BMC Health Services Research最新文献

{"title":"Technical efficiency of public health facilities in Punjab, Pakistan: application of a two-stage data envelopment analysis.","authors":"Ain Ul Momina, Taimoor Ahmad, Rubeena Zakar, Sara Shahzad, Fayaz Ahmad, Salman Mahmood, Florian Fischer","doi":"10.1186/s12913-026-15847-7","DOIUrl":"10.1186/s12913-026-15847-7","url":null,"abstract":"<p><strong>Background: </strong>This study analyses the technical efficiency of public health facilities in Punjab, Pakistan, using a two-stage data envelopment analysis (DEA) approach. The study focuses on family planning service delivery, addressing suboptimal contraceptive prevalence, and service utilization.</p><p><strong>Methods: </strong>Data were collected from 100 public health facilities managed by the Primary and Secondary Health Department, with 50 from the Delivering Accelerated Family Planning in Pakistan (DAFPAK) project and 50 non-cohort facilities. DEA was used to assess technical efficiency, considering inputs such as contraceptive stock, staff availability, and facility size. In addition, we used the Simar-Wilson regression to analyse the influence of environmental factors.</p><p><strong>Results: </strong>The average efficiency score was 78%, with variations across facility types. Basic Health Units and Rural Health Centers showed significant resource optimization gaps. A negative association was observed between the number of other healthcare providers in the catchment area and facility efficiency, indicating the importance of aligning service provision with local demand.</p><p><strong>Conclusion: </strong>DEA effectively identifies inefficiencies and informs resource optimization in public health facilities in Punjab. The findings offer valuable insights for improving family planning services and healthcare delivery in resource-constrained settings.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching for the better? understanding how contextual conditions influence patients' choice of primary care provider.","authors":"Caroline Blomberg-Ohlström, Inger K Holmström, Magnus Fredriksson, Ulrika Winblad","doi":"10.1186/s12913-026-15798-z","DOIUrl":"10.1186/s12913-026-15798-z","url":null,"abstract":"<p><strong>Background: </strong>Considering current expectations that patients will stimulate competition based on quality among healthcare providers through informed choices, this study aims to advance understanding of patients' limited engagement in choosing a primary care provider.</p><p><strong>Methods: </strong>The study focuses on how contextual conditions-such as institutional and social settings-influence decision-making. Conducted in a Swedish primary care context, the study employed a qualitative approach, using thematic analysis of interviews with 18 respondents who had experience seeking primary care services. To further explore contextual influences, respondents were asked to reflect on and contrast their decisions regarding primary care providers with those related to other services, such as nursing homes or schools.</p><p><strong>Results: </strong>Respondents were generally less engaged in seeking information about primary care providers compared to other types of service choices. Five themes of contextual conditions were found to influence engagement in the informed choice process: (1) the perceived necessity to choose, (2) the visibility of differences between providers, (3) the expectation of equal service quality, (4) the presence of personal relationships connected to providers, and (5) the continuity of the care relationship.</p><p><strong>Conclusions: </strong>Findings suggest that efforts to promote informed patient choice in primary care need to extend beyond the provision of information to address the contextual conditions that shape engagement. Policymakers aiming to increase competition and patient agency in healthcare should make provider differences more visible and clarify the purpose and impact of choice.</p><p><strong>Clinical trial registration: </strong>Not relevant.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Swedish healthcare workers managed the early weeks of the COVID-19 pandemic: sensemaking across organisational, interpersonal and individual levels.","authors":"Helena Månsson Sandberg, Mats Jong, Miek C Jong, Erika Wall","doi":"10.1186/s12913-026-15826-y","DOIUrl":"https://doi.org/10.1186/s12913-026-15826-y","url":null,"abstract":"<p><strong>Background: </strong>In times of crisis the need to make sense of the situation becomes particularly evident. The perspective of sensemaking captures how individuals seek to clarify and understand what is going on when they encounter ambiguous, unexpected or confusing events, such as the COVID-19 pandemic. Sensemaking may occur at different but mutually interrelated organisational, interpersonal and individual levels. During the COVID-19 pandemic, healthcare workers (HCWs) faced multifaceted challenges related to their work. This study aimed to explore how HCWs managed their daily work during the early weeks of the COVID-19 pandemic through the perspective of sensemaking across organisational, interpersonal and individual levels.