Primary health care research & development最新文献

Aim: The aim of this study was to describe nurses' experiences of competence development in home care.

Background: Home care services are increasingly used to support clients' coping at home. As the number of clients with multiple diseases is growing, continuous competence development is needed.

Methods: Qualitative cross-sectional study. Four registered nurses (RNs) and seven licenced practical nurses (LPNs) from one well-being services county in Finland participated in interviews. The data were analysed with thematic analysis.

Findings: Three themes were found in the analysis: having adequate competence to work as a nurse in home care, being a competent and developing licenced practical nurse, and being an improving and developing registered nurse. Competence development requires continuous training. Nurses need various practises to update their knowledge and skills. Managers have an important role in supporting, organizing, and timing competence development opportunities.

Objective: To describe the perception of primary care (PC) among medical students from two universities in Peru.

Methods: A cross-sectional study was conducted among third- to seventh-year medical students from two universities in Lima, Peru. A questionnaire was applied to evaluate perceptions of PC. Crude and adjusted prevalence ratios (aPR) with their 95% confidence intervals (95% CI) were calculated to assess factors associated with a favorable perception.

Results: Data from 418 medical students were analyzed (women: 60.8%, mean age: 23.4 years). Only 2.2% expected to work in PC after graduation. Regarding perceptions of PC, 82% agreed or strongly agreed that PC is a preparatory step toward medical residency, 55% felt cases were less interesting, and 44% believed the income was lower compared to hospital work. Being enrolled at Universidad Peruana Unión (aPR: 3.35, 95% CI: 1.85-6.05) and having completed an external rotation in PC (aPR: 1.36, 95% CI: 1.03-1.80) were associated with a favorable perception.

Conclusion: Among the assessed students, most viewed PC as a step toward residency, and nearly half considered cases less interesting and income lower compared to hospital work. A favorable perception was associated with university affiliation and having completed external rotations in PC during training.

Aim: Our objective was to describe the self-management intervention (SMI) programmes carried out in primary care practices (PCPs) in France between 2010 and 2022.

Background: SMIs are included in the recommendations for chronic disease management, but access remains inequal. Primary care has been identified as a favourable setting for their development.

Methods: In partnership with the French Ministry of Health Office of Non-Communicable Diseases, we contacted all Regional Health Agencies (n = 18) to collect the following information from the self-management programme forms: year of authorization/declaration, SMI type, administrative structure, self-management and coordination team, and programme content.

Findings: At the 13 participating Regional Health Agencies, we identified 4,922 SMI programmes among which 18% (n = 889) were developed in primary care settings and 5.5% (n = 271) in PCPs. Among the 127 forms on SMI programmes at PCPs (2.6%), multi-professional PCPs (57.5%, n = 73) and healthcare centres (25.9%, n = 33) were the most represented. All programmes had a coordinator (mostly general practitioners, 34.7%, n = 24) among whom 69.7% (n = 69) were trained in coordination. The self-management team included a mean of 8.1 (5.5) primary care providers. The main themes were diabetes (34.6%, n = 44), diabetes and cardiovascular diseases (15.6%, n = 20), and cardiovascular disease (10.2%, n = 13). In France, self-management programmes in PCPs are still rare, lack a multimorbidity approach, and are carried out mainly in PCPs with inter-professional collaboration. A qualitative study to identify the barriers and levers to SMI programmes in PCPs may be particularly relevant.

Background: Life satisfaction, a core component of subjective well-being, has not been comprehensively explored among urban slum populations. This study aimed to psychometrically assess the Satisfaction with Life Scale (SWLS) and examine socio-demographic correlates of life satisfaction among adults in Gorakhpur, India.

Methods: A cross-sectional study was conducted among 406 participants (52.5% male, 47.5% female) selected through multistage random sampling across eight urban slums in Gorakhpur. Eligible individuals were aged 18 years or above and residents of the selected slum areas. Data were collected using a pre-validated version of the SWLS and a structured socio-demographic questionnaire, administered via the EpiCollect5 through face-to-face interviews. Descriptive and comparative analyses were used to assess group differences across socio-demographic variables.

Results: The SWLS showed good internal consistency (α = 0.842) and satisfactory inter-item correlations (r = 0.375-0.654, p < 0.01). Males reported significantly higher life satisfaction than females, particularly among married and cohabiting individuals (27.30 vs. 23.75, p = 0.001) and non-vegetarian consumers (27.28 vs. 24.25, p < 0.001). Participants from joint families showed higher satisfaction than those in nuclear households (26.79 vs. 20.29, p = 0.011). Women aged 56-65 had the lowest satisfaction scores (14.50 ± 0.71), with half reporting neutrality or dissatisfaction.

