Primary Institutions Research Articles

Understanding the behavioral determinants that predict barriers and enablers of screening and treatment behaviors for diabetic retinopathy among Bangladeshi women: findings from a barrier analysis

Background and aimWhile early detection and timely treatments can prevent diabetic retinopathy (DR) related blindness, barriers to receiving these DR services may cause permanent sight loss. Despite having similar prevalence to diabetes and DR, women are less likely than men to perform these behaviors due to multi-faced barriers in screening and receiving follow-up treatments for DR. This study, therefore, aimed at identifying the barriers to – and enablers of – screening and follow-up treatments behaviors for DR among women aged more than 40 years with diabetes from the behavioral perspectives in Bangladesh.MethodsThis Barrier Analysis study interviewed 360 women (180 “Doers” and 180 “Non-doers”) to explore twelve behavioral determinants of four DR behaviors including screening, injection of anti-vascular endothelial growth factor (anti-VEGF medication), laser therapy and vitro-retinal surgery. The data analysis was performed to calculate estimated relative risk to identify the degree of association between the determinants and behaviors, and to find statistically significant differences (at p < 0.05) in the responses between the Doers and Non-doers.ResultsAccess to healthcare facilities was the major barrier impeding women from performing DR behaviors. Difficulty in locating DR service centers, the need to travel long distances, the inability to travel alone and during illness, challenges of paying for transportation and managing workload significantly affected women’s ability to perform the behaviors. Other determinants included women’s perceived self-efficacy, perceived negative consequences (e.g. fear and discomfort associated with injections or laser treatment), and cues for action. Significant perceived enablers included low cost of DR treatments, supportive attitudes by healthcare providers, government policy, and perceived social norms.ConclusionThe study found a host of determinants related to the barriers to and enablers of DR screening and treatment behaviors. These determinants included perceived self-efficacy (and agency), positive and negative consequences, perceived access, perceived social norms, culture, and perceived risk. Further investments are required to enhance the availability of DR services within primary and secondary health institutions along with health behavior promotion to dispel misconceptions and fears related to DR treatments.

The Psychosocial in Norwegian Teacher Education in Light of Epistemic Objects and Therapeutic Culture

In this article we examine how therapeutic culture disseminates into and affects teacher education in Norway. This is done through a close examination of knowledge practices revolving around the term psychosocial. Based on fieldwork data and drawing on Karin Knorr Cetina’s concept of epistemic objects, we analyse how the psychosocial is practised, taught, and interpreted in a Norwegian primary and secondary teacher education institution. We identify three key epistemic characteristics of the psychosocial: ubiquity, emotional orientation, and self-centeredness. Due to its oscillation between compatibility and friction, the psychosocial is both nurturing and disruptive, intuitive, and demanding, meaningful and alienating. More broadly, the application of the psychosocial in teacher education can be understood in light of the interplay between intellectualisation and emotionalisation processes in modern societies. By providing insight into a previously unexplored area, the article contributes to new understandings of the changing cultural conditions of the teaching profession.

City of Gauze: Medicine and the Governance of Urban Poverty

Abstract How is urban poverty governed? Scholarship emphasizes the significance of social assistance programs and criminal legal systems, but considerably less attention has been given to medical institutions. Drawing on contemporary and historical evidence across journalistic, bureaucratic, and academic texts, we conceptualize and compare three arenas for medically governing the poor in Los Angeles, California: clinical medicine, welfare medicine, and penal medicine. In addition to detailing the differences between these formations of medicine, we illustrate how each is embedded in similar political and productive relations. Ending with a call to reframe medicine as a primary institution for governing the poor, this article helps advance a relational vision of governance.

Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis.

Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.

Perception of consanguineous marriage among the qatari population.

Hereditary blood diseases are widespread among the Arab population due to the high rates of consanguineous marriages; research regarding the perception of consanguineous marriage in some countries, such as Qatar, is extremely scarce. Therefore, this study aimed to investigate the prevalence of consanguineous marriage and assess the perception of consanguineous marriage among the Qatari population. A cross-sectional study used a self-administered questionnaire among 395 Qatari adults aged 18-35 who attended primary healthcare institutions in Qatar. A convenience sampling technique was used to select the study participants. An independent t-test was used to compare the significance of the mean between the two groups with positive and negative perceptions of consanguineous marriage. Categorical data were analyzed for association using the chi-square or Fisher's exact test. Finally, a multiple logistic regression analysis was conducted to determine the significant predictors of the positive perception of consanguineous marriage. A significant level was set at p < 0.05. Approximately 45% of the participants had a positive perception toward consanguineous marriage, and the most common reason stated by those participants was "habit and traditions." The prevalence of consanguineous marriage among married couples was 62.6%, and among those with consanguineous marriage, most were married to first cousins (81.7%). Moreover, compared to the participants with negative perceptions of consanguineous marriage, those with positive ones were significantly older, married, with lower educational levels and higher monthly income levels, did not hear about glucose-6-phosphate dehydrogenase (G6PD) deficiency, did not know what kinds of diseases are being screened in the premarital test, and were married to a relative. The prevalence of consanguineous marriage is high among the Qatari population, and this requires an immediate need for community-based campaigns to raise public awareness about the problem and its potential impact.

