Primary Health Care Services Research Articles

Strategy for Improving Smoking Cessation Services in Primary Health Care

Amidst the rising numbers of smokers in Indonesia and the increasing burden of smoking-related diseases on the country, the Smoking Cessation Services (SCS) still fail to operate optimally. The aim of this research is to develop a more effective strategy for the SCS model based on the challenges encountered during its implementation. The research method employed qualitative study with a case study approach. The research location was in Depok City, chosen as a national exemplary of SCS. Research period from February to May 2024. Data collection was conducted through in-depth interviews and observations at Community Health Centers who involved in SCS including health professionals, health promotors, and managers. The findings indicate that the SCS is not yet optimal due to insufficiently trained staff, low patient turnout, and failure to achieve the target quit rate. The services still focus on counseling and have not yet incorporated pharmacotherapy. The research concludes that short-term alternative strategies include follow-up calls to patients, establishing telecommunication groups with patients, and reaching out to new patients through schools, while long-term strategies such as program integration and building a telemedicine information system could be implemented to enhance patient visits.

The Commercialization of Cuban Medical Services in Primary Health Care

Introduction: The activity of the health sector and its exports require a comprehensive and systemic approach. Cuba has resources that affect the growth of health tourism. Marketing the services that are carried out every day in Primary Health Care is not integrated into the work system of its professionals. Objective: Implement a strategy for the commercialization of Cuban Medical Services from Primary Health Care. Methods: An intervention study with a single study group was carried out between July 2022 and June 2023, in the municipality of Trinidad, Sancti Spíritus province. 90 participants were included. Qualitative and quantitative research techniques and procedures were integrated. The feasibility test was applied to reach a consensus among the specialists consulted. Results: the female sex predominated. Before applying the strategy, the level of information was 100% inadequate, and then it went to a 98.88% adequate level of information. The applied strategy solves the essential problems of the investigation. The opinion of the specialists was in favor of the applicability of the strategy. Conclusions: The strategy introduced positive modifications in the knowledge of those included in the study. It was considered very appropriate by the specialists consulted, so its application is viable.

Predictors of maternal pertussis vaccination acceptance among pregnant women in Norway

ABSTRACT Maternal vaccination against pertussis is safe and provides effective protection against pertussis for the newborn, but the vaccine coverage rate remains generally low. Norway is currently planning for introduction of routine maternal pertussis vaccination. To assess maternal pertussis vaccination acceptance among pregnant Norwegian women, we surveyed women at 20–40 weeks gestation in 2019. Among the 1,148 pregnant women participating in this cross-sectional study, 73.8% reported they would accept pertussis vaccination during pregnancy if it was recommended, 6.9% would not accept and 19.2% were undecided. Predictors for low likelihood of accepting pertussis vaccination during pregnancy included low confidence in health authorities and in maternal pertussis vaccination safety and effectiveness, low awareness and adherence to influenza vaccination during pregnancy, and low awareness of pertussis vaccination. The major reasons reported for not accepting or being undecided about maternal pertussis vaccination were lack of information on vaccine safety for both mother and child. Most women reported that they would consult their general practitioner or a midwife for information if they were offered maternal pertussis vaccination. General practitioners and midwives were also regarded as the most trustworthy sources of information if the women were in doubt about accepting vaccination. We conclude that information addressing safety concerns and raising awareness about maternal pertussis vaccination could increase acceptance of maternal pertussis vaccination. Our findings highlight the pivotal role of the antenatal and primary health care services in providing such information to pregnant women.

”Being ill was the easy part”: exploring cancer survivors’ reactions to perceived challenges in engaging with primary healthcare

ABSTRACT Purpose Cancer survivors experience barriers to primary healthcare (PHC) services. The aim was to explore reactions to and opinions about perceived challenges associated with PHC access and quality among cancer survivors in Sweden, including how they have acted to adapt to challenges. Methods Five semi-structured focus group interviews were conducted with cancer survivors (n = 20) from Skåne, Sweden, diagnosed with breast, prostate, lung, or colorectal cancer or malignant melanoma. Focus groups were mixed in regard to diagnosis. Data were analysed using a descriptive template analysis approach. Results In light of perceived challenges associated with access to adequate PHC, participants experienced that they had been forced to work hard to achieve functioning PHC contacts. The demands for self-sufficiency were associated with negative feelings such as loneliness and worry. Participants believed that cancer survivors who lack the ability to express themselves, or sufficient drive, risk missing out on necessary care due to the necessity of being an active patient. Conclusions The findings highlight negative patient experiences. They have implications for the organization of care for cancer survivors as they indicate a need for more efficient post-treatment coordination between cancer specialist care and PHC providers, as well as increased support for patients leaving primary cancer treatment.

