This study aimed to redesign the model for providing primary healthcare (PHC) in rural Iran using a grounded theory approach.

Iran’s PHC system, although historically successful, faces structural, managerial, and demographic challenges that limit its responsiveness to emerging population health needs. A context-sensitive redesign is therefore required.

This applied qualitative study used grounded theory methodology. Semi-structured interviews were conducted with 25 senior PHC managers, policymakers, and academic experts selected through purposive and theoretical sampling. Data collection and analysis proceeded concurrently using open, axial, and selective coding in MAXQDA 20. PCAT dimensions were used as sensitizing concepts, while allowing new categories to emerge inductively.

The core category identified was ‘strengthening PHC through integrated service delivery and system enablement’. The redesigned model includes core service delivery components (utilization, access, continuity, coordination, comprehensiveness, and affiliation with place/provider) and enabling system components (evidence-based planning, managerial capacity strengthening, financing and payment management, effective surveillance and supervision). These enabling components function as structural supports sustaining effective PHC delivery in rural Iran.

To examine the relationship between access to routine primary healthcare (PHC) and receipt of dental visits.

PHC plays a vital role in promoting overall health and connecting patients to preventive services. Regular dental visits are crucial for preventing oral health issues and managing chronic diseases associated with oral health. However, disparities in healthcare access may influence the likelihood of individuals receiving necessary dental care.

Data from 8, 727 participants ≥ 20 years in the 2017–2020 National Health and Nutritional Examination Survey were used for cross-sectional analysis. Logistic regressions explored the relationship between PHC and ‘past-year dental visits’, while controlling for sociodemographics.

84% of the study population had access to routine PHC, and 63% had a past-year dental visit. Adults with PHC were significantly more likely to have had a past-year dental visit (OR = 2.24; 95% CI: 1.76–2.84). This was true for women, the oldest adult age group, and those with the highest educational levels. Black study participants were less likely to have had a past-year dental visit (OR = 0.55; 95% CI: 0.54, 0.83), so were the unmarried and those without health insurance.

Access to routine PHC significantly increases the likelihood of a past-year dental visit, with gender, age, and educational levels having strongest effects. However, Black adults remain less likely to utilize dental services, even with access to routine PHC and health insurance. Strengthening the physician-dentist patient partnership through integrated delivery models of care that embed oral health services with primary care could be key.

This study aimed to adapt the Chronic Conditions Physician–Patient Relationship Scale (CC-PPR) into Turkish and to examine its validity and reliability among patients with chronic diseases receiving care from family physicians.

A methodological study was conducted with 254 adult patients attending the Family Medicine Centers between May 01-October 01, 2025. The adaptation process followed World Health Organization guidelines. Construct validity was examined using confirmatory factor analysis (CFA), and reliability was assessed through internal consistency (Cronbach’s α, McDonald’s ω) and item–total correlations.

The CFA supported the original one-factor, 22-item structure with an excellent model fit (χ2[209] = 59.847, p = 1.000; comparative fit index [CFI] = 1.000; Tucker–Lewis index [TLI] = 1.016; root mean square error of approximation [RMSEA] = 0.000; standardized root mean square residual [SRMR] = 0.048). Sampling adequacy was good (Kaiser–Meyer–Olkin [KMO] = 0.970; Bartlett’s χ2[231] = 5934.429, p < 0.001). All standardized factor loadings were high (0.63–0.81, p < 0.001). Internal consistency was excellent (Cronbach’s α = 0.977; McDonald’s ω = 0.976), and corrected item–total correlations ranged from 0.74 to 0.86. Marital status, employment status, and type of health institution were significantly associated with relationship scores (p < 0.05).

The Turkish version of the CC-PPR is a psychometrically robust, unidimensional, and reliable tool for evaluating the quality of family physician–patient relationships among individuals with chronic conditions. It can be used to assess communication and relational competencies of family physicians, support patient-centred care initiatives in chronic disease management.

Continuity of care refers to the consistent and coordinated delivery of healthcare services over time. Continuity has been associated with improvements in morbidity and mortality, yet its decline has been identified as a significant concern amid increasing pressures in primary care.

This review aimed to inform current policy initiatives by synthesizing evidence on how continuity of care is measured, the current challenges faced and proposed future interventions in UK general practice.

