Frontiers in health services最新文献

{"title":"Community health worker certification as a pathway to workforce development and career advancement: a qualitative study.","authors":"Uchenna Benedine Okafor, Iyabo Obasanjo","doi":"10.3389/frhs.2026.1902919","DOIUrl":"https://doi.org/10.3389/frhs.2026.1902919","url":null,"abstract":"<p><p><b>Background:</b> Community Health Workers (CHWs) play a vital role in bridging between healthcare systems and underserved communities. Although CHW certification has expanded across the United States, limited research has examined whether certification supports long-term career advancement and workforce development for CHWs themselves. This study examined how certified CHWs perceive the role of certification in shaping career trajectories and long-term workforce retention, with implications for CHW program design and public health workforce policy. A qualitative study using semi-structured interviews was conducted with 30 certified CHWs recruited from a database maintained by the Central Maryland Area Health Education Center (AHEC). Interviews were conducted virtually via Zoom and analyzed using Braun and Clarke's six-step reflexive thematic analysis framework. Five themes were identified: (1) CHW certification as a pathway to workforce development and career advancement; (2) CHW work as a calling rooted in service and advocacy; (3) CHWs as bridges between healthcare systems and communities; (4) barriers to certification and workforce integration; and (5) long-term commitment to public health and community impact. CHW certification serves a function beyond credentialing; it is a workforce development tool that supports career mobility, professional identity, and long-term engagement in public health. Addressing persistent barriers, including low wages, limited opportunities for advancement, and scope-of-practice confusion, is essential to sustaining a robust CHW workforce.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1902919"},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225489","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":"Youth access and utilization of HIV services in Homa Bay, Kenya: protocol for a mixed-methods study.","authors":"Lawrence Ojala, Wilson Manyasa, Mabel Nangami, Nyawira Gitahi, Leslie A Enane","doi":"10.3389/frhs.2026.1892411","DOIUrl":"10.3389/frhs.2026.1892411","url":null,"abstract":"<p><strong>Background: </strong>Youth aged 15-24 years continue to experience substantial HIV-related vulnerability, particularly in sub-Saharan Africa. Although HIV prevention, testing, treatment and support services have expanded, barriers related to knowledge, stigma, confidentiality, affordability, geographic accessibility, provider attitudes and the organization of health services continue to affect young people's engagement with HIV services. Homa Bay County has one of the highest HIV burdens in Kenya, yet evidence on the factors influencing youth access to and utilization of HIV services in the county remains limited.</p><p><strong>Objective: </strong>This study aims to assess access to and utilization of HIV services among youth aged 15-24 years in Homa Bay Town Sub-County, Kenya, and to examine individual, household, community and health-system factors associated with utilization.</p><p><strong>Methods: </strong>A mixed-methods cross-sectional study will be conducted among youth aged 15-24 years residing in Homa Bay Town Sub-County. The quantitative component will target 400 youth recruited through a multistage sampling approach involving ward-based stratification, selection of community-based clusters, and participant selection within selected clusters. Quantitative data will be collected using a structured researcher-administered questionnaire. The qualitative component will comprise focus group discussions with youth and key informant interviews with healthcare providers, peer educators and community gatekeepers. Quantitative data will be analysed using R. Descriptive statistics and bivariate analyses will be followed by multivariable logistic regression to identify factors independently associated with HIV service utilization. Qualitative data will be analysed thematically. Findings from the two components will be integrated using narrative synthesis and thematic matrices.</p><p><strong>Expected contribution: </strong>The study will generate context-specific evidence on individual, social and health-system factors influencing youth HIV service utilization in Homa Bay Town Sub-County. The findings will inform the design and strengthening of youth-friendly HIV services and contribute to implementation strategies aimed at reducing barriers to HIV prevention, testing and care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1892411"},"PeriodicalIF":2.