Comparative Study on Chronic Obstructive Pulmonary Disease Screening Tools in Primary Healthcare Institutions in Beijing, China.

Chronic obstructive pulmonary disease (COPD) has a high incidence rate in China, but the diagnosis rate remains insufficient. This study aimed to explore and compare COPD screening tools for primary healthcare institutions in China. Exploring COPD Screening Tools and Their Combined Use for Primary Healthcare Institutions in China. From September 2022 to March 2023, a screening for COPD was conducted among residents aged 35 years and above in primary healthcare institutions in Beijing, China. The screening involved the use of the CAPTURE scale, COPD-SQ scale, and peak expiratory flow rate test. Any positive results from these screening tests were followed by further pulmonary function testing to confirm the diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curves were calculated for each screening tool alone and in combination. A total of 986 individuals completed the screening tests. The positive rates for the CAPTURE scale, COPD-SQ scale, and peak flow meter screening were 41.78%, 29.11%, and 52.03%, respectively. Of the participants, 166 (24.09%) underwent pulmonary function tests, with an average age of 61.69±13.68 years. The peak flow meter screening showed the highest sensitivity (83.78%) when used alone, while the COPD-SQ scale exhibited the best specificity (59.69%), positive predictive value (31.58%), and negative predictive value (58.56%). Significant differences (P<0.05) were observed between any two of the three screening tools. Among the combinations, the peak flow meter screening + COPD-SQ scale showed the highest accuracy, with a Youden index of 0.277 and an AUC of 0.638. There is variation in the accuracy of existing screening tools for COPD when used alone. For primary healthcare institutions, the optimal COPD screening tool is the combination of peak flow meter screening and the COPD-SQ questionnaire. If limited by screening equipment conditions, the COPD-SQ questionnaire can be used alone for screening.

Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review.

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.

Awareness of Hospice Care Among Community-Dwelling Elderly Participants.

Background and Purpose: The main goal of hospice care is to improve the quality of life for people who are at the end-of-life phase. However, investigations on the awareness of hospice care among community-dwelling elderly participants are limited. This work aimed to reveal the awareness status of hospice care and explore the factors influencing the awareness rate among elderly participants. Methods: A questionnaire survey was conducted among individuals aged 60 years and above. Results: A total of 4,969 individuals aged 60 years and above were randomly selected from 48 primary medical institutions in Handan. The awareness rate of hospice care in the baseline survey was 19.3% (n = 959). All included individuals were divided into two groups in accordance with their awareness of hospice care. The awareness of hospice care among participants with low educational level, living alone, and afraid of talking about death was low (p < .05). Implications for Practice: The level of awareness of hospice care among community-dwelling elderly participants is low. The influencing factors included educational level, living status, and fear of talking about death. The community-dwelling elderly participants' awareness of hospice care must be improved. It is recommended that public medical education and training should be enhanced to improve knowledge and awareness of hospice care among community-dwelling elderly residents with low educational level, living alone, and afraid of talking about death.

Repository for academic documents, algorithms and data: A utility in an educational context

Data repositories currently constitute essential programs within institutions. In fact, universities are the primary institutions that promote the creation, management and storage for the safekeeping of a variety of documents, data and/or projects. This work is carried out within the framework of institutional need and the application of knowledge by the students and professors in the software degree program at a university in Ecuador. This project centers on a web application that makes it possible to manage, upload and download resources. This initial version focuses on the resources related to academic projects, data sets and algorithms. The scalability characteristics have been carefully introduced to ensure a progressive evolution of other types of resources and functionalities, in accordance with educational needs. Several aspects of the web interfaces are based on the characteristics of other existing repositories, and a series of tests related to functionality have been conducted in order to move beyond the introductory stage of use, to begin with, by the university community. This project is carried out according to a conception based on contributions, in which the agents, in principle, are members of the institution. The intensive and collaborative use of this utility will contribute to the growth of a data culture within the institution. Furthermore, the collection and organization of data for the purposes of study and research by the different university degree programs makes it possible to analyze and contrast them from different perspectives.

