Journal of Primary Care and Community Health最新文献

Background: Global Initiative for Asthma (GINA) has recommended inhaled corticosteroid (ICS)-Formoterol as Track-1 treatment for patients. Using ICS and SABA (Short-Acting Beta-Agonist) as a reliever is an alternative Track-2 option. Both modalities are tied to type of inhaler use, dry powder inhalers (DPI) and propellent-containing metered-dose inhalers (pMDI). Compared to propellent-free DPI, pMDI have much higher carbon footprint (CF) detrimental to the environment. Leveraging on dispensed inhaler data from the electronic medical records of patients managed in primary care, the study aimed to quantify their CF using Budesonide-Formoterol (BUD-FOR) DPI alone, compared to those who were treated with BUD-FOR DPI + pMDI as a reliever.

Methods: Electronic medical records from 8 public primary care clinics were analysed, covering adult asthma patients (aged ≥21) between 2018 and 2023. Data on inhaler dispensing, asthma control test (ACT) scores and rescue therapy (RT) needs were assessed. CF was computed based on inhaler canisters dispensed. Associations between treatment modality, asthma control, RT and CF were analysed using Generalized Estimating Equations.

Results: A total of 5634 patients using BUD-FOR DPI were included. Over the study period, Track-1 usage increased substantially from 466 to 2317 patients, while Track-2 rose modestly from 628 to 758. In 2023, 78.5% of patients achieved good asthma control compared to 68.7% in Track-2. The total CF per patient was substantially lower in Track-1 compared to Track-2 (3.3 vs 62.4 kgCO₂e). Patients in Track-1 had a significantly lower CF by 60 kgCO₂e (P < .001), had 1.5 times higher odds to achieve good asthma control based on ACT scores (P < .001) and had approximately 30% lower odds of receiving RT (P < .001). The average number of SABA-pMDI canisters dispensed per patient declined from 2.8 to 2.1 over the study period. BUD/FOR inhalers use per patient per year was consistently higher in Track 2 compared to Track 1, with an average difference of 1.2 canisters (5.3 vs 4.1).

Conclusion: Patients managed under Track-1 treatment approach demonstrated significantly better asthma outcomes and lower CF. These findings highlight potential of Track-1 treatment as the preferred strategy, enabling better clinical outcomes and reduced environmental impact.

The Screen Dependency Scale (SDS) is a parent-report tool designed to assess screen media dependency in preschool children which was originally developed in Malay within the Malaysian community. This study aimed to translate and validate the English version of the Screen Dependency Scale (SDS) to enable broader participation, particularly in urban areas where English is widely used. Phase 1 involved forward and backward translation by 2 language experts. An addiction specialist reviewed the back-translated version against the original followed by Face Validity by 14 parents. Phase 2 consisted of a cross-sectional study involving 195 parents of children aged 4 to 6 years. Construct validity was tested using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). CFA showed all items had factor loadings of 0.50 or higher. Model fit indices (RMSEA = 0.08; CFI = 0.92) indicated a good fit. The English SDS demonstrated excellent internal consistency (Cronbach's alpha = .89). Thus, the English version is a valid and reliable tool for assessing screen dependency in Malaysian preschoolers.

Background: Digital health literacy (DHL) may be important in promoting health. However, there is little understanding of how social support and utilizing electronic resources are associated with DHL.

Objectives: To assess whether perceived social support of internet use, use of digital resources, and medical services serve as mediators and moderators in the pathway between DHL and self-reported health (SRH).

Methods: A cross-sectional telephone survey of 587 respondents aged 60+ was conducted in Israel in 2024. Respondents reported their DHL, SRH, perceived support of internet use, use of digital resources, and sociodemographic measures. Information regarding their actual use of digital health services for 2024 was retrieved from the healthcare service database. Statistical analyses were performed using moderation mediation models with SRH as the dependent variable.

Results: Perceived social support in internet use was a significant mediator between DHL and SRH. The direct effect was 0.0046 (CI 0.001, 0.008) and the indirect effect was 0.0017 (CI 0.0005, 0.003). Use of digital resources and services were not associated with SRH and do not serve as significant moderators of the association between DHL and SRH.

Conclusions: As more medical services have and are becoming digitalized the importance of the digital divide is increasing. Perceived support in using digital resources may enable individuals to overcome the digital divide and benefit from the digital resources available. It is important to note that findings are correlational due to the cross-sectional nature of the study.

