To synthesize evidence on approaches used in the co-design of maternal and early childhood primary care interventions with structurally marginalized populations.

Involving end-users when developing health interventions can enhance outcomes. There is limited knowledge on how to effectively engage structurally marginalized populations (i.e., groups that are affected by structural inequities resulting in a disproportionate burden of social exclusion and poor health) when co-designing maternal child primary care interventions.

A rapid scoping review was conducted by searching EMBASE and CINAHL for studies indexed between January 2010 and December 2024. Peer-reviewed studies describing co-designed health interventions or services tailored to structurally marginalized populations during prenatal, postpartum, or early childhood periods were included if they reported on one or multiple steps of a co-design process in community-based primary care practices in high-income countries.

Of the 5970 records that were screened, nine studies met the inclusion criteria. The co-designed interventions included three eHealth tools, a health- and social-care hub, a mental health service, a health literacy program, an antenatal care uptake intervention, an inventory of parenting support strategies, and a fetal alcohol spectrum disorder prevention campaign. Women, mothers, fathers, and health- and social-service providers contributed to the co-design process by participating in workshops, focus groups, individual interviews, or surveys. They provided feedback on intervention prototypes, existing resources, and new intervention designs or practice models. Ethical and practical considerations related to the population and context (e.g., marginalization) were not consistently addressed.

This synthesis on intervention co-design approaches with structurally marginalized populations can provide guidance for primary care organizations that are considering maternal child health intervention co-design with this clientele. Future work should include a critical reflection on the ethical and practical considerations for co-design with structurally marginalized populations in the context of maternal and early child care.

This study explores the perspectives of cancer lay health providers and civil society on the barriers and facilitators to cancer detection and treatment among women.

In 2010, the Moroccan Ministry of Health implemented a national plan for cancer care and control. Activities focused on strengthening multisectoral collaboration in cancer care and control, including promoting early detection in primary care. Despite progress in reducing women’s cancer mortality, socio-cultural challenges impede further gains. Elucidating the perspectives of the community-based and civil society allied in cancer control is critical to addressing cancer disparities.

Data were collected through in-depth interviews with cancer lay health advisors (n = 10) and civil society members (n = 10) on topics of challenges and opportunities to improve care-seeking and treatment. Data were analysed using thematic analysis and guided by the socio-ecological model.

Barriers and facilitators to early diagnosis and treatment were identified at levels of the individual, family, community/societal, and the health system. Barriers to early detection include taboo and stigma, fear of death, and gender norms and roles. Financial and geographic barriers, lack of psychosocial support, and poor health system/provider communication were major deterrents related to treatment. Results suggest intervention targets to reduce late-stage presentation for women, including enhancing educational efforts and augmenting community outreach linkages to primary care.

This study aims to evaluate the effect of smokers’ nicotine addiction levels and physical activity capacities (aerobic capacities) on exhaled carbon monoxide (CO) measurement values in respiratory air.

This study is a cross-sectional epidemiological descriptive type study. About 146 smokers, aged 18 and above, who applied to Hacettepe University Family Medicine outpatient clinics between March and May 2023 were included in the study. The Fagerström Test for Nicotine Dependence (FTND) and 6-minute walk test (6-MWT) were performed to the participants, and the relationship of the data with exhaled CO level was examined.

In the data we obtained, it was observed that the addiction score evaluated by the FTND had a positive, moderately statistically significant effect on the CO level (r = 0.483 p < 0.001). Although the percentage of aerobic capacity (physical activity capacities) assessed by the 6-MWT appeared to have a very weak negative relationship with the exhaled CO level, it was found to be not statistically significant (r = −0.112 p = 0.177).

The data we obtained showed that smoking addiction has harmful effects such as increasing CO in the body, but there is no relationship between physical activity and the amount of exhaled CO. It has been observed that quitting smoking and complying with lifestyle change recommendations are an important necessity for a healthier life. To improve patients’ overall health outcomes, family physicians are crucial in helping patients quit smoking and encouraging lifestyle modifications. This study might have encouraged the reflection of smoking habits and thus motivated quitting.