The challenge of home and community older adult care in China: a survey of the capability of primary care physicians in providing geriatric healthcare services

IntroductionIn the context of ageing at home and in the community, healthcare services for older adult people in China are mainly provided by primary care physicians (PCPs). This study aimed to understand the level of geriatric healthcare service capability of PCPs in China and to give recommendations for improving care.MethodsWe surveyed PCPs in the eastern, central, and western regions of China, using a combination of multi-stage stratified cluster sampling and typical sampling. We evaluated the capability of PCPs in geriatric healthcare services in terms of diagnosis and treatment of common diseases, health management of the older adult, and health management of patients with chronic diseases. We compared the capability of PCPs in different regions, in urban and rural areas, and with different characteristics.ResultsWe found that Chinese primary care doctors had a low level of education and tended to be older in age. We also found a lack of general practitioners in China. Among the 8,469 respondents, 6,497 (76.7%) could diagnose and treat common diseases; 7,755 (91.6%) were capable of managing the health of the older adult, and 7,787 (91.9%) could manage the health of patients with chronic diseases.ConclusionResults indicated that China’s primary care physician workforce was of low quality. There were deficiencies in all competencies in geriatric healthcare services, and there were differences in capability between urban and rural areas. The findings suggest China’s primary healthcare services should be strengthened with targeted training and an emphasis should be placed on developing basic skills in geriatric healthcare services.

Strategies for effective and efficient delivery of primary health care by village health workers: A scoping review using the Rodgers' Evolutionary Concept Analysis Framework.

Village health workers (VHWs), popularly known as community health workers (CHWs) in some contexts and settings, should effectively complement health care providers in primary health care (PHC) delivery in Zimbabwe. However, they continue to offer services that do not address current and emerging health issues. This study aims to review the literature and develop a conceptual framework to improve the effectiveness and efficiency of VHWs in service delivery. Rodgers' evolutionary framework was used to analyse the concept of 'strategies for effective and efficient delivery of PHC by VHWs'. Articles and reports published in English from 2010 to 2022 in peer-reviewed journals from the PUBMED, EBSCO, ScienceDirect and Google Scholar databases were reviewed. After screening and removal of duplicates a total of 52 articles and two reports were reviewed to identify antecedents, attributes and consequences of strategies to improve PHC services by village health workers. The antecedents included an enabling work environment, community participation, motivation, incentives, integration of community health into national health systems, and information and communication technology. The attributes consisted of ongoing training and skills development, mutual respect and trust, enhanced contact between VHWs and communities and supportive supervision. The consequences were equitable access to and improved quality of PHC service delivery. The concept of PHC service delivery by VHWs has evolved from health promotion to curative care through task shifting and is now an integral part of the health system. A supportive and enabling work environment, anchored in community participation, empowers VHWs to deliver equitable services effectively and efficiently.Contribution:The development of strategies for improving VHW service delivery and a conceptual framework informed by findings from the reviewed literature.