Medication Administration Practices Among Nurses: An Observational Study from Oman

Safe medication administration is vital in ensuring patients’ safety and enhancing their quality of life. This study aimed to observe nurses' practice in medication administration in Hospitals and primary healthcare institutions to identify and examine the different steps of the medication administration process for quality assurance and safe drug administration. The methodology of the study employed a cross-sectional design using quantitative descriptive data within health institutions at South Sharqiyah Governorate. Data from the direct observation of 99 nurses (once at a time) were observed while they were preparing and administering medications using the disguised observation method (DDM). The data was recorded via Microsoft Access using a descriptive approach (frequencies and percentages) for analysis. The areas of concern in the study were: the five rights of medication administration, documentation, the use of patient’s identifiers, double checking and drug labeling. The trained observer completed the checklist after observing the nurses’ medication administration. Data were collected from 99 observations for analysis. Data analysis was conducted using descriptive and inferential statistics in the SPSS software version 26. The quantitative data illustrates that only 34.3% of nurses performed an independent double check by another nurse, only 56.6% performed appropriate labeling, and 62.6% confirmed the patient’s identity using at least two patient identifiers. Most medication administrations meet the “Five Rights” criteria (right patient =92.9%; right medication=98%; right dose=97%; right route=98%; and right time=97%). A statistically significant association was found between the participant's age and right time (p=0.013); and between years of experience and right medication (p=0.005), right dose (p=0.019) and right route (p=0.004). In this study, the nurses' poor areas of practice in medication administration were identified as double-checking of medication, labeling, and use of patient identifiers. Checking the right of medication administration and documentation post the procedure was the most followed by nurses in the medication administration process. The relevance of the study to clinical practice is the continuing education and clinical audits for nurses regarding basic pharmacology, medication administration policy, factors contributing to medication errors, and strategies preventing medication errors should be a priority.

Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China

Primary healthcare institutions (PHIs) in China have experienced a sizable decline in medical services in recent years. Despite the large regional disparities in China, there is a lack of evidence on the differential patterns of medical services offered by PHIs, especially from a spatial perspective. This study examines whether residents in more remote areas use more medical services offered by township healthcare centers (THCs), a main type of PHIs. Linking medical visits to 923 THCs in a western Chinese province in 2020 with the driving time and geographic coordinates from the Gaode map, a leading map navigation provider in China, we applied a multilevel linear model and a geographically weighted regression to examine spatial heterogeneity in medical service utilization. We showed that a one-hour increase in the shortest driving time between THCs and the local county hospitals was associated with an average 6% increase in THCs outpatient visits and a 0.6% increase in THCs inpatient visits. Our findings suggest that THCs located in more remote areas provided more medical services, especially outpatient services. This study may improve our understanding of the spatial disparity in medical services provision for THCs in western China. We suggest that more attention should be paid to enhance the quality of THCs in remote areas, which deserve a higher priority in the process of improving the quality of primary healthcare. Health policymaking in developing regions such as western China should take geographic factors into account.

Epidemiological and clinical characteristics of scrub typhus in northern Fujian, China, from 2015 to 2019

BackgroundThis study aimed to analyze the epidemiological and clinical characteristics of scrub typhus in northern Fujian Province on the southeast coast of China.MethodsA retrospective analysis was performed on 303 patients with scrub typhus admitted to the First Hospital of Nanping City, Fujian Province, from January 2015 to December 2019. The epidemic characteristics were analyzed, such as the annual number of cases, age distribution, sex distribution, and seasonal distribution in each region. The patient's clinical manifestations, signs, complications, auxiliary examinations, and prognosis were analyzed.ResultsFrom 2015 to 2019, the age distribution of scrub typhus cases was mainly concentrated in 40–49 y (17.16%), 50–59 y (24.09%), and 60–69 y (26.73%). There were no sex differences among the patients. 68.98% of the cases were concentrated in rural areas, with farmers having the highest proportion. However, this study compared prognostic factors in the cured and uncured groups, and found significant differences in non-farmer occupation and diagnosis time ≥ 8 days. Scrub typhus showed two peaks north of Fujian; the prominent peak was from June to July, and the other slight rise was from October to November. The SDE plot showed that the cases were mainly concentrated in Yanping, Shunchang, Zhenghe, and Songxi counties. The number of cases in hilly and mountainous areas was higher than in plain areas. The main diagnostic methods in this area are based on specific eschar and epidemiology, while the positive rate of the Weil-Felix test is low.ConclusionsThe results of this study can guide primary care institutions to improve the level of diagnosis and treatment of scrub typhus and take effective public health intervention measures in endemic areas.