We conducted a literature search for articles published before 15 February 2024, to explore continuity in UK primary care. Screening and data extraction followed PRISMA Scoping Review guidelines, with all studies undergoing double screening to determine eligibility.

A total of 180 papers were included (95 quantitative, 76 qualitative and 9 mixed-methods). Across the literature, continuity of care was most commonly conceptualized and measured as relational continuity, the Usual Provider of Care (UPC) Index was the most commonly used metric. Informational and managerial continuity were rarely assessed. Certain patient groups, including those with long-term conditions, mental health needs, and multimorbidity, were reported to place greater value on continuity of care. Higher relational continuity was associated with improved patient satisfaction, care coordination and reduced hospital admissions. However, sustaining continuity was frequently challenged by workforce pressures and fragmented information transfer. Although formal and informal interventions to enhance continuity were described, tensions between continuity and access persisted, and continuity was reported to vary across patient groups.

The decline in continuity of care has implications for patient experience and system outcomes. This review highlights the need for system-level approaches and national policy reforms to support continuity, while addressing workforce constraints, access pressures and unequal experiences of care. Further research is needed to evaluate the effectiveness and sustainability of continuity-enhancing interventions and to identify any potential unintended consequences.

To explore behavioural determinants influencing General Practitioner (GP)-led medication reconciliation (MedRec) and inform the development of a theory-informed implementation strategy tailored to the primary care context.

Despite national and international recommendations endorsing MedRec to reduce medication errors, its consistent implementation in primary care remains limited.

We conducted a qualitative study involving GPs working in the largest Health Region in Portugal, building on findings from preceding quantitative studies. Data were analysed using a Theoretical Domains Framework (TDF)-informed approach. Key determinants were mapped to intervention functions using the Behaviour Change Wheel (BCW), and candidate behavioural change techniques (BCTs) were subsequently proposed.

A total of 22 GPs participated in three focus group discussions. The ‘Environmental context and resources’ domain gathered the most coded segments, related to patients, other health professionals, electronic health records, and time constraints, mainly reflecting perceived barriers. ‘Knowledge’ and ‘Skills’ emerged as key domains, with ambiguity in the MedRec definition undermining its explicit recognition and influencing other domains. Facilitators included GPs’ commitment to patient safety aligned with GPs’ professional role. The interplay between barriers and facilitators suggested a cascading effect across domains. Candidate BCTs proposed to address these determinants included feedback on behaviour/outcomes, self-monitoring, prompts/cues, restructuring and adding objects to the environment. This study provides a theory-informed foundation for designing tailored implementation strategies to support MedRec practices in Portuguese primary care. Future work should focus on assessing the appropriateness, feasibility and acceptability of the proposed BCTs within the constraints of real-world primary care settings.

This study aimed to assess knowledge, lifestyle behaviours, and sociodemographic associations regarding hypertension control among adults in urban Ghana.

Hypertension is a major contributor to cardiovascular morbidity and mortality in Ghana. However, data on population-level knowledge of its risk factors and related lifestyle behaviours in urban settings remain limited.

A cross-sectional analytical survey was conducted between August 2023 and September 2024 across four urban regions. Using stratified convenience sampling, 7096 adults aged 18–67+ years were recruited. Data on sociodemographic, lifestyle behaviours, and hypertension knowledge were collected via a structured questionnaire.

Participants had a mean age of 37.27 (±8.73) years, with a majority being female (63.85%) and married (97.66%). Educational attainment varied. Females constituted most hypertensive cases, particularly for stage 2 hypertension, while males had a notably higher prevalence of pre-hypertension among those aged 27–53 years. Age and body mass index showed significant positive correlations with systolic and diastolic blood pressure (p < 0.01). Men were significantly more likely to smoke and consume alcohol (p < 0.01). Logistic regression indicated that regular exercise reduced the odds of hypertension diagnosis (OR = 0.72, CI: 0.54–0.96), while older age increased the odds. The study underscores the need for targeted public health strategies. Priorities include promoting physical activity and weight management, alongside smoking/alcohol cessation programs tailored for high-risk men. Early intervention for younger adults with pre-hypertension and enhanced educational outreach for less-educated groups are crucial.