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217457","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":"Prevalence and associated factors of catastrophic health expenditure among adults with chronic pain in an urban slum of Delhi: a community-based cross-sectional study.","authors":"Shivani Rao, Kinshuk Gupta, Priyanka Aggarwal, Amod Laxmikant Borle, Nandini Sharma, Mongjam Meghachandra Singh","doi":"10.3389/frhs.2026.1933208","DOIUrl":"10.3389/frhs.2026.1933208","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic pain is a major and growing public health challenge with a disproportionate burden across sex, age, and socioeconomic groups. As its prevalence continues to rise, it imposes substantial financial hardship on affected households, particularly in low- and middle-income countries (LMICs) where healthcare is largely financed through out-of-pocket expenditure (OOPE). However, the risk of catastrophic health expenditure (CHE) among individuals with chronic pain remains poorly characterised. This study aimed to estimate the prevalence of CHE and identify its associated factors among community-dwelling adults with chronic pain in an urban slum of Delhi.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A community-based cross-sectional analytical study was conducted among 151 adults with chronic pain (pain persisting &gt;3 months on most or all days) residing in Gokalpuri, North-East Delhi. Participants were recruited by simple random sampling from a household register. CHE was defined as OOPE exceeding 10% of annual household income. Sociodemographic, clinical, and healthcare utilisation variables were assessed using a semi-structured questionnaire. Multivariable logistic regression was used to explore factors associated with CHE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The prevalence of catastrophic health expenditure was 28.5% (95% CI: 21.4-36.4), with an overshoot of 5.3 percentage points and a mean positive overshoot of 18.4 percentage points (95% CI: 11.6-25.3). Nearly all participants (96.0%) incurred some out-of-pocket expenditure (OOPE), with a median annual direct expenditure of ₹6,000 (IQR: ₹2,400-24,000). Direct medical costs constituted 89.5% of total direct OOPE, with medications being the single largest component. Among the 16 working participants, the median number of workdays lost was 72 days per year (IQR: 60-132), with a range of 24-240 days, corresponding to a mean of 100.5 workdays per participant per year (SD: 58.6). Nearly three-quarters (72.2%) delayed treatment due to financial reasons. Borrowing from family members or relatives was the most common coping strategy to meet treatment expenses (80.1%). On multivariable analysis, daily pain (aOR 7.30; 95% CI: 2.73-19.55) and lower socioeconomic status (aOR 0.05; 95% CI: 0.005-0.41), were significantly associated with CHE, while married status was associated with lower odds of CHE (aOR 0.24; 95% CI: 0.08-0.73).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;More than one in four adults with chronic pain in this urban community experienced catastrophic health expenditure. Out-of-pocket spending was dominated by medication costs. Daily pain, lower socioeconomic status, and unmarried/separated/widowed status were associated with greater financial vulnerability. Strengthening public sector pain management capacity, expanding essential medicines availability, and extending social protection schemes may help to reduce the financial hardship chronic pain imposes on India's most vulnerable ho","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1933208"},"PeriodicalIF":2.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217515","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":"A digital spiritual health collaborative care model within accountable care organizations: a community case study.","authors":"Alex Beth Schapiro, James E Barr, Csaba Szilagyi","doi":"10.3389/frhs.2026.1944486","DOIUrl":"10.3389/frhs.2026.1944486","url":null,"abstract":"<p><p>Spirituality is an established dimension of whole-person care and is increasingly recognized as a determinant of health, yet integrating spiritual care into value-based, population health care models, including Accountable Care Organizations (ACOs), remains rare. This descriptive community case study details the implementation of a novel digital spiritual health collaborative care model within ACOs in New Jersey, USA. The Atlantic Health ACO and Optimus Healthcare Partners ACO have 4,000 providers serving approximately 530,000 attributed patients in 11 different value-based payer arrangements, both risk and non-risk. Drawing on the interprofessional spiritual care framework, the program embedded a board-certified chaplain within the ACOs' Integrated Care team, delivering specialist spiritual care to patients with chronic and serious illnesses via telephone and videoconference visits, with care documented directly in the shared electronic medical record. A two-item spiritual screening tool was administered by ambulatory care team members across primary care and specialty practices; 96/147 (65.3%) patients screened positive, and 58/96 (60.4%) enrolled in spiritual health services. Chaplain assessments identified grief and loss (62.1%), isolation (41.4%), existential concerns (31.0%), and conflicted or challenged belief systems (29.3%) as the