We sought to explore the knowledge and perceptions of obesity care among general practice nurses in the Republic of Ireland.

Obesity is a complex condition driven by the interplay of social, cultural, environmental, genetic, biological and psychological factors. Despite its recognition as a chronic disease, it is underdiagnosed and undertreated in primary care. General practice nurses (GPNs) play a critical role in the monitoring of risk factors and treatment of chronic diseases, but their role in the management of obesity in primary care is less well described.

A cross-sectional cohort study was conducted. An anonymous online survey was disseminated asking a broad range of questions on levels of training, knowledge, perceptions and barriers to obesity care.

Of 240 GPNs who completed the survey, 93% were aware that obesity aetiology is multifactorial. Identified causes which imply “personal responsibility” rated highly (73%). Most GPNs are comfortable having discussions about weight (74%). They reported discussing behavioural interventions more frequently than pharmacological treatments or bariatric surgery. Perceived lack of time in appointments (83%), lack of training (71%), shortage of specialist care (72%) and cost of treatments (67%) were the highest rated barriers to providing care. Lack of time in appointments (67%) and fear of causing offence (57%) were the highest rated barriers to initiating a discussion with patients about weight. GPNs felt their own BMI influenced how patients with obesity view their advice. Many GPNs (40%) reported they had no training in obesity care, while 54% had attended at least one obesity-themed webinar or conference.

GPNs recognise their essential role in obesity care. We have identified the need for dedicated consultation time and further training for GPNs to enable discussion of treatment options and support appropriate care pathways, including access to specialist care.

Public health specialists (PHSs) are responsible for developing and implementing health promotion policies and can contribute to healthcare delivery at all levels. Discrete choice experiments (DCEs) can inform policy by identifying healthcare professionals’ job preferences and the trade-offs they are willing to make between job attributes. This study aimed to investigate job preferences among PHSs, including trade-offs between job attributes and the probability of choosing specific job scenarios.

This cross-sectional analytical study was conducted among 183 PHSs. Job attributes and levels were determined through a literature review and semistructured interviews with specialists. The questionnaire was administered online. A mixed logit model was used to estimate preferences for different attribute levels. Latent class analysis (LCA) was performed to identify subgroups with similar preference patterns. Simulations of job uptake probabilities were also conducted and willingness-to-pay (WTP) estimates were calculated.

Five of the six job attributes significantly influenced preferences, ranked as follows: proximity to family/friends, working environment, salary, developmental status of the workplace, and managerial position. LCA indicated that preference weights varied across subgroups defined by sociodemographic and professional characteristics.

In addition to monetary incentives, ensuring proximity to family and providing a supportive working environment appear to be the most effective strategies for improving the employment of PHSs. Financial incentives are particularly important for managerial roles, especially among junior PHSs without prior managerial experience.

This study aimed to explore the experiences of midwives providing care in primary care walk-in clinics (PCWCs) within refugee camps, examining the challenges they encounter, and the relevance the ORAMMA framework.

Refugee camps present a complex environment for maternal care provision, due to limited resources, high population mobility, cultural and linguistic diversity, and increased psychosocial vulnerability among women. Midwives often being the primary providers of maternal care, must address both social and clinical needs. The ORAMMA framework was developed to support culturally sensitive and equitable maternity care for migrant and refugee populations. However, limited evidence exists regarding field experiences of ORAMMA-guided midwifery practice.

A qualitative study design was employed to capture midwives’ in-depth experiences. Data were collected from 22 ORAMMA-trained registered midwives working in refugee camp PCWCs. Data were collected using semi-structured individual interviews (n = 15) and two focus groups (n = 7). Data were thematically analysed to identify recurring patterns and key themes.

Midwives reported persistent challenges, including inadequate infrastructure, shortages of essential medical supplies and disrupted care continuity. Language and cultural barriers limited effective communication, trust-building, and clinical decision-making. Despite these constraints, midwives demonstrated adaptability and professional resilience, through collaborative teamwork, creative problem-solving, and culturally sensitive care. ORAMMA training strengthened their confidence and awareness in providing care, although participants emphasised the need for enhanced material resources, interpreter services, and psychosocial support. Overall, findings highlight the value of ORAMMA-guided capacity-building to support midwives’ resilience and commitment to quality care delivery.