Breastfeeding self-efficacy is a mother’s confidence in her ability to breastfeed, influencing her decision to do so. Across the world, due to low breastfeeding self-efficacy and limited attention to breastfeeding practices expose mothers and infants to adverse health outcomes and poor mother–child bonding and development. Most previous studies focused on breastfeeding knowledge, but there is limited research on breastfeeding self-efficacy and its associated factors. Thus, this study aimed to assess breastfeeding self-efficacy status and determinant factors among postnatal women in Gurage Zone public hospitals, Central Ethiopia.

A facility-based mixed-method cross-sectional study was conducted among 422 systematically selected women in Gurage Zone public hospitals, Central Ethiopia, from February 15 to March 15, 2025. Data were collected using a pre-tested interviewer-administered questionnaire, entered into Epi-Data 4.1, and analyzed using SPSS 26. Four focus group discussions were conducted with purposive sampling and analyzed thematically. Binary logistic regression identified factors associated with breastfeeding self-efficacy at P < 0.05.

In this study, the overall breastfeeding self-efficacy status was 51.3% (95% CI: 47, 56). Women’s primary educational attainment (AOR = 1.97; 95%CI:1.01,3.83), secondary and above educational attainment (AOR = 3.30; 95%CI: 1.87,5.85), ANC contacts (AOR = 2.24; 95%CI:1.37,3.63), breastfeeding experience (AOR = 3.59; 95%CI:2.10,6.13), moderate perceived social support (AOR = 2.96; 95%CI:1.47,5.55), and high perceived social support (AOR = 3.23; 95%CI:2.02,6.59) were significantly associated with breastfeeding self-efficacy.

In this study, 48.7% lacked breastfeeding confidence. Educational status, ANC contact, breastfeeding experience, and perceived social support were associated with breastfeeding self-efficacy. Therefore, strengthening health education and counseling is needed to improve postpartum women’s breastfeeding confidence..

An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world and safe for nearly all women. However, very few women in Southwestern Ethiopia use.

To identify factors influencing an intention to use the intrauterine device among family planning users in Southwestern, Ethiopia.

A facility-based cross-sectional study was conducted among 784 modern family planning users from 15th October to 15th November 2020. An interviewer-administered questionnaire was used. Estimates were generated using logistic regression model.

Thirty percent intended to use IUD. The most commonly cited reasons for their lack of an intention to use IUD were fear of side effects, lack of knowledge, and husband disapproval. Being able to read and write (AOR = 3.33 [95% C.I. 1.48, 7.49]) compared to those unable to read and write; Being rich (AOR = 1.69 [95% C.I. 1.02, 2.82]) compared to the poor; being knowledgeable about IUD (AOR = 2.74 [95% C.I. [1.67, 4.51]); having higher reproductive health autonomy (AOR = 1.53 [95% C.I. [1.09, 2.16]) were found to be significant factors influencing women’s intention to use an IUD.

Nearly one-third of women who attend health facilities are currently using contraception reported an intention to use an IUD in the future. Public health interventions should focus on the cited reasons reaching all the community in need, and give priority for women who unable read and write, and lowest wealth status. Further interventional studies were recommended to determine effective interventions to increase women’s intention to use intrauterine device.

The aim of this study was to determine the relationship between the physical activity levels and cognitive perceptions of physicians and the frequency of exercise prescribed by primary care physicians.

This cross-sectional study was conducted with 221 primary care physicians. A questionnaire of three sections was administered, including questions prepared according to the American College of Sports Medicine (ACSM) recommendations evaluating the current practices of the physicians on the subject of prescribing exercise, the General Practice Physical Activity Questionnaire (GPPAQ), Cognitive Behavioural Physical Activity Questionnaire (CBPAQ).

A significant relationship was determined between the daily physical activity of the physician and exercise prescribing rates (P = 0.005). From the data obtained from the GPPAQ and the CBPAQ, it was determined that as the activity level increased, so the Outcome Expectation (P < 0.001), Self-regulation (P < 0.001), Total Cognitive Activity (P < 0.001) points increased. The frequency of prescribing exercise was found to be <20% for all chronic diseases for which exercise is known to be effective. A significant relationship was determined between prescribing exercise and the total number of correct responses to the questions measuring the level of knowledge according to the ACSM recommendations (P < 0.001). Mann-Whitney U and Kruskal-Wallis tests were used for non-normally distributed data, while Pearson, likelihood ratio, and chi-square tests were used for analyzing relationships between categorical variables.

