Rural Primary Health Care Centers Research Articles

Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings. The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality. Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers. Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.

Model Development of Telemedicine for Hypertension Patients in a Rural Primary Healthcare Center in Thailand: A Qualitative Study

Background: Hypertension services were disrupted by the COVID-19 pandemic. Telemedicine was heavily used to overcome this disruption. The aims of this study were to describe a typical hypertension service and recommendations for telemedicine development for hypertension patients in a rural, Sub-District-level, primary healthcare center.Methods: A qualitative case study was utilized. In-depth interviews were conducted with healthcare staff at a rural primary healthcare center in April 2023. The interview process was continued until data saturation had been achieved. Data from the interviews were assessed via the triangulation method. Analytic induction was used to analyze the data.Conclusion: The total number of participants was 10 persons (3 male and 7 female). The median age was 42 years old (min. 32, max. 58). The qualitative results revealed that participants believed that telemedicine provided adequate hypertension services. The patients’ data was sent from the primary healthcare center to the secondary hospital (Provincial level) via the internet system. Communications between the patients and doctors at the provincial hospital were executed via video calls. All services were performed and completed at the primary healthcare center. The use of telemedicine by Sub-District healthcare hospitals could mitigate the limitations of traditional care, such as the lack of physicians, delays in treatment, and limited medical equipment. The engagement of stakeholders was the key factor in the success and sustainability of the program.

Service quality: perspective of people with type 2 diabetes mellitus and hypertension in rural and urban public primary healthcare centers in Iran

ObjectiveThis study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran.MethodsThe Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17.ResultsAmong the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants’ anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers.ConclusionStudy reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.

Prevalence of metabolic syndrome, its continuous severity score, and correlated cardiovascular risk among postmenopausal women of a selected rural area of Bangladesh

Background: In Bangladesh, very few studies evaluated metabolic syndrome (MetS) among postmenopausal women (PMW) in a rural setting. Again, none of these studies used and tested the proposed continuous MetS score. Therefore, the objective of this study was to estimate the prevalence of MetS among PMW and evaluate the correlation of its severity score with the absolute risk of cardiovascular diseases (CVD) over the next 10-years. Methods: From a rural primary health care center, we recruited 265 PMW of 40-70 years of age who had no CVD. The MetS was defined according to modified Adult Treatment Panel III criteria and the continuous MetS severity score was constructed using a standardized Z-score for each component (high-density lipoprotein cholesterol, lipid accumulation product and diastolic blood pressure) by regressing them onto the age. CVD risk was assessed using the lab-based Globorisk score. Results: About 35.1% of the PMW had MetS and the proportion of central obesity, generalized obesity, physical inactivity, diabetes, and hypertension were higher among those with MetS than those without. A highly significant CVD risk score difference (U=4594.50, P&lt;0.001) was observed between the subjects with and without MetS. Similarly, CVD risk showed a significant linear correlation (P&lt;0.001) with the MetS severity score, which was adjusted for daily physical activity metabolic equivalent of task, body mass index and low-density lipoprotein cholesterol. Conclusion: We found that one-third of PMW in a selected rural area of Bangladesh had MetS and a significant correlation of its severity score with CVD risk. A large-scale study is warranted to confirm the current findings with more precision. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(3): 133-138

Patterns of tobacco use among patients visiting primary health centers in India: An exploratory study