most prevalent spiritual health concerns. The chaplain communicated spiritual concerns and spiritual health insights to care team members through consult notes. Nearly half of enrolled patients received referrals to supportive resources within the health system or the broader community through a developing Spiritually Integrated Network. Implementation was supported by targeted staff education on spiritual health and interprofessional spiritual care. The program demonstrated operational feasibility and meaningful patient engagement through a Patient-Centered Medical Home (PCMH) primary care infrastructure. The PCMH principles of person-centered orientation, team-based care, care coordination, and quality-focused value-based incentives offered a practical and supportive framework for embedding spiritual health into ambulatory workflows. These findings suggest that ACOs operating within PCMH models may be particularly suited for integrating spiritual care. This work addresses a critical gap in population health practice and points toward the potential contribution of spiritual health programs to the Quintuple Aim, warranting further research.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1944486"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217422","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 agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors among nurse managers: an explanatory mixed-methods study.","authors":"Ebtsam Aly Abou Hashish, Hend Alnajjar","doi":"10.3389/frhs.2026.1950319","DOIUrl":"10.3389/frhs.2026.1950319","url":null,"abstract":"<p><strong>Aim: </strong>To describe agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors among nurse managers and explore how these practices are experienced in clinical management.</p><p><strong>Background: </strong>Agile leadership, organizational responsiveness, and innovation are increasingly relevant to nursing management. However, these concepts may overlap substantially when measured through same-source self-report, making qualitative contextualization important for understanding how they are experienced in practice.</p><p><strong>Methods: </strong>An exploratory sequential explanatory mixed-methods study was conducted in a tertiary Saudi hospital. Forty-four nurse managers completed measures of agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors. Thirty-two nurse managers then participated in semi-structured interviews analyzed thematically. Quantitative data were analyzed descriptively and exploratorily, and qualitative data were analyzed thematically. Greater interpretive weight was given to the qualitative phase.</p><p><strong>Results: </strong>Nurse managers reported moderate agile and ambidextrous leadership and high organizational agility and innovation behaviors. The four measures showed near-unity correlations, limiting construct-specific interpretation. Qualitative analysis generated five themes: agile leadership as flexibility and human-centered responsiveness; ambidextrous leadership as balancing opening and closing behaviors; organizational agility as adaptive unit functioning; innovation as problem-driven practice; and contextual challenges influencing leadership effectiveness.</p><p><strong>Conclusion: </strong>The findings indicate a highly interrelated agile leadership-organizational functioning profile. The primary contribution lies in the qualitative findings, which show how nurse managers described flexibility, delegation, balancing operational and improvement work, problem-driven innovation, and contextual constraints within Saudi clinical management. Larger multisite and multi-source studies are needed to determine whether the measured constructs are empirically distinct.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1950319"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217494","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":"Designing for implementation: development, delivery, and multi-method evaluation of a clinician training program for a novel technology-based concussion assessment tool.","authors":"Joshua Shore, Christine Provvidenza, Andrew Lovell, Brintha Ingaramoorthy, Elise Christopoulos, Andrea Hickling, Michael Hutchison, Sarah E P Munce, Kathryn J Schneider, Roger Zemek, Isabelle Gagnon, Elaine Biddiss, Shannon E Scratch","doi":"10.3389/frhs.2026.1937910","DOIUrl":"10.3389/frhs.2026.1937910","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Implementation strategies like user training are often excluded from research activities for digital health technologies (DHTs) or reserved for advanced stages of evidence generation. This may contribute to challenges in clinical translation due to usability, feasibility, fidelity, and scalability issues. Using the example of a concussion assessment tool called &lt;i&gt;R2Play,&lt;/i&gt; we demonstrate how clinicians can be engaged in developing training resources for DHTs during early stages of evidence generation and illustrate potential benefits of this approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;(1) Develop