{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:00:59Z","timestamp":1777950059976,"version":"3.51.4"},"reference-count":52,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T029919\/1"],"award-info":[{"award-number":["MR\/T029919\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,7]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess the prevalence of diabetes and associated risk factors and to deepen understanding of the diabetes burden in Ga Mashie, an urban-poor area in Accra, Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional epidemiological cluster survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>We surveyed adults aged over 25 years in 80 enumeration areas within Ga Mashie, targeting 959 randomly selected households based on the 2021 census.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>\n                      Household-level data included household membership and structure, water and sanitation, cooking infrastructure and asset ownership. Individual-level data encompassed demographics, lifestyle behaviours and biometric measurements. Diabetes was identified through random blood glucose levels \u226511.1\u2009mmol\/L or a prior diagnosis, with obesity defined as a body mass index &gt;30\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and central obesity as a waist circumference-to-height ratio &gt;0.5. We derived weighted prevalence estimates and compared these estimates by age, sex and wealth using unadjusted ORs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The survey, achieving a 67% response rate, covered 854 individuals from 644 households. It unveiled a notable prevalence of risk factors known to be associated with diabetes: 47.2% for alcohol consumption (95%\u2009CI 43.7% to 50.8%), 50.7% for insufficient physical activity (95%\u2009CI 46.0% to 55.3%), 28.9% for unhealthy snack consumption (95%\u2009CI 24.5% to 33.7%), 35.1% for obesity (95%\u2009CI 31.3% to 39.1%) and 74.5% for central obesity (95%\u2009CI 70.8% to 77.9%). Diabetes affected 8.2% of the population aged \u226525 (95% CI 6.4% to 10.5%), with disparities evident across age, wealth and sex (2.66 greater odds in females for diabetes (95%\u2009CI 1.38 to 5.12)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diabetes and its risk factors are highly prevalent in Ga Mashie, with significant demographic disparities underscoring the need for targeted interventions. The study highlights the critical challenge diabetes poses in urban-poor contexts, emphasising the necessity for tailored health initiatives to mitigate this burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119125","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:50:25Z","timestamp":1777873825000},"page":"e119125","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of diabetes and associated risk factors in Ga Mashie, Accra, Ghana: a cross-sectional CARE Diabetes community-based survey"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-9954","authenticated-orcid":false,"given":"Carlos Salvador","family":"Grijalva-Eternod","sequence":"first","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"},{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kojo Mensah","family":"Sedzro","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana"},{"name":"Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-6518","authenticated-orcid":false,"given":"Kafui","family":"Adjaye-Gbewonyo","sequence":"additional","affiliation":[{"name":"Institute for Lifecourse Development, University of Greenwich, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Boatemaa","family":"Kushitor","sequence":"additional","affiliation":[{"name":"Department of Community Health, Ensign Global College, Kpong, Ghana"},{"name":"Department of Food Science and Centre for Sustainability Studies, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swaib Abubaker","family":"Lule","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mawuli Komla","family":"Kushitor","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Planning and Management, Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4277-435X","authenticated-orcid":false,"given":"Akanksha Abhay","family":"Marphatia","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"},{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Gray","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3937-175X","authenticated-orcid":false,"given":"Samuel","family":"Amon","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana"},{"name":"Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-1098","authenticated-orcid":false,"given":"Olutobi Adekunle","family":"Sanuade","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, The University of Utah, Salt Lake City, Utah, USA"},{"name":"Department of Health Systems and Population Health Sciences, Tilman J Fertitta Family College of Medicine, University of Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael Baffour","family":"Awuah","sequence":"additional","affiliation":[{"name":"Regional Institute for Population Studies, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3286-6565","authenticated-orcid":false,"given":"Leonard","family":"Baatiema","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana"},{"name":"Centre for Tropical Medicine and Global Health Research, University of Oxford Nuffield Department of Medicine, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-5937","authenticated-orcid":false,"given":"Irene Akwo","family":"Kretchy","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5496-3289","authenticated-orcid":false,"given":"Daniel","family":"Arhinful","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwadwo Ansah","family":"Koram","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Fottrell","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"key":"2026050322501020000_16.4.e119125.1","unstructured":"International Diabetes Federation . IDF diabetes atlas 2021, 10th edn. 2021."},{"key":"2026050322501020000_16.4.e119125.