Incorporating exercise prescription training into the core medical and family medicine curricula may increase physicians’ self-efficacy and contribute to overcoming barriers in prescribing exercise.

Efficient triage in general practice is critical to optimize appointment allocation and minimize patient delays. Delays in receiving clinical information, such as photographs or symptom questionnaires, lead to unnecessary consultations and inefficiencies. This study evaluated the feasibility and impact of a structured pre-triage protocol requesting photos and questionnaires for common conditions (skin, eye, tonsillitis, and urinary tract infections).

A pre-post intervention quality improvement project was conducted in a UK general practice. Triage administrators were instructed to proactively request photographs for skin and eye complaints and symptom questionnaires for tonsillitis and UTIs at initial patient contact. Outcomes included process metrics (number of pre-triage requests, proportion of cases managed directly by the triage GP) and subjective measures of ease, speed, satisfaction, and confidence.

The protocol increased photo requests for skin (mean increase 4.0/session, Cohen’s d = 7.77) and eye (2.2/session, d = 4.09) conditions, while questionnaire requests remained unchanged. The proportion of skin cases managed directly by the triage GP increased significantly (from 0.2 to 2.2 cases/session, d = 1.65), and eye case management also improved. Questionnaire-based pathways showed minimal change in efficiency or direct management. Subjective feedback indicated a slight reduction in triage speed, but ease and satisfaction were maintained, while diagnostic confidence increased, particularly for photo-supported conditions.

A structured pre-triage protocol is feasible, acceptable, and potentially effective in enhancing triage efficiency, particularly for visually assessable conditions like skin and eye presentations. By enabling earlier access to essential information, such protocols may reduce unnecessary consultations, improve workflow, and support clinician confidence.

This article provides an overview of the professional roles of audiologists and speech-language pathologists (S-LPs) in interprofessional primary care.

Current published literature considering primary care delivery within comprehensive interprofessional teams contains little representation of professionals from the fields of audiology and speech-language pathology.

An illustrative case scenario highlights the key roles of audiologists and S-LPs in primary care, and how collaborative relationships within an interprofessional primary care team structure can enhance the overall quality of care provided to patients and to their families.

As experts in the prevention, diagnosis, and rehabilitation of communication disorders, with S-LPs supporting speech and swallowing disorders and audiologists supporting hearing and vestibular disorders, S-LPs and audiologists are well-positioned to support meaningful participation in primary care across the lifespan and in collaboration with different healthcare professionals, including patients experiencing cognitive decline.

The dual burden of tuberculosis (TB) and diabetes mellitus (DM) presents a growing challenge for health systems in low- and middle-income countries (LMICs), including Pakistan. Despite global and national policies advocating for integrated care, evidence on health facility readiness to operationalize integration remains scarce. This study assessed the readiness of TB basic management units (BMUs) to deliver integrated TB-DM care and explored implementation barriers using the Consolidated Framework for Implementation Research (CFIR).

We conducted an explanatory sequential mixed-methods study from September 2024 to February 2025 across 13 TB BMUs in five districts of Pakistan. Quantitative readiness data were collected using a structured tool adapted from the WHO Service Availability and Readiness Assessment (SARA), generating a composite score across four domains. Subsequently, qualitative data were gathered through multi-stakeholder focus group discussions with healthcare providers, facility managers, patients, caregivers, and policymakers. Reflexive thematic analysis was conducted and mapped to CFIR Inner Setting constructs to contextualize quantitative findings.

Only one facility demonstrated high readiness, while 12 showed low readiness. Facilities lacked routine comorbidity screening, trained staff, diagnostic capacity, and essential medicines. Key barriers included inadequate infrastructure, workforce shortages, fragmented information systems, and low prioritisation of integrated care. Financial constraints and limited coordination further hindered implementation.

This study highlights critically low readiness among TB facilities in different districts of Pakistan to deliver integrated TB-DM care, reflecting systemic weaknesses across core domains. Strengthening systems, building capacity, and improving integration strategies are essential to bridge gaps between policy and practice.