Social prescribing (SP) is increasingly recognised as a key component of primary care, implemented in at least 25 countries by 2023. In England, SP has been nationally rolled out through Primary Care Networks (PCNs), though many areas, including Redbridge in East London, had pre-existing VCSE-led models. How national and local approaches integrate in practice remains underexplored.

This study used a two-step qualitative design. First, documentary analysis of service planning and evaluation documents mapped the SP referral pathway in Redbridge before and after the national rollout. Second, 16 semi-structured interviews were conducted with purposively sampled stakeholders from PCNs, RedbridgeCVS, the local authority, and the Clinical Commissioning Group, exploring service integration and delivery experiences. Data were analysed using the Framework Method, combining deductive coding against predefined themes with inductive identification of emergent categories.

RedbridgeCVS was widely valued for its expertise, especially in managing complex cases, training link workers, and facilitating access to local services. However, integration across PCNs was inconsistent. Participants reported variation in GP engagement, referral processes, and support structures. PCN link workers faced capacity pressures, unclear role boundaries, and limited access to clinical supervision, affecting the sustainability and coherence of service delivery.

Integrating national and local SP models requires clearer leadership, standardized referral pathways, and consistent support for link workers. Without greater alignment across primary care and VCSE partners, the full potential of SP risks being undermined. Link workers must be recognized and supported as core members of the primary care team.

Regulatory instruments are a key necessity to implement public-private partnership’s strategy. This study aimed to explore the stakeholders’ experience on financial incentive-based regulatory instruments for public-private partnership in Iran’s primary health care (PHC) delivery system.

This qualitative study was involved face-to-face interviews with 18 stakeholders in primary health care partnership projects including employers, experts, contractors, and executive managers of contracted companies operating as a private health sector participant in primary health care services. The data were analyzed using the framework analysis method.

Twenty-four codes were developed. Findings showed that the current state of financial incentive-based regulatory instruments in Iran’s PHC delivery system faced some challenges despite existing capacities. These challenges include the lack of an independent trustee for access to capital, and a comprehensive regulatory program to facilitate private sector participants’ access to capital, and partnership contracting mechanisms. Findings also showed main challenges of these instruments related to access to capital, tax incentives and subsidies, staff mobility control mechanisms, partnership contracting mechanisms, and provider payments.

The presence of significant challenges in Iran’s health care system can impact the private sector’s motivation to participate in primary health care. By improvement the infrastructure, reforming legal processes, and providing financial incentives, the government can boost the private sector’s motivation in primary health care and advance the health sector’s goals.

Older adults with multimorbidity (OAMM) commonly receive depression and pain management through primary care, where symptoms are typically assessed through retrospective recall. Even with validated questionnaires, recall bias has been reported in younger populations for both depression and pain. However, recall bias for depression and pain has not been explored in OAMM. We examined discrepancies between prospectively measured and recalled symptoms of depression and pain among OAMM.

We analysed data generated from a 14-day pilot feasibility trial of ecological momentary assessment (EMA) in OAMM (N = 18, age range 67–95). We examined discrepancies between retrospectively assessed depression and pain intensity over two weeks compared to follow-up, baseline characteristics correlated with discrepancies, and recency effects.

We found overreporting across most symptoms, with the largest discrepancies between prospectively recorded and recalled symptom scores for pain intensity and fatigue (d = .49). There was no association between recalled and EMA-measured items for appetite and trouble sleeping. Pain intensity at day 14 was associated with discrepancies in recalled pain (r = −.52, p =.029), and both day 14 mood and negative self-thoughts were associated with discrepancies in trouble concentrating recall (r = −.67, p =.002 and p = −.72, p <.001, respectively) – suggesting recency effects.