In the United States, roughly one million pregnancies occur every year from the misuse and discontinuation of oral contraceptives – which may be affected by an individual’s exposure to social determinants of health (SDOH). For those experiencing poorer SDOH, significant barriers may exist when family planning. Thus, our primary objective is to examine associations between domains of SDOH and contraceptive use as well as pregnancy intention using the Behavior Risk Factor Surveillance System (BRFSS).

A cross-sectional analysis of 2017 BRFSS was conducted using the SDOH module to examine differences in family planning. We used bivariate and multivariable logistic regression models to measure associations, via odd ratios, between SDOHs and contraceptive use and pregnancy intention controlling for other sociodemographic variables.

We found that individuals experiencing negative SDOH who reported running out of food (AOR: 0.65; CI: 0.50-0.86), were unable to afford balanced meals (AOR: 0.64; CI:0.49-0.84), or had no money left at the end of the month (AOR: 0.45; CI: 0.32-0.64) were less likely to have used contraceptive methods compared to those not experiencing challenges within these SDOH domains. Among women not utilizing contraceptive methods, individuals not intending to get pregnant were more likely to report difficulty affording balanced meals or having financial stability compared to women attempting to become pregnant.

Our study found that the SDOH domains of monthly financial instability and food insecurity are significantly associated with women not using contraceptive measures but not wanting to become pregnant. Addressing barriers to contraceptive access and FP is becoming more important with shifting policies regarding women’s reproductive healthcare. For women seeking contraceptive and FP advice, increased funding may help provide a solution.

The purpose of this study was to report on the prevalence of hypertension and anaemia, and types of medications prescribed to expectant mothers attending antenatal clinics at Intermediate Hospital Katutura in Windhoek, Namibia.

Millennium Development Goals 4 and 5 speak to reduction of child mortality and improvement of maternal health by 2015, respectively. Gestational hypertension is a major contributor to maternal and perinatal mortality and is reported to affect up to 10% of women world-wide. Prevalence of anaemia among pregnant women is reported higher in low- and middle-income countries than in developed countries.

This was a cross-sectional study involving the review of outpatient and clinic health records for patients attending antenatal clinics at Intermediate Hospital Katutura, Windhoek during October to November 2022. Data for patients on first antenatal clinic visit were obtained from facility antenatal clinic patient registers while that of follow-up patients were from patient health passports. All expectant mothers over 18 years of age who had provided written consent to participate, were included. Data collected were: age, body weight, haemoglobin concentration, blood pressure, gravida, number of babies delivered, pregnancy stage, comorbidities, and prescribed medications. The results were summarised using descriptive statistics. A p-value <0.05 is considered to be statistically significant.

354 records were included: 303 (85.6%) first visit, and 51 follow-up (14.4%). There was a significant correlation between systolic blood pressure (BP) and body weight (r = 0.31, p < 0.001). 13.5% of first-time visitors had haemoglobin levels lower than the normal range (11 g/dL). Difference in haemoglobin levels between trimesters 1 and 3 were significant (p < 0.001). Methyldopa was prescribed for all hypertensive expectant mothers. To reduce the incidences of anaemia and hypertension during pregnancy, women of childbearing age should be encouraged to attend antenatal visits earlier in pregnancy and to take measures for body weight reduction, respectively.

Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.

We aimed to translate the 36-factor eFI to a Canadian context.

We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.

A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.

This study aimed to understand primary healthcare providers’ beliefs about barriers and facilitators providing culturally competent midlife care to migrant women.

Primary healthcare is the entry level to the health system. It is usually the first point of contact in accessing the healthcare system and provides a range of services including health promotion and prevention. Migrant women are less likely to access and engage in health screening and health promotion activities and consequently may miss out on optimal health in older age.

A cross-sectional study including two free-text questions, part of an online survey, was thematically analysed. 76 primary healthcare providers answered the free-text questions.