Participatory action research (PAR) methods effectively engage communities in identifying health priorities in low-resource settings. This study applied PAR methods during the establishment of a Health and Demographic Surveillance System (HDSS) in Gorakhpur, Uttar Pradesh, India.

We implemented seven PAR methods across rural and urban populations: transect walks, resource mapping, social mapping, seasonal mapping, focus group discussions, semi-structured interviews, and community ranking exercises. Data were collected in September 2023 following facilitator training. Visual materials and field notes were thematically categorized, while audio-recorded interviews were transcribed, translated, and analysed with combined inductive-deductive thematic analysis. Community health priorities were quantitatively analysed through free listing, pile sorting, and ranking.

Five major themes emerged: (1) Community context revealed diverse caste compositions and essential infrastructure; (2) Health priorities included acute conditions (fever, joint pain), chronic diseases (hypertension, diabetes), healthcare access limitations, and WASH issues; (3) Key contributors to poor health encompassed inadequate WASH facilities, limited health awareness, and discrimination; (4) Healthcare access barriers included absent primary care facilities, financial constraints, limited transportation, and poor service quality; (5) Community suggestions addressed both social determinants and healthcare services, emphasizing governance participation, WASH interventions, and improved healthcare infrastructure.

PAR methods successfully identified community-defined health needs and barriers, demonstrating consistency across urban and rural settings. Community members provided concrete recommendations for health system improvements, validating the importance of incorporating local voices in HDSS design. The alignment between community priorities and documented regional health challenges underscores how participatory methods can shape surveillance activities to foster sustainable health improvements and enhance governance capacities. These insights directly informed HDSS operational plans, creating a foundation for responsive and equitable health surveillance systems.

England’s Family Hubs and Start for Life (SfL) Programme Guidance recommends strengthening early years services by increasing workforce capacity and capability through innovative skill mix models. However, evidence regarding how different innovative early years skill mix workforce models operate, function, and influence outcomes remains limited. To address this gap, five local authorities in England that are existing SfL sites received funding from the Department of Health and Social Care (DHSC) to design and pilot innovative early years skill mix workforce models to enhance their Family Hub offers and better support families with children under two.

The evaluation is guided by each site’s Theory of Change and uses a mixed-methods design. The study consists of five workstreams. First, pilot models will be mapped through documentary analysis, including content analysis of role descriptions and audits of workforce activities recorded in clinical diaries. Second, system-level mechanisms, facilitators, and barriers to implementation will be examined through reviews of service and management data and semi-structured interviews with key stakeholders. Third, relational structures underpinning effective practice will be explored using 75 family-level case studies and Social Network Analysis to assess professional networks and their influence on family and practitioner experiences. Fourth, impacts will be estimated using Synthetic Control Methods to assess effects on Healthy Child Programme outcomes, alongside cost and cost-benefit analyses. Finally, the broader application of skill mix working will be explored through semi-structured interviews and case studies across additional local authorities.

Practice guidelines for Australian primary health professionals (PHPs) highlight their crucial role in preventive care. However, PHPs report a lack of knowledge and skills regarding early childhood obesity prevention. This study aimed to identify the training needs of Australian PHPs – including child and family health nurses (CFHNs), general practitioners, general practice nurses and other community-based health professionals – to support early childhood health promotion and obesity prevention.

From August 2022 to July 2023, PHPs were recruited to participate in an online survey and semi-structured interviews. Quantitative data was analysed descriptively and qualitative data analysed using reflexive thematic analysis.

227 PHPs returned a survey (46% CFHNs) and 28 were interviewed (13 CFHNs). Almost a quarter (23%) of participants had not received any continuing education regarding early childhood health behaviours and obesity prevention, with general practice professionals less likely to have participated in such education. PHPs identified a need to develop skills in growth assessment and working with children at risk of obesity. Digital and visual parent-facing resources were required to support PHPs’ discussions of child health behaviours. Important components of education were case studies, self-paced learning, and live interactive discussions (37–46% of PHPs rated as highly important). PHPs sought interactive education activities from reputable service providers and reported time and cost were barriers to education.

Australian PHPs require access to evidence-based education and resources to support early childhood health promotion and obesity prevention. Professional education providers should prioritize interactive and flexible modes of delivery.

