Primary Health Care Settings Research Articles

Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial.

Repetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of rumination-focused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder. A randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-to-treat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively. Group RF-CBT significantly reduced self-reported insomnia at post-treatment and self-reported insomnia and depression at the 2 month-follow-up, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life. The current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution.

The Effectiveness of Common Interventions in the Management of Sickle Cell Disease in Primary Care Settings: A Review.

Sickle cell disease (SCD), a chronic condition that affects men and women equally, continues to present a public health burden in the United States due to its associated morbidity and complications. Despite advances in medical knowledge and the design of novel therapies for managing the disease, its burden remains compounded because of increasing rates of immigration arising from global displacements and economic unrest in many countries.We thus conducted a comprehensive literature review of publications from 2000 to 2022 to gather guidelines on managing SCD, with a search through four databases, PubMed, Embase, Google Scholar, and Cochrane; 42 articles met the final inclusion criteria after the full-text article screening process. In the United States healthcare system, primary care physicians (PCPs) are generally providers who cater to the lifelong management of chronic medical conditions, SCD not being an exception. While more SCD patients now present to primary care clinics, many PCPs still lack the confidence and adequate experience necessary to manage the condition effectively. The gap created by the shortage of PCPs extensively equipped to provide comprehensive SCD care leads to poor health outcomes for patients. It is imperative now more than ever to continue to raise awareness about this condition at the provider level, to ensure that patients receive well-rounded care to improve their quality of life and clinical outcomes. Providing up-to-date knowledge about existing and novel therapies and/or modalities of SCD treatment would undoubtedly equip the PCPs with self-assurance to manage the condition adeptly. Thus, we explore various public health interventions such as hydroxyurea therapy, pneumococcal vaccination, penicillin therapy, iron chelation therapy, and clinical decision support tools that have been implemented in primary healthcare settings and shown to be effective in improving SCD care. We also discuss recent advancements that can lead to improved outcomes for SCD patients in the future.

Depression, Anxiety and Stress Among Patients with Type 2 Diabetes Mellitus in Primary Health Care in Kosovo

Background: At a global level, over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world’s population. The presence of depression, anxiety, and stress (DAS) has major consequences for individuals with diabetes. The aim of this study was to determine the prevalence of DAS among adult patients with T2DM in primary health care (PHC) settings in Kosovo and to determine any association between DAS, sociodemographic characteristics, and other risk factors. Methods and Results: This cross-sectional study was conducted in seven Main Family Medicine Centers in Kosovo (Prishtina, Mitrovica, Peja, Prizren, Ferizaj, Gjilan, and Gjakova) from November 2022 to February 2023. The study included 596 adult patients above 18 years of age who were diagnosed with T2DM at least one year ago. By gender, more respondents were female ((F 55.4% vs. M 44.6%); adults aged 30-59 accounted for 38.4%, aged 60+ ‒ 57.7%. Anxiety was the most common type of psychological distress among the subjects (82.0%), depression was second with a prevalence of 74% and stress third with a prevalence of 43.0%. Females were predominant among respondents regarding the three forms of mental health problems: Depression (F 75.8% vs. M 71.8%), Anxiety (F 86.1% vs. M 77.1%), and Stress (F 48.5% vs. M 36.1%) Subjects with only primary education were more likely to be depressed (79.6%, P=0.0072; OR=1.689, 95% CI: 1.153 ‒ 2.477). HbA1C >6.5% was found to be strongly associated with depression (76.4%, P=0.002; OR=2.071, 95% CI: 1.305 ‒ 3.284). Female gender and the presence of comorbidities were found to be significantly associated with anxiety. Female gender, level of education, history of DM in the family, presence of comorbidities, and HbA1c >6.5% were significantly associated with stress. Conclusion: Our study showed that the prevalence of DAS is high in patients with T2DM. Periodic screening of patients with diabetes in PHC settings for early signs of psychological distress using easy and inexpensive validated screening tools like the DASS-21 questionnaire is recommended.

