This study aimed to evaluate the prevalence, types, and duration of diagnosed cancers among adult type 2 diabetes mellitus (T2DM) patients in a primary care setting in Türkiye and to examine associated clinical and demographic factors according to T2DM duration.

T2DM is a growing global health concern linked to increased risks of various cancers. Epidemiological data suggest a complex relationship involving shared risk factors and pathophysiological mechanisms such as hyperinsulinemia, inflammation, and obesity.

This descriptive, cross-sectional study was conducted at an education-family health centre (EFHC), analysing medical records and patient interviews. The sample included 442 patients with T2DM registered at Marmara University Tuzla EFHC, of whom 152 had a diagnosed cancer. Data collected encompassed cancer prevalence, types, sociodemographic characteristics, clinical features (including body mass index, T2DM duration, comorbidities), and cancer duration.

The prevalence of cancer among T2DM patients was 34.4%. The most common cancers were prostate in men and breast in women. No significant correlation was observed between T2DM duration and cancer duration; however, breast cancer was less frequent among women with longer T2DM duration compared to their cancer duration. A high rate of obesity and comorbidities was noted in the cohort. Cancer prevalence among Turkish T2DM patients in primary care is notably high, highlighting the importance of integrated screening and risk factor management. These findings underscore the need for targeted preventive strategies and personalized patient care to reduce cancer-related morbidity and mortality in diabetic populations.

This study aims to evaluate the cardiovascular disease risk and related factors among incarcerated individuals in a closed prison.

Cardiovascular diseases represent a leading cause of global mortality, among incarcerated individuals facing heightened risks attributable to environmental and lifestyle factors.

This cross-sectional study was conducted with foreign-nationed inmates aged 40–69 at Maltepe No. 3 L-Type Closed Prison in Istanbul, Türkiye, using World Health Organization (WHO) risk assessment tools. Data has been collected from January to March 2023 through in-person interviews, anthropometric assessments, and laboratory tests.

Of the 366 participants, all of them were male, mean age was 47.4 years (±6.2), as ethnic origin 74.6% were Asian. The median cardiovascular risk score was 6% (range: 1–52%), 74.6% classified as low-risk, 21.0% as moderate-risk, and 4.4% as high or very high-risk. Significant predictors of elevated cardiovascular risk included advanced age (p < 0.001), smoking (p < 0.001), systolic/diastolic hypertension (p < 0.001), and abdominal obesity (p = 0.005). Individuals exhibiting high-risk profiles showed increased levels of total cholesterol, LDL-C, HbA1c, and fasting blood glucose (p < 0.001). No correlation was found between incarceration duration and cardiovascular risk.

This study emphasises the importance of individual health evaluation including BMI and cardiovascular risk assessment and implementing preventive measures, such as smoking cessation, healthy diet and exercise programmes to protect low-and moderate-risk individuals and to lower the high risk as normal population. These preventive health services can be provided in primary care centres located in prison settlement.

To explore general practitioners’ (GPs’) views and experiences of providing services in Adelaide residential aged care homes (RACHs) and identify barriers, enablers, and suitable models of care (MoC).

National reports describe persistent challenges with GP access in RACHs. Residents often have limited choice of visiting GPs, and fee-for-service payments incentivise episodic rather than proactive care.

A qualitative study comprising semi-structured interviews was conducted with Adelaide-based GPs. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. The i-PARIHS framework informed interview questions and interpretation.

Twelve GPs participated, with a median interview time of 24 minutes (range, 18–49 minutes). Five themes were generated: 1. Poor remuneration and work–life balance, 2. Growing demands, operational inefficiencies and limited support, 3. Regulatory and administrative burdens detracting from care, 4. Small and diminishing cohort of GPs, and 5. Strengths and limitations across MoC. To improve care coverage, some GPs proposed a shared roster, with GPs rotating on-site to see their own residents and provide interim reviews for others.