</p><p><strong>Method: </strong>The data was collected through individual interviews with 18 nurses and physicians between March and May 2020, and analysed using a reflexive thematic analysis.</p><p><strong>Findings: </strong>The analysis revealed an overarching pattern of sensemaking as a way of holding clinical practice together throughout uncertainty. At an organisational level, sensemaking included how organisational structures contributed to stability in the organisation of work. The interpersonal level captured how understanding of uncertain circumstances was grounded in a collective understanding wherein HCWs reflected together and in relation to others. The individual level of sensemaking captured HCWs´ capability and commitment to continuing to provide care, despite uncertain circumstances.</p><p><strong>Conclusions/implications: </strong>The findings imply that sensemaking at organisational, interpersonal and individual levels is an important consideration for healthcare organisations when facing future crisis or other uncertain events. Clear organizational directives are important for fostering a shared understanding of how uncertain situations should be interpreted and managed in practice. Furthermore, HCWs need opportunities and time for interaction with colleagues, enabling them to collectively construct meaning and maintain a sense of stability when managing uncertainty. It is also important to acknowledge HCWs´ individual knowledge, experiences and capability to sustain clinical practice despite conditions of uncertainty.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of pre-visit computer-assisted history-taking with a structured copy-ready summary on documentation completeness in screening for inflammatory rheumatic diseases: a randomized pilot study.","authors":"Anna Roemer, Tim Wilhelmi, Daniel Fink, Manuel Göbel, Juliana Hack, Jonathan Bamberger, Felix Mühlensiepen, Karolina Gente, Sebastian Kuhn, Philipp Klemm, Johannes Knitza","doi":"10.1186/s12913-026-15808-0","DOIUrl":"10.1186/s12913-026-15808-0","url":null,"abstract":"<p><strong>Background: </strong>Clinical encounters in outpatient care are constrained by high demand, limited consultation time, and documentation requirements. Computer-assisted history-taking (CAHT) may improve the structured collection of patient information before consultations and disease screening, but evidence is limited. This randomized pilot study evaluated whether pre-visit CAHT combined with a copy-ready summary increased documentation completeness and assessed patient and physician acceptance.</p><p><strong>Methods: </strong>MAESTRI was a multicenter, parallel-group, randomized pilot study conducted across rheumatology, dermatology, and orthopedics outpatient services. Adults at increased risk of an underlying inflammatory rheumatic disease (IRD) were randomized to pre-visit CAHT or usual care. Specialty-specific questionnaires generated structured narrative summaries covering predefined screening-relevant items. The primary outcome was documentation completeness, assessed by a blinded reviewer as the percentage of these predefined items present in the final clinical documentation. Secondary and exploratory outcomes included patient and physician acceptance, usability ratings, and free-text feedback.</p><p><strong>Results: </strong>Of 45 screened patients, 43 were randomized and analyzed. The mean age was 54.2 years (SD 14.3), and 29 participants (67.4%) were female. All intervention-group clinical notes contained the generated summary. Overall median documentation completeness was 100.0% (IQR 100.0-100.0) in the intervention group compared with 46.9% (IQR 10.0-68.8) in the control group (p < 0.001), with consistent differences across rheumatology, dermatology, and orthopedics. CAHT acceptance was high among both patients and physicians, with 41 of 43 patients (95.3%) willing to complete and the six responding physicians (100%) willing to offer digital pre-visit questionnaires before future appointments. Qualitative feedback was predominantly positive, with patients reporting that pre-visit questionnaires could improve consultation preparation, support recall of symptoms, and help physicians focus the visit on relevant issues. Some participants emphasized that digital questionnaires should complement, rather than replace, direct physician interaction.</p><p><strong>Conclusions: </strong>Pre-visit CAHT combined with a structured, copy-ready summary substantially increased the completeness with which predefined screening-relevant information was transferred into clinical documentation while also suggesting high acceptance among both patients and physicians. These findings support further evaluation in a larger trial assessing workflow impact and clinical impact.</p><p><strong>Trial registration: </strong>The study was registered at German Clinical Trials Register (DRKS; ID: DRKS00036519). Date of Registration: 2025-03-31.