migrants living with pre-existing mental ill health.</p><p><strong>Conclusion: </strong>This scoping review offers an overview of the existing literature on the enablers and barriers faced by migrants with pre-existing mental ill-health when accessing primary healthcare services. The findings illuminate the complexities that migrants with a pre-existing mental ill-health diagnosis experience when accessing primary healthcare services. There is a need to tailor primary healthcare services to adequately meet the unique needs of migrant populations living with a pre-existing mental ill-health diagnosis.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needs analysis of learning objectives for a lifestyle medicine curriculum in family medicine residency program: an E-Delphi study.","authors":"Vildan Mevsim, Yasemin Özkaya, Duygu Ayhan Başer, Gökçe İşcan, Merve Saniye İmançer, Oğulcan Çöme, Tolga Günvar, Irfan Yurdabakan","doi":"10.1186/s12875-026-03421-3","DOIUrl":"10.1186/s12875-026-03421-3","url":null,"abstract":"<p><strong>Background: </strong>Lifestyle Medicine (LM) plays a critical role in the prevention, treatment, and even reversal of chronic diseases through evidence-based lifestyle interventions. Despite its importance, LM is not yet systematically embedded into family medicine residency training. Current approaches often focus narrowly on behavior change and lack an integrated curriculum framework. This study aimed to identify and reach expert consensus on the core learning objectives necessary for incorporating LM into family medicine specialty education in Turkey.</p><p><strong>Methods: </strong>A two-round electronic modified Delphi (E-Delphi) method was employed to gather consensus from a multidisciplinary expert panel. Fifteen participants-including family medicine academicians, practicing physicians, residents, and professionals in medical education, nutrition, and sports medicine-evaluated 114 learning objectives developed by a steering committee through literature review. A 5-point Likert scale was used for scoring, with consensus defined as ≥ 80% agreement, a median score ≥ 4, and an interquartile range (IQR) ≤ 1.</p><p><strong>Results: </strong>In the first round, consensus was achieved for 107 objectives. In the second round, 96 learning objectives reached final consensus, covering eight core domains: introduction to LM, nutrition, physical activity, sleep health, stress management, substance use, sexual health, social relationships, and environmental exposures. Highest agreement was observed in nutrition and physical activity; objectives related to stress regulation, sleep assessment, and environmental policy received lower consensus, indicating areas needing further curricular clarification.</p><p><strong>Conclusion: </strong>The findings provide a foundational framework for curriculum development and may guide international efforts to integrate LM into postgraduate medical education.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated holistic chronic wound care package for skin-NTDs and other conditions for the primary healthcare setting in Ethiopia.","authors":"Tigest Ajeme, Oumer Ali, Agumasie Semahegn, Asrat Mengiste, Eiman Siddig Ahmed, Mersha Kinfe, Selamawit G Kebede, Stephen Bremner, Vasso Anagnostopoulou, Malcolm Brewster, Gail Davey, Abebaw Fekadu, Maya Semrau","doi":"10.1186/s12875-026-03425-z","DOIUrl":"10.1186/s12875-026-03425-z","url":null,"abstract":"<p><strong>Background: </strong>Globally, chronic wounds resulting from diverse etiologies impose a significant physical, psychosocial, and economic burden and have remained a highly neglected public health challenge. Yet, people in rural Ethiopia have limited access to quality and comprehensive wound care. There is a marked paucity for an integrated, holistic care model in the primary healthcare settings. Hence, this study aimed to develop a context-tailored, integrated, holistic, chronic wound care package in Ethiopia.</p><p><strong>Methods: </strong>A multi-method approach was applied, including a scoping review, formative assessments, Theory of Change workshops and a qualitative validation study. Purposive sampling was employed to recruit participants. Collected data were transcribed, coded, and thematically analysed to generate insights for refining the intervention package.</p><p><strong>Results: </strong>A total of 49 stakeholders participated in the Theory of Change (ToC) workshops, while 36 participants were included in the qualitative study. The intervention package is structured around six core thematic components: awareness-raising and stigma reduction, capacity-building, active case detection and follow-up, program and supply chain management, Institutional and community-based rehabilitation, monitoring, and evaluation. Implementation and scale-up of these components are designed to cascade across three levels of the existing primary healthcare system, specifically the health organization, the health facility level, and the community level.