Background: Tobacco is a public health concern at global and national levels. The state of Gujarat has 28.6% prevalence of tobacco use, 22% in males and 8% in females. Rajkot, the fourth largest and fastest growing city in Gujarat, is not free from the burden of tobacco use. Aim: The aim of this study was to assess the patterns of tobacco use and utilization of tobacco cessation services in the city of Rajkot. Methodology: This was a cross-sectional observational study conducted on adult tobacco users attending rural and urban primary healthcare centers (PHCs) in Rajkot. At least 16 participants were recruited from all 75 PHCs (a total of 1152) using probability sampling. Study instruments comprised semi-structured proforma, Fagerstrom Test for Nicotine Dependence, and readiness to change questionnaire. Responses were analyzed using SPSS version 26.0. Results: A total of 1161 participants were included. Smokeless tobacco (n = 967, 83.3%) was preferred over smoking. Mava was the most common smokeless tobacco preparation consumed. The median age of onset was 28 years (interquartile range [IQR]: 22–37), and the median duration of use was 5 years (IQR: 4–10). Males had a significantly greater duration of abstinence (U = 1218.6, P = 0.002), greater readiness to quit (χ 2 [df] = 35.66 [8], P = 0.001), and anticipated success (χ 2 [df] = 28.71 [8], P = 0.004) in abstaining. While utilization of tobacco cessation services was poor overall, counseling (32.5%) and nicotine replacement therapy (19%) were the most commonly used. Conclusion: There is a need for in-depth research on tobacco use among smaller communities, upscaling harm reduction services for tobacco use. Prevention and IEC initiatives need to be revamped considering the special needs of female tobacco users.

De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia

ObjectiveTo explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DesignQualitative exploratory research conducted between October and November, 2021. LocationFour urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. ParticipantsForty-six professionals from different categories of the PHC team and health centre directors. MethodPurposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. ResultsExperiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. ConclusionsThe replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.

Patient Waiting Time at Primary Healthcare Centers in Riyadh Region, Saudi Arabia: A Cross-sectional Study

BackgroundPatient waiting time can adversely affect health services utilization and continuity of care, impacting patient satisfaction. In Saudi Arabia, there is limited information about the average waiting time at primary healthcare centers. Therefore, this study quantifies patient waiting time for services offered in Ministry of Health primary healthcare centers in Saudi Arabia.Materials and methodsA cross-sectional study utilizing secondary data from the Health Information System at primary healthcare centers in Riyadh was conducted in December 2020. Ten primary healthcare centers were selected. All patients visiting the selected centers during the study period were included, except those who needed emergency care or came for services without seeing the physician. Data regarding patient waiting time in minutes for different stages of primary healthcare services were collected.ResultsThe median total waiting time was 23 min. The median waiting time for pre-consultation and consultation were 6.00 and 6.78 min, respectively. The waiting time for pharmacies in rural primary healthcare centers was 22.1 min, while there was no recorded information regarding pharmacy waiting time in urban primary healthcare centers. The total waiting time at urban primary healthcare centers was longer than at rural primary healthcare centers, with a significant difference between both groups (t = − 15.5, P < 0.001). Patient age, marital status, educational level, occupation, and weekdays were significant factors influencing waiting time (P < 0.05).ConclusionThis study reveals positive outcomes regarding the average waiting time in primary healthcare centers in the Riyadh region. Further primary research is recommended.

Health Equity in Sickle Cell Research and Access to Therapy

Health Equity in Sickle Cell Research and Access to Therapy

Integrated care for older people based on information and communication technology: a scoping review protocol

IntroductionIntegrated care is an effective means of coping with the increasingly complex healthcare needs of elderly and alleviating pressure on national pension services. WHO regards integrated care as a method...

Effectiveness of Written Dietary Advice for Improving Blood Lipids in Primary Care Adults-A Pragmatic Randomized Controlled Trial (MYDICLIN).