Optimal use of red cell volume distribution width-to-platelet ratio to exclude cirrhosis in patients with chronic hepatitis B

Background and aimsHepatitis B virus (HBV) infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma (HCC). Ruling out cirrhosis is important when treating chronic hepatitis B (CHB). The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis score based on four factors (FIB-4), and red cell volume distribution width-to-platelet ratio (RPR) in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis. MethodsBetween 2005 and 2020, 2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio. A grid search was applied to identify optimal cut-off values with a sensitivity of >90% and a negative predictive value (NPV) of at least 95%. ResultsOverall, 1309 individuals (175 patients with cirrhosis) were included in the derivation dataset, and 873 (117 patients with cirrhosis) were included in the validation cohort. The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821, which was comparable to that of APRI (0.818, P = 0.7905) and FIB-4 (0.803, P = 0.2395). When applying an RPR of 0.06, cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%, while it misclassified 12 of 175 (6.9%) patients in the derivation cohort. In the validation cohort, RPR had a sensitivity and NPV of 97.4% and 99.0%, respectively, and only misclassified 3 of 117 (2.6%) patients. Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups. ConclusionA recently established cut-off value for RPR (≤0.06) was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate. This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertension-associated complications and screening for HCC, particularly in middle and primary healthcare settings.

INTEGRATING PHYSIOTHERAPISTS INTO PRIMARY HEALTH CARE IN SAUDI ARABIA: A CROSS-SECTION SURVEY

Purpose: This study aimed to explore the experiences of physiotherapists regarding their integration and identify the facilitators and challenges they encountered in primary health care. Understanding the perceived barriers, facilitators, and management strategies for successful integration is crucial in developing an informed framework to support future integration initiatives. Method: The study included eligible participants who were practicing physiotherapists, regardless of gender. Inclusion criteria required active engagement in the profession and possession of a Bachelors degree in physiotherapy. On the other hand, unemployed physiotherapists, individuals above 60 years of age, non-practicing physiotherapists, and those with degrees in technical studies were excluded from the study. Data was collected using a cross-sectional observational design through an Internet-based survey. The survey was conducted using the secure and anonymous Survey Monkey platform, ensuring participant confidentiality and obtaining informed consent. The survey specifically targeted registered physiotherapists in Saudi Arabia, allowing for the collection of valuable data from this specific population. Results: Upon analyzing the survey data, a total of 39 responses were received. The demographic breakdown of the respondents revealed that 46% of the completed questionnaires were filled out by therapists working in the Eastern province. The survey also shed light on the work experience of the participants, with a significant portion (43%) having practiced as therapists for 6-10 years. Regarding their professional environment, 73% of participants strongly agreed on the importance of teamwork, while 68% acknowledged the role of effective communication in their work. Furthermore, a substantial 70% strongly agreed that there is a lack of efficient space for physical therapy within primary healthcare (PHC) facilities. Resources were also identified as a challenge, with 65% of respondents indicating a shortage of necessary equipment and resources for physical therapy in PHC. Conclusions: The survey responses provide valuable insights into the challenges and barriers related to integrating physical therapy into the primary healthcare (PHC) setting. These challenges range from a lack of understanding and clear referral processes to issues with space, resources, and workload. These findings can inform strategies aimed at improving the integration and delivery of physical therapy services within PHC, address the identified challenges, and enhance the overall quality of care.

Triaging of patients by general practitioners (GPs) in primary health care settings: a neglected aspect in the health policy & practice in Nepal