We found preliminary evidence of recall bias among OAMM, including overreporting and recency effects of pain and depression symptoms. Given the reliance on recall during primary care visits, more research is needed.

Earthquake is a traumatic event with significant physiological and psychological effects, profoundly altering individuals’ lives. This study aimed to determine the relationship between death distress and fertility intentions among women who experienced the Kahramanmaras earthquake in Türkiye on February 6, 2023.

This descriptive, correlational study included 294 married women residing in an earthquake-affected region of Turkey. We collected data using the Participant Information Form and the Brief Death Distress Scale.

A total of 294 women participated in this study. The mean death distress score was 25.65 ± 7.46. The death depression dimension had the highest score among the subdimensions of the death distress scale (11.02 ± 3.61). Age, income level, pregnancy, number of children, extent of house damage during the earthquake, and experience of being trapped under debris were factors influencing death-related distress. Women who changed their fertility intentions had higher levels of death distress, anxiety, and obsession than those who did not change their fertility intentions.

This study provides a new perspective for understanding post-earthquake changes in married women’s mental health and fertility behavior. Death distress is a key factor that should be considered in planning post-disaster healthcare services for women.

Patient portals (PPs) are digital healthcare programs providing patients with access to their electronic health records with features aiding patients in managing their care. Although PPs are now widely used in primary care (PC), the desirability of its features is less known.

This study aims to describe the current and anticipated use of PP features and the socio-demographic profile of PP users accessing these features.

A cross-sectional survey of patient and caregiver experiences with virtual care in PC in Ontario, Canada, was conducted from December 2022 to March 2023. A survey section captured use/anticipated use of PP features: ‘communicating with practice’, ‘viewing records’, ‘entering record information’, ‘receiving practice information’, and ‘scheduling appointments’. We report on respondents with/without PP access and their use/anticipated use of PP features, and analyzed associations between respondent socio-demographic data and the current use of a number of PP features using Pearson chi-square test.

A total of 970 responses (743 patients (P) and 227 caregivers (C)) were obtained with respondents having PP access (P:57%; C:62%) and indicating using all (P: 43%; C:45%), some (P:55%; C:52%), or no (P: 2%; C:4%) PP features. For those with PP access, age (65+ years (14%) compared to <65 years (1%)), employment status (unemployed (6%) compared to employed (1%)), and language at home (non-English (9%) compared to English (1%)) were significantly associated with not using any PP features (percentages represent those not using any PP feature). Our findings provide insights into equity aspects to be considered for future PP implementation.

Moral distress among healthcare workers can have serious repercussions, including reduced morale, decreased quality of care, apathy, burnout, and workforce attrition. While much research has documented moral distress, few studies have considered how to effectively mitigate it. This study sought to enhance understanding of moral distress by exploring not only who is affected and why, but also examining strategies for addressing it.

An online survey was conducted with primary care healthcare professionals in British Columbia, Canada, from October to December 2022, including physicians, nurses, homecare aides, and long-term care aides. The survey gathered sociodemographic data, documented experiences of moral distress, and explored methods used to mitigate it. We specifically analysed responses to two open-ended questions on how respondents addressed moral distress, categorizing responses by profession, gender, and racial identity.

Employing a socio-ecological framework, we organized mitigation strategies across four levels: individual, interpersonal, community/organizational, and societal/systemic. Strategies ranged from personal coping mechanisms – such as mindfulness and exercise – to more collective actions aimed at changing workplace culture and policies. At the organizational and systemic levels, participants offered recommendations for structural reforms to improve support for healthcare staff.

This study highlights the multifactorial nature of moral distress, showing that it arises from a complex interplay of systemic, organizational, interpersonal, and individual factors. Our findings emphasize the importance of developing multi-level approaches to mitigate moral distress in healthcare, addressing both immediate individual needs and broader organizational and policy changes that promote a healthier work environment.

We aimed to examine advice interactions among family physicians using social network analysis (SNA) by categorizing advice interaction according to the five advice dimensions.

Inter-individual interactions for information exchange is a powerful tool for the pursuit of solutions to issues. These interactions may involve advice-seeking.