Lifestyle management is the first line of treatment for moderately elevated blood lipids in healthy individuals. We investigated the effectiveness of providing food-based written advice for lowering low-density lipoprotein (LDL) cholesterol (intervention) or triglycerides (control) in a pragmatic randomized controlled trial with two parallel arms from 2018–2019 at a rural primary health care center. We sent feedback letters after 3 weeks and 6 months. Out of the 113 adult primary care patients randomized, 112 completed the study. There were no differences between the intervention and control groups for changes in LDL cholesterol after 3 weeks (mean ± standard deviation −0.21 ± 0.38 vs. −0.11 ± 0.34 mmol/L, p = 0.45) or 6 months (−0.05 ± 0.47 vs. 0.02 ± 0.41 mmol/L, p = 0.70) (primary outcome). Following the advice to consume plant sterols and turmeric was associated with a reduction in LDL cholesterol after 3 weeks. Following the advice to consume less carbohydrates was associated with reduced triglycerides. In the intervention arm, 14 individuals (25%) reduced their LDL cholesterol by ≥10% after three weeks. Their reduction was attenuated but maintained after six months (−7.1 ± 9.2% or −0.31 ± 0.38 mmol/L, p = 0.01 compared with baseline). They differed only in higher adherence to the advice regarding turmeric. In conclusion, this undemanding intervention had little effect on blood lipids for most individuals.

Data quality and data use in primary health care: A case study from Iran

Informed decision-making in Primary Health Care (PHC) is a foundation of universal health coverage, and depends on high-quality data. This study explores the perception of primary healthcare workers on data quality and data use in a northern Iranian city. A cross-sectional study was conducted with participation of 348 healthcare workers in urban and rural PHC centers of Rasht city. The data were collected using a validated self-administered questionnaire. Then SPSS statistics software was employed for the analysis process. The mean score of data quality and data use were 6.43 ± 1.68 and 5.89 ± 2.18 out of 10, respectively. Data accessibility (7.10 ± 1.88) and data accuracy (5.88 ± 2.18) had the highest and lowest mean scores from the workers' perspective. The volume of the data collected, frequency of training program on HIS, supervision and providing feedback, and the existence of incentive mechanism were associated with data quality and data use. In these settings, the overall perceived data quality and data use were at a relatively desirable level. Reducing the amount of the data collected training health workers on data management, supportive supervision, constructive feedback, and developing incentive mechanisms will improve the data quality and data use in the PHC centers.

Teledermatology: The New Normal?

Teledermatology: The New Normal?

“We have either obsolete knowledge, obsolete equipment or obsolete skills”: policy-makers and clinical managers’ views on maternal health delivery in rural Nigeria

ObjectiveThe objective of this paper is to explore policy-makers and clinical managers’ views on maternal health service delivery in rural Nigeria.DesignThis is a qualitative study using key informant interviews. Participants’...

Medical students using the technique of 55-word stories to reflect on a 6-week rotation during the integrated primary care block

Background. Reflection and reflective practice are identified as a core competency for graduates in health professions education. Students are expected to be in a position to process experiences in a variety of ways through reflective learning. In doing so, they can explore the understanding of their actions and experiences, and the impact of these on themselves and others. Objectives. To draw on 5-weekly reflections by final-year medical students during the integrated primary care block placement. These reflections explore the learning that occurred during the rotation and the change in experiences during this period, and illustrate the use of reflection as a tool to support the development of professional practice. Methods. This descriptive qualitative study analysed students’ 55-word reflective stories during a 6-week preceptorship in either a rural or urban primary healthcare centre. The writing technique of short 55-word reflective stories was used to record student experiences. Inductive thematic analysis was conducted using MAXQDA software. This involved identifying the most commonly used words for each week through a word cloud, highlighting each week’s most notable focus for learning to generate themes and sub-themes. Results. Analysis of 127 logbook entries generated 464 stories on a range of experiences that had a significant impact on learning. Students’ reflections in the first 2 weeks were linked to personal experiences and views about the block. In subsequent weeks, reflections focused on the individual responses of students to the learning experiences regarding the curriculum, patient care, ethics, professionalism and the health system. Conclusions. The reflections highlighted the key learning experiences of the medical students and illustrated how meaning is constructed from these experiences. The 55-word stories as a reflection tool have potential to support reflection for students, and provide valuable insight into medical students’ learning journey during their clinical training.

Validation of a screening test for alcohol use, the Russian Federation.