a clinician training program for &lt;i&gt;R2Play&lt;/i&gt; administration; (2) Deliver the &lt;i&gt;R2Play&lt;/i&gt; training program to clinician participants across multiple research sites; (3) Evaluate the training program based on participant reactions and learning using a multi-method approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Kern Model for Medical Curricula guided training development, which involved a needs assessment, specifying learning objectives, and selecting education strategies. Training was delivered to clinician participants at four sites in two parts: (1) asynchronous online learning modules (1 h); and (2) live training session to practice &lt;i&gt;R2Play&lt;/i&gt; administration tasks (1 h). Evaluation measures based on the Kirkpatrick Model for Training Evaluation included module-embedded knowledge check questions, live training task completion scores, post-training survey, and follow-up interview. Quantitative measures were analyzed descriptively (frequencies, proportions, means), and content analysis was applied to interview data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighteen clinicians participated (&lt;i&gt;n&lt;/i&gt; = 15 women), primarily physiotherapists (&lt;i&gt;n&lt;/i&gt; = 11) and athletic therapists (&lt;i&gt;n&lt;/i&gt; = 3). Survey and interview feedback generally indicated positive reactions (satisfaction, relevance, engagement) and learning perceptions (knowledge, skills, confidence). Participants objectively and subjectively experienced most difficulty in learning system set-up, delivering precise assessment level instructions, and explaining assessment scoring metrics. Interview data highlighted topics requiring additional content (navigating software interface, interpreting results, troubleshooting). Suggested improvements included an end-to-end workflow demonstration, mock run-through, and opportunities to observe experienced users.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Training programs for DHTs should consider addressing technical proficiency (i.e., system set-up and operation), clinical reasoning (i.e., interpreting data), and communication with care recipients. Early multicenter studies involving end-user training can help enhance the usability of DHTs and identify additional strategies to foster implementation. This work adds to limited empirical literature on how to prepare clinicians for using DHTs through evidence-based practical recommendation","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1937910"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217398","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":"The utility of the \"consideRATE\" patient-reported experience measure in hospital patients receiving specialist palliative care: a two-phase prospective pilot study.","authors":"Claudia Virdun, Davinia Seah, Mona Ramsay, Richard Chye, Annmarie Hosie","doi":"10.3389/frhs.2026.1933654","DOIUrl":"10.3389/frhs.2026.1933654","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported experience measures (PREMs) are increasingly central to ensuring healthcare quality. Uncertainty about the utility of PREMs for hospital patients with palliative care needs has limited their use in this population.</p><p><strong>Aim: </strong>To determine the utility (feasibility, acceptability, and appropriateness) of implementing the PREM \"consideRATE\" for patients receiving specialist palliative care and to explore its perceived value for quality improvement.</p><p><strong>Design: </strong>A two-phase prospective pilot study incorporating PREM administration, screening logs and field notes, and focus groups.</p><p><strong>Setting/participants: </strong>The study was conducted in a specialist palliative care unit and consultative service in a metropolitan Australian hospital. Participants were recruited by research staff and included adult inpatients receiving specialist palliative care or their carers (PREM completion and feedback) and multidisciplinary staff (clinicians, managers, and quality and governance personnel) (focus groups).</p><p><strong>Results: </strong>Across 219 eligible participation occasions, 188 PREMs were completed (86% participation rate). No patient or carer distress was reported during PREM administration, and occasional spontaneous comments recorded in field notes indicated appreciation for the opportunity to provide feedback. Staff participants viewed consideRATE as meaningful and actionable, and perceived that the data could support the identification of improvement priorities and advocacy for system change. They also stated that administration support was essential and that routine implementation of consideRATE was not feasible within existing clinical workloads.</p><p><strong>Conclusions: </strong>Supported administration of consideRATE in a specialist palliative care unit and consultative service resulted in high participation and completion rates with no reported distress among participating patients and carers. Staff considered the measure appropriate and perceived the data as useful for informing quality improvement, but concluded that sustainable routine implementation would require dedicated human resources and integration into the hospital's quality systems.