Conclusion: The findings highlight the importance of gender, family structure and dietary habits as key socio-cultural correlates of life satisfaction in urban slum communities. The presence of moderate satisfaction levels despite material hardship highlights the need for context-sensitive well-being frameworks and community-informed interventions in similar low-resource settings.

Aim: This paper aims to describe what constitutes good-quality, accessible, affordable and acceptable primary care for migrants. This includes identifying system adaptations and offering evidence- and practice-based recommendations and guidance for primary care organizations and professionals on how to deliver such care.

Background: Migration has significantly diversified European populations. Migrants often face structural, linguistic, cultural, and systemic barriers in accessing appropriate primary care. While these challenges are well-documented, implementation of effective, inclusive care remains inconsistent across countries.

Methods: This position paper presents a narrative synthesis of existing literature, expert opinions, and recent policy developments. It draws on evidence from healthcare research, policy analyses, and recommendations developed by the European Forum for Primary Care working group on migrants, primarily covering developments from the past decade.

Findings: High-quality primary care for migrants requires coordinated action across care delivery, capacity building, and system-level structures. Care delivery must be person-centred and comprehensive, supported by interprofessional collaboration and professional interpretation. Capacity building depends on training and education that embed diversity-sensitive care, cultural humility, and structural competency. At the system level, policies should guarantee equitable access, continuity of care, and inclusive quality monitoring, while fostering intersectoral partnerships and community engagement.

Conclusion: Embedding person-centred, diversity-sensitive, and community-oriented principles into primary care systems is essential for achieving equitable healthcare for migrant populations. This is an urgent plea to healthcare policymakers, organizations, and professionals to undertake action to realise these reforms as they not only improve care for migrants but contribute to stronger, sustainable and more resilient health systems overall.

Health care providers (HCPs) with histories of adverse childhood experiences (ACEs) are at increased risk for burnout, which can threaten healthcare quality. This study examines the relation between ACEs and burnout among HCPs in primary care clinics at a safety-net hospital and whether this association is buffered by resilience. Sixty-seven HCPs (68.7% women; 44.8% White; M _age = 36.7 years, SD _age = 9.8) recruited from a large, public U.S. healthcare system participated in an anonymous study assessing their ACE history, resilience, and burnout symptoms. ACE scores were positively correlated with burnout, r =.25, p =.048. A moderation analysis revealed main effects of ACEs, B = .17, SE = .07, p = .013, and resilience, B = -.34, SE = .08, p = .000, on HCP burnout, when controlling for years in healthcare. ACEs and resilience interacted to predict burnout, n = 55, B = -.11, SE=.05, p = .029. A positive relation was found between ACEs and burnout for HCPs who reported low, t = 3.21, p = .002, and average, t = 2.57, p = .013, resilience levels. Resilience appears to mitigate, or even prevent, burnout among HCPs, although it may be most helpful for those with ACE histories. Healthcare systems can build a more resilient workforce by offering routine, system-wide exposure to trauma-informed professional development or self-care opportunities to their HCPs.

Aim: To develop strategies to lower barriers to sexual and reproductive health (SRH) care for migrant women (MW) in Milan, Lombardy, Italy.

Background: SRH is a fundamental human right, yet MW experience poorer SRH outcomes than non-MW due to cultural, linguistic, legal, and financial barriers. Despite Italy's universal healthcare system (Servizio Sanitario Nazionale, SSN), disparities persist.

Methods: Quantitative SRH data from the health information system of a non-governmental organization (NGO) clinic in Milan was used to describe the demographic, socioeconomic, and administrative profile of MW with SRH needs, and to examine factors associated with SRH-related consultations. Qualitative data were collected through semi-structured interviews with 29 stakeholders, including MW, healthcare workers, NGO representatives, and policymakers. Thematic analysis was guided by a socio-ecological framework across individual, organizational, societal, and policy levels.

Findings: SRH needs were the most frequent presentations among MW accessing the clinic. Most MWs came from Romania, Morocco, and Peru. Nearly half of those eligible for SSN registration were not enrolled, primarily due to lack of awareness. Economic vulnerability was strongly linked to SRH needs, while language proficiency alone showed no significant effect. Interviews underscored the importance of culturally sensitive care and mental health support. They also emphasized the inconsistent enforcement of regulations across government facilities and legislative gaps that leave certain groups, particularly undocumented EU nationals, without essential services. Community networks and stronger coordination across providers - including formal collaboration between NGOs and the SSN - were identified as promising levers to improve SRH access and equity in Milan and similar settings.