General Practitioners are the backbones of the primary health care and whole health system around the world. United nation declaration in Alma Ata about primary health care and WHO reinforcement regarding the importance of robust primary health care for universal health coverage are major catalysts to sensitize the government to implement triaging of patients through primary care by general practitioners. Nepal lacks strong primary health care system utilizing general practitioners as frontline health service providers in the community level. This has made people travel a long distance risking high expenses to get basic healthcare. The overcrowding in tertiary care hospitals is a result of improper triaging and referral system. General practitioners in Nepal work in emergency departments of hospitals and medical colleges, do private practices and a small number of GPs work in health departments of Ministry of Health and Population. Proper mobilization of GPs and establishing primary health care system is paramount to achieve equity, efficiency and effectiveness in health services. Current health policies and program must be reviewed and updated based on the evidences from the studies. CME (Continuous Medical Education) was organized in Chitwan for General Practitioners as a regular program of GPEMAN(General Practice and Emergency Medicine Association of Nepal). Participants were asked about primary health care system in Nepal and its opportunities and barriers. Majority of participants 84% (32 out of 38) pointed out that poor health policy and lack of recognition of General Practice for primary health care as first contact physicians by the government are the major challenges and barriers. Evidences will guide government and concerned stakeholders to establish robust primary healthcare system to increase access, efficiency, effectiveness of health service and to reduce out-of-pocket expenditure and disease burden in the community.

Red flags to screen for vertebral fracture in people presenting with low back pain.

Red flags to screen for vertebral fracture in people presenting with low back pain.

Frequency and Pattern of Antibiotic Prescription for Common Infections Presented in Five Primary Healthcare Centers, Cairo, Egypt

Abstract Background rationale antibiotic prescription is a key strategy to control antibacterial resistance. Objectives to measure the antibiotic prescription rate, and to identify the most commonly prescribed antibiotic, and to explore the reasons for irrational antibiotic prescription in five primary healthcare (PHC) settings in Egypt. Method A Cross-sectional study was conducted on 535 prescriptions collected from five primary healthcare centres; and checklists about symptoms and signs of common health problems of respiratory tract, gastrointestinal tract and urinary tract for antibiotic prescription was fulfilled. Results Antibiotic prescription rate was (33.8%) and the most commonly prescribed antibiotic was Amoxil (Penicillin) (31.5%). Only (26.4%) of antibiotic prescriptions were adherence to the guidelines of Ministry of health of Egypt. Only (31.3%) of patients had upper respiratory tract infection were treated according to the guidelines where Tonsillitis was the most common URT diagnosis (43%), where only (34.3%) of them took Amoxil, followed by bronchitis (67.2%), where (46.3%) of them took Amoxil (adherent to guidelines). Only (31.2%) of patients had lower respiratory tract infection were treated according to the guidelines. Most of urinary tract infections were found among females (86.8%) and cipro was the most commonly prescribed antibiotic (39.5%). Conclusion Antibiotics are frequently prescribed in primary health care centers in Egypt, and most of these prescriptions are inappropriate. Training sessions for physicians is mandatory to improve their awareness, attitude and practice towards antibiotics prescription.

The impact of nursing practice environments on patient safety culture in primary health care: a scoping review.

Patient safety has in recent decades become a global concern. It is a key priority area of healthcare organisations, and has a direct impact on patient health and wellbeing. Work environments can strongly impact nurses' wellbeing and may ultimately produce different outcomes for both professionals and patients. The adverse events occurrence is an example of how work environments influence outcomes, and there is evidence of this correlation in several studies conducted in recent years. To map the knowledge regarding the impact that nursing practice environments have on safety culture in primary healthcare settings, as primary health care concentrates a significant portion of the population's care. This review was conducted following the methodology proposed by the Joanna Briggs Institute (JBI) for scoping reviews. Study selection, data extraction, and synthesis were performed by two independent reviewers. Based on Population (or participants), Concept, and Context (PCC) framework, studies were considered that addressed nurses' practice environment and patient safety culture in primary health care. All studies published or unpublished from 2002 to the present were considered. Seven studies were included in this review; however, the existing evidence on the relation between nurses' practice environments and patient safety is still limited in primary healthcare settings. Although clear evidence was not found, several characteristics of nursing practice environments that may impact healthcare safety were found, such as leadership, communication, and organisational culture and policies. More research directed at primary healthcare nursing practice settings is needed and could be valuable in defining and implementing strategies that promote the safety of care.

Assessing the Impact of a Service Excellence Program on Improving Patient Experience at Primary Health Care Centers.

Frontline clinical staff play a crucial role in shaping patient experience and, therefore, require adequate training and education to deliver exceptional service. This study aimed to assess the impact of a service excellence and quality training program on frontline clinical staff's knowledge, perception, and attitude towardpatient experience and service excellence. We also examined the effect of this intervention on patient experience scores. This study utilized a pre-post intervention design, where frontline clinical staff completed a questionnaire to establish baseline "knowledge and perception scores" and "attitude scores" related to patient experience. The same questionnaire was administered after the training program to measure any changes in scores. Patient experience scores were collected from existing data, comparing results from different quarters before and after the intervention. The training and education program covered various components, including effective communication, empathy, service standards, and service recovery. A total of 256 staff members, including nurses, physicians, and allied healthcare professionals, participated in the training program. The study found statistically significant improvements in all components of staff knowledge, perception, and attitude. Specifically, there was a median improvement in knowledge and perception scores, which increased from 77.2% to 96.5%. Additionally, attitude scores showed a median improvement from 73.8% to 92.5%. Moreover, the overall patient experience score increased from 62% to 72.4%. The study revealed significant improvements in staff knowledge, perception, and attitude, along with enhanced patient experience scores. These findings suggest a potential role for targeted interventions in enhancing patient experience and supporting ongoing quality improvement in primary healthcare settings.

Adapting and piloting a social contact-based intervention to reduce mental health stigma among primary care providers: Protocol for a multi-site feasibility study

Stigma among primary care providers (PCPs) is a barrier to successful integration of mental health services in primary healthcare settings globally. Therefore, cross-culturally adaptable and feasible strategies are needed to reduce stigma among PCPs. This protocol is for a multi-site pilot study that aims to adapt and evaluate cross-cultural feasibility and acceptability of a social contact-based primary healthcare intervention in 7 sites in 5 low-and-middle-income countries. A mixed methods pilot study using an uncontrolled before-after study design will be conducted in China (Beijing, Guangzhou), Ethiopia (Sodo), India (Bengaluru, Delhi), Nepal (Syangja), and Tunisia (Testour). The intervention, entitled REducing Stigma among HealthcAre ProvidErs (RESHAPE), is a collaboration with people with lived experience of mental health conditions (PWLE), their family members, and aspirational figures (who are PCPs who have demonstrated high motivation to integrate mental health services). PWLE and their family members are trained in a participatory technique, PhotoVoice, to visually depict and narrate recovery stories. Aspirational figures conduct myth busting exercises and share their experiences treating PWLE. Outcomes among PCPs will include stigma knowledge, explicit and implicit attitudes, and mental healthcare competencies. To understand the feasibility, and acceptability of the intervention, qualitative interviews will be carried out with PWLE, family members, and aspirational figures, PhotoVoice trainers, mental health specialists co-leading the primary care trainings, and PCPs receiving mental health training. The sites will also generate evidence regarding feasibility, acceptability, recruitment, retention, fidelity, safety, and usefulness of the intervention to make further adaptations and modifications. The results will inform cross-cultural guidelines for collaboration with PWLE when conducting mental health training of primary healthcare workers. The results will be used to design future multi-site hybrid trials focusing on effectiveness and implementation.

Prevalence and awareness of Herpes Zoster Among Saudi Patients with Diabetes Mellitus, A Cross Sectional Study in Al-Ahsa, Saudi Arabia

Background: Herpes zoster (HZ) is a painful vesicular rash that happens when an infection with the varicella-zoster virus in the sensory ganglia is reactivated. The incidence and severity of HZ and its complications increase with advancing age, with a marked increase after 50 years of age. In addition, diabetes mellitus has been found to be a risk factor for severe, persistent postherpetic neuralgia.
 Methods: This descriptive cross-sectional hospital-based study was conducted in Al-Ahsa City, Eastern Saudi Arabia, in 2023. The study population included patients with DM who visit outpatient (ambulatory care) in primary or secondary health care setting. The convenience sample included 224 participants. A validated closed-ended interview questionnaire was used to collect data. The collected data were analyzed by the SPSS program version 28, and both descriptive and inferential statistics were used.
 Results: The study included 224 participants, more than half (54.5%) of whom were female. The mean (SD) age of the sample was 61.1 ± 8 years. Most of the participants (97.8%) were married, and 29.0% had a secondary school education level. More than half of the participants (56.7%) had heard of HZ. Only 6.7% had been diagnosed with HZ, and 23.7% knew someone who had been diagnosed with HZ. In addition, 18.8% had been vaccinated against HZ. Most patients (80.8%) cited healthcare providers as their primary source of HZ knowledge, followed by friends/relatives (37.9%). More than half of the participants were aware of HZ (62.1%) and had a positive attitude towards HZ (55.8%) respectively. Awareness of HZ was positively correlated with a higher level of education, a high income, a short duration of diabetes, having heard of HZ, being diagnosed with HZ, knowing someone who had been diagnosed with HZ, and being vaccinated against HZ among diabetic patients.
 Conclusion: The results revealed low vaccination rates and low awareness of HZ. The study recommends that education in simple language should be provided through various media to increase community awareness about HZ and its vaccine. Additionally, healthcare providers should promote and recommend HZ vaccinations for DM patients.

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study.

Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self-management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses'efforts to support patients'participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germanyand Spain. The data was analyzed using thematic coding. We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a 'biomedical' approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitionersand PHC planners. PHC nurses should be trained in communicative competencewhen discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. This study is part of a research project associated with the research network 'forges: User-oriented care: Promotion of health in the context of chronic diseases and care dependency'. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.

General practitioners’ perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study

BackgroundSignificant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics.MethodsA qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically.ResultsTwenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services.ConclusionsThe study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

Medication use problems and factors affecting older adults in primary healthcare

BackgroundAs the largest demographic group utilizing primary healthcare facilities, older adults often face the challenge of managing multiple chronic illnesses, leading to numerous medications. ObjectiveThe present study aims to assess medication use problems among older adults and explore the factors affecting them in primary healthcare settings. MethodsA mixed-method study was conducted to establish a baseline understanding of the perspectives and challenges faced by older adults, with regards to medication use. Translated Medication Use Questionnaire (MedUseQ), a patient-centered tool, was distributed to older adults above 60 in primary healthcare settings to assess their frequency of problems related to medication use. Fifteen semi-structured interviews were conducted to explore this topic in depth. Descriptive and inferential analyses were conducted with quantitative data. Interviews were transcribed verbatim, and thematic analysis was conducted. Quantitative and qualitative findings data were triangulated. ResultsThe study involved 393 participants. The most common problems with regards to medication use were polypharmacy (55.4%), administration difficulties (48.4%), limited awareness about adverse drug events (47.3%), issues with adherence (46.5%), and accessibility to primary healthcare (42.7%). Approximately 55% were satisfied with the older adult-centered medication use services by pharmacist and doctors. The qualitative findings showed that major factors affecting medication use were forgetfulness, language barriers, lack of awareness, transportation problems, long waiting times, and multiple visits to healthcare facilities. ConclusionThe findings of this study reveal that a significant proportion, around 50%, of the older adult population face challenges with medication use in Penang. These difficulties mainly stem from medication administration, adherence, accessibility, polypharmacy, and inadequate medication knowledge. The qualitative analysis further highlighted several factors that contribute to such medication-related problems. Given the rapidly aging Association of Southeast Asian Nations (ASEAN) population, it is essential to devise effective solutions and strategies to tackle medication use-related issues among older adults.

Effectiveness of a Health Education Program in Hypertensive Patients with Dyslipidemia and/or Microalbuminuria: A Quasi-Experimental Study in Vinh Long Province, Vietnam.