Introduction/objectives: Despite the efficacy of vaccines in preventing disease and disability and their cost-effectiveness, a proportion of the population remains reluctant to vaccination. Vaccination literacy is one of the main determinants of vaccine decision-making. The aims of this study were to assess the measurement properties of the Hungarian version of a vaccination literacy instrument and describe the level and determinants of vaccination literacy among the Hungarian adult population.

Methods: A cross-sectional study was conducted on a sample of 1205 Hungarian adult respondents within the European Health Literacy Population Survey 2019-2021. The data were collected by computer-assisted telephone survey in December 2020. The questionnaire covered the following topics: sociodemographic data, self-perceived health, social support, and general and vaccination literacy. The instrument's internal consistency was measured using Cronbach's alpha, its reliability was assessed based on the Spearman-Brown correlation coefficient. The construct validity of the questionnaire was examined using principal component analysis based on a polychoric correlation matrix. Multivariate ordered logistic regression analyses investigated the relationship between vaccination literacy and other relevant variables.

Results: The Cronbach's alpha was 0.78, while the Spearman-Brown correlation coefficient was 0.725. The principal component analysis extracted 1 significant factor that explained 69% of the total variance. The Hungarian adult population had a good level of vaccination literacy (mean score: 82.4, 95% CI 74.9-89.8). We found that social support (OR for the moderate support: 1.93, OR for the strong support: 2.19; P < .001 for both), lack of financial deprivation (OR: 2.05, P < .001), and secondary education level (OR: 1.50, P: .024) are positively correlated with vaccination literacy.

Conclusion: We recommend using the vaccination literacy instrument to identify individuals with inadequate vaccination literacy. Interventions focusing on social support and education to promote vaccine-related information would contribute to enhancing vaccination literacy.

First Contact Physiotherapy Practitioners (FCPPs) are working across the UK to deliver musculoskeletal services to patients within general practice. Little is known about the impact of the model and how variation in delivery may lead to different experiences and outcomes of the service amongst patients and general practice staff. This study explored staff and patient experiences of First Contact Physiotherapy in general practice to determine what works, for whom, under what circumstances, and how. Qualitative interviews were conducted in general practice sites across Great Britain. Interviews were based on initial programme theories identified in an earlier realist review and consensus event. We conducted 80 remote interviews with practice staff and patients, and a further 3 interviews with respondents with other roles related to First Contact Physiotherapy provision. All interviews were analysed using a realist approach. Seven overarching theory areas were identified: 1. Awareness of FCPPs; 2. Communication and integration into practice; 3. FCPP approach in primary care; 4. FCPP additional qualifications; 5. Practice workload; 6. FCPP personal development; and 7. Employment models of FCPP. Three key areas were identified as integral to successful service delivery and implementation: FCPP integration; skillset and impact on resource use; and employment model. Findings from this study strengthen the evidence by providing a robust piece of empirical work about the key issues and contexts impacting successful implementation of the FCPP role into general practice, which will aid decision makers when developing First Contact Physiotherapy services.

Background: The COVID-19 pandemic highlighted significant health disparities across the United States, with Texas ranking among the lowest in healthcare quality. This study explores the relationship between county-level factors and COVID-19 cases in Texas daycare centers. Unlike broader studies on COVID-19 disparities, this research uniquely examines the daycare population, a critical yet understudied environment, through county-level social determinants of health.

Methods: Using 2020-2022 Covid data from the Texas Health & Human Services Commission and the 2020 County Health Rankings, we analyzed COVID-19 case counts among children and staff in licensed daycare facilities across 225 Texas counties. We classified counties into 4 patterns: high child-high staff, high child-low staff, low child-high staff, and low child-low staff. We also examined the association between county-level determinants and pandemic patterns.

Results: Counties with higher COVID-19 cases in daycare centers have higher proportions of racial/ethnic minorities, but with better access to primary care physicians, better socioeconomic conditions (eg, % of children in poverty and median household income) and greater urbanization (P < .05). Spatial analysis of child and staff cases show the clustered transmission areas, in which southeastern counties with more Native Indians (1.48%) have a higher number of staff affected by COVID-19 than counties with fewer Native Indians (1.21%-1.26%).

Conclusion: These findings underscore the influence of better access to screening on the COVID-19 counts, highlighting the importance of epidemiological surveillance. Improving healthcare access, addressing economic inequalities, and tailoring mitigation strategies are key to closing the gaps in different transmission rates among daycare centers.