The whole network approach was adopted and face-to-face research was conducted with 139 family physicians. Data were analysed using social network software, UCINET and visualized using the NETDRAW software. To examine the multidimensional advice networks, the frequency, density, reciprocity (dyad) measures were used. The Quadratic Assignment Procedure was used in UCINET to measure the correlations between the dimensions of advice. The Girvan–Newman algorithm was used to examine clustering in the advice network.

Density values in the advice dimensions were very low. This indicates that the network was sparse, with limited interactions among family physicians in terms of giving and receiving advice. The strength of the ties in the dimensions was realized through validation, solutions, problem reformulation, meta-information, and legitimization, respectively. The results showed that the relationships between the dimensions were moderately, positively and significantly correlated. The advice network exhibited high modularity. Family physicians tended to seek advice from colleagues at the family health centers where they worked. We presented a visual representation of advice networks in primary healthcare settings. Identifying multidimensional advice networks through social network analysis can provide insight into how information is disseminated among family physicians. Our findings could contribute to decision makers in developing solution-oriented processes.

This study aimed to develop a European definition of Community Health Centres (CHCs) as a model of primary care, assess the acceptability and feasibility of this model among experts, and propose a common framework to guide CHC implementation across European countries.

CHCs have existed in Europe for more than five decades and are increasingly recognized as effective models for delivering comprehensive, equitable and integrated primary care. Despite their established global presence, there remains a need to contextualize and define CHCs within Europe’s diverse healthcare systems.

Building on the International Federation of Community Health Centres (IFCHC) definition, a refined version comprising 35 key statements was developed through expert consultations. A two-round Delphi study was conducted with 31 experts from 16 countries, using five-point Likert-scale questionnaires to evaluate the acceptability and feasibility of each statement.

All 35 statements were rated as acceptable and feasible (average value >3 on the five-point Likert scale). The most highly rated elements included respect for human rights, accessibility irrespective of socioeconomic status, interprofessional collaboration, and integrated, people-centred care. Although feasibility ratings were slightly lower than acceptability ratings, they improved in the second round, indicating increased consensus. Statements concerning governance, community participation, and responsibility for specific population subgroups received lower feasibility ratings. Overall, the findings demonstrate broad expert consensus on the relevance and adaptability of the CHC model within Europe. While some implementation challenges persist, particularly regarding governance, interprofessional collaboration, and intersectoral coordination, the proposed definition offers a robust foundation for strengthening primary care across diverse European contexts.

The aim of our study was to understand how routine pharmacy practice was impacted during the COVID-19 pandemic and the consequences for patient access.

Community pharmacists are among the most accessible primary care providers, playing a vital role in primary care access for patients. During the COVID-19 pandemic, community pharmacists took on numerous additional roles to support safe primary care access. As health systems are in the latter stages of recovery from the pandemic, understanding how the pandemic impacted routine community pharmacy practice and the repercussions for post-pandemic practice is important.

Between September 2020 and January 2021, we interviewed 11 pharmacists working in community pharmacies in Nova Scotia, Canada. We thematically analyzed qualitative data pertaining to pharmacists’ perceptions of pandemic impacts on providers, patients, and pharmacy practice.

The COVID-19 pandemic greatly impacted community pharmacy practice, patients, and community pharmacists. Participants recommended maintaining some of the community pharmacy practice changes and suggested that continuing to expand the scope of practice for pharmacists is essential to meeting population health needs moving forward. Pharmacists recognize and are willing to maintain the essential roles they have assumed in facilitating patient access to primary care. Decision-makers should consider providing the necessary supports (e.g., communication software) and funding support to enable the full scope of community pharmacist practice.

To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.

Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.

Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0–16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.

Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3–6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.

To explore the primary health care experiences of Indian immigrants living with chronic illnesses in Australia.

Primary health care is integral for managing health issues for people living with chronic illnesses. Despite Indian migrants being the largest overseas-born population in Australia to use primary health care services for their chronic illnesses, at this time, limited literature reports on their experiences in Australia.