Competing priorities as a result of migration and settlement experiences, the healthcare systems’ limited resources to respond to the needs of migrant population and culturally informed beliefs and behaviour about menopause were viewed as barriers to midlife care for migrant women. Flexible models of primary healthcare and coordinated engagement with community groups were proposed to address these barriers. Primary healthcare providers perceived the current primary healthcare model to be inadequate to address the additional needs of migrant women. A review of the model of care may include ‘task shifting’ where nurses provide advanced care to migrant women in midlife. Perceptions of midlife and menopause are informed by culture. Hence, a culturally informed health promotion programme led by migrant women may be one strategy to address the limited participation in preventative healthcare including health screening at the time around menopause.

A crucial step towards improving the care of people with fibromyalgia is understanding current practice. Our systematic review aims to address this by synthesising the global evidence around healthcare use in people with fibromyalgia, including its variation across groups of people, geographical locations, and over time.

Fibromyalgia is a chronic condition characterized by widespread pain alongside a broad range of non-pain symptoms. Its substantial impact on peoples’ lives and high prevalence mean that ensuring people with fibromyalgia receive evidence-based and appropriate care is a clinical and research priority. Whilst guidelines recommend that people with fibromyalgia receive a prompt diagnosis, care that focuses on non-pharmacological interventions, and in many countries should be predominantly managed in the community, existing evidence indicates they often wait many years for a diagnosis, commonly receive long-term opioid medicines, and see multiple hospital specialists.

Relevant databases will be searched, with 25% of screening, data extraction, and quality appraisal conducted by two reviewers. Eligible studies will have evaluated healthcare use in adults with fibromyalgia using data obtained from electronic health record, registry, or insurance databases (providing generalizable findings in large, representative datasets). Data will be synthesized using meta-analysis and/or synthesis without meta-analysis where possible.

By providing an in-depth analysis of healthcare use and its variation in people with fibromyalgia, the results from this systematic review could be used to benchmark practice, inform targeted management strategies to those with the highest levels of healthcare use (and therefore care need), and provide insight into whether certain countries require specific guideline/policy changes.

Heart failure is a complex disorder, that can require hospitalization and specialist care, which patients may experience challenges accessing. In Northamptonshire, an innovative approach to heart failure services was introduced to address these challenges. This study aimed to explore and understand the diffusion dynamics of the heart failure service in Northamptonshire, focusing on adoption and implementation determinants.

This qualitative study involved 11 in-depth interviews with four patients, two community carers, one general practitioner, one nurse, one programme director, and two interviews with a community cardiologist. The diffusion of innovation-guided inductive and deductive thematic analyses were used to identify themes and subthemes.

The community heart failure services incorporated community cardiology clinics and community asset groups. Implementation of these innovations was characterized by competent leadership, positive managerial relationships between community cardiologists, general practitioners, and third-sector professionals, a ‘tension for change’ to reduce hospital admissions, improve access, and dedicated funding (‘slack resources’). The ‘relative advantage’ identified by both service providers and patients was access to specialist care closer to home, rehabilitation, education, and nutrition services. The heart failure innovation aligned with the organizational values of primary care and third-sector organizations, facilitating readiness for adoption and implementation. Challenges emerged from limited management accountabilities, such as inadequate administrative and information technology support, hindering the implementation.

The heart failure innovation was perceived to improve care, navigating both facilitators and challenges. The diffusion of innovation theory highlighted the importance of governance and the performance of community heart failure services within a complex intervention context.

Parents’ confidence in their parenting abilities, or parenting self-efficacy (PSE), is an important factor for parenting practices. The Tool to measure Parenting Self-Efficacy (TOPSE) is a questionnaire created to evaluate parenting programmes by measuring PSE. Originally, it was designed for parents with children between the ages of 0–6 years. A modified version specifically for parents of infants aged 0-6 months (TOPSE for babies) is currently being piloted. In this study, we translated TOPSE for babies and investigated the reliability of the Norwegian version.

To investigate the reliability of the Norwegian version of TOPSE for babies.