GP engagement in Adelaide RACHs remains constrained by inadequate remuneration, growing demands, system inefficiencies, and limited support. Addressing these challenges requires improved remuneration reflecting care complexity, more streamlined information systems, and adjustments to prescribing and administrative requirements. Regular scheduled in-hours visits and strong relationships with staff and residents were key facilitators. A shared GP roster may improve access, continuity, and coordination while reducing on-call burden and inefficiencies in RACH work, thereby supporting more proactive, timely care. This warrants future implementation research.

To investigate the barriers and facilitators experienced by general practitioners (GPs) as primary referrers of patients to combined lifestyle interventions (CLIs).

In the Netherlands, evidence-based CLIs are implemented as a possible strategy to tackle overweight and obesity, with GPs authorized as the primary referrer. However, certain target groups are underrepresented in CLI participation and dropout remains a challenge, highlighting the opportunity to strengthen referral practices. Insight into factors influencing GP referral is needed to improve implementation of CLIs.

This qualitative study was conducted within general practices in Dutch primary healthcare, using semi-structured interviews. Interviews were conducted with GPs (n = 16) who had at least one year of experience with referral to CLIs. The interview guide and analyses were guided by the COM-B model and the Theoretical Domains Framework. Interviews were audio recorded and transcribed verbatim. A reflexive thematic analysis was performed by two independent coders, combining deductive and inductive coding.

Three referral behaviours to CLIs were identified: 1) extensive, 2) critical, and 3) limited. GPs’ referral behaviour to CLIs was influenced by an interaction between their capability, opportunity, and motivation to refer. Perceived facilitators were GPs’ awareness and knowledge of CLIs, beliefs about effectiveness, beliefs about capabilities, and ease of use of referral systems. Perceived barriers were GPs’ doubts about effectiveness, habits, role identity, lack of knowledge, limited collaboration and communication with CLI providers, and unmotivated patients. These insights may optimize referral and thereby intervention reach and equitable access to CLIs, with potential public health benefits.

This article examines how general practitioners (GPs) in Italy and Spain manage patients with mental health needs in daily primary care practice, and how their discretionary choices shape the substantive reach of universal access to care.

Modern healthcare systems in Italy and Spain formally guarantee universal access to primary care. However, mental health services in primary care reveals persistent gaps between this normative principle and everyday practice. Drawing on Lipsky’s Street-Level Bureaucracy (SLB) theory, GPs are understood as frontline professionals whose discretion operates within, and is shaped by, conditions of resource scarcity, time pressure, and limited access to psychosocial services.

A qualitative cross-national design was employed, including 42 semi-structured interviews with 20 GPs and 22 patients with mental health needs in Spain and Italy, conducted between June and November 2022. Data were analysed through an inductive-deductive coding process.

Two principal patterns of discretionary practice emerged. First, GPs exercise discretion differentially by patient age: investing in psychoeducation, counselling, and motivational support with younger patients, while moving more rapidly towards pharmacological management with older patients. This age-based categorization operates as a coping strategy that shapes patients’ candidacy for psychosocial versus pharmacological care. Second, GPs actively normalize psychological distress as a counter-medicalization strategy, primarily with younger patients. Despite significant institutional differences between the two healthcare systems, these patterns converge across Italy and Spain, suggesting they reflect structural features of the SLB role under resource scarcity rather than system-specific dynamics.

Inclusion health focuses on populations systematically excluded from healthcare including people experiencing homelessness, vulnerable migrants, and those with justice system involvement. Despite political commitments to National Health Service (NHS) equity, inclusion health remains inconsistently embedded in undergraduate medical curricula. This curriculum development report describes an educator workshop undertaken to identify priorities and practical strategies for embedding inclusion health within a medical school curriculum.

A structured workshop was conducted during Anglia Ruskin University School of Medicine’s 2025 Annual Educator Day. Multidisciplinary educators from a range of organisations participated. Small-group discussions explored four areas: populations affected by healthcare exclusion, barriers to access and engagement, challenges to student involvement in inclusion health settings, and opportunities for curriculum development. Emerging priorities were shared during a plenary session to confirm resonance with discussions. Subsequent structured thematic synthesis of facilitator notes identified curriculum priorities and implementation strategies.