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1933654"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186614","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":"A person-centered continuity pathway for pediatric contrast-enhanced imaging: sustaining one multisensory context across home, hospital, and scanner transitions.","authors":"Tommaso Liuzzi, Carmela Napolitano, Fiammetta D'Arienzo, Martina Frascari Diotallevi, Donatella Lettori, Andrea Magistrelli, Aurelio Secinaro","doi":"10.3389/frhs.2026.1940926","DOIUrl":"10.3389/frhs.2026.1940926","url":null,"abstract":"<p><strong>Background: </strong>Pediatric contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) require sustained cooperation, procedural immobility, and venous access, creating operational and experiential challenges for children, families, and imaging services. Existing nonpharmacological interventions generally address isolated procedural segments and do not preserve a familiar context across home, hospital, and scanner transitions.</p><p><strong>Innovation: </strong>Euterpe-Radiology (Euterpe-RAD) is a consent-gated, five-module institutional pathway that sustains one autobiographically anchored multisensory context-family-voice recordings, a personalized therapeutic composition, and child- or family-selected visual content-from home familiarization through hospital preparation, venous access, acquisition, and closure. Continuity is defined by content identity, coverage of four predefined transitions, and stability of the caregiver and therapeutic roles. The added value of continuity over single-segment preparation is a design hypothesis and is not tested here.</p><p><strong>Approach: </strong>This community case study describes pathway design and initial implementation under institutional quality-improvement governance. The pathway was offered to eight caregivers; six consented and two declined, both citing the organizational burden of the home-based component. Three children entered Module 1. One completed all five modules and underwent contrast-enhanced CT without sedation. Of the other two, one was excluded when photosensitivity was identified during the opening tele-anamnesis, and one completed home familiarization but did not undergo CT because cannulation was not tolerated. In three additional consenting children, the interval between referring-unit authorization and the scheduled examination was shorter than the 5-7-day home-familiarization window. Module 1 therefore could not be delivered; these children received hospital-stage music-therapy support only and underwent CT without sedation. These encounters are classified as partial deliveries rather than five-module completions. No MRI examination was delivered.</p><p><strong>Conclusions: </strong>One complete CT pathway was delivered without modification of acquisition or contrast protocols. The exclusions, procedural discontinuation, and partial deliveries define implementation boundaries rather than effects. These counts do not establish effectiveness, acceptability, or a sedation-sparing effect; the MRI branch remains a design specification, and prospective comparative evaluation is required.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1940926"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186579","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":"Primary healthcare, climate-related health impacts and intercultural dialogue: bibliometric evidence of a fragmented research field.","authors":"Nidia Ponte, Fátima Alves, Diogo Guedes Vidal","doi":"10.3389/frhs.2026.1909093","DOIUrl":"10.3389/frhs.2026.1909093","url":null,"abstract":"<p><p>Primary healthcare, climate-related health impacts, and intercultural dialogue are increasingly relevant to health equity and health service adaptation, yet it remains unclear whether these domains form an integrated research field or remain partially connected literatures. This systematic bibliometric analysis addresses this question by mapping how primary healthcare, climate-related health impacts, and intercultural dialogue appear in the literature. For this purpose, records were retrieved from Scopus, Web of Science Core Collection, PubMed, SciELO, RCAAP and Google Scholar, with additional records identified through exploratory searching and the lead author's library. Records published between 1 January 2007 and 31 March 2026 in English, Portuguese or Spanish were included if they addressed one or more domains of the pre-specified Population-Exposure-Outcome framework: primary healthcare physicians and culturally diverse adult patients (Population); direct or indirect health impacts of climate change (Exposure); and intercultural dialogue strategies relevant to the primary-care doctor-patient relationship (Outcome). Records were managed in Rayyan and Microsoft Excel. Descriptive analyses characterised search yield, source