Exploring lack of trust and its impact on access and utilization of primary healthcare services among African immigrant women in the United States: a qualitative study of Ethiopian immigrant women

BackgroundLack of trust is a critical issue in healthcare that contributes to the growing disparities in access and utilization of health among minoritized and disadvantaged populations in the U.S. This study explored how lack of trust affects Ethiopian immigrant women’s (EIW) primary healthcare (PHC) experience and the personal and structural factors exacerbating the problem.MethodA qualitative cross-sectional design was used to collect data through in-depth interviews with EIW (N = 21) living in six states (MO, MD, VA, KS, MI and IN) and Washington DC using a pilot-tested semi-structured interview guide. A mix of purposive and snowball sampling was used to recruit participants who: (1) identify as an Ethiopian immigrant; (2) identify as a female; (3) be 18 years and older; (4) arrived in the U.S. within the last five years; and (5) speak Amharic or English languages. The interviews were recorded, transcribed verbatim, translated and cleaned for errors. An inductive thematic analysis was followed to analyze data using Nvivo12 software.ResultsThe findings showed that lack of trust is a significant concern among EIW negatively affecting their PHC experience and decisions in seeking care. The thematic analysis revealed five major factors contributing to the erosion of trust in PHC among EIW: (1) reliance on medication in U.S. healthcare system (2) preference for traditional homemade remedies over PHC recommendations and modern medicine (3) faith and its influence on trust and PHC decisions (4) lack of transparency in PHC, and (5) multilevel discrimination in PHC.ConclusionThe analysis suggested that PHC professionals provide understandable and contextualized health information, practice transparency, familiarize themselves with the healthcare system in immigrants’ countries of origin by asking their patients, and prioritize culturally competent care to gain trust. At structural and policy levels, reform is needed to dismantle systemic problems that enable and perpetuate discrimination, diversify the healthcare workforce, revise healthcare training curriculums and procedures to reflect immigrant needs, establish multi-sectoral collaboration between health, education, and immigration sectors to create conducive care environment for immigrants. Further research and conversation around alternative medicine is vital to expand evidence-based and inclusive PHC services for immigrants.

DETERMINATION OF FEARS OF BURNOUT AND COVID EMPLOYEE IN PRIMARY HEALTH SERVICES IN THE MIDDLE OF THE PANDEMIC

Aim: This study aimed to assess healthcare workers' burnout levels and fear of COVID, along with the associated factors. Method: This descriptive and cross-sectional study focuses on all healthcare workers employed in primary healthcare services within a province in Central Anatolia. Instead of using a sampling method, the study included primary healthcare workers who agreed to participate (n=500).In the study, data were collected from healthcare professionals using a sociodemographic questionnaire, COVID-19 Fear Scale and Maslach Burnout Inventory. Before the research began, study Ethics Committee approval was obtained from the Nevşehir Hacı Bektaş Veli University Non-invasive Research Ethics Committee (Approval No. 2021.07.214). Data were analyzed using one-way MANOVA, Duncan's test, and Pearson correlation. Results: The study revealed that healthcare workers who had contracted COVID reported higher scores in the depersonalization burnout sub-dimension. Emotional burnout scores were significantly higher among those who experienced exclusionary behaviors from their immediate circle or neighbors, while personal achievement burnout scores were lower among those with lower income levels (p

Determining household out of pocket payments, incidence of catastrophic expenditures and impoverishment among patients with malaria in Zambia's path towards Universal Health Coverage.