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6"},{"key":"2026050322501020000_16.4.e119125.3","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-S062"},{"key":"2026050322501020000_16.4.e119125.4","first-page":"103","article-title":"Diabetes Mellitus: Screening and Diagnosis","volume":"93","author":"Pippitt","year":"2016","journal-title":"Am Fam Physician"},{"key":"2026050322501020000_16.4.e119125.5","unstructured":"World Health Organization (WHO) . Diabetes. 2023. Available: http:\/\/tinyurl.com\/2bwe5e9c [Accessed 07 Nov 2023]."},{"key":"2026050322501020000_16.4.e119125.6","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.21.9.1414"},{"key":"2026050322501020000_16.4.e119125.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843"},{"key":"2026050322501020000_16.4.e119125.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"2026050322501020000_16.4.e119125.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2009.10.007"},{"key":"2026050322501020000_16.4.e119125.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2021.05.013"},{"key":"2026050322501020000_16.4.e119125.11","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/S2213-8587(17)30181-X","article-title":"Diabetes in sub-Saharan Africa: from clinical care to health policy","volume":"5","author":"Atun","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026050322501020000_16.4.e119125.12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/inthealth\/ihy067","article-title":"Prevalence and risk factors for diabetes mellitus among adults in Ghana: a systematic review and meta-analysis","volume":"11","author":"Asamoah-Boaheng","year":"2019","journal-title":"Int Health"},{"key":"2026050322501020000_16.4.e119125.13","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1782"},{"key":"2026050322501020000_16.4.e119125.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240984","article-title":"How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization\u2019s African regional targets","volume":"15","author":"Tesema","year":"2020","journal-title":"PLoS One"},{"key":"2026050322501020000_16.4.e119125.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-016-3845-8","article-title":"Prevalence and determinants of diabetes among older adults in Ghana","volume":"16","author":"Gatimu","year":"2016","journal-title":"BMC Public Health"},{"key":"2026050322501020000_16.4.e119125.16","first-page":"93","article-title":"Prevalence study of type 2 diabetes mellitus in the Ashanti region of Ghana: a systematic review of risk factors","volume":"27","author":"Katey","year":"2022","journal-title":"J Endocrinol Metab Diabetes S Afr"},{"key":"2026050322501020000_16.4.e119125.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8227(01)00374-6"},{"key":"2026050322501020000_16.4.e119125.18","doi-asserted-by":"publisher","DOI":"10.1007\/s13410-011-0035-1"},{"key":"2026050322501020000_16.4.e119125.19","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-14-1069","article-title":"Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: a qualitative study of dietary preferences, knowledge and practices","volume":"14","author":"Doherty","year":"2014","journal-title":"BMC Public Health"},{"key":"2026050322501020000_16.4.e119125.20","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e15448","article-title":"Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension","volume":"9","author":"Baah-Nyarkoh","year":"2023","journal-title":"Heliyon"},{"key":"2026050322501020000_16.4.e119125.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001342","article-title":"Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study","volume":"2","author":"Alhassan","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026050322501020000_16.4.e119125.22","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/4760624","article-title":"The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study","volume":"2020","author":"Kretchy","year":"2020","journal-title":"J Diabetes Res"},{"key":"2026050322501020000_16.4.e119125.23","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2023.2297513","article-title":"The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana","volume":"17","author":"Lule","year":"2024","journal-title":"Glob Health Action"},{"key":"2026050322501020000_16.4.e119125.24","unstructured":"Ghana Statistical Service . 2021 population and housing census. Available: http:\/\/tinyurl.com\/4pvtu8h8 [Accessed 19 Jan 2024]."},{"key":"2026050322501020000_16.4.e119125.25","unstructured":"Office for National Statistics . Families and households statistics explained. 2023. Available: http:\/\/tinyurl.com\/yzcmsr4m [Accessed 30 Nov 2023]."},{"key":"2026050322501020000_16.4.e119125.26","unstructured":"World Health Organization . Ghana - steps 2006, Greater Accra region. 2006. Available: http:\/\/tinyurl.com\/yc3aa8sr [Accessed 30 Nov 2023]."},{"key":"2026050322501020000_16.4.e119125.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjnut.2022.12.014"},{"key":"2026050322501020000_16.4.e119125.28","unstructured":"World Health Organization (WHO) . Global physical activity questionnaire: GPAQ version 2.0. Geneva, 2019."},{"key":"2026050322501020000_16.4.e119125.29","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czl029"},{"key":"2026050322501020000_16.4.e119125.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-018-0319-2","article-title":"Association between random glucose and all-cause mortality: findings from the mortality follow-up of the German National Health Interview and Examination Survey 1998","volume":"18","author":"Baumert","year":"2018","journal-title":"BMC Endocr Disord"},{"key":"2026050322501020000_16.4.e119125.31","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1185\/03007995.2012.659243","article-title":"Random blood glucose measurement for epidemiological studies: its significance and limitations","volume":"28","author":"Kawada","year":"2012","journal-title":"Curr Med Res Opin"},{"key":"2026050322501020000_16.4.e119125.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-13646-3","article-title":"Perceptions of community members on contextual factors driving cardiovascular disease behavioural risk in Ghana: a qualitative study","volume":"22","author":"Mensah","year":"2022","journal-title":"BMC Public Health"},{"key":"2026050322501020000_16.4.e119125.