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Healthcare

Healthcare is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI.
The European Medical Association (EMA), Ocular Wellness & Nutrition Society (OWNS) and Italian Society of Nephrology Nurses (SIAN) are affiliated with Healthcare and their members receive discounts on the article processing charges.
Indexed in PubMed | Quartile Ranking JCR - Q2 (Health Policy and Services | Health Care Sciences and Services)

All Articles (14,784)

Background: Healthcare quality is increasingly dependent on the patients’ perspective to ensure care aligns with patients’ needs and experiences, especially for those living with chronic conditions such as diabetes. The Swedish National Diabetes Register instrument (NDR) combines patient-reported experiences and outcomes to evaluate patient-centered diabetes care, but it has not yet been accessible in Arabic. This study aimed to assess the validity and reliability of the Arabic version of the Swedish National Diabetes Register questionnaire among patients with diabetes. Methods: A cross-sectional study was carried out from July to August 2023 at 47 primary healthcare centers in Saudi Arabia, involving 594 adult patients with diabetes. Reliability was measured with Cronbach’s alpha and composite reliability. Construct validity was tested using confirmatory factor analysis, and discriminant validity was assessed through the Heterotrait–Monotrait Ratio. Data analysis was performed using SPSS (version 28) and the lavaan package in R (version 4.3.2). Results: The Arabic version showed high internal consistency, with Cronbach’s α ranging from 0.716 to 0.886 and CR between 0.663 and 0.855. It also exhibited good model fit indices, including χ2/df of 2.72, RMSEA of 0.054, SRMR of 0.073, and a CFI above 0.90. All item loadings were statistically significant (p < 0.01). The HTMT values were below 0.85, confirming adequate discriminant validity. Conclusions: The Arabic version of the NDR instrument is a valid and reliable tool for measuring patient-reported experiences and outcomes among Arabic-speaking patients with diabetes, which supports its application in diabetic care across the Arab region. Health policymakers in the region are recommended to incorporate this validated Arabic tool into their national diabetes initiatives.

1 January 2026

Translation process.

Background: Health literacy is increasingly recognized as an essential determinant of health, readiness, and safety in the military, especially as health systems become more digitalized. However, evidence on general and digital health literacy in the armed forces remains limited. This study examined levels of general health literacy and digital health literacy among Lithuanian soldiers and explored their associations with sociodemographic, service-related, and health characteristics. Methods: A cross-sectional survey was conducted among 603 military personnel serving in the national armed forces. General and digital health literacy were measured with HLS19-Q12 and HLS19-DIGI. Data on sociodemographic and military characteristics, self-rated health, and self-reported long-term illnesses were collected. Descriptive statistics, correlation analyses, and multivariable regression models were used to analyze the data. Results: The sample was predominantly male (81.9%) with a mean age of 39.08 years (SD = 8.89). The mean general health literacy score was 80.1 (SD = 19.17), whereas the mean digital health literacy score was 67.81 (SD = 30.05). Overall, 45.0% of soldiers had excellent general health literacy, and 12.0% had inadequate general health literacy; 42.1% had excellent digital health literacy, and 35% had inadequate digital health literacy. Higher levels of health literacy were positively associated with better self-rated health and social status. No statistically significant associations were found between health literacy and gender, age, education, length of service, type of military service, and self-reported long-term health complaints. Conclusions: Military personnel in this study displayed relatively high general health literacy, yet digital health literacy was lower and more unevenly distributed, indicating a potential vulnerability for health outcomes as access to information, communication, and care increasingly relies on digital platforms. Given the cross-sectional design, causal inferences cannot be drawn. Military health services may build on existing health literacy strengths while considering strategies to address digital health literacy gaps (e.g., targeted training, tailored support, and user-friendly digital solutions, including service design), acknowledging that feasibility and implementation depend on organizational context and resources.

1 January 2026

Distribution of general and digital health literacy levels.

Neglected Occupational Risk Factors—A Contributor to Diagnostic Delays in Lung Cancer

  • Cristina Mandanach,
  • Andreea Maftei and
  • Ocxana Maria Țocan
  • + 2 authors

Introduction: For lung cancer, the total interval time to diagnosis (TITD) is very important. If not detected by the screening program, the actual guidelines emphasize the need for a short delay to assure the initiation of treatment before 2 months from the initial symptoms. In order to shorten TITD, the individual risk has to be properly assessed by the primary physician. Objective: The assessment of the influence of the occupational exposure on the diagnostic delay—from the onset of symptoms to confirmed diagnosis—in a population of patients with lung cancer. Material and methods: A total of 110 cases were recruited and were divided into two groups based on the individual assessment by an occupational physician. Results: There were 38 cases (34.55%) at high risk according to their occupational exposure and 72 controls. On average, the TITD was 3.41 +/−5.12 months. The TITD was significantly longer in the high-risk group (p = 0.03). A larger proportion cases had longer TITD: 55.17% of cases vs. 44.83% of controls (p = 0.006). In a multivariate analysis including covariates’ age, sex, level of education, health literacy, number of packs-years, family history of cancer, and previous lung diseases associated with a high risk of lung cancer, the highest risk derived from the previous occupational exposure was the only variable statistically associated with TITD (OR = 10.57, 2.06–54.34, p = 0.01). Discussion: Awareness about the occupational risk in workers who are or have been exposed and in health providers could reduce the total interval time to diagnosis.

1 January 2026

Distribution of level of health literacy in the total sample.

Introduction: Parents of children presenting global developmental delay (GDD) need to be involved in their therapy to intensify treatment. Vojta therapy (VT) is an intensive physiotherapeutic treatment that can be administered at home. Whilst parental experience of Home-Based Program (HBP) for preterm or cerebral palsy is well documented, there is a lack of understanding about parents of GDD children on HBP with VT. Objectives: The aim of this work was to describe parents’ perspectives concerning their participation in, concerns with, and perception of the results of an HBP with VT. Methods: A qualitative case design based on an interpretative approach was presented. A purposeful sampling was used. Data was collected in two stages: firstly, semi-structured interviews, and secondly, photo-elicitation. An inductive thematic analysis was used. Results: Seventeen parents were included. Three themes emerged from parents’ perspectives. Firstly, parents’ active participation in VT, which includes their desire to become an active agent to contribute to their child’s improvement, their implication of compromise, learning process, time required, effort, and factors that influence their adherence and continuity. Secondly, parents’ perception of the results achieved: motor improvement and better resting, feeding, and breathing; and time and commitment required to achieve them. Thirdly, parents’ initial concerns about suitability, daily implementation, therapy functioning, or evidence, as well as concerns about emotional bonds. Conclusions: Parents universally perceive that their commitment and efforts were rewarded. They recognized that the emotional bond with their child was strengthened by the therapy. The results regarding the beneficial effects perceived by the parents should be treated with caution, as no instruments for assessing the effect or efficacy were used in this study.

1 January 2026

Participant recruitment procedure.

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Healthcare - ISSN 2227-9032