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation.

The fragmentation and uneven quality of primary medical resources in China call for a deepening of integrated healthcare reform. China is promoting its county medical community (CMC) reform on a large scale in county-level administrative regions to promote the integration of local primary healthcare systems through information technology, which is consistent with the current trend of the digital governance era. Considering that the construction of a county medical community involves collaborative relationships between multi-level subjects, the evolutionary game theory was adopted in this study to construct a game model between the lead hospital of a CMC and primary healthcare institutions, and then the incentives of government department support were introduced to analyze the behavioral evolution of these three subjects. Taking into account the uncertainty of the real-life environment and information transformation, white Gaussian noise was introduced as a random disturbance term, and a numerical simulation was performed. In the two-subject model we focus on four parameters: information and management authority ceded by the primary healthcare institutions, integration coefficient of CMC information construction, intensity factor of information integration in the CMC, and medical resources delivered by the lead hospital. In the three-subject model we focus on three parameters: information and portion of authority ceded by the primary healthcare institutions and government departments, policy effect coefficient of CMC construction, and intensity of government departments' support for CMC construction. The simulation results show that there is a positive incentive for the concession of management power and information from the primary healthcare institutions to the lead hospital, but further determination of empowerment boundaries is needed. The lead hospital can improve the balance of medical resources in the county through the downward transfer of medical resources, but long-term resource delivery may inhibit the enthusiasm of the lead hospital. An improvement in the information integration intensity of the CMC can promote the efficient flow of information and knowledge and enhance the organizational closeness of the county medical community. At the same time, the integration of CMC information construction reduces the cost of collaboration among medical community members and streamlines and consolidates business modules, which can promote more efficient use of medical resources. The government departments' policies and funds provide obvious incentives to the lead hospital and primary healthcare institutions, but there is a need to explore appropriate financial payment ratios to balance the government's financial pressure.

Construction of Magnetic Core-Large Mesoporous Satellite Immunosensor for Long-Lasting Chemiluminescence and Highly Sensitive Tumor Marker Determination.

Chemiluminescence immunoassay exhibits high sensitivity and signal-to-noise ratio, thus attracting great attention in the early diagnosis and dynamic monitoring of diseases. However, the collection of conventional flash-type chemiluminescence signal (<5s) relies heavily on automatic sampling and reading instrument. Herein, a novel core-satellite multifunctional chemiluminescence immunosensor is designed for the efficient enrichment and highly sensitive determination of cancer biomarker carcinoembryonic antigen (CEA) with enhanced and long-lasting output signal that can be conveniently recorded by a simple microplate plate reading instrument. Anti-CEA monoclonal antibody 2 (Ab2) modified Fe3 O4 @SiO2 microspheres (Fe3 O4 @SiO2 -Ab2, 370nm in diameter) are synthesized as the core for selectively capturing and enriching target CEA in solution, and anti-human CEA monoclonal antibody 1 (Ab1) and horseradish peroxidase (HRP) co-immobilized dendritic large-mesoporous silica nanospheres (MSNs-HRP/Ab1, 80nm in diameter, pore size: 17nm) are synthesized as the satellite for efficient immunological recognition and signal amplification. The as-designed core-satellite magnetic chemiluminescence immunosensors exhibit a broad linear range of 0.01-20ngmL-1 and a low detection limit of 3.0pgmL-1 for the convenient, highly specific, and sensitive determination of CEA in human serum. Such core-satellite chemiluminescence immunosensors are expected to act as a powerful tool for in vitro detection of various biomarkers, overcome the defect of conventional chemiluminescence relying heavily on expensive and bulky automatic instruments and popularize chemiluminescence analysis to primary medical institutions and remote areas.

Changemakers share their why, collaborate as critical friends, and highlight leadership skills

Background: Changemakers are justice-minded individuals working toward implementing positive and sustainable change within their communities.Aim: The project created a space for Changemakers to connect, engage in critical dialogue, and leave with shared knowledge and skills to dismantle oppressive, deficit-based educational systems in the aftermath of COVID-19.Setting: From October 2021 to June 2022, 18 American and South African Changemakers from primary, secondary, and higher education institutions exchanged messages about their regional context and attended the Changemaker Symposium in South Africa.Method: This qualitative study examined how the Changemaker framework guided educators to frame [ubuntu], convene [masikhule], and ignite change [skep verandering]. They framed the strengths and challenges in their regions. Teams convened to address challenges using assets-based ideas that oppose deficit thinking and allow them to become leaders who ignite agency to ignite systemic change. The individual and group narratives were collected via open-ended questions, group discussions, and written artifacts.Results: They developed statements on: exploring reasons for teaching, collaborating with critical friends, and developing critical leadership skills. A phenomenological analysis of the narratives examined commonalities within each Changemakers’ lived experience.Conclusion: Findings indicate that this process allowed participants to collaborate and reimagine ways to inspire others while renewing their commitment to the responsibilities they face as educators affected by the pandemic.Contribution: From this project, educators have a framework to participate in global discourse that illuminates commonalities through critical friendships, decreases burnout, humanizes their experiences and increases the implementation of culturally responsive and sustaining inclusive practices.