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insistent individualisation and eroding egalitarianism: Dominant discourses of equality in Swedish healthcare policy.","authors":"Marcus Lauri, Anna-Karin Hurtig, Per E Gustafsson, Ida Linander","doi":"10.1186/s12913-026-15824-0","DOIUrl":"10.1186/s12913-026-15824-0","url":null,"abstract":"<p><strong>Background: </strong>Equality is a core objective that is frequently invoked in Swedish healthcare policy, yet its meaning is rarely examined in depth. This study analyses how equality is articulated in two contemporary healthcare reforms. The aim is to map the extent to which discussions on equality are present and how it is assumed that equality is to be achieved, analyse the meanings of equality that are produced, and discuss and problematise possible implications.</p><p><strong>Methods: </strong>The study applies discourse theory and conceptual discussions on equality, in the analysis of two major Swedish governmental reform reports: one on highly specialised care (SOU 2015:98) and the other on primary healthcare (SOU 2020:19).</p><p><strong>Results: </strong>Three meanings of equality were identified, of which the first two are more commonly articulated. Firstly, equality is articulated as sameness and uniformity, particularly in relation to geographical access, coordination across actors and locations, and the standardisation of care through knowledge production and exchange. Secondly, equality is framed as individual agency and patient responsibility, emphasising patients as co-creators of care through mechanisms such as individual care plans and patient contracts. To a lesser extent, equality is also articulated as responsiveness to healthcare needs. The two dominant meanings reflect liberal and individualised notions of equality that prioritise uniform access and the removal of difference, alongside an emphasis on individual responsibility.</p><p><strong>Conclusions: </strong>The analysis suggests that these dominant articulations marginalise more egalitarian or distributive understandings of equality that would take into account social determinants of health and unequal structural conditions. While equality occupies a central position in Swedish healthcare policy, its meaning is increasingly shaped by liberal values rather than commitments to social justice or redistribution. This has important implications for how healthcare reforms are designed and for the capacity of policy to address healthcare inequalities in practice.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare professionals' awareness of climate change and its association with eco-anxiety and environmental sensitivity: a cross-sectional study.","authors":"Tuğba Özdemir, Tuğba Çetinol Taştemel, Gülendam Karadağ","doi":"10.1186/s12913-026-15770-x","DOIUrl":"10.1186/s12913-026-15770-x","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals play an essential role in addressing the health impacts of climate change. Understanding how their awareness of climate issues and eco-anxiety relate to environmental sensitivity is critical for strengthening their capacity to respond to climate-related risks. This study aimed to examine the relationship between healthcare workers' climate change awareness, levels of eco-anxiety, and their environmental sensitivity.</p><p><strong>Methods: </strong>A cross-sectional, correlational design was employed. The study included 460 healthcare professionals aged 18 years or older working in clinical settings. Data were gathered using a socio-demographic form, the Environmental Sensitivity Scale, the Global Climate Change Awareness Scale, and the Eco-Anxiety Scale. Analyses were conducted using SPSS 24.0, including descriptive statistics, Spearman correlation, and multiple linear regression.</p><p><strong>Results: </strong>Healthcare professionals demonstrated moderate levels of climate change awareness and environmental sensitivity, while eco-anxiety levels were moderate. Regression analysis showed that awareness of global climate change, being a nurse, being aged 45 years or older, and membership in an environmental organization were significant predictors of environmental sensitivity, whereas the rumination sub-dimension of eco-anxiety showed only a marginal, non-significant association (p=0.064).</p><p><strong>Conclusions: </strong>The findings indicate that cognitive engagement with climate-related concerns, climate awareness, and certain demographic characteristics are associated with environmental sensitivity among healthcare professionals. Enhancing educational efforts, institutional support, and environmental policies may strengthen their capacity to address climate-related health risks and promote environmentally responsible practices in healthcare settings.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why are voluntary health insurance holders willing to pay tax towards public healthcare? A qualitative study from Sweden.","authors":"Linn Kullberg, Paula Blomqvist, Ulrika Winblad","doi":"10.1186/s12913-026-15708-3","DOIUrl":"10.1186/s12913-026-15708-3","url":null,"abstract":"<p><strong>Background: </strong>Voluntary health insurance (VHI) is increasing in many European healthcare systems, including the tax-funded public healthcare systems found in Northern Europe. As private alternatives to publicly financed health services expand, there is a risk that the willingness to pay tax towards redistributive public healthcare systems will diminish. This study investigated how employer-funded VHI holders accounted for their continued willingness to pay income tax to suppor the public healthcare system and the motivation underlying their tax compliance.