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240938","article-title":"Factors influencing self-management in relation to type 2 diabetes in Africa: A qualitative systematic review","volume":"15","author":"Suglo","year":"2020","journal-title":"PLoS One"},{"key":"2026050322501020000_16.4.e119125.34","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-023-01508-x","article-title":"Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review","volume":"23","author":"Opoku","year":"2023","journal-title":"BMC Endocr Disord"},{"key":"2026050322501020000_16.4.e119125.35","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1017\/S0007114510003399","article-title":"Nutrient intakes and dysglycaemia in populations of West African origin","volume":"105","author":"Anderson","year":"2011","journal-title":"Br J Nutr"},{"key":"2026050322501020000_16.4.e119125.36","doi-asserted-by":"crossref","DOI":"10.3390\/jfmk8030127","article-title":"Understanding Physical Activity Behavior in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study","volume":"8","author":"Amin","year":"2023","journal-title":"J Funct Morphol Kinesiol"},{"key":"2026050322501020000_16.4.e119125.37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.6018\/sportk.518091","article-title":"Impact of physical activity, BMI and sociodemographic and lifestyle factors on the risk of diabetes in 9,511 Ghanaian adults","volume":"11","author":"L\u00f3pez S\u00e1nchez","year":"2022","journal-title":"SPORT TK-Revista EuroAmericana de Ciencias Del Deporte"},{"key":"2026050322501020000_16.4.e119125.38","doi-asserted-by":"crossref","first-page":"18","DOI":"10.14302\/issn.2474-3585.jpmc-18-2059","article-title":"Managing Overweight and Obesity in Ghana from a Cultural Lens: The Complementary Role of Behaviour Modification","volume":"2","author":"Hagan","year":"2018","journal-title":"J Prev Med Care"},{"key":"2026050322501020000_16.4.e119125.39","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0272274","article-title":"Barriers and facilitators of weight management: Perspectives of the urban poor in Accra, Ghana","volume":"17","author":"Afrifa-Anane","year":"2022","journal-title":"PLoS One"},{"key":"2026050322501020000_16.4.e119125.40","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-13588-w","article-title":"Effect of age and sex on the associations between potential modifiable risk factors and both type 2 diabetes and impaired fasting glycaemia among West African adults","volume":"22","author":"Issaka","year":"2022","journal-title":"BMC Public Health"},{"key":"2026050322501020000_16.4.e119125.41","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-12-210","article-title":"Diabetes mellitus type 2 in urban Ghana: characteristics and associated factors","volume":"12","author":"Danquah","year":"2012","journal-title":"BMC Public Health"},{"key":"2026050322501020000_16.4.e119125.42","doi-asserted-by":"crossref","unstructured":"Gad M , Kazibwe J , Abassah-Konadu E , et al . The epidemiological and economic burden of diabetes in ghana: a scoping review to inform health technology assessment. Endocrinology (including Diabetes Mellitus and Metabolic Disease) [Preprint] 2023. doi:10.1101\/2023.04.19.23288806","DOI":"10.1101\/2023.04.19.23288806"},{"key":"2026050322501020000_16.4.e119125.43","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002024","article-title":"Changes in trends and patterns of glycaemic control at Ghana\u2019s National Diabetes Management and Research Centre during the era of the COVID-19 pandemic","volume":"3","author":"Swaray","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2026050322501020000_16.4.e119125.44","doi-asserted-by":"crossref","first-page":"7003","DOI":"10.1002\/nop2.1956","article-title":"Patient perspective on barriers in type 2 diabetes self-management: A qualitative study","volume":"10","author":"Tuobenyiere","year":"2023","journal-title":"Nurs Open"},{"key":"2026050322501020000_16.4.e119125.45","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1141080","article-title":"Continuity of care among diabetic patients in Accra, Ghana","volume":"11","author":"Awumee","year":"2023","journal-title":"Front Public Health"},{"key":"2026050322501020000_16.4.e119125.46","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1111\/jocn.14835","article-title":"Barriers to diabetic self-care: A qualitative study of patients\u2019 and healthcare providers\u2019 perspectives","volume":"28","author":"Mogre","year":"2019","journal-title":"J Clin Nurs"},{"key":"2026050322501020000_16.4.e119125.47","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/casp.2447","article-title":"Building cardiovascular disease competence in an urban poor Ghanaian community: A social psychology of participation approach","volume":"30","author":"de\u2010Graft Aikins","year":"2020","journal-title":"J Community Appl Soc Psychol"},{"key":"2026050322501020000_16.4.e119125.48","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1111\/1471-0528.17113","article-title":"Who cares about antenatal care?","volume":"129","author":"Paul","year":"2022","journal-title":"BJOG"},{"key":"2026050322501020000_16.4.e119125.49","doi-asserted-by":"publisher","DOI":"10.1370\/afm.23"},{"key":"2026050322501020000_16.4.e119125.50","doi-asserted-by":"crossref","first-page":"5741","DOI":"10.1002\/nop2.1825","article-title":"Narratives of type 2 diabetes mellitus patients regarding the influence of social issues on diabetes self-management: Implications for patient care","volume":"10","author":"Korsah","year":"2023","journal-title":"Nurs Open"},{"key":"2026050322501020000_16.4.e119125.51","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.pcd.2012.12.001","article-title":"Random glucose is useful for individual prediction of type 2 diabetes: results of the Study of Health in Pomerania (SHIP)","volume":"7","author":"Kowall","year":"2013","journal-title":"Prim Care Diabetes"},{"key":"2026050322501020000_16.4.e119125.52","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-4116"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:50:34Z","timestamp":1777873834000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,5,3]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2026-119125"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119125","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}