Understanding the Impact of the COVID-19 Pandemic in a Weak Healthcare System: The Case of Nigeria

Since the first case of the Coronavirus was discovered in Lagos State, Nigeria, concerns were raised about the impact of a widespread virus outbreak. These concerns have been cultivated by the weak Nigerian healthcare system. Despite the fact that the virus is not widely known in the nation, its effects on health and wellness are a big cause for concern. This study examined the state of Nigeria’s healthcare system, the general attitude toward the pandemic, and the implications for pandemic containment. In-depth interviews with 45 participants, including key informants who were health workers, were conducted as part of the qualitative method used in this study. The findings of this study found a paucity of medical professionals and materials in Nigerian hospitals and other primary healthcare institutions. It also turned out that some people continue to deny that the virus even exists while ignoring health precautions. This study strongly recommends that social workers participate in community health education initiatives that aim to dispel ingrained cultural and traditional myths about the virus, launch successful grass-roots campaigns to increase public awareness of the devastating Coronavirus pandemic and revitalize cottage hospitals and other primary healthcare facilities, particularly in rural areas.

Multicenter evaluation of a simple and sensitive nucleic acid self-testing for SARS-CoV-2

A rapid and accurate COVID-19 diagnosis is a prerequisite for blocking the source of infection as soon as possible and taking the appropriate medical action. Herein, we developed GeneClick, a device for nucleic acid self-testing of SARS-CoV-2, consisting of three modules: a sampling kit, a microfluidic chip-based disposable cartridge, and an amplification reader. In addition, we evaluated the clinical performance of GeneClick using 2162 nasal swabs collected at three medical institutions, using three commercial RT-qPCR kits and an antigen self-test as references. Compared to RT-qPCR, the sensitivity and specificity of the GeneClick assay were 97.93% and 99.72%, respectively, with a kappa value of 0.979 (P ​< ​0.01). Of the 2162 samples, 2076 were also tested for SARS-CoV-2 antigens. Among the 314 positive samples identified by GeneClick assay, 63 samples were undetected by antigen tests. Overall, the GeneClick nucleic acid self-test demonstrated higher accuracy than the antigen-based detection. Based on the additional features, including simple operation, affordable price, portable device, and reliability of smartphone APP-driven sampling and result reporting, GeneClick offers a powerful tool for field-based SARS-CoV-2 detection in primary healthcare institutions or at-home use.

Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020

ObjectiveStandardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the...

Frequency and Awareness of Diabetes Mellitus in Participants of Primary Healthcare in the Capital of Turkey

Introduction: Awareness-based approaches are proven to reduce disease-related complications, depressive symptoms, anxiety during the disease process, economic losses due to disease, and improve quality of life in diabetes patients. This study aims to present the frequency and awareness of diabetes mellitus in patients who applied to a primary health care institution in the capital city of Turkey. Materials and Methods: This cross-sectional study was conducted in the capital city of Turkey. In statistical analysis; descriptive statistics, Mann Whitney U, Kruskal Wallis and logistic regression analysis methods were employed for the statistical analysis part of this research. Results: 24.4% of the participants had diabetes. Regarding diabetes awareness level, statistically significant differences were found in age, education level, marital status, income, attention to healthy nutrition, BMI and presence of chronic disease. Employment variable has been identified as the factor that affected the diabetes awareness score the most in multiple logistic regression analysis. When only the participants with diabetes were examined in the multiple logistic regression analysis, it was found that the factor affecting the diabetes awareness score the most was diabetes type. Other influencing factors were determined as diet for diabetes and receiving diabetes education, respectively. Conclusion: Despite of many research that were carried out under the roof of diabetes awareness in the world and in Turkey, the desired level of knowledge and awareness is yet to be reached. Further research needs to be conducted in order to reach this goal

Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial—a stepped wedge cluster randomized trial protocol

BackgroundThe poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.MethodsA cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of “usual care” as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.DiscussionFostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.Trial registrationAsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW