Primary Health Care Research Articles (Page 1)

ABSTRACT This study aimed to explore how students reflect on their caring encounter with a patient. For this purpose, the research has a reflective lifeworld and, as such phenomenological approach, utilizing individual written narratives as data. Before data collection, the students were educated in an approach to caring communication, supported by a life-world perspective. The students were offered a supplementary training session on the communication approach. Emphasis is placed on adopting an attitude that regards the patient as a subject with unique lived experiences. The participants were recruited from the Primary Health Care Specialist program. During the students’ clinical training, they encountered a patient and reflected upon the encounter afterwards. A reflective lifeworld research perspective was used to analyze the students’ narratives. It was found that students engaging in life-world-led encounters with patients presented various challenges, primarily in maintaining an open and flexible approach by bridling their own preunderstandings, attentively listening to patients’ narratives without interruption were highlighted as significant challenges. Remaining fully present in the moment to actively engage with patients’ descriptions was regarded by the students as both demanding and rewarding. The findings suggest the need for teachers to actually engage in reflective teaching in their professional contexts.

Background: Exclusive breastfeeding is an economically cheap, a yet crucial health practice which provides optimal nutrition for infants and short-term contraception for the mothers. The aim of this study was to assess the awareness and perception of exclusive breastfeeding as a method of family planning among nursing mothers in Ovia, Edo State, Nigeria and to identify factors that influence its perception which is vital to ensuring improved maternal and child health. Methods: A cross-sectional study design was adopted involving 290 nursing mothers selected using a multi-stage sampling technique. Data was collected through structured, self-administered questionnaire adapted from previous studies. Data analyses applied descriptive and inferential statistics using SPSS version 25.0, with logistic regression employed to identify significant predictors. A p value of less than 0.05 was considered statistically significant. Results: The majority (76.9%) of the respondents had knowlege of exclusive breastfeeding, about half (47.2%) were familiar with exclusive breastfeeding as a form of family planning method but only 15.2% strongly perceived exclusive breastfeeding as a good method of family planning. Age and occupation were significant predictor, with an odds ratio (OR) of 0.291 (p=0.001, CI=0.156-0.542) and occupation (p=0,041, CI=0.026-0.931) respectively. Conclusion: The study revealed that although knowledge of exclusive breastfeeding as a method of family planning was high among nursing mothers in Ovia, their perception was poor. The findings emphasize the need to ensure healthcare providers are equipped with the necessary knowledge and tools to effectively educate nursing mothers about exclusive breastfeeding as a method of family planning.

ABSTRACT Objective. To describe the process and initial program outcomes of integrating perinatal mental health into maternal and child health services in Belize. Methods. This was an exploratory study using both qualitative and quantitative methods. The qualitative data was extracted from project reports that described the process involved in the integration of mental health into primary health care facilities. The quantitative data was collected through a retrospective review of records of patients screened for perinatal mental health in 16 primary health care facilities from July to December 2024. Results. The results were organized into two sections. The first comprised the process for integrating perinatal mental health into maternal health services, which included training of primary maternal health care providers, development of Standard Operating Procedures on the use of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool and for referral protocols, and supportive supervision and monitoring. The second was the program outcomes, which included 485 pregnant women and adolescents who were screened and of whom 162 (33.4%) had an EPDS score of 12 or greater. All 23 (26.1%) adolescents and 139 (35.0%) adults with a positive screening were referred for mental health evaluation. Of those referred, only 59 (36.4%) were evaluated, and 27 (45.8%) were diagnosed with a mental health disorder. Of the 27 diagnosed, 19 (32.2%) were confirmed to be experiencing a depressive episode, the rate of which was significantly higher among adolescents: 5 (62.5%) compared with 14 (27.5%) adults ( P < .05). Conclusion: The findings of this exploratory study indicate that within the existing health system in Belize, the integration of perinatal mental health into maternal health care at the primary health care level is feasible and essential, particularly for identifying high-risk groups such as adolescents. It is imperative to improve uptake of mental health referrals for evaluation and treatment after screening.