</p><p><strong>Conclusion: </strong>This study introduced a context-driven, integrated, and holistic wound care package aimed at managing chronic wounds alongside their associated mental health and psychosocial challenges. The package encompasses interventions that address the physical, psychological, and social impacts of chronic wounds in individuals affected by neglected tropical diseases of the skin and related conditions. It employs multilevel implementation strategies targeting individuals, communities, and the health system to reduce morbidity, disability, and the economic and psychosocial burdens linked to chronic wounds. This standardized, scalable, and sustainable care model provides a promising approach for Ethiopia and other low- and middle-income countries.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators in access to cervical cancer secondary prevention in Cochabamba, Bolivia: a qualitative study of healthcare providers' perceptions.","authors":"Carla Huanca Challgua, Daniel Eid Rodriguez, Isabel Goicolea, Ida Linander","doi":"10.1186/s12875-026-03422-2","DOIUrl":"10.1186/s12875-026-03422-2","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs' perceptions of barriers and facilitators for women's access to CC secondary prevention in Cochabamba, Bolivia.</p><p><strong>Methods: </strong>Qualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque's access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels.</p><p><strong>Results: </strong>HCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal-community level, barriers included family-transferred misconceptions, gender norms, and women's fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational-structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening.</p><p><strong>Conclusions: </strong>HCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women's lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of diabetes self-management and glycemic control among patients with diabetes mellitus in conflict-affected Palestine.","authors":"Fuad Farajalla, Abd-Alrahman Halahla, Ashraf Jehad Abuejheisheh, Ayman Salameh, Mohyeddin Al-Allama, Momin Rasras","doi":"10.1186/s12875-026-03423-1","DOIUrl":"10.1186/s12875-026-03423-1","url":null,"abstract":"<p><strong>Background: </strong>Poor glycemic control and inadequate self-management drive the global diabetes mellitus (DM) burden. In conflict-affected Palestine, structural barriers worsen outcomes, yet diabetes management self-efficacy (DMSE) remains understudied.</p><p><strong>Aim: </strong>To assess diabetes management self-efficacy and glycemic control, their interrelationship, and the independent predictors of each among patients with diabetes mellitus in conflict-affected Palestine.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 418 adults with type 1 or type 2 DM attending governmental diabetes clinics in the Hebron governorate, West Bank, Palestine. Data were collected using the Arabic-validated Diabetes Management Self-Efficacy Scale (DMSES) and a structured clinical questionnaire. Non-parametric tests and two multiple linear regression models were applied to identify independent predictors, with HbA1c and DMSE scores specified as the two dependent variables.</p><p><strong>Results: </strong>Glycated hemoglobin (HbA1c) was suboptimal (median = 7.50, IQR = 2.30), while DMSE was moderate (median = 3.45/5, IQR = 1.10). Blood glucose management was the strongest subdomain, whereas physical exercise was the weakest. Former smoking (β = 0.202, 95% CI: 0.430, 1.494, p < .001), lower physical activity frequency (β = 0.156, 95% CI: 0.098, 0.455, p = .003), and diabetes-related complications (β =-0.154, 95% CI: -1.132, - 0.210, p = .004) independently predicted higher HbA1c. Lower physical activity (β =-0.177, 95% CI: -0.208, - 0.060, p < .001), longer disease duration (β =-0.135, 95% CI: -0.177, - 0.021, p = .013), lower income (β = 0.163, 95% CI: 0.081, 0.348, p = .002), and lower education (β = 0.127, 95% CI: 0.018, 0.227, p = .022) independently predicted lower DMSE.</p><p><strong>Conclusion: </strong>Clinical, behavioral, and socioeconomic factors independently predicted glycemic control and self-efficacy. The DMSE-HbA1c disconnect indicates structural barriers impede self-management behavior. Integrating clinical education with economic and structural support is essential to improve diabetes outcomes in conflict-affected settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}