ObjectiveTo validate a Russian-language version of the World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT).MethodsWe invited 2173 patients from 21 rural and urban primary health-care centres in nine Russian regions to participate in the study (143 declined and eight were excluded). In a standardized interview, patients who had consumed alcohol in the past 12 months provided information on their sociodemographic characteristics and completed the Russian AUDIT, the Kessler Psychological Distress Scale and the Composite International Diagnostic Interview to identify problem drinking and alcohol use disorders. We assessed the feasibility of administering the test, its internal consistency and its ability to predict hazardous drinking and alcohol use disorders in primary health care in the Russian Federation.FindingsOf the 2022 patients included in the study, 1497 were current drinkers with Russian AUDIT scores. The test was internally consistent with good psychometric properties (Cronbach’s α : 0.842) and accurately predicted alcohol use disorders and other outcomes (area under the curve > 75%). A three-item short form of the test correlated well with the full instrument and had similar predictive power (area under the curve > 80%). We determined sex-specific thresholds for all outcomes, as non-specific thresholds resulted in few women being identified.ConclusionWith the validated Russian AUDIT, there is no longer a barrier to introducing screening and brief interventions into primary health care in the Russian Federation to supplement successful alcohol control policies.

Antibiotic use on acute respiratory tract infection nonpneumonia and nonspecific diarrhea in Primary Health Care Centre in Banjarbaru City, South Kalimantan, Indonesia.

Acute respiratory tract infection (ARTI) nonpneumonia and nonspecific diarrhea are the most common cases in primary health care centre (PHCC) in Indonesia with the enormous use of antibiotics. The aims of this study were to analyze the antibiotic use and factors affected to the quality of antibiotic use in PHCC in Banjarbaru City, South Kalimantan, Indonesia. The study was conducted in four PHCCs, two in urban and two in rural areas. All of the patients visited these PHCCs since March to April 2018 were recruited as samples after signing informed consent. Data were analyzed using SPSS version 18. There were no significant difference in antibiotic use between urban and rural PHCC, both on ARTI nonpneumonia and nonspecific diarrhea. The most prescribed antibiotics were amoxycillin and cephadroxil. Based on DDD/1,000 patients-day calculation, the quantity of antibiotics in urban PHCC was 3,544.4 and in rural PHCC was 3,478.6. Physicians with more than seven years of service, both in rural and urban PHCCs, were prescribe the antibiotics higher than who had been working for shorter period. There were no significant difference between physicians who had trained on rational drug use and had not trained yet in urban PHCC (p=0.874), while in rural PHCC there were a significant difference among them. The quantitative analysis showed that the antibiotics use in DDD in urban PHCC was 3,544.416 and in rural PHCC was 3,478.693. Factors affected to the quality of antibiotic use were physician's years of service and rational drug use training's.

Early Infant Diagnosis of HIV in Primary Health Care Centers

Background: Early diagnosis of HIV to identify infected children for early therapy is aimed at preventing high mortalities associated with child HIV infection. Early infant diagnosis (EID) intervention occurs across the three tiers of the Nigerian health care delivery system, including the primary health care centers (PHC). This study evaluates the implementation of early infant diagnosis of HIV in PHCs in a southern state of Nigeria. Methods: This was a cross-sectional descriptive study that took place between September and November 2019. Primary data were obtained from an interviewer-administered questionnaire on 120 health workers in six Local Government Areas (LGA) that were selected through a multi-stage, random sampling method. Secondary data were from the records of program implementation at the state headquarters of Ministry of Health and the PHCs. Results: A total of 116 (96.6%) health workers were interviewed; 17.2% were males, and 82.8% were females. More than two-thirds of respondents were aged between 41 and 60 years and 84.5% of them had worked in the PHC system for 11 years and above. Rural or urban location of the PHC, educational level of the health workers, and years of service in the PHC system did not have any significant effect on implementation of EID program in the health facilities. Implementation of EID program was ineffective in both rural and urban PHCs of Akwa Ibom state with the p-value of 0.337. In multiple regression analysis, access to EID program and provision of adequate supplies significantly affected implementation of the program with p = 0.001 and p = 0.000 respectively. Conclusion and Implication for Translation: The study indicates general ineffectiveness in the implementation of EID in a Southern State of Nigeria. There is need to improve access to EID services and provide needed supplies if the state, and by extension Nigeria, hopes to meet the target of joining the global community in ending HIV by 2030. Copyright © 2021 Markson. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Common mental disorders among seasonal migrant farmworkers in Northwest Ethiopia