Hypertension, a major health concern, is associated with significant mortality and disease burden worldwide, including Vietnam. Comprehensive interventions targeting medication, lifestyle modifications, dyslipidemia (DLP), and microalbuminuria (MAU) are vital for effective hypertension management and reducing the risk of cardiovascular disease complications (CDV). While medication interventions have proven efficacy, the evidence regarding the effectiveness of community-based health education interventions in managing DLP and MAU is limited. Therefore, this study aims to evaluate the effectiveness of community health education interventions in reducing hypertension risk factors and achieving hypertension management objectives, as well as managing DLP and MAU among hypertension patients. A quasi-experimental study was conducted on 330 hypertensive patients with dyslipidemia (DLP) and/or microalbuminuria (MAU) who were divided into a control group (n = 164) and an intervention group (n = 166). The control group received standard national hypertension management, while the intervention group received additional intensive health education provided by trained volunteers. The effectiveness of the intervention was assessed by comparing outcomes such as lifestyle factors, BMI control, treatment adherence, hypertension control, and DLP and MAU status between the two groups before and after a two-year intervention period. The health education intervention resulted in significant reductions in dietary risk factors, specifically in fruit and vegetable consumption (p < 0.001). There was a lower prevalence of high salt intake in the intervention group compared to the control group (p = 0.002), while no significant differences were observed in other dietary factors. Smoking habits and low physical activity significantly decreased in the intervention group, with a notable disparity in physical activity proportions (p < 0.001). Both groups showed significant improvements in achieving hypertension management targets, with the intervention group demonstrating superior outcomes. The intervention was effective in reducing the prevalence of risk factors, particularly treatment non-adherence, blood pressure control, and low physical activity. Additionally, the intervention group had a higher likelihood of achieving DLP and MAU control compared to the control group. This study underscored the additional positive impact of incorporating health education by non-professional educators in achieving favorable outcomes, including better control of BMI, blood pressure, medication adherence, and management of dyslipidemia (DLP) and microalbuminuria (MAU). Further research is warranted to fully explore the potential of health education in primary healthcare settings and maximize its effectiveness.

A developmental perspective of influences on the onset and early trajectory of chronic pain in children attending physiotherapy in primary health care settings: An integrative review

Chronic pain in childhood leads to long-term social, emotional, physical, and financial impacts, with lifelong heightened pain sensitivities. The prevalence of chronic pain in children has increased over the past 20 years. Physiotherapy is often the place of initial intervention for a child in pain, and initial treatment is predictive of chronic pain and can predict outcomes. Children’s pain experiences and responses are thought to be more modifiable than those of adults; therefore, quality physiotherapy interventions have the potential to positively influence the onset and early trajectory of chronic pain. Using a childhood developmental lens, this integrative review aimed to draw together research literature about biopsychosocial factors influencing chronic pain onset and early trajectory in primary-school-aged children. The results of the review contribute novel understandings for physiotherapists in primary healthcare. A range of biopsychosocial concerns including age at onset and pain duration, neuro-biological aspects, psychological influences, parental impacts, sleep quality, trauma history, and stress interact with children’s learning and development. Taken together, these factors have potential to influence chronic pain onset and early trajectory in children. Adopting a holistic understanding of childhood development in the early management of childhood chronic pain would promote positive physiotherapy interventions and may avoid pathologising what is developmentally normal.

Validity and reliability test of the brief symptom rating scale 5 (BSRS-5) questionnaire in Indonesian version as an assessment tool for psychological disorders in Indonesia.

Psychological disorders in workers is associated with physical health problems and decreased work productivity costing the impact of workplace accidents. We can minimize these problems by introducing screening programs with a simple screening tool for psychological disorders. One of the questionnaires used in several countries to assess psychological disorders is the Brief Symptom Rating Scale - 5 (BSRS-5). Thus, this study aimed to assess the validity and reliability of the Brief Symptom Rating Scale - 5 (BSRS-5) in the Indonesian version. The BSRS-5 was translated into a local language (Bahasa), and experts judgment in the forward and backward translation process. What collected BSRS-5 data in a primary health care setting on 64 respondents. Internal reliability was tested using Cronbach's alpha. Factorial validity was done using exploratory factor analysis to investigate whether BSRS-5 items properly measure the underlying dimensions of psychological disorders. External (criterion) validity was analysed by looking at the relationship between BSRS-5 and Depression, Anxiety and Stress Scale -21 (DASS-21), using the coefficient correlation. The BSRS-5 questionnaire was produced from transcultural validation using the ISPOR method. The results of the construct validity test for all questions between (0.634-0.781) with a significance level <0.05. The factor analysis values for all statements >0.3 were all items having Eigenvalues >1 yielded into one factor. The instrument performed well in detecting common psychological disorders. The BSRS-5 had good internal reliability (α=0.770). The external validity test results with DASS-21 showed that BSRS-5 correlated with the DASS-21 dimensions of depression and stress with correlation values of 0.397 and 0.399. In opposition to correlated BSRS-5 with the dimension of anxiety in DASS-21 showed no correlation with a correlation value of 0.237. Therefore, another gold standard questionnaire is required to evaluate psychological distress based on each item in BSRS-5. The BSRS-5 is a satisfactory screening tool for identifying common psychological disorders such as Insomnia, Anxiety, Depression, Hostility, and Inferiority in the community. The absence of correlation with anxiety in this assessment tool needs another gold standard questionnaire, or professional assistance is required for further evaluation to follow up on psychological disorders.

Perceptions of Barriers to Using Opioid Analgesics: A Mixed Methods Study.

Availability and accessibility of opioids are a worldwide problem. In low-resource settings, such as Ethiopia, access to opioids is either limited or nonexistent and legally restricted in health care settings. This study aimed to identify barriers for the availability and accessibility of opioids in Ethiopian rural and regional health care settings. A mixed-method case study design was used. A total of 220 nurses from primary, secondary, and tertiary health care settings were invited to participate in a survey of knowledge and practice. For the qualitative interview, 38 participants were recruited from educational facilities, health services, and the community across a region. Barriers in availability and accessibility of opioid analgesics were expressing pain considered as a sign of weakness, lack of knowledge, side effect concerns about prescribing morphine, only doctors being authorized to prescribe morphine, lack of foreign currency to import morphine ingredients, and inequity in accessing morphine in hospitals and none in rural health care settings. The findings of this study indicate that opioids, particularly morphine, were not consistently available and accessible to all patients in need. Health professionals lacked knowledge about opioids. Strengthening the existing pain-free initiatives and improving the type, dose, and supply of morphine could help reduce needless suffering and enhance access to essential pain medicines for those in need.

KNOWLEDGE, ATTITUDE, AND PRACTICE OF HUMAN PAPILLOMA VIRUS VACCINATION AMONG PRIMARY HEALTH CARE PHYSICIANS IN AL AHASA, SAUDI ARABIA

Introduction:Human papillomavirus (HPV) has been linked to a variety of cancers in both men and women. HPV is a DNA virus that causes warts on the skin and mucous membranes. Some HPV strains can cause cancers such as anal, vulvar, vaginal, penile, and cervical cancer. All of these cancers are preventable if the vaccine is used correctly. In Saudi Arabia, two types of HPV vaccine are available: bivalent vaccine (Cervarix) and quadrivalent vaccine (Gardasil). The purpose of this study was to assess Saudi physicians knowledge, attitude, and practice regarding HPV vaccine. Method:A cross-sectional study was conducted in Saudi Arabia by 2022, with the studys target population being physicians working in primary health care settings in the Ministry of Health. The study included 385, however only 289 participants who worked in primary health care under the Ministry of Health, AlAhsa have responded. The Ethics Committee has approved the research. Results: Total 289 doctors working in AlAhhsa primary health care centers were included in the study, with 136 females (47.06%) and 153 male (52.94%). The majority of the participants, 259(89.62%), were Saudi, and almost half (49.83%) had less than 5 years of experience. Family medicine consultants and specialist had higher level of knowledge about HPV vaccine than family medicine residents and GP with mean(SD) of 4.19(1.27), 4.71(1.40), 3.81(1.45) and 3.50(1.33) respectively. There was a significant correlation between level of knowledge with practice and attitude towards HPV vaccine ( p=0.001). Conclusion:Primary health care physicians working in PHC inAlAhasa ,Saudi Arabia have basic knowledge about HPV vaccine with a preference for consultants with a higher percentage, then specialists, and lastly residents.