In countries without a gatekeeping system, including China, promoting primary healthcare (PHC) utilization can improve system efficiency and reduce healthcare burden. However, evidence on diabetes patients' PHC utilization and its impact on health outcomes remains limited. This study employs continuity of care (COC) to examine care-seeking behavior at PHC institutions in China and assess its association with clinical outcomes and healthcare costs. We conducted a retrospective cohort study in Yuhuan, Zhejiang Province, China, including 3,672 patients newly diagnosed with diabetes between 2016 and 2019. Data from chronic disease management records, follow-up service records, and electronic medical records from 2020 to 2023 were linked. COC was assessed from 2020 to 2022 using standard measures including the Continuity of Care Index (COCI), Usual Provider of Care (UPC), and Sequential Continuity (SECON), as well as PHC-specific measures: the Primary Healthcare Index (PHCI) and a binary indicator for having the primary healthcare institution as the usual provider of care (PHC-UPC). We evaluated clinical outcomes (hospitalization, glycemic control) and healthcare costs in 2023. Logistic and linear regression models were used to assess association, adjusting for patient demographics and clinical characteristics. The mean PHCI was 0.73. Higher PHCI was significantly associated with decreased outpatient costs (P < 0.001), decreased inpatient costs (P < 0.001), and a lower likelihood of hospitalization (OR = 0.503, P < 0.001). Similarly, having used a PHC-UPC was associated with reduced outpatient and inpatient costs (P < 0.001) and a lower likelihood of hospitalization (OR = 0.708, P < 0.001). However, among patients with poorly controlled diabetes, neither PHCI nor having used a PHC-UPC showed a positive association with glycemic control (OR = 0.496, P = 0.003; OR = 0.629, P = 0.002). Continuity at PHC significantly lowers hospitalization and healthcare costs in China's non-gatekeeping system. However, no significant improvement in glycemic control among poorly controlled diabetes was observed. Strengthening PHC capacity for personalized diabetes management and timely hospital referrals is essential to optimize outcomes.

Atrial fibrillation (AF) is a prevalent arrhythmia with significant health risks, often underdiagnosed due to limitations in traditional screening methods. This study investigates the effectiveness of an AI-based electronic stethoscope for AF screening, comparing it to other portable devices. A retrospective study was conducted using 496 cardiac sound recordings from patients with and without AF. The recordings were divided into derivation and validation datasets. An AI model, combining ResNet34 and a 12-layer Vision Transformer (ViT), was developed and trained on the derivation dataset. The model's performance was evaluated using sensitivity, specificity, accuracy, positive and negative predictive values, and the area under the receiver operating characteristic (ROC) curve (AUC). Additionally, a non-consecutive day twice cardiac sound collection was performed on 74 samples to assess the model's consistency. The AI model achieved high performance metrics in both derivation and validation datasets. In the derivation dataset, sensitivity was 0.95 (95% CI, 0.90-0.97), specificity was 0.90 (95% CI, 0.83-0.94), accuracy was 0.92 (95% CI, 0.90-0.96), positive predictive value was 0.92 (95% CI, 0.87-0.96), and negative predictive value was 0.93 (95% CI, 0.86-0.96). In the validation dataset, sensitivity was 0.94 (95% CI, 0.88-0.98), specificity was 0.91 (95% CI, 0.83-0.96), accuracy was 0.93 (95% CI, 0.89-0.96), positive predictive value was 0.93 (95% CI, 0.86-0.97), and negative predictive value was 0.93 (95% CI, 0.85-0.97). The AUC for the derivation dataset was 0.92 (95% CI, 0.89-0.96), and for the validation dataset, it was 0.93 (95% CI, 0.88-0.97). The non-consecutive day cardiac sound collection resulted in a Cohen's Kappa value of 0.74, indicating good consistency in the model's judgments. The AI-based electronic stethoscope shows promise as a reliable and accessible tool for AF screening, with potential applications in primary healthcare and general population screening.