The study included 123 parents of children aged 0–18 months who completed a digital version of the TOPSE questionnaire. Professional translators performed the translation from English to Norwegian and a back translation in collaboration with the author group. Mean and standard deviation were calculated for each of the questionnaire’s six domains, and a reliability analysis was conducted using a Bayesian framework for the total sample (parents of children aged 0–18 months) and specifically for the parents of the youngest group of children (0–6 months).

The Norwegian version of TOPSE for babies is a reliable tool for measuring parenting self-efficacy. However, some variations exist across the children’s age groups and domains. The overall Bayesian alpha coefficient for the suggested domains ranged from 0.54 to 0.83 for the entire sample and from 0.63 to 0.86 for parents with children aged 0–6 months. For two of the domains, one item in each proved to largely determine the low alpha coefficients, and removing them improved the reliability, especially for parents with children aged 0–6 months.

This study aimed to evaluate the validity and reliability of the Turkish version of the Contraceptive Self-Efficacy in Women in Sub-Saharan Africa (CSESSA) scale.

Contraceptive self-efficacy is a crucial predictor of utilization of modern contraceptive methods. However, the existing tools for comprehensively assessing contraceptive self-efficacy are limited. Methods: The sample of this methodological study consisted of 510 female participants of reproductive age. The translation and cultural adaptation of the scale were performed. For validity, content validity and construct validity were tested. For reliability, test-retest reliability, Cronbach’s alpha coefficient, and item-total score correlations were evaluated. Findings: The goodness-of-fit indices showed an overall acceptable fit with the three-factor model. Cronbach’s alpha for the overall CSESSA scale was 0.867, and for the three subscales, it ranged from 0.77 to 0.84. The scale’s test-retest reliability was found to be r = 0.83 (p < 0.001), and the item-total correlations score ranged from 0.495 to 0.646. The Turkish version of the scale is a valid and reliable tool to measure the contraceptive self-efficacy of women of reproductive age. This scale can provide a comprehensive understanding of self-efficacy by assessing various dimensions of contraceptive self-efficacy.

The primary objective of this study is to assess the workload situation within Iran’s primary healthcare (PHC) sector, with an emphasis on identifying workforce needs and ascertaining any existing shortages or surpluses.

Over the past four decades, the establishment of PHC in Iran has been a significant accomplishment for the country’s healthcare system. Iran places substantial importance on achieving universal health coverage through PHC, aligning with global health goals, and acknowledging the critical role of human resources in this context. This commitment has enabled widespread and inclusive access to PHC services for both urban and rural populations across the nation. The primary objective of this study is to assess the workload situation within Iran’s PHC sector, with an emphasis on identifying workforce needs and ascertaining any existing shortages or surpluses.

In 2023, a retrospective cross-sectional survey in Iran’s PHC sector sampled 1,212 individuals from 557 units across seven districts. Units were selected based on predetermined criteria for proportional representation of eligible occupational groups. Data was collected using tailored electronic questionnaires, covering facility and individual characteristics, working time, activities, and support tasks. Shortages or surpluses were assessed using Workload Indicators of Staffing Need (WISN) ratios under various scenarios, utilizing data from 2022 registration systems. Adjusted time data-informed workload pressure calculations.

Customizing the WISN protocol to each country’s context is crucial, involving stakeholders in study design, including sample selection and data collection methods. Contextual facility information aids analysis, necessitating standardized data collection approaches for diverse registration systems.

This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.

Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.

We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.

Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days – a statistically significant association (AOR: 1.25; 95% CI: 1.09–1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14–1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

Primary health care (PHC) delivered in Austria’s newly established primary health care units (PHCU) is based on interprofessional collaboration (IPC) between health care and social professionals.

This study aims to explore the requirements and challenges in IPC in Austrian PHCUs from the perspective of health care and social professionals.

15 semi-standardized, online, mono-professional focus group interviews were conducted with a total of 58 professionals with the following backgrounds: biomedical sciences, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiography, social work, and speech therapy. The participants were representatives from PHC practice (especially PHCUs), respective educational institutions, and professional organizations. The data were inductively analysed using qualitative content analysis according to Mayring.