This study aims to assess the perspectives of patients with chronic conditions on the use of the Assessment of Burden of Chronic Conditions (ABCC) tool during consultations with their healthcare providers in primary care.

The increasing prevalence of chronic conditions, including multimorbidity, poses major challenges to healthcare systems today, particularly in primary care where most chronic care takes place. Effective management strategies are crucial for improving quality of life (QoL). The ABCC tool offers a unique approach to chronic disease management by facilitating shared decision-making and self-management.

This qualitative phenomenological study involved semi-structured interviews. Fourteen patients with chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes mellitus (T2DM) and/or chronic heart failure (CHF) were recruited from a previously conducted quasi-experimental study on the effectiveness of the ABCC tool.

Participants generally expressed satisfaction with the comprehensive questionnaire, user-friendly design and clear visualisation. They appreciated the opportunity to facilitate discussions with healthcare providers and help with monitoring. However, some confusion around the grey balloons in the tool highlighted the need for clearer explanations. Participants had limited awareness of advanced treatment recommendation functions.

This study provides valuable insights into patients’ experiences with the ABCC tool. Despite challenges such as recall bias and limited awareness of certain features, participants generally expressed satisfaction with using the tool. Based on these findings, the tool can be further improved and its use should be further supported. However, the ABCC tool shows promise as a valuable instrument for improving consultations in clinical practice.

In the US, cardiovascular diseases (CVD) are the leading cause of death and disability. Cost-related medication non-adherence (CRMN) can have serious consequences and worsen CVD outcomes. We examined the relationship between CVD risk factors and CRMN among US adults.

CDC’s 2019–2021 National Health Interview Survey (NHIS) data were used to examine CRMN among adults, categorized into three groups based on reported risk factors. We used chi-square tests, and logistic regression to determine factors associated with CRMN.

Among 49,464 participants, young, unmarried individuals, females, less educated, and participants from the South had higher CRMN than older, married individuals, males, and those with higher education residing in the other regions. Current smokers and those with more CVD risk factors also reported higher CRMN than former and never-smokers. Conversely, those aged 65 or older, with high-income, and excellent self-rated health had lower CRMN than younger participants, low-income families, and those with poor self-rated health. Public insurance and Medicaid participants had lower CRMN than uninsured (OR 0.13, 95% CI, 0.04–0.45, and OR 0.24, 95% CI, 0.15–0.36). Stratified analysis by diabetes, hypertension, and hyperlipidemia, revealed participants with high-income had lower odds of CRMN (OR 0.38, 95% CI, 0.28–0.50; OR 0.39, 95% CI, 0.28–0.58; OR 0.37, 95% CI, 0.27–0.51 respectively) than those with lower- incomes.

Adults under 65 with more CVD risk factors and lacking insurance coverage are at higher risk of CRMN. Therefore, strengthening prescription drug coverage and targeted interventions are necessary to reduce CRMN among those with cardiovascular risk factors.

This study examined gaps in adherence to preventive care recommendations for adults with Down Syndrome (DS) in Connecticut and explored the underlying factors collecting caregiver and primary care physician (PCP) perspectives.

Primary healthcare plays a vital role in preventing health issues. Despite well-defined clinical guidelines for adults with DS, studies show gaps in preventive care delivery for this population.

A mixed-methods study included chart reviews, a focus group and a survey of PCPs. Chart reviews examined records of adults with DS who received care between January 1, 2017, and December 31, 2022, for adherence to recommended preventive services. The focus group explored caregivers’ experiences with preventive care, and the survey assessed PCPs’ knowledge of prevention needs for adults with DS.

Chart reviews of 241 adults with DS found low adherence to preventive care guidelines. Only 2.1% met the wellness visit benchmark, and 30.7% met the thyroid test benchmark. Themes from the caregiver focus group included challenges accessing care, clinicians’ lack of DS-specific knowledge and difficulties maintaining health and wellness outside the office setting. Of 81 PCPs surveyed, most reported feeling inadequately prepared to care for adults with DS. Only 27% reported relevant training, and 53% were unaware of annual thyroid function test recommendations.

The study reveal gaps in preventive care for adults with DS and underlying reasons from a caregiver and provider perspective. Further analysis of care for adults with DS and targeted interventions will contribute to improved preventive care for this population.