A qualitative exploratory approach was adopted for this study. Through purposive sampling, 11 participants were recruited, and data was collected using semi-structured interviews. The interviews were transcribed verbatim and thematically analysed.

Three themes and six sub-themes emerged from the thematic analysis. The first theme ‘being a mix of experiences’ presented participants’ positive and negative experiences related to communication, compassion, quality of care and length of consultations. The second theme ‘facilitators to accessing primary health care services in Australia’ described the benefits of telehealth and having a common cultural background as that of the general practitioner. Meanwhile, the third theme ‘barriers to accessing primary health care services in Australia’ identified unavailability of preferred GPs and waiting times and delays for in-person appointments as barriers that hindered access to PHC services in Australia.

Primary health care experiences of Indian immigrants with chronic illnesses in Australia were a mix of positive and negative experiences, similar to that of other immigrants. Faster accessibility and compassionate services among migrants were highlighted to be needing extra attention by way of further research and acknowledging the unique diversity of individuals.

To assess the acceptability and appropriateness of remote patient monitoring and self-administered pulse oximetry among high-risk COVID-19 patients, triage centre staff, and study personnel in Tegucigalpa and Comayagüela, Honduras.

During the COVID-19 pandemic, the Honduras Secretariat of Health and partners conducted a randomized trial to assess the impact of remote patient monitoring with versus without self-administered pulse oximetry in high-risk populations in urban Honduras. Acceptability and appropriateness were examined to inform future intervention adaptation.

This mixed-methods study included trial participants, study and triage centre staff. Data sources include trial data, computer-aided self-interviews, and in-depth interviews. The trial ran from March 2022 to January 2023.

1767 participants completed a disenrollment questionnaire. Thirty-four providers completed a self-interview, and 16 participated in an in-depth interview. Respondents understood interventions and expressed positive attitudes; SESAL staff attitudes were less positive. 94.9% of participants reported willingness to participate again. Some staff expressed concern over participant comprehension and pulse oximeter self-administration, but participants reported successful use. Providers were confident implementing the intervention, but some questioned its appropriateness given competing priorities. Overall, study participants and healthcare providers believed interventions were an acceptable way to monitor for deterioration during the acute phase of a COVID-19 infection. Findings showed that an intervention can be acceptable, but appropriateness may be less clear-cut due to competing priorities. The approach shows promise for adaptation to other settings experiencing health emergencies where technology penetration is high and healthcare availability does not align with demand; appropriateness considerations should be explored prior to implementation.

To examine parents’ lived experiences of implementing cot-only advice in a contemporary Australian cohort, assess alignment with the international literature on infant sleep and shared sleep practices, and determine whether explicit risk minimization guidelines address information needs identified by parents.

The risk elimination approach to shared sleeping has dominated public health messaging for decades but has been unsuccessful in reducing Sudden Unexpected Deaths in Infancy (SUDI) rates, while bedsharing rates have remained stable. The risk minimization approach offers an alternative, pragmatic framework for reducing controllable risks.

A retrospective, secondary, qualitative directed content analysis of free-text responses related to bed-sharing drawn from the 2017 Infant Care Awareness and Routines Evaluation among Queenslanders (I-CARE Qld Study) cross-sectional survey dataset. 3,341 primary caregivers (97% mothers) of infants aged approximately three months, born in Queensland between April and May 2017. For this secondary analysis, free-text responses related to co-sleeping/bedsharing were extracted and analysed qualitatively in line with study objectives.

Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby. Nearly a third of this cohort reported difficulty following advice to sleep their baby separately citing infant temperament/ needs, breastfeeding and caregiver fatigue or exhaustion as top rationales for this difficulty, aligning with earlier international findings. Some awareness by parents of risk minimization strategies to improve shared sleep safety was evident and in alignment with current Queensland Clinical Guidelines. There is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents and families through the adoption of a universal, proactive risk minimization approach to shared sleep. Co-designing guidance with parents may serve to bridge the gap between idealized and real-world implementation of safer infant sleep strategies.