The analysis displayed two main fields discussed by the participants, the setting for IPC and the professional relationships. The content analysis revealed three and four topics, respectively, within the main discussion fields. Within the setting for IPC, these topics were elaborated on (1) the operational area where IPC takes place in PHC, (2) the structural and organizational premises for this cooperation in PHCUs, and (3) the observed benefits of PHCUs for patients. Regarding the professional relationships, these topics were discoursed: (1) successful IPC, (2) challenges in IPC, (3) competencies required for IPC, and (4) previous and present corresponding training content.

Austrian health care and social professionals aim to get more involved in PHC in general and PHCUs specifically. They see opportunities and also challenges for their professional groups. Specific training is desired focusing on the unique requirements of Austrian PHCUs and equipping the workforce for the intensive, necessary, and beneficial collaboration between multiple professional groups in the increasingly important setting.

To summarize the findings from the PHC Measurement and Improvement (PHCMI) initiative in the World Health Organization WHO Eastern Mediterranean Region (EMR) and highlight key lessons to build PHC-oriented health systems.

To support countries in enhancing their commitment to the primary health care (PHC) approach, the WHO Regional Office for the Eastern Mediterranean (EMRO) established the PHCMI initiative in 2019 to evaluate PHC performance and identify priorities for improvement.

Building on the experience of the global PHC Performance Initiative (PHCPI), PHCMI updated the master indicator list through iterative processes and reflecting country priorities. Progress in five domains: system/structure, inputs, processes, outcomes, and impact was assessed. Existing policy documents, data sources, and key informant interviews were used in the assessment.

Of the 21 countries and one territory, 14 participated in the assessment including Afghanistan, Bahrain, Egypt, I.R. of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Oman, Pakistan, occupied Palestinian territory, Qatar, and Yemen. Despite the observed heterogeneity in PHC implementation, most countries reported that public primary care services were acceptable, accessible, and affordable. Strong leadership, the existence of PHC-related national health policies, and the engagement of stakeholders were key success factors.

Areas for additional attention include the need to increase investment in PHC, increase the PHC workforce, enhance equitable distribution of the workforce, expand training of primary care clinicians, improve health information systems, and inform the population on the benefits of preventive care. Health systems should be more tailored to the PHC approach and encouraged towards a more holistic view of the PHC approach.

The PHCMI initiative provides a foundation for an open discourse for advancing universal health coverage (UHC) and health security in EMR and re-orienting health systems towards the PHC approach.

This study aims to assess the effect of primary health care (PHC) service provision continuity on inpatient admissions for people with chronic diseases in Estonia.

Non-communicable diseases (NCDs) were collectively responsible for more than 7 out of 10 deaths worldwide in 2019. As the burden of NCDs increases, PHC has an increased role of coordinating care management. High-performing PHC can reduce unnecessary hospitalizations. Estonia has a strong PHC system focusing on multidisciplinary care. Yet it has not been evaluated for its effect on hospitalizations. Therefore, it is imperative to evaluate PHC continuity to improve care for NCD patients.

This study used routinely collected electronic medical billing data of the Estonian population aged 15 years or older from 2005 to 2020 identifying patients with seven ambulatory care sensitive chronic (ACSC) conditions. We developed an indicator to describe the continuity of PHC. Charlson Comorbidity Index (CCI) was used to assess the impact of comorbidities and we controlled the patient’s age, gender, county of residency and socio-economic status. We estimated multilevel logistic regression models with family doctor patient list random effects to assess how the odds of hospitalization depend on continuity of care, allowing for confounders.

We identified that 45% of the adult Estonian population had at least one of the target diagnoses. Among the target population, 96% had contact with their PHC providers. We found that there is a non-linear relationship between PHC continuity and patient outcomes. Any contact with PHC provider during the past 5 years decreases odds for hospitalization, but hospitalization risk is higher for people who are elderly and have higher CCI score. We found that after accounting for patient characteristics, differences among patient lists minimally impact outcomes. Further research should explore policies to better support family doctors in reducing hospitalizations for chronic patients.