{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:51:56Z","timestamp":1787061116073,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims<\/jats:title>\n Non\u2010communicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, represent a major public health burden in Palestine. The World Health Organization's Package of Essential Non\u2010Communicable Disease Interventions (PEN) was introduced to strengthen primary healthcare services in low\u2010resource settings. However, evidence on its association with patient\u2010level clinical outcomes in Palestine remains limited. This study aimed to assess the association between PEN implementation and clinical outcomes, including blood pressure, glycemic control, and disease\u2010related complications.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A comparative cross\u2010sectional study was conducted across 18 primary healthcare clinics in Hebron, Palestine, between February and May 2025. A total of 440 patients (220 receiving PEN\u2010based care and 220 receiving conventional care) were recruited using convenience sampling. Data were collected through structured questionnaires and clinical records. Bivariate analyses were performed using Mann\u2013Whitney\n U<\/jats:italic>\n and\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n tests. Multivariable logistic and linear regression models were used to adjust for potential confounders. Effect estimates were reported as adjusted odds ratios (AOR) and beta coefficients (\n \u03b2<\/jats:italic>\n ) with 95% confidence intervals (CI).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients receiving PEN\u2010based care had lower systolic blood pressure (mean difference \u22122.93\u2009mmHg;\n \u03b2\u2009<\/jats:italic>\n =\u2009\u22122.93, 95% CI [\u2009\u2212\u20095.61, \u22120.25],\n p<\/jats:italic>\n \u2009=\u20090.032) and lower HbA1C levels (\n \u03b2<\/jats:italic>\n \u2009=\u2009\u22120.42, 95% CI [\u2009\u2212\u20090.78, \u22120.06],\n p<\/jats:italic>\n \u2009=\u20090.021) compared with conventional care, although the absolute difference in HbA1C was small. Fasting blood glucose was substantially lower in the PEN group (mean difference \u221230.15\u2009mg\/dL,\n p<\/jats:italic>\n \u2009<\u20090.001). The PEN approach was associated with higher odds of controlled blood pressure (AOR\u2009=\u20091.78, 95% CI [1.15, 2.74]) and HbA1C (AOR\u2009=\u20091.64, 95% CI [1.05, 2.56]), and lower odds of complications (AOR\u2009=\u20090.52, 95% CI [0.34, 0.79]). Patients in the PEN group also reported significantly higher healthcare utilization and adherence indicators.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The PEN approach was associated with modest improvements in clinical outcomes, reduced complications, and enhanced healthcare utilization among patients with hypertension and diabetes in primary care settings. However, given the cross\u2010sectional design, these findings should be interpreted as associations rather than causal effects. Further longitudinal and experimental studies are required to confirm these findings and evaluate long\u2010term impact.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hsr2.72337","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:20:28Z","timestamp":1776165628000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between the WHO Package of Essential Non\u2010Communicable Disease Interventions and Clinical Outcomes Among Patients With Hypertension and Diabetes in Palestine: A Comparative Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Zeenat","family":"Mesk","sequence":"first","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2414-7982","authenticated-orcid":false,"given":"Mohammad","family":"Qtait","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethar","family":"Harahsha","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amani Abu","family":"Haltam","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaima","family":"Ashour","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Khallaf","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel","family":"TiTI","sequence":"additional","affiliation":[{"name":"Nursing College, Palestine Polytechnic University Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"World Health Organization \u201cNoncommunicable Diseases Fact Sheet \u201d published 2023 https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00025-8"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.29392\/001c.26921"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/23779608251343611"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.18502\/ijph.v53i10.16700"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229081"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000503992"},{"issue":"1","key":"e_1_2_13_9_1","first-page":"22","article-title":"Evaluation of WHO PEN Interventions on Diabetes Management in Gaza","volume":"4","author":"Baradeyia R. A.","year":"2018","journal-title":"Palestinian Medical Journal"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-006763"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2020.574111"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.18502\/ijph.v53i4.17019"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czad016"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02255-y"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00118-9"},{"key":"e_1_2_13_16_1","volume-title":"Annual Health Report","author":"Ministry of Health (MoH)","year":"2022"},{"key":"e_1_2_13_17_1","unstructured":"World Health Organization WHO Package of Essential Noncommunicable (Pen) Disease Interventions for Primary Health Care in Low\u2010Resource Settings 2nd ed.(WHO 2020) https:\/\/www.who.int\/publications\/i\/item\/who-pen."},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.17.203695"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72337","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.72337","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:47:51Z","timestamp":1783021671000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.72337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/hsr2.72337"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.72337","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-09-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72337"}}