Educators described current inclusion health exposure as incidental, fragmented, and insufficiently supported. Key challenges included stigma, mistrust, digital exclusion, limited placement capacity, and a lack of structured student preparation and debriefing. Priorities for curriculum development included longitudinal community-based primary care placements, stronger partnerships with third-sector organizations and people with lived experience, integration of inclusion health across professionalism, leadership and wellbeing teaching, and incorporation of inclusion health competencies into assessment.

Embedding inclusion health within undergraduate medical education requires intentional curriculum design aligned with primary care realities, national policy, and assessment frameworks. Development-focused approaches offer practical routes to strengthening equity-focused competencies across both newly established and long-standing medical schools.

To characterise baseline levels and contextual triggers of public speaking anxiety (PSA) among family medicine residents and to examine whether a theory-driven educational intervention was associated with short-term changes in PSA across cognitive, behavioural, and psychological dimensions.

Effective communication is a core competency in primary healthcare. However, while clinical consultation skills are prioritised, academic presentation skills are systematically absent from most family medicine residency curricula. This ‘null curriculum’ leaves primary care trainees unprepared for professional advocacy, academic leadership, and teaching roles.

A quasi-experimental one-group pre-test–post-test study was conducted involving 199 family medicine residents at a tertiary hospital in Türkiye. A theory-based single-session educational intervention was delivered. PSA was measured using the validated Turkish Public Speaking Anxiety Scale (PSAS). The study was reported in accordance with TREND and CRISP guidelines for primary care research.

Before the intervention, 87.4% of residents had never received formal PSA training. Academic instructors were the most frequently reported source of anxiety (82.9%) compared with patient encounters (4.0%). Following the intervention, total PSAS scores were associated with a statistically significant short-term decrease (p < 0.001). Significant short-term reductions were observed across cognitive (p = 0.005), behavioural (p < 0.001), and psychological (p < 0.001) dimensions. In exploratory subgroup analyses, married residents (p = 0.026) and senior residents (p = 0.002) appeared to experience larger short-term improvements, although these findings should be interpreted cautiously. These findings suggest that structured educational support may be beneficial for a subset of family medicine residents and that academic presentation skills warrant consideration as part of residency training; however, given the mixed individual-level responses and absence of a control group, this recommendation should be treated as preliminary pending controlled longitudinal evidence.

This study aimed to explore how individuals with complex multimorbidity perceive and experience the management of their health in everyday life and healthcare encounters.

Patients with two or more health conditions may be challenging for general practitioners (GPs) who must provide adequate treatment(-s) in a healthcare system structured mainly around single-disease models. For patients, the lived experience of this multimorbidity can be demanding, as it often involves managing multiple appointments, medications, and medical advice alongside everyday life. This situation may be particularly challenging for patients who live with multiple physical and mental health conditions.

Semi-structured individual interviews with eight individuals with complex multimorbidity living in Denmark. Analysis was guided by thematic analysis.

The analysis resulted in two main themes. First, ‘Multiple diagnoses – not multimorbidity’ describes how the participants did not expect overall continuity across diagnoses but appreciated recognition of the cumulative burden of multimorbidity. They expected continuity within each speciality and developed agentic strategies to achieve this. Some were successful; others were not. Second, ‘Managing treatment and illness in everyday life’ describes how the participants navigated tensions between medical recommendations and personal priorities as they deliberately pursued valued activities at the expense of their long- or short-term health. A professional lifeline, was a significant support for the participant. This person was often the GP. These findings underscore the active role of patients and the GP’s role in recognizing their resources to develop patient-centred care that is responsive to and realistic for the individual patient.

This study examines how community participation and empowerment processes are shaped and fostered in practice in the context of community health centres (CHCs) in Emilia-Romagna, Italy.

European health care systems are encouraged to make their primary health care more people centred. With the introduction of CHCs, Italy is promoting this development. In this context, community participation and empowerment represent important features.

This qualitative study draws on the experiences of practitioners and stakeholders working in the field of community participation and empowerment in CHCs. We conducted 19 in-depth interviews and our interviewees provided descriptions from 14 good-practice CHCs. The examples were organized according to different levels of participation, thus highlighting four themes: a) connecting with the community by informing, meeting, and proposing activities; b) consulting with the community to identify its needs; c) collaborating with the community (including prior consultation); and d) the community as the leader of the process.