Background: People with complex needs often have unmet biopsychosocial needs that require integrated services through intersectoral collaboration. Few studies have evaluated the factors influencing intersectoral collaboration for health improvement of a vulnerable population between non-profit organizations (NPOs) and primary health care partners in rural areas. The objectives of the study are: (1) to describe intersectoral collaboration between an NPO and its social and primary health care partners in a rural setting; and (2) to identify the elements that facilitate or hinder this collaboration.

Methods: An instrumental case study was conducted through field research. Data collection included non-participant observation, semi-structured interviews, and analysis of documents. A thematic analysis was then carried out, and a case story was written.

Results: The case study provides an in-depth account of the case, its context, and the key factors influencing intersectoral collaboration. Fourteen factors were identified as having a significant impact on intersectoral collaboration with the NPO. These factors had positive and negative effects on collaboration efforts. Several of these effects are also factors that had, in turn, effects on collaboration.

Conclusion: Implementing intersectoral collaborations requires a shared vision, healthy relationships, and transparent, respectful communication, among other important factors. Our study provides leaders of healthcare projects in rural areas with actionable advice to address potential challenges and enhance the effectiveness of their collaborative efforts.

Aim: To explore the role of community organisations in providing social support and facilitating self-management for individuals with type 2 diabetes in Ethiopia.

Methods: A phenomenological study approach was employed, utilising in-depth interviews and focus group discussions with a purposive sample of 25 participants. This included members of neighbourhoods and leaders of local community organisations (known locally as Idir, Equb, Tsewa, or Mahiber), as well as members of the diabetes association. Reflexive thematic analysis was employed to analyse the data.

Findings: A total of 25 individuals participated in the study, including (n = 8) members of community organisations, (n = 7) community organisation leaders, (n = 5) religious leaders, (n = 3) women's association leaders, (n = 1) church-based fundraiser, and (n = 1) diabetes association representative. Three major themes were identified regarding the role of community organisations in providing social support and facilitating self-management: 1. Community cultural perceptions and diabetes awareness. 2. Community support and social networks in managing diabetes. 3. Collaboration and strategies to overcome systemic challenges in diabetes management within the community. A holistic and collaborative approach among community organisations helps support individuals with diabetes by providing essential resources. These include organising transportation to medical appointments, mobilising financial resources for treatments, and offering emotional and spiritual support, all of which enhance diabetes management. Despite these positive contributions, structural and cultural barriers persist. Religious views on diabetes influence support from faith-based institutions, with some leaders rejecting biomedicine in favour of faith-based healing.

Conclusion: Community organisations play a crucial role in providing social support and facilitating self-management for individuals with diabetes in Ethiopia. They help overcome obstacles, mobilise resources, and fill gaps in formal healthcare by promoting healthier lifestyles. However, the effectiveness of community organisations is hampered by a lack of knowledge and awareness of effective diabetes management.

Background: Chronic musculoskeletal pain is a major health issue worldwide, characterized by a significant disease burden that leads to disability and reduced quality of life. Its prevalence is increasing, particularly among the aging population. Research is needed to provide effective, individualized, and theory-based eHealth self-management interventions to improve clinical outcomes, and access to care. There is a lack of consensus in the literature on the concept of eHealth self-management support for chronic musculoskeletal pain.

Objective: The aim of this study is to conduct a concept analysis of eHealth self-management support for chronic pain within the framework of the Social Cognitive Theory.

Methods: Our study was guided by Mckenna's 9-step process for concept analysis as a framework: (1) Select the concept; (2) Determine the purpose of the analysis; (3) Identify the uses; (4) Determine attributes; (5) Identify a 'model case'; (6) Identify alternative cases; (7) Identify antecedents and consequences; (8) Consider context and values; and (9) Identify empirical indicators. We searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE, Web of Science, and other sources between 2000 and 2025. Studies were included if they met the predetermined inclusion and exclusion criteria.

Results: A total of 12 studies were included to define the main attributes, antecedents, and consequences. The attributes were: (1) Person-centered, accessible, personal, and facilitated behavioral change; (2) Web-based multidisciplinary education, modeling, and vicarious learning; (3) Web-based goal setting, activity planning, self-monitoring, and automated personalized feedback for motivational enhancement; and (4) Web-based social support and communication with healthcare providers.

Conclusion: This study has delineated the concept of eHealth self-management support for chronic pain and provided a foundation for future research.