The World Health Organisation (WHO) estimates that about 3.2 billion people which is nearly half of the world's population are at risk of malaria. Annually about 216 million cases and 445,000 deaths of malaria occur globally. Africa accounted for 90% and 91% of the malaria cases and deaths respectively. Zambia has earmarked malaria elimination on its path to Universal Health Coverage (UHC). This paper aims to determine the incidence of Out-of-Pocket Payments (OOP) and Catastrophic Health Expenditures (CHE) and impoverishment among households with malaria patients in Zambia. The paper focusses on the incidence of OOP and impoverishment for malaria in a setting without user fees for accessing primary malaria health care services and virtually no user fees at all levels of care if referred through the referral system. The results of this study will also serve as a baseline for tracking Zambia's path towards achieving malaria financial access on its path towards UHC among patient with malaria. The study uses a nationally representative cross-sectional survey of households in both rural and urban areas of Zambia. The study employed probability sampling procedures. A two-stage stratified cluster sample design was used. We analyse a total of 2,005 households that had at least one member suffering from malaria with a recall period of four weeks for out-patients and six months for the in-patient respectively. A logistic regression model was estimated with a Categorical Dependent variable being CHE (CHE = = 1, or otherwise = = 0). A household is considered impoverished if it fell below the poverty line due to OOP. All data was analyzed using Stata version 2013. The results show that although the country has a free malaria policy at primary care level and virtually at all levels if referred through the health system process, households are still incurring costs in accessing health care services. Incidence of CHE and impoverishment were reflected at all levels. In terms of CHE, the poorest contributed almost 30% while the wealthier quintile contributed about 10%. Similarly, impoverishment effects of OOPs are more pronounced in the poorest quintile. The OOP composed mainly of transport, followed by diagnosis and medicines and was lowest for Insecticide-treated bed nets (ITNs) payments. The high costs of transport that the households had to incur when accessing health services could be due to the long distance that the households have to face as they travel to the health facilities as most of the facilities in Zambia are still outside the 5 km radius. The drug expenditure could be explained by the drugs running out of stock. Low expenditure on ITNs could be due to the country's strategy of mass distribution working to give the country's universal financial protection on ITNs for malaria. This study sought to address gaps in OOP and the associated incidence of CHE and impoverishment for malaria, distribution of OOP among Social Economic Status (SES) setting and determinants of OOP in Country that has earmarked malaria elimination in the UHC agenda. Understanding household's costs related to malaria will enable targeting intervention to accelerate Zambia's path towards elimination of malaria and therefore contribute to attainment of the Sustainable Development Goals of household's financial access to UHC. Thus, the study will also serve as a baseline for tracking UHC for household financial access to malaria care that the country has embarked on.

Supporting Patients' Use of Digital Services in Primary Health Care in England: Synthesis of Evidence From a Mixed Methods Study of "Digital Facilitation".

General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined "digital facilitation" as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services. We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study's objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions. Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package's results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders. Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them. Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions.

Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives

Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives

Care delivery in the context of district mental healthcare plans in Ghana: a qualitative study exploring experiences of primary healthcare workers and service users

ObjectiveTo explore the perceptions and experiences of mental health service users and healthcare workers regarding the implementation of district mental healthcare plans (DMHPs) in three district demonstration sites in Ghana.DesignThe...

Assessment of Patient Satisfaction Attaining Primary Health Care Services at Health Centers in Mogadishu, Somalia.

Patient satisfaction in healthcare a crucial aspect of quality assessment, especially in resource-limited settings like Mogadishu, Somalia, where challenges in service quality persist due to socioeconomic and infrastructural constraints. It plays a significant role in evaluating the overall healthcare experience and provides valuable insights into healthcare system strengths and weaknesses. This study aimed to assess patient satisfaction in primary health care facilities in Mogadishu to identify areas for improvement. A facility-based cross-sectional survey of 358 patients was conducted from August 2023 to November 2023; Data was collected through questionnaires and analyzed using SPSS software. Quantitative data was analyzed using appropriate statistical methods, such as descriptive statistics and chi-square tests, to examine the relationships between patient satisfaction and various factors the statistical significance was declared at p-value < 0.05. Ethical approval was obtained from the Ministry of health Somalia before data collection permission was also obtained from the health facility in charges. While a majority of respondents, 71.5% express overall satisfaction with the healthcare services provided, there were significant concerns regarding empathy, privacy, facility cleanliness, and waiting times. There is a statistically significant association between patients' visit frequency and their perceptions of various healthcare aspects. Patients who visited the healthcare facility 2-4 times expressed significantly more positive perceptions of healthcare providers' competence (p < 0.020), empathy (p < 0.009), time spent (p < 0.001), pharmacy services (p < 0.001), and facility cleanliness (p < 0.001) when compared to those with first-time visits or more frequent visits. The study highlights the importance of addressing communication gaps, enhancing facility hygiene, and reducing waiting times to improve patient satisfaction. To enhance patient satisfaction and overall healthcare quality, recommendations include healthcare provider training, facility hygiene upgrades, and the implementation of strengthened privacy protocols in Mogadishu's primary healthcare facilities.

Housing Australian Children: A Snapshot of Health Inequities in the First 2000 Days.

Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. A cross-sectional latent class analysis (LCA) was conducted on 4355 Australian children aged 4 to 5years who participated in the Longitudinal Study of Australian Children. Nine binary indicators-dwelling tenure, external condition, affordability, stability, crowding, cleanliness, fuel poverty, and noise exposure-were used to generate latent housing typologies. Generalized linear models with robust standard errors described disparities in quality of life, injury, disability, and health service use across these housing typologies. Four distinct housing typologies were identified in this cohort: "good condition, affordable, and secure" (60%); "insecure" (11%); "crowded" (24%); and "unsuitable" (5%). Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.

Primary Health Care Systems and Their Contribution to Universal Health Coverage and Improved Health Status in Seven Countries: An Explanatory Mixed-Methods Review.

Primary health care (PHC) systems and their successes and challenges vary between and within countries. We elucidate the role of PHC on health status and universal health coverage (UHC) by describing the achievements and challenges of PHC systems in seven countries representing the three economic levels: high-income (Belgium, Australia), middle-income (South Africa, Thailand), and low-income countries (Cambodia, Ethiopia, and Nepal). We adopted a mixed-methods approach and (a) extracted quantitative data on the key health and universal health coverage index of countries and (b) conducted a scoping review of the PHC systems in these countries. We used key terms related to the following eight domains: service delivery, health workforce, health information system, health financing, medicines, and leadership and governance (the WHO's building blocks for national health systems) and community participation and multisectoral actions (other pillars of PHC) to identify the relevant literature and searched six databases: PubMed, Scopus, Embase, PsycINFO, CINAHL, and Cochrane Library. A total of 58 articles were identified and included in this review; data were charted and synthesised narratively. There is variation in health services coverage and health status across the three economic levels. Countries expanded access to PHC services using strategies like telehealth and CHWs but faced challenges in sustainability, workforce retention, and service quality. Community engagement and multisectoral actions helped, though gaps in governance, resources, and essential medicines hindered progress towards UHC. By addressing the challenges and leveraging successful strategies, countries can move closer to achieving the goal of universal health coverage and improving health outcomes for all.

Patient pathways in primary health care – an interview study across various health care personnel in a Canadian and a Norwegian county

BackgroundDue to demographic changes in the Western world governments emphasize the need for viable solutions, e.g. through decentralization of specialist health care services and better coordination within and between health care services. Both Norway and Canada have been through health care reforms and initiatives aiming to improve continuity and coordination of services. Organizational change to primary care in both countries encompasses both team-based service delivery involving allied health professionals, and new blended payment models. The objective of this study was to explore patient pathways in primary healthcare from various health personnel’s perspectives, and across various primary care organizations in Norway and Canada.MethodsThe study had a qualitative design, including interviews with physicians, nurses and managers (n = 19) in primary care, from a county in Norway and a region in Canada. Data were analyzed with a thematic approach, in line with recommendations from Braun & Clarke.ResultsThree themes were identified: 1) Structural challenges, 2) Towards a more specialized primary health care and 3) Dedication could improve continuity. Findings indicate that coordinating health care services was assumed difficult due to different health care levels, funding systems, managements, electronic record systems and organizations. Hospitals were assumed more task oriented, while primary health care services were considered more care oriented, and this challenged the coordination across organizations. Primary care services were perceived to be more and more specialized, also representing a threat for coordination and continuity. Health care personnel in both countries perceived that dedicated personnel for each patient could improve information flow and continuity across services.ConclusionsAchieving continuity and coordination of health care services seems challenging. Integration strategies seem essential for reducing silo thinking and fragmentation of health care services.

Childhood Maltreatment and Revictimization in Young Adulthood: Is Problematic Substance Use a Mediator? A Linked Survey-Register Data Study.