BackgroundSeasonal migrant farmworkers in Ethiopia are a vulnerable segment of the population facing numerous threats to their mental health. This research aimed to determine the magnitude of common mental disorders (CMDs) and its associated factors among seasonal migrant farmworkers in the northwest of Ethiopia.MethodsA cross-sectional study was conducted. A total of 950 seasonal migrant farmworkers were selected randomly. CMDs were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect the associated characteristics of socio-demographic data. Data were analyzed using descriptive statistics, bivariate, and multivariable binary logistic regression. The adjusted odds ratio (AOR) with a 95% confidence level was used to declare a statistically significant association with CMDs.ResultsThe prevalence of CMDs was found to be 23.05% (219/950; 95% CI 20.47–25.84) among seasonal migrant farmworkers. The prevalence of psychological stress was 74.53% (708/950; 95% CI 71.65–77.20). Having a daily income below USD 5 (AOR = 1.53, 95% CI: 1.10–2.15), moderate perceived stress (AOR = 3.18, 95% CI: 1.18, 5.36), severe perceived stress (AOR = 16.15, 95% CI: 8.96, 29.11), and heat-related illness (AOR = 1.60, 95% CI: 1.11, 2.30) were associated with a higher likelihood of experiencing CMD. On the other hand, those seasonal migrant farmworkers who migrated for the first time (AOR = 0.38, 95% CI: 0.23–0.65) and those who received health related information (AOR = 0.60, 95% CI: 0.42, 0.85) were less likely to have CMDs.ConclusionIn this study, CMDs were found to be prevalent among seasonal migrant farmworkers. These findings highlight the importance of systematic development of community-based mental health services in combination with rural primary health care centers and an integrated approach to the health care of farmworkers such as screening, early identification, and treatment of CMDs of seasonal migrant farmworkers.

Factors affecting the technical efficiency of rural primary health care centers in Hamadan, Iran: data envelopment analysis and Tobit regression

BackgroundStudying and monitoring the efficiency of primary health care centers has a special place in the health system. Although studies have been conducted in the field of efficiency in Iran, few have focused on rural primary health care centers. In addition, previous studies have not used the child mortality rate and Behvarzes as input and output.ObjectiveThe present study was conducted aimed to estimate the technical efficiency of rural primary health care centers and determinant factors in Hamadan using data envelopment analysis and Tobit regression.MethodsThis is a Longitudinal study of rural primary health care centers in Hamadan province (2002–2016). Data Envelopment Analysis was employed to estimate technical efficiency of sampled health facilities while Panel Tobit Analysis was applied to predict factors associated with efficiency levels. The outputs were child mortality rate under 1 year of age and child mortality rate 1 year to 5 years of age. The input was Behvarzes (rural health workers).ResultsThe results of efficiency analysis showed that the average efficiency scores of the centers had a fluctuating trend during the period of the study, but the average performance scores generally decreased in 2016, as compared with 2002. The highest and lowest average performance scores were observed in 2003 (0.78) and 2013 (0.56), respectively. Number of physicians and rural primary healthcare centers per population had a positive statistically significant and the number of midwives and the total fertility per population had a negative statistically significant effect on efficiency.ConclusionsThe findings suggest some level of wastage of health resources in primary health centers. Findings indicate a level of waste of health resources in primary health centers. Behvarz functions in providing primary care services can be considered in the reallocation and optimal use of available resources at the level of rural health centers.

Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease

BackgroundThe use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are.MethodsWe conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design.ResultsAccording to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals.ConclusionThe rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.