Availability and access to quality laboratory diagnostics at the primary healthcare (PHC) level are critical to achieving universal health coverage. However, significant access disparities still exist. This evaluation aimed to understand the current laboratory capacity and infrastructure for communicable diseases testing at the PHC level and identify systemic challenges affecting access. This evaluation was conducted in eight low-middle-income countries (Cambodia, China, Lao PDR, Malaysia, Mongolia, PNG, Philippines, and Solomon Islands) in the WHOWestern Pacific Region. Data were collected by reviewing existing WHO and country-level policies, guidelines, and reports on laboratory services for communicable diseases at the PHC level, as well as virtual interviews with participants at various levels of healthcare. Most countries are progressing well towards improving laboratory access at all levels. Activities contributing to improved access include point-of-care testing, integrated sample transport systems to facilitate referral of samples, community engagement, and efforts towards combating stigma and discrimination. Vertical disease programs supported by development partners bridge the funding and capacity gaps for several high-priority public health problems, but these support streams are dynamic and often diminishing. The systemic challenges identified were categorized into three thematic areas: (1) weaknesses in primary healthcare systems; (2) limited community and individual engagement; and (3) persistent socio-economic barriers. Potential solutions and recommendations should include a stepwise approach customized for each country's context in collaboration with all stakeholders. Despite the progress already achieved, most countries in the region still face significant challenges in improving access to essential laboratory services for communicable diseases at the PHC level.

To evaluate primary healthcare (PHC) nurses' knowledge, attitudes, and confidence in dengue-related practice and to identify predictors of confidence. A multicenter cross-sectional survey. The study was conducted from May to August 2024 with 488 PHC nurses from 85 PHC units across 21 provinces in Indonesia. Established questionnaires measuring knowledge, attitudes, and confidence in dengue-related practice were translated into Indonesian and psychometrically tested prior to use. Data were analysed using descriptive statistics, independent t-tests, Pearson's correlations, and multiple linear regression analysis with SPSS for Windows, version 27.0. The mean knowledge score was 4.3 (SD = 1.3) out of 7, indicating insufficient knowledge. The mean attitude score was 28.4 (SD = 4.3) out of 35, reflecting generally positive attitudes toward dengue prevention. The mean confidence score was 19.1 (SD = 3.5) out of 25, suggesting moderate confidence in dengue-related practice. Higher education (B = 0.78), familiarity with national guidelines (B = 1.01), greater knowledge (B = 0.22), and more positive attitudes (B = 0.33) significantly predicted confidence levels. These predictors explained 23% of the variance in confidence scores. PHC nurses demonstrated insufficient dengue-related knowledge, positive attitudes, and moderate confidence in clinical practice. Confidence was significantly associated with higher education, familiarity with national guidelines, greater knowledge, and more positive attitudes toward dengue prevention. These findings highlight the need to increase nurses' awareness and use of dengue national guidelines and to implement targeted professional development programs to enhance dengue management competence, although the use of convenience and snowball sampling may limit generalizability. This study addresses the limited research on PHC nurses' confidence for dengue management. It found that higher education, guideline familiarity, knowledge, and attitudes significantly predicted confidence. This study adhered to the STROBE checklist. No patient or public involvement.

Abstract Introduction The number of patients diagnosed with mental health conditions has increased, with many of these patients presenting to the primary care setting. Primary care pharmacists are well placed to support people living with mental health conditions, as they review patients with chronic conditions in practice and provide advice on medication-related problems [1]. However, studies have identified the need to better integrate pharmacists as members of the mental health team and provide further mental health training to better utilise this profession [2–3]. Aim The aim of this study was to explore the facilitators and barriers to primary care pharmacists providing mental health care during medication reviews. Methodology A qualitative study was conducted, utilising face-to-face or virtual one-to-one semi-structured interviews. Participants included pharmacists with experience conducting medication reviews, working within primary care roles (including cluster pharmacists and prescribing-advisors). Data was analysed using inductive thematic analysis to facilitate the exploration of unanticipated themes. All study materials received ethical approval from the necessary regulatory bodies (Cardiff University’s School of Pharmacy and Pharmaceutical Sciences committee and CTMUHB Research and Development department) prior to commencement. Results A total of twenty-seven pharmacists were invited to participate, of whom thirteen responded and were subsequently interviewed. Three key themes were identified: (1) competence in conducting mental health care during medication reviews; (2) primary care infrastructure; and (3) community of practice. Discussion Participants highlighted a disparity between theoretical knowledge and applied confidence, resulting in an advisory role being adopted in practice. Further training in less confident areas, an awareness of local patient resources and better communication with specialist services was also highlighted. The need for emotional and professional support from peers was a key area discussed, as well as structural difficulties associated with the role. To better enhance the use of training in practice, formal peer support structures are essential to improve confidence and application of knowledge. This may be implemented through buddying systems, supervision sessions, or allocated group discussions. This will also be essential in providing emotional support to pharmacists. The development and implementation of structured mental health review resources for pharmacists and patients may also be beneficial to support individuals in practice. Our study identifies the need for clarification around pharmacist expectations within the cluster role, to reduce role ambiguity and improve pharmacists’ perspectives on conducting mental health medication reviews. Better connectivity between primary care and specialist mental health services, along with the potential for longer time allocation for challenging mental health medication reviews, would also facilitate mental health care. Future training should focus on pharmacological areas, such as cross-tapering antidepressants and dose increases; along with non-pharmacological, such as managing unstable patients and motivational interviewing techniques. The main limitation of this study was the potential introduction of bias, including social desirability bias, acquiescence bias and confirmation bias. To mitigate these risks, the interview schedule was developed with consideration of the existing literature and external expertise were sought from three clinical pharmacists. The researcher also employed reflexivity to identify and mitigate personal biases and maintain objectivity.

Recognizing Guttate Psoriasis in Primary Care: A Pediatric Case Report Following a Streptococcal Pharyngitis Infection.

Access to essential medicines is fundamental to achieving universal health coverage. According to WHO, these medicines should be consistently available and affordable. However, in many low- and middle-income countries, health facilities experience frequent stockouts and high prices, limiting access and affordability. Such barriers reduce adherence, increase out-of-pocket spending, and compromise health outcomes. Assessing availability and affordability in primary health care facilities is therefore crucial to inform policy and promote equitable access. To assess the availability and affordability of essential medicines and associated factors in Wolaita region, Ethiopia, 2022. A facility-based cross-sectional study was conducted from February 1-30, 2022. Thirty public health facilities were selected, six from each of five districts. Sample size was determined using a single population proportion formula. Data were collected through patient exit interviews, entered into EpiData 3.1, and analyzed in SPSS version 25. Multivariable logistic regression was employed to identify factors associated with affordability. Of 601 patients, 98% participated. The average availability of 26 selected core essential medicines was 56.53%. Among patients, 58.1% reported prescribed medicines as unaffordable. Factors significantly associated with affordability included level of health facility [AOR (95% CI) = 3.450 (2.275-5.231)], health status [AOR = 1.807 (1.027-3.179)], educational status [AOR = 3.413 (1.363-8.548)], and place of residence [AOR = 1.596 (1.019-2.551)]. Essential medicine availability was low across facilities. Many patients were unable to obtain prescribed drugs due to unavailability and unaffordability. District and zonal health offices should ensure timely replenishment to strengthen access.

Bedridden patients heavily rely on caregivers for daily living activities and accessing care. They have the issues not only with physical health but also psychosocial and spiritual health. This study implemented a home-based supportive care model based on primary healthcare approach for bedridden patients and assessed its feasibility and effect. This model was implemented at a primary health center in rural Ballabgarh, Haryana. Health workers identified the bedridden patients, and medical interns assessed their concerns across physical, mental, social, and spiritual domains. Individual care plans were developed after family meetings, including caregiver training. Health workers conducted monthly home visits for medication refills and supportive care. Baseline and 3-month follow-up assessments used Edmonton symptom assessment scale-revised (ESAS-r) and distress thermometer to assess effect. Feedback was collected from patients, caregivers, and health workers. Of the 74 identified bedridden patients, 71 were enrolled. The mean age was 52.8 years, with a median bedridden duration of 6.1 years. The common symptoms included pain (91.7%), sleep-related issues (60.4%), and tiredness (56.3%). Postintervention, significant reductions were observed in distress scores (median score reduced from 6 to 4.5, P <0.05), pain (median score 5 to 4, P-value<0.05), tiredness (median score 2 to 0.5, P-value < 0.05), and depression (median score 1.5 to 0, P-value <0.05) on ESAS-r. Feedback from health workers and interns highlighted increased self-confidence, compassion for others, and gained respect in the community. This model of home-based supportive care was feasible and effective in reducing the symptoms and distress among bedridden patients.

Abstract Background Despite the evidence supporting the importance of spiritual health to people’s wellbeing across diverse fields of treatment, the topic of spiritual health is not currently mentioned in National Health Service (NHS) training materials for social prescribers. Previous research with social prescribers has identified a need for training around spiritual health in primary care. This study sought in-depth understanding of these training needs and how they may be met. Method Semi-structured interview data specific to the subject of training needs were extracted from interview data from a wider study, which explored barriers and facilitators to spiritual health discussions within social prescribing. UK-based social prescribers aged 18 + working in primary care were recruited purposively from different geographic areas, with data collected between December and February of 2025. An inductive, iterative approach was taken to the thematic analysis of data. Results Findings were generated from interviews with 12 participants with three main themes: the value and need for spiritual health training , approaches to training , and the value of learning from peers and patients . However, while social prescribers interviewed broadly recognised the benefits that spiritual health training could bring to their work with patients, there were some who did not feel this was relevant to their role. Conclusions Participants identified how integrating spiritual health discussions into social prescribing improved not only patients’ health but also their own knowledge and skills. In-person training was widely felt to be appropriate for discussions around spiritual health. However, participants noted the limitations of one-off training sessions within this context, and highlighted the potential benefits of ongoing learning within the workplace. Peer learning appears to be a valuable and useful method of training for the topic of spiritual health, recognising social prescribers’ understanding of holistic health and focusing on the relevance of spiritual health to patients. Including the topic within NHS competency frameworks and training materials would also greatly support the relevance of spiritual health to social prescribing roles.

Background: Beverage intake is a consequential yet underappreciated driver of health in Mediterranean settings. Comparative evidence for Spain and Italy based on harmonised measures is scarce. This study addresses that gap by profiling beverage portfolios and their sociodemographic correlates in parallel adult samples from both countries. Methods: We conducted a cross-sectional analysis of adults in Spain (n = 483) and Italy (n = 403) using aligned, validated instruments (NutSo-HH; NutSo-HH-Ita). Outcomes were water (Wtr), sugar-sweetened soft drinks (Sfd), juice (Juc), energy drinks (End), coffee (Cff), alcohol (Alc), and episodes of intoxication (Gtd). Associations were assessed via non-parametric tests, multivariable linear models, and an EBIC-selected Gaussian graphical model (GGM). Main results: Italians reported higher Alc and Gtd; Spaniards reported higher Sfd and Juc. Wtr was comparable across countries, and Cff differences were marginal. Age and sex emerged as the most consistent correlates (older age and male sex with higher Alc; younger age with higher Sfd), whereas education and income were not stable determinants. The GGM suggested behavioural clustering of Sfd–Juc–End, with weak partial correlations for other beverages after adjustment. Implications: Distinct country profiles imply differentiated priorities. In Spain, interventions could prioritise reducing sugar-sweetened beverage intake among younger adults through age-targeted primary care counselling, mandatory water (and unsweetened milk) availability in schools, tiered excise taxes on sugar-sweetened drinks, and restrictions on child- and youth-directed marketing of high-sugar beverages. In Italy, primary care and community health services could routinely screen adults for risky alcohol use and deliver brief, culturally attuned advice that promotes lower-risk patterns of wine consumption during meals. Given the cross-sectional design, self-report measures, and non-probabilistic sampling, findings should be interpreted as context-sensitive markers rather than causal determinants; nevertheless, they highlight concrete prevention approaches and regulatory levers for each country’s beverage-related health risks.

Primary antenatal care providers are seen as instrumental in shaping healthy pregnancy outcomes. However, there are organizational and system-level barriers that hinder the needed support for mental health care among pregnant women and there remains a dearth of research exploring the specific challenges and opportunities encountered by clinicians in providing mental health support to pregnant women with common mental disorders (CMDs) in the prenatal period. This study explored clinicians' (obstetric providers) perspectives in managing CMDs among women during the prenatal period. This study employed a qualitative exploratory design. Twelve interviews were conducted with clinicians (doctors and midwives) working in primary care settings, guided by a semi-structured interview guide. Data were analyzed using qualitative content analysis. Managing CMDs in pregnancy was described as not a priority as illustrated in five categories: many warning signs, relying on own experiences, no time, overwhelmed in a role, and working with families. This study's findings suggest that primary healthcare obstetric practice does not have the required training in mental health among clinicians to screen and treat for CMDs in pregnant women in Ghana. Therefore, healthcare facilities must prioritize the integration of mental health services within routine obstetric care, ensuring that pregnant women have access to comprehensive mental health interventions alongside their routine antenatal care.

Schools play a fundamental role in educating conscious, responsible, and committed individuals toward environmental care and preservation. They integrate the cultural legacy of our ancestors into this process, thereby educating individuals with values ​​and developing environmental competencies based on sustainability. This research aimed to implement the planting of medicinal plants as a pedagogical strategy to preserve ancestral knowledge among sixth-grade students at Nuestra Señora del Carmen Educational Institution in the municipality of Pital, Huila, given the threat of extinction of this knowledge as a result of human activity and actions. Using a qualitative approach and descriptive action research methodological design, a pre-test was applied to diagnose students' level of knowledge about these plants, and a post-test was used to evaluate the pedagogical strategy. The results obtained revealed the positive effects of this pedagogical proposal on students, developing meaningful learning and pro-environmental competencies toward the preservation of ancestral knowledge surrounding the use of medicinal plants in primary health care.

Long Covid is the persistence of symptoms beyond 12 weeks following acute Covid-19 infection. It is estimated to affect one in ten people and can be extremely debilitating. With few publicly funded long Covid clinics, most people rely on primary care providers as a first point of contact. There is currently limited understanding of the experience of accessing primary health care by adults living with long Covid in New Zealand. To explore the experiences of accessing primary health care by adults living with long Covid. A narrative inquiry approach was used to capture participants lived experiences of accessing primary health care. Zoom interviews and discussions were conducted with study participants. The automatically generated transcripts were reviewed and corrected, and the collated data were analysed using Braun and Clarke's thematic analysis. Eighteen people participated in the interviews. Codes were identified and, through an iterative process, themes were generated, reviewed, and named. The seven themes included lack of upskilling of primary care staff; let down by the Government; self-advocacy and its cost; and throwing money at it. The picture painted by participants was bleak with a sense that the world had moved on from Covid-19 and left them behind, with some experiencing a lack of support in primary health care. Reducing the likely long-term health and economic burden of long Covid requires targeted investment and action by Government at every level, along with better utilisation of the allied health workforce in primary care.

BackgroundLong Covid is the persistence of symptoms beyond 12 weeks following acute Covid-19 infection. It is estimated to affect one in ten people and can be extremely debilitating. With few publicly funded long Covid clinics, most people rely on primary care providers as a first point of contact. There is currently limited understanding of the experience of accessing primary health care by adults living with long Covid in New Zealand.PurposeTo explore the experiences of accessing primary health care by adults living with long Covid.MethodsA narrative inquiry approach was used to capture participants lived experiences of accessing primary health care. Zoom interviews and discussions were conducted with study participants. The automatically generated transcripts were reviewed and corrected, and the collated data were analysed using Braun and Clarke’s thematic analysis.ResultsEighteen people participated in the interviews. Codes were identified and, through an iterative process, themes were generated, reviewed, and named. The seven themes included lack of upskilling of primary care staff; let down by the Government; self-advocacy and its cost; and throwing money at it.Conclusion(s)The picture painted by participants was bleak with a sense that the world had moved on from Covid-19 and left them behind, with some experiencing a lack of support in primary health care. Reducing the likely long-term health and economic burden of long Covid requires targeted investment and action by Government at every level, along with better utilisation of the allied health workforce in primary care.

Objective: To identify facilitating and hindering factors for implementing a care transition strategy for adult patients undergoing elective colorectal cancer surgery, within a primary health care (PHC) context, addressing gaps in the literature on implementation challenges and contextual factors influencing such strategies. Methods: This complex mixed methods study combined a randomized clinical trial (RCT) and a qualitative component within an Implementation Research framework. The RCT enrolled adult patients with colorectal cancer, while the qualitative phase included a multilevel sample of participants. Iterative data integration occurred throughout the planning, implementation, and evaluation phases. The intervention was assessed using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. Statistical analyses were conducted using IBM SPSS Statistics 22.0, applying descriptive and inferential methods. Results: Our findings revealed that the adoption of the intervention was satisfactory; however, Reach, Efficacy, and Implementation were not achieved. Facilitating factors included recognition of the potential of the care transition strategy to improve patient outcomes, and the intervention’s feasibility, replicability, and low cost. The main hindering factors identified included poor communication between care levels, inadequate material resources, and high workload. Integration of qualitative insights helped explain the limited quantitative impact, highlighting contextual challenges during the COVID-19 pandemic. Conclusions: The care transition strategy was well accepted by participants and health care providers, demonstrating potential to strengthen continuity of care between hospital and PHC services. Nonetheless, significant organizational and resource-related barriers hindered its effectiveness. Future studies are required to adapt transitional care models to overcome communication gaps, optimize resource allocation, and enhance implementation in similar settings.

Innovative Health Education Strategies: Training Professionals in Hypertension and Diabetes Care in Primary Health Care

ABSTRACT Objectives Sub-threshold cases of depression and anxiety disorders in older adults are often undetected and undertreated. The 7-item Duke Anxiety-Depression Scale (DUKE-AD) assesses mental distress; this study evaluated the psychometric validity and cross-cultural applicability of its Persian version (DUKE-AD-PERSIAN). Methods A cross-sectional study among 500 older adults assessed for content and face validity as measured by 20 experts, and estimated content validity ratio (CVR) and item-level content validity index (I-CVI). Exploratory and Confirmatory Factor Analyses (EFA, CFA) examined the factor structure. Results Participants had a mean age of 70.62 ± 7.42 years and mean anxiety-depression score of 25.05 ± 22.39. The implemented EFA and CFA’s outputs (CMIN = 29.933, DF = 11, pvalue = 0.002, CMIN/DF = 2.721, RMSEA = 0.05 (95% CI: 0.034, 0.084), PNFI = 0.511, PCFI = 0.515, TLI = 0.969, IFI = 0/984, CFI = 0.984) supported unidimensionality of the scale. The estimated reliability and stability coefficients (Cronbach’s α = 0.98, ICC = 0.97) were acceptable. Conclusions Findings supported the reliability and validity of the Persian DUKE-AD as a brief self-report measure for assessing anxiety and depression in older adults. Clinical Implications The Persian DUKE-AD enables efficient screening of anxiety and depression symptoms among older adults, facilitating early intervention in primary care and community health settings.