</p><p><strong>Methods: </strong>A qualitative approach based on 19 semi-structured interviews with individuals holding an employer-funded VHI in Sweden was used. The interviews were analysed using thematic analysis.</p><p><strong>Results: </strong>The findings suggest a continued willingness to pay tax towards the public healthcare system among Swedes with an employer-funded VHI. The support was motivated by a moral logic and belief in the principle of equal access to health for all citizens. Respondents also expressed ambivalence about gaining faster access to care than others.</p><p><strong>Conclusion: </strong>These accounts suggest that the growth of employer-funded VHI does not by itself erode the willingness to fund public healthcare, and that the egalitarian principles underpinning a universal system can sustain a sense of obligation to contribute even among those who use private healthcare. The ambivalence respondents expressed indicates that contributing on egalitarian grounds and benefiting from privileged access are not easily reconciled.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic and productivity outcomes of workplace health programmes incorporating blood-based laboratory screening: a systematic review.","authors":"Dominik Swadźba, Sebastian Makuch, Siddarth Agrawal","doi":"10.1186/s12913-026-15428-8","DOIUrl":"https://doi.org/10.1186/s12913-026-15428-8","url":null,"abstract":"<p><strong>Background: </strong>Workplace health programmes increasingly include blood-based laboratory screening, promoted to lower costs and improve productivity, yet the economic case is contested and previous reviews have not isolated programmes with a blood-based screening component. We systematically reviewed the economic and productivity outcomes of such programmes.</p><p><strong>Methods: </strong>Following PRISMA 2020 and a prospectively registered protocol, we searched PubMed, Scopus, Web of Science, EconLit, the Cochrane Library, and grey literature (WHO, ILO) from January 2000 to May 2026. Eligible studies evaluated workplace programmes incorporating blood-based laboratory or biomarker screening in working adults and reported at least one economic or productivity outcome. Selection, extraction, and quality appraisal, using design-appropriate tools (RoB 2, Newcastle-Ottawa Scale, NIH before-after tool, CHEC list), were performed in duplicate with adjudication. Because outcome metrics were too heterogeneous to pool, findings were synthesised narratively by direction of effect across six domains, with sensitivity and subgroup analyses.</p><p><strong>Results: </strong>Fifty-six studies were included, mostly US observational or single-arm designs; six were randomised trials, none at low risk of bias. Healthcare-cost outcomes (29 studies) were predominantly favourable (21 studies) and remained so among higher-quality studies. Return on investment (20 studies) was uniformly favourable, with no attenuation in the direction of effect across study quality. Absenteeism (23 studies) was inconsistent, and presenteeism (7) and staff turnover (1) were rarely measured, reflecting reliance on administrative rather than validated measures. Patterns were robust in sensitivity analyses.</p><p><strong>Conclusions: </strong>Workplace programmes incorporating blood-based screening were associated with favourable healthcare-cost and return-on-investment results in most studies, but the return-on-investment signal showed no attenuation with study quality and is hard to separate from reporting and selection bias; absenteeism was inconsistent and productivity rarely assessed. Favourable economics appeared almost exclusively where screening was coupled to a structured, coordinator- or physician-led pathway, not offered alone-a contrast to read cautiously, since screening-only programmes were seldom evaluated economically. The evidence does not support blood-based screening as a stand-alone cost-saving measure and suggests, as a hypothesis, that its value lies less in testing than in support that turns detection into sustained behaviour or treatment change. Rigorous, controlled, non-US studies with validated productivity measures are needed.</p><p><strong>Systematic review registration: </strong>Open Science Framework, https://doi.org/10.17605/OSF.IO/M4W8C CLINICAL TRIAL NUMBER: Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between support and uncertainty: employers' perspectives on workplace inclusion of people with mental health problems.","authors":"Silvia Krumm, Lea Mayer, Sarah Feige, Nicole Stasch, Lena Renz, Christiane Braun-Volkert, Reinhold Kilian, Edith Almer","doi":"10.1186/s12913-026-15665-x","DOIUrl":"10.1186/s12913-026-15665-x","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing awareness of mental health in the workplace, people with mental health problems continue to face substantial barriers to labour market participation. While stigma-related explanations have been widely addressed, less is known about how employers respond to mental health problems within the constraints of everyday organisational practice. This study explores employers' perspectives on workplace inclusion, with a particular focus on ambivalences, facilitating orientations, and expectations towards employees with mental health problems.</p><p><strong>Methods: </strong>This study reports findings from the first, qualitative phase of a participatory mixed-methods research project conducted in Southern Germany. Between November 2022 and August 2023, we conducted 29 semi-structured interviews with employers from companies across different sectors. Data were analysed using structured qualitative content analysis.</p><p><strong>Results: </strong>Employers described ambivalent orientations towards the inclusion of people with mental health problems. While mental health issues were seen as increasingly normalised and framed within broader societal developments, employers reported uncertainties regarding work organisation, team functioning, and predictability. Facilitating orientations included social responsibility, recognition of the health-promoting role of employment, pragmatic responses to labour shortages, and positive prior experiences. At the same time, workplace participation was often described as depending on employees' transparency regarding work-related limitations, individual responsibility for managing mental health, and disclosure as a prerequisite for employers' support and mutual trust.</p><p><strong>Discussion: </strong>Workplace inclusion of people with mental health problems appears to depend not only on employers' attitudes but also on practical considerations related to work organization and team functioning. Employers' perspectives reflected ambivalence, balancing commitments to participation with concerns about predictability, fairness, and collective functioning. Expectations regarding disclosure, responsibility, and transparency were central to perceived feasibility of support.</p><p><strong>Conclusions: </strong>Addressing these organisational dynamics may help inform more context-sensitive strategies to promote sustainable labour market participation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' experiences of musculoskeletal pain self-management and perspectives on virtual physiotherapy in Saudi Arabia: a reflexive thematic analysis.","authors":"Norah AlMuhana, Dalia Alimam, Walaa Moslem, Sara Bin Shehan, Nezar Al Torairi, Hana Alsobayel","doi":"10.1186/s12913-026-15695-5","DOIUrl":"https://doi.org/10.1186/s12913-026-15695-5","url":null,"abstract":"<p><strong>Background: </strong>Patients with musculoskeletal (MSK) pain in Saudi Arabia frequently employ self-directed management strategies in the absence of timely professional physiotherapy. This qualitative study was conducted as the first phase of a research programme investigating virtual MSK self-management in Saudi Arabia. Its findings subsequently informed the development and design of a hybrid virtual self-management programme for low-risk MSK patients.</p><p><strong>Methods: </strong>Eight gender-separated focus groups (n = 36) were conducted in Arabic at a tertiary care facility in Riyadh between July and October 2025. Sessions were held in-person or via Zoom. Audio recordings were transcribed verbatim using automated transcription (TurboScribe AI) as a first-pass tool, and the resulting transcripts were subsequently verified line by line by the research team. Data were analysed using reflexive thematic analysis following Braun and Clarke's six-phase framework. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).</p><p><strong>Results: </strong>Four interconnected themes were constructed: (1) Self-Management Without Structured Guidance - patients enacted symptom-driven strategies as rational responses to delayed professional care access; (2) Barriers to Physiotherapy Engagement and Adherence - structural, psychological, and relational factors disrupted access and adherence; (3) Limited Health Literacy and Educational Needs - community and individual knowledge gaps were identified, including a culturally specific educational need that has received limited attention in the MSK self-management literature for guidance on adapting Islamic prayer (Salah) during MSK pain; and (4) Conditional Acceptance of Virtual and Hybrid Physiotherapy Models - participants generally preferred hybrid care in which virtual delivery served as follow-up after in-person assessment and technique acquisition, not as an entry point to rehabilitation.</p><p><strong>Conclusions: </strong>Patients described relying on informal self-management strategies, which they attributed to the systemic lack of timely access to professional care. To our knowledge, a culturally specific finding that has received limited attention in the musculoskeletal self-management literature is patients' need for guidance on adapting Islamic prayer (Salah) during MSK pain. These findings informed the development of a culturally adapted hybrid virtual self-management programme, with implications for patient education and physiotherapy service design at the study institution and similar tertiary settings in Saudi Arabia, aligned with the national Vision 2030 health strategy.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}