{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:00:40Z","timestamp":1790427640192,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus affects more than 500 million adults worldwide, yet up to 80% of related complications are preventable through evidence\u2010based care. Clinical practice guidelines function as key prevention policy instruments; however, their implementation and integration into health systems vary substantially, with important implications for prevention access and health equity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>This study aimed to examine how national policy integration architecture within diabetes management guidelines influences access to preventive care and health equity across diverse health system contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comparative qualitative policy analysis evaluated national diabetes management guidelines from seven countries (United States, United Kingdom, Japan, India, Ghana, Colombia, Australia) using the Health Policy Triangle and Integration Continuum Framework. Guidelines were scored on integration strength (1 to 5 scale) across clinical, financial and administrative domains. Equity analysis examined financing barriers, workforce distribution and cultural adaptations. Inter\u2010rater reliability testing achieved substantial agreement (Cohen's kappa 0.68).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All guidelines converged on evidence\u2010based clinical content, yet integration scores varied threefold (range 2 to 5). High\u2010integration systems (United Kingdom, Australia; scores 5) achieved prevention medication access rates exceeding 80% among eligible populations through unified financing and zero cost\u2010sharing. Partial\u2010integration systems (United States, India, Ghana; scores 2 to 3) showed 30% to 50% access despite comparable clinical recommendations. Integration strength correlated strongly with implementation effectiveness (Spearman\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Financing structure emerged as the primary equity determinant. Countries with fragmented payment systems preserved disparities despite equity language in guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preventing diabetes complications at scale requires integrated health systems where financing, workforce, and monitoring align with guideline intent. Policy priorities should emphasise unified financing, elimination of cost\u2010sharing for preventive therapies, and mandatory equity monitoring in quality frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70591","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:36:18Z","timestamp":1788892578000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health System Integration and Equity in Type 2 Diabetes Prevention: A Comparative Policy Analysis of Seven National Guidelines"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1471-4375","authenticated-orcid":false,"given":"Richard","family":"Marfo","sequence":"first","affiliation":[{"name":"Department of Nursing University of Massachusetts Boston Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9363-3834","authenticated-orcid":false,"given":"Dennis","family":"Miezah","sequence":"additional","affiliation":[{"name":"Department of Nursing University of Massachusetts Boston Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8079-3963","authenticated-orcid":false,"given":"Rockson","family":"Ansong","sequence":"additional","affiliation":[{"name":"Louisiana State University Baton Rouge Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2894-4161","authenticated-orcid":false,"given":"Musah","family":"Abubakari","sequence":"additional","affiliation":[{"name":"Department of Nursing University of Massachusetts Boston Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3249-9101","authenticated-orcid":false,"given":"Evans F.","family":"Kyei","sequence":"additional","affiliation":[{"name":"Capstone College of Nursing, University of Alabama Tuscaloosa Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2991\/jegh.k.191028.001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2012.08.005"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2021.05.013"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-1795"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/9.4.353"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpopen.2020.100016"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.39.6.7056"},{"key":"e_1_2_10_9_1","volume-title":"A Standard Framework for Levels of Integrated Healthcare","author":"Heath B.","year":"2013"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckae070"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-Sint"},{"key":"e_1_2_10_12_1","unstructured":"National Institute for Health and Care Excellence. (2023).Type 2 Diabetes in Adults: Management (NICE Guideline NG17) https:\/\/www.nice.org.uk\/guidance\/ng17."},{"key":"e_1_2_10_13_1","volume-title":"Treatment Guide for Diabetes 2022\u20132023","author":"Japan Diabetes Society","year":"2023"},{"key":"e_1_2_10_14_1","volume-title":"Guidelines for Management of Type 2 Diabetes","author":"Indian Council of Medical Research","year":"2018"},{"key":"e_1_2_10_15_1","volume-title":"National Standard Treatment Guidelines for Common Conditions in Ghana","author":"Ghana Ministry of Health","year":"2023"},{"key":"e_1_2_10_16_1","unstructured":"Ministerio de Salud y Protecci\u00f3n Social Colombia. (2020). Gu\u00eda de pr\u00e1ctica cl\u00ednica para el diagn\u00f3stico tratamiento y seguimiento de la diabetes mellitus tipo 2 en la poblaci\u00f3n mayor de 18 a\u00f1os https:\/\/www.minsalud.gov.co\/."},{"key":"e_1_2_10_17_1","volume-title":"Management of Type 2 Diabetes: A Handbook for General Practice","author":"Royal Australian College of General Practitioners","year":"2025"},{"key":"e_1_2_10_18_1","volume-title":"Assessing Chronic Disease Management in European Health Systems: Country Reports (Observatory Studies Series No. 39)","author":"Nolte E.","year":"2015"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41073-016-0007-6"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzu071"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2011.10.006"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-017-0858-3"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1038062"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-339"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0103754"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-018-0260-4"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30446-2"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa938"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-56103-5_13"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133109990120"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018826"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001258"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223159"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70591","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.70591","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:31:16Z","timestamp":1790425876000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.70591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/jep.70591"],"URL":"https:\/\/doi.org\/10.1111\/jep.70591","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-01-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70591"}}