contribution, screening attrition, document profile, language, geographical context, publication venues and citation visibility. VOSviewer supported keyword co-occurrence, temporal overlay and co-authorship mapping. These analyses were conducted on the full-text assessed corpus, distinct from the smaller subset retained for qualitative synthesis. Searches identified 19,211 records: 13,816 after deduplication; 801 reports sought for retrieval, of which 56 could not be retrieved. This left 745 reports for full-text assessment, none of which met the complete Population + Exposure + Outcome configuration; the strongest partial intersection comprised 64 reports addressing only Population and Outcome. Keyword co-occurrence analysis reinforced this pattern: a consolidated thematic core centred on access to healthcare, cultural competence, primary healthcare, communication, migrant populations and sociocultural diversity, whereas climate-related terms remained more peripheral, more recent and less structurally embedded. Taken together, these findings indicate that primary healthcare, climate-related health impacts and intercultural dialogue remain adjacent rather than integrated bodies of literature, with cultural competence and migrant-health research far more consolidated than the climate-health dimension. Closing this gap requires research that directly examines how climate-sensitive health risks are recognised, communicated and negotiated in intercultural primary-care encounters, to inform both clinical training and climate-adaptation policy.<b>Systematic Review Registration</b>: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038912, PROSPERO CRD420251038912.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1909093"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186551","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":"Implementing Somalia's National Transformation Plan 2025-2029 for health-system reform: a policy and practice review of governance, financing, and institutional readiness.","authors":"Nor Haji Osman, Dahir Osman Mohamed, Hamdi Mohamud Osman, Abdifatah Nour Rage, Abdiweli Mohamed Abdi, Mohamed Ismael Iman, Aweis Ahmed Moallim, Abdirahman Mohamed Jimale, Mohamed Ahmed Ali, Ismail Dahir Ahmed, Abdikarim Abdi Adam, Abdirahman Ahmed Mohamud, Siham Mohamed Dhakane, Osman Mohamed Mohamud","doi":"10.3389/frhs.2026.1934347","DOIUrl":"https://doi.org/10.3389/frhs.2026.1934347","url":null,"abstract":"<p><p>Somalia's National Transformation Plan (NTP) 2025-2029 presents an ambitious health-reform agenda centred on maternal and child health, workforce development, health-system strengthening, regulation, financing, digitalisation, and emergency preparedness. The policy challenge is whether the institutional conditions required for implementation can be assembled in a fragile, federal, highly aid-dependent and predominantly mixed-provider health system. This Policy and Practice Review critically examines the implementation readiness of the NTP health chapter and proposes a sequenced framework for converting national commitments into measurable results. A structured narrative review was undertaken from June to July 2026 using peer-reviewed literature, national policy documents, and reports from governmental and international institutions. Evidence was interpreted through the health-policy triangle, the updated Consolidated Framework for Implementation Research (CFIR), applied prospectively to anticipated determinants, and a health-system resilience lens. The synthesis generated six interdependent proposed readiness foundations: a negotiated federal-state governance compact; a technically validated, costed and sequenced operational plan; sustainable financing and strategic purchasing; workforce and regulatory capacity; integrated information, monitoring and public accountability systems; and shock-responsive adaptive management. Important policy strengths include explicit targets for service coverage, workforce expansion, hospital rehabilitation, regulation and digital health. Key risks include inconsistent or under-specified targets and baselines, uncertain fiscal pathways, weak federal-state role specification, and dependence on external resources and non-state providers. Comparative evidence suggests that contracting and pooled financing can expand services when stewardship, fiduciary safeguards, workforce integration, community accountability and learning systems develop concurrently. We propose a phased 2026-2029 pathway prioritising technical validation, essential-service continuity, subnational compacts, workforce payroll transition, interoperable data systems and annual public performance reviews. The proposed framework is prospective and has not yet been empirically validated; consultation with federal and subnational authorities, providers, partners, civil society and communities is required before formal adoption.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1934347"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198279","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}