In terms of the four themes and the extent of involvement, we identified a variety of processes aimed at supporting community participation and empowerment and provided various examples. We described the different goals of community participation and empowerment (e.g., the appropriateness, accessibility and visibility of CHC services; improved health; the mobilization of community resources; the construction of supportive networks; and the creation of spaces for capacity-building), the interviewees’ reported potential benefits; the community participation methods used (e.g., world cafés, workshops) and the different target groups addressed (e.g., specific disadvantaged groups or entire local community).

Consumer perspectives in Primary Health Care (PHC) need further exploration in Bangladesh. The study aimed to explore consumer-perception-based availability and accessibility of PHC services, along with equity, in a lower health outcome district.

A cross-sectional study was conducted in the low-performing district, Moulvibazar. Adult Health Care Consumers (HCCs, n = 417), attending PHC facilities were purposively selected and data were collected through face-to-face interviews. Individual questions were weighted, and Self-Reported Availability Score (SRAvS) and Self-Reported Accessibility Score (SRAcS) were derived (0–100% scale). Equities in availability and accessibility were explored by analysing gender (male–female), location (rural–urban), and Income-Quintiles (InQ).

Proportions of HCCs perceiving availability of services were low: laboratory diagnosis (19%), nutrition-health education (31%), basic emergency (49%), and ‘most of the time drug supply’ (18%). Of HCCs, 43% visited other facilities. Accessibility was fair (eg, waiting time ≤30 minutes for 86% and <one hour for 11%). Median SRAvS ranged from 42 to 52 with no difference between any of the two gender-, location-, or InQ-based groups. Median SRAcS ranged from 65 to 95 and it was significantly lower among urban vs rural (p < 0.001) subgroups. In the regression analysis, higher age (p = 0.041), female gender (p < 0.001) and urban location (p = 0.049) were found to be significantly associated with lower SRAcS.

Comprehensive availability of PHC services is poor in a low-performing district of Bangladesh. Overall accessibility to PHC services is relatively better, but it is lower for urban consumers. Gender, location and socioeconomic status are important factors to modulate inequities in service availability and accessibility.

This study aimed to explore patient perspectives on standardized screening for social needs within the context of primary care in Canada.

Social determinants of health significantly influence patient health outcomes. While standardized screening for patient social needs has gained momentum, patient perspectives on the utility of said screening, particularly within the Canadian context, remains underexplored.

Semi-structured interviews were conducted with participants aged 18 and older (n = 195), recruited from a larger multi-site study, using purposive maximum-variation sampling across four Canadian provinces (Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador). Questions asked during the interviews focused on financial well-being (ability to afford basic needs), housing status, social well-being, transportation, ability to afford utilities, and employment status. These interviews followed another study component where participants were asked to complete a short social needs questionnaire (the SPARK tool). Data was analysed using a thematic content analysis. Five themes were generated, including (1) openness to screening for social needs, (2) value in healthcare providers knowing patients’ social needs, (3) overall scepticism and trust/distrust in the healthcare system and professionals; (4) potential for harm; (5) meaningful engagement and provider training on social needs.

Participants were generally comfortable being asked about their social needs but stressed the importance of privacy, especially regarding financial well-being (ability to afford basic needs and extended health-care related expenses), as well as clear usefulness of the data and building physician-patient trust. Participants were generally open to social needs screening, though discomfort emerged when discussing race, employment, housing, and financial well-being, largely driven by concerns about privacy, trust, and data use. These findings highlight the importance of transparent communication, robust data governance, and explicit informed consent to support acceptable and effective implementation of social needs data collection.

To explore general practitioners’ and radiologists’ expectations of ankle radiography for chronic complaints.

Ankle complaints are a frequent reason for general practitioner (GP) consultations and ±20% of ankle radiography requests are for chronic complaints. It is unknown what GPs and radiologists expect from ankle radiography for chronic complaints.