Victims of childhood maltreatment often experience revictimization later in life. However, there is scant knowledge of the explanatory mechanisms that generate this phenomenon. Problematic substance use is a maladaptive coping strategy that may increase the risk of revictimization after maltreatment. We used linear regressions and mediation analyses to investigate the explanatory role of problematic substance use in the association between childhood maltreatment and violent revictimization in young adulthood. We analyzed linked survey-register data on a sample of senior high school graduates in Norway (n = 3,156) who were followed longitudinally until ages 32 to 33 (2021). Ordinary least squares regression analyses showed that childhood maltreatment was associated with both problematic substance use and violent revictimization, adjusted for a wide range of covariates. Moreover, problematic substance use was associated with an increased risk of violent revictimization in young adulthood. Mediation analyses showed that about one eighth (12.0%) of the association between childhood maltreatment and violent revictimization was mediated by problematic substance use. Sensitivity tests indicated that the mediation may be susceptible to unmeasured confounding. Thus, it is unclear whether the mediating role of problematic substance use can be interpreted causally within a counterfactual framework. In conclusion, reducing problematic substance use among victims of childhood maltreatment may mitigate the risk of violent revictimization later in life. Early detection and tailored treatment of problematic substance use could be one way to prevent violent revictimization following childhood maltreatment. Therefore, equitable access to primary and specialized healthcare services is essential, both for victims of maltreatment and individuals with habits of (borderline) problematic substance use. However, the majority of the maltreatment-revictimization pathway (88.0%) is not statistically explained by substance use, which implies that other mechanisms are also at play.

Challenges in oral health practice in Somalia: a call for regulatory strengthening and inclusion into primary healthcare services

BackgroundOral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development.MethodsWe conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis.ResultsIn this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country.ConclusionThis study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia.Clinical trial numberNot applicable.

Competences of Nurse Managers in Primary Health Care and hospital services in the context of Local Health Units: A scoping review protocol

Introduction: This article is a protocol of a scoping review that pretends to examine the role of nurse managers in the context of a newly-evolved organizational structure, with a particular focus on their perceptions, emotions, actions and capacity to transition between different levels of care within a local health unit. Objective: To map and characterize the specific contents by competencies of nurse managers in primary health care and hospital services in health local units. Methodology: This scoping review represents the initial phase of a larger, mixed-methods, cross-sectional investigation into the competencies of nurse managers at the two levels of care in Health Local Systems: primary health care and hospital care. The search will encompass terms such as "nurse managers," "leadership," "health management," and "local health units," with searches conducted in databases including PubMed and Scopus. Qualitative, quantitative and mixed-methods studies will be considered for inclusion. Two reviewers will select the studies based on the Joanna Briggs Institute methodology, and the extracted data will be subjected to descriptive analysis and categorized into main themes. Conclusion: This research has the potential to make a substantial contribution to the understanding and improvement of healthcare management in integrated settings. The findings will be of benefit not only to nurse managers, but also to users and the healthcare system as a whole.

Exploring validated strategies for screening for eating disorders in adolescents and adults in primary health care: a scoping review protocol

BackgroundThis study will be the first scoping review dedicated to investigating screening strategies for eating disorders specifically performed in the primary health care setting, as no comprehensive examination has been performed to date. Our primary aim is to explore the available literature and assess and identify validated screening strategies for eating disorders in adolescents and adults within the primary care context.MethodsThe study protocol was developed following the guidance outlined by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols and the Joanna Briggs Institute methodology for scoping reviews. This study will adhere to the PRISMA extension for scoping reviews to report review data. The protocol was registered on the Open Science Framework. The review will include studies that involve validated screening strategies for eating disorders in adolescents and adults utilising primary health care services. Experimental, quasiexperimental, observational, qualitative, and mixed-methods study designs and reviews will be eligible without language or publication year restrictions. Six databases (MEDLINE-PubMed, Embase, LILACS, CINAHL, Web of Science, PsycINFO) and grey literature will be searched. Studies will be selected and extracted by two independent reviewers via online Covidence. The results will be presented in narrative form and through tables and graphs. When possible, descriptive qualitative content analysis will be conducted.DiscussionThe expected results of this scoping review will shed light on validated strategies for screening for eating disorders in primary health care. This will equip health care professionals with well-substantiated empirical evidence. Moreover, it is anticipated to uncover research gaps, nurturing the ongoing development and refinement of screening strategies for eating disorders in primary health care. The results will be widely disseminated to the scientific community, policy-makers, service providers, and the general public.Systematic review registrationThis protocol has been registered on the Open Science Framework (https://osf.io/pybvf).