Background: Ethiopia has been working to achieve universal health coverage through optimizing the Health Extension Programme (HEP). The HEP optimization aspires to increase health service access, quality, and equity through different strategies, including establishing HEP units in health centres and primary hospitals. Therefore, understanding the processes of the HEP unit and its implementation experience is crucial for scale-up and sustainability.

Aim: This paper aims to document and share the lessons learned from implementing the HEP unit.

Method: This research collected qualitative data from 14 districts/woredas in 2023. Forty-three in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted. Audio-recorded data were transcribed verbatim and translated. A thematic analysis approach was used to analyze the data, and direct quotations were used to present the findings.

Result: In the Improve Primary Health Care Service Delivery (IPHCSD) project implementation sites, all 64 health centres, and primary hospitals established HEP units. Setting up the unit improved healthcare provision by promoting collaboration and teamwork, enhancing their skills, coordination, technical support to the catchment health post and increased access to healthcare services through outreach delivery. However, challenges such as a shortage of human resources, dedicated offices for the unit coordinators and team members, inadequate stakeholders' engagement in the establishment processes, and insufficient tools and supplies were identified.

Conclusion: The HEP unit has improved community-level health services, enhanced health professionals' skills and teamwork, and technical support to catchment health posts. Strengthening community engagement, advocacy, mentorship, training, and ensuring sufficient staffing, infrastructure, and supplies are essential for the programme's scale-up and sustainability.

Aim: To examine whether the association between child marriage and maternal healthcare utilization differs between conflict and non-conflict settings, and whether armed conflict amplifies the negative effects of child marriage on maternal healthcare utilization.

Background: Armed conflicts hinder progress in reproductive and maternal health, particularly in low- and lower-middle-income countries, by weakening health systems, disrupting access to care, and increasing gender-based vulnerabilities. Child marriage, which is common in such contexts, may further limit women's ability to seek adequate maternal healthcare. While both conflict exposure and child marriage are known to adversely affect maternal health outcomes, evidence on their intersection remains limited. Understanding their combined influence is essential for designing effective primary healthcare and humanitarian interventions.

Methods: We used data from 82 Demographic and Health Surveys (1994-2020) across 49 countries, linked spatially and temporally with armed conflict information from the Uppsala Conflict Data Program. The sample included 452,192 women aged 15-49. Maternal healthcare utilization was measured using continuum-of-care indicators: at least one antenatal care (ANC) visit, four or more ANC visits, four or more ANC visits with institutional delivery, and four or more ANC visits with institutional delivery and postnatal care (PNC). Associations were estimated using binomial logistic regression models, with robustness checks including interaction effects, macro-level analyses, and mediation analyses.

Findings: Women married before age 18 had significantly lower odds of utilizing maternal healthcare compared to those married at 18 or older. These disparities were strongest in conflict-affected areas, where child brides consistently showed the lowest utilization of ANC, institutional delivery, and PNC. Maternal education, household wealth, urban residence, and media exposure partially mitigated these associations. Additional analyses confirmed the robustness of findings across alternative model specifications, conflict measures, and subgroups.

Aim: To explore facilitators and barriers to smoking cessation among smokers experiencing socioeconomic disadvantage, from the perspectives of patients and healthcare providers (HP) participating in the STOP randomized controlled trial (STOP-RCT).

Background: Smoking remains disproportionately prevalent among socioeconomically disadvantaged individuals, contributing to significant health disparities. The STOP-RCT evaluates a preference-based smoking cessation intervention offering free nicotine replacement therapy (NRT) and e-cigarettes to disadvantaged smokers.

Methods: A qualitative study was conducted involving semi-structured interviews with 14 participants and 5 HP from the STOP-RCT. Data collection explored participants' smoking cessation experiences, perceptions of the intervention, the quitting process, and the factors that influence cessation. Thematic analysis was used to analyse the transcribed data. Themes were categorized into structural and individual factors, refined iteratively, and supported by illustrative quotes.

Findings: Four key facilitators were identified: (1) longer consultations enabling tailored support; (2) regular follow-up promoting patient engagement; (3) immediate and free access to NRT and carbon monoxide (CO) monitoring, reducing financial and practical barriers while providing feedback; and (4) shared decision-making, strengthening trust and improving the fit of support. These findings highlight the importance of addressing both treatment approach (contextual) and interpersonal factors for this population. Considering these elements may help adapt cessation programmes to the specific difficulties and needs of patients with low socioeconomic position, thereby reinforcing treatment adherence and improving effectiveness.