A qualitative study was conducted with GPs and radiologists. Semi-structured focus group discussions were held online or live until data saturation was reached. The topic guide included: reasons for radiography, content of requests and reports, and the impact of results on patient management. The recorded interviews were transcribed and subsequently coded inductively in Max-QDA.

Five focus groups with 24 GPs and 3 focus groups with 11 radiologists were held. Radiologists focussed more on urgent diagnoses that were less considered by GPs for their rareness. GPs indicated to request ankle radiography more often for patient-, physician-related and organizational reasons than for medical indications. Radiologists expect requests to include a specific question accompanied by applicable clinical information including a specific pain location. GPs in their turn expect a short conclusion of the report answering their question.

GPs and radiologists have different expectations of radiography for chronic ankle complaints. Important in GPs’ rationale behind requesting ankle radiography for chronic complaints are non-medical factors and prevalence of ankle disorders, while radiologists also focus on more rare diagnoses than GPs. More research on the added value and accuracy of ankle radiography for chronic complaints in primary care settings is necessary.

Community-based programmes exist to support older people and their caregivers remaining out of hospital on discharge. Little is known about how consumers of a community-based programme perceive the different components provided during community TCP.

To explore how older people and caregivers perceive how a transition care programme (community-based TCP) influenced older people staying at home following hospital discharge. Secondly, to assess if experience of TCP could be explained by the person-centred care model (PCC).

Both (i) older people and (ii) caregivers were interviewed at a single metropolitan health setting. Experiences leaving hospital, the challenges, and the TCP components identified that supported or hindered consumers to remain at home were explored. Thematic content analysis was used to examine the two consumer groups separately. Secondarily, a mapping exercise assessed if PCC could be identified during analysis.

Fifteen interviews (older people (n = 8), caregivers (n = 7)) were conducted between April 2019 and January 2021. There were seven older people themes including, (i) Limited understanding of TCP content, (ii) Things are different once home, (iii) Developing action plans for continence care, (v) Developing action plans for walking. Three caregiver themes including, (i) Challenges with the discharge home on many fronts, (ii) Getting the right resources in the right way, were found. Most thematic sub-groups could be mapped to PCC constructs (6/9 (67%) caregiver, 5/9 (56%) older people). Health and social care resources are acknowledged, particularly equipment and information access, however gaps exist in how TCP fully aligns with PCC, according to consumers.

This study aims to evaluate the facilitators and barriers to the implementation, adoption, and participation of these programs.

The Prediabetes Intervention, Management, and Evaluation (PRIME) program is an initiative that integrates digital health tools with community pharmacy services to encourage lifestyle behaviour changes among participants with prediabetes. While PRIME demonstrates effectiveness in clinical outcomes, the integration of such programs into community pharmacy services remains limited.

In-depth focus group discussions and one-on-one interviews were conducted with participants and pharmacists who were involved in PRIME. The semi-structured interviews focused on the experiences and perceptions of the implementation of PRIME and its influence on behaviour change. All audio-recorded interviews were transcribed, coded, and analysed using thematic analysis techniques, leading to the development of major themes.

Seven focus groups and twenty interviews were conducted among 37 participants and 10 pharmacists. Five themes were developed: 1) Intrinsic motivations towards better health; 2) Influence of rapport building; 3) Improved convenience to healthcare access; 4) Resource and support; and 5) Innovation with digital health. Key barriers were related to the use of digital health tools (technical difficulties, lacking engaging functionalities) and resources (workload management, availability of prediabetes-specific guidelines). The participants perceived the blended approach of in-person support with technology-assisted interventions in PRIME as an effective way to build healthier lifestyles. While community pharmacy-based prediabetes management programs like PRIME can be effective in driving healthier lifestyles, several barriers hinder their broader adoption. Addressing these barriers could enhance the implementation and uptake of these programs.

To explore the barriers to good consultations in government primary health care (PHC) clinics, in Botswana.

Good consultations improve adherence to treatment, treatment outcomes, and health seeking behaviour while bad consultations do the opposite. We explored the barriers to good consultations (doctor patient interactions) in public PHC clinics in Botswana. Knowledge of these barriers may help in crafting strategies to eliminate the barriers and improve health care.

This was a descriptive qualitative study in which patients and doctors were interviewed. A semi structured interview guide was used to collect data, until data saturation. Public PHC clinics and participants were purposively selected to ensure variety in both. The data was analysed for themes, manually and using NVivo software.

Barriers included patients’ and doctors’ negative behaviours and attitudes, inadequate time to conduct consultations, not having time to do physical examination of patients, and high patient volumes. Other barriers were drug and equipment shortages, lack of privacy, and communication barriers.

Barriers to good consultations included health system level, doctor level, and patient level barriers. Thus, corrective interventions will need to target patient, doctor, and health system factors. These interventions should target improving doctors’ and patients’ behaviours and attitudes during consultations. Health system interventions should be directed at medicine and equipment shortages, as well alleviating the problem of high patient loads per doctor. Addressing communication barriers between patients and doctors should be part of the interventions to improve consultations and healthcare in public PHC clinics.

This paper explores barriers and facilitators to training of community health workers (CHWs) and outreach team leaders (OTLs) in South Africa, from the perspectives of provincial managers.

Ward-based Primary Health Care Outreach Teams (WBPHCOTs), comprised of generalist CHWs, supervised by OTLs (nurses), are a central pillar of South Africa’s primary health care system, increasingly playing a critical role in extending services to underserved communities. As their responsibilities expand, effective and well-resourced training is essential; however, training approaches remain uneven across provinces.

Between July and August 2023, a descriptive exploratory qualitative study was conducted among 15 purposively selected provincial managers whose roles involved interfacing/engaging with CHW responsibilities across the country’s eight provinces. Telephone interviews were audio-recorded, transcribed verbatim and thematically analysed using Atlas.ti 23.

Three key themes emerged: (i) current training practices and implementation approaches; (ii) training challenges and systemic gaps; and (iii) strategies for strengthening CHW and OTL training. Training is undermined by varying educational backgrounds and literacy barriers between CHWs and OTLs, a shortage of master trainers, and systemic constraints, particularly the absence of a dedicated training budget, inaccessible updated training materials, and logistical issues, including limited internet access and transport.

Findings highlight the need for standardised, updated training materials, practical skills training, and translation of resources into local languages. Formal mentorship programmes, leadership and communication training for OTLs, and a dedicated training budget would alleviate systemic constraints. Increasing master trainers and partnerships with external organisations, to transfer skills and build internal capacity can strengthen support for CHWs and OTLs, improving service delivery and health system outcomes.

Early diagnosis of autism spectrum disorder (ASD) remains a significant challenge due to the time-consuming and subjective nature of traditional diagnostic methods. This study proposes a reliability-oriented hybrid deep learning framework that provides a low-cost, scalable, non-invasive, and AI-assisted pre-screening tool for early ASD risk indication and referral support.

The proposed system integrates two independent deep learning architectures: (1) a ResNet18 model optimized with 10-fold cross-validation using static periocular image data, and (2) a multi-CNN facial image classification ensemble combining ResNet50, EfficientNet-B0, and DenseNet121 architectures. The periocular pathway uses the fine-tuned ResNet18 fully connected softmax layer as its decision boundary. The facial pathway uses weighted probabilistic averaging, and the two subsystem outputs are subsequently combined through an OR-based reliability fusion rule. Additionally, explainable artificial intelligence (Grad-CAM) was employed to visualize decision-relevant regions.

The static periocular ResNet18 model achieved a sensitivity of 90%, while the multi-CNN facial classification ensemble reached a sensitivity of 87.1% and an AUC of 0.948. Under the conditional-independence assumption, OR-based reliability fusion yielded an analytically estimated system-level sensitivity of 0.9871, corresponding to a joint false-negative probability of approximately 1.29%.

The developed hybrid model is positioned as an AI-assisted pre-screening and early-referral support tool, not as a replacement for clinical evaluation. By combining reliability-oriented parallel fusion with explainable AI, the system supports clinical transparency and offers a scalable pathway for early ASD risk indication.