{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:49:21Z","timestamp":1788997761377,"version":"build-2803163510"},"reference-count":20,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"unspecified","delay-in-days":168,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus presents a major public health challenge globally, with India bearing a disproportionate burden. Early detection and management at the primary healthcare (PHC) level are critical but remain underexplored in rural contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a phenomenological qualitative study in Akola district from western Vidarbha region of India. Data were collected through 15 key informant interviews with healthcare providers, 11 interviews with patients and 13 focus group discussions with community health workers. Thematic analysis was performed following Braun and Clarke\u2019s framework, and intercoder reliability was established (Cohen\u2019s Kappa=0.85).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Barriers included limited provider knowledge, patient health literacy gaps, fragmented referral systems and resource shortages. Facilitators encompassed training initiatives, home-based screening innovations, community awareness programmes and integration of specialist support. A conceptual framework was developed mapping systemic, provider and community-level determinants influencing diabetes outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Strengthening early diabetes screening and management at the PHC level requires multifaceted interventions encompassing workforce capacity development, supply chain improvements and community engagement. The findings offer a scalable model for integrating diabetes care into primary health systems in resource-constrained settings, contributing to global efforts to address the rising non-communicable disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003126","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T14:45:17Z","timestamp":1765982717000},"page":"e003126","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Challenges and strategies for early diagnosis and management of type 2 diabetes mellitus at the primary healthcare level in rural Western Vidarbha, India: a qualitative study"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8624-4131","authenticated-orcid":false,"given":"Umesh","family":"Kawalkar","sequence":"first","affiliation":[{"name":"Department of Community Medicne, Government Medical College, Washim, Maharashtra, India"},{"name":"Department of Community Medicine, Jawaharlal Nehru Medical College Sawangi (M), Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4814-2695","authenticated-orcid":false,"given":"Abhay","family":"Gaidhane","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Jawaharlal Nehru Medical College Sawangi (M), Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0652-1611","authenticated-orcid":false,"given":"Sumit","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Mankar","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Jawaharlal Nehru Medical College Sawangi (M), Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Ambadekar","sequence":"additional","affiliation":[{"name":"Director Health Services, Public Health Department, Government of Maharashtra, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priti","family":"Kogade","sequence":"additional","affiliation":[{"name":"NTCP Cell, Civil Surgeon Office, Government of Maharashtra, Akola, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"2026010703082054000_3.2.e003126.1","first-page":"217","article-title":"Epidemiology of type 2 diabetes: Indian scenario","volume":"125","author":"Mohan","year":"2007","journal-title":"Indian J Med Res"},{"key":"2026010703082054000_3.2.e003126.2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.5.1047"},{"key":"2026010703082054000_3.2.e003126.3","first-page":"323","article-title":"India -diabetes capital of the world: now heading towards Hypertension","volume":"55","author":"Joshi","year":"2007","journal-title":"J Assoc Physicians India"},{"key":"2026010703082054000_3.2.e003126.4","first-page":"1","article-title":"Classification, pathophysiology, diagnosis and management of diabetes mellitus","volume":"6","author":"Baynes","year":"2015","journal-title":"J Diabetes Metab"},{"key":"2026010703082054000_3.2.e003126.5","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1038\/414782a","article-title":"Global and societal implications of the diabetes epidemic","volume":"414","author":"Zimmet","year":"2001","journal-title":"Nature New Biol"},{"key":"2026010703082054000_3.2.e003126.6","unstructured":"Nirupam Bajpai and Sangeeta Goyal . Primary health care in India: coverage and quality issues. Working paper series, center for globalisation and sustainable development. The Earth Institute; 2004."},{"key":"2026010703082054000_3.2.e003126.7","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v9.29041","article-title":"Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers","volume":"9","author":"Odusola","year":"2016","journal-title":"Glob Health Action"},{"key":"2026010703082054000_3.2.e003126.8","doi-asserted-by":"crossref","DOI":"10.1186\/1753-6561-6-S5-O13","article-title":"Challenges in organizing quality diabetes care for the urban poor: a local health system perspective","volume":"6","author":"Bhojani","year":"2012","journal-title":"BMC Proc"},{"key":"2026010703082054000_3.2.e003126.9","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.10.1821"},{"key":"2026010703082054000_3.2.e003126.10","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-6-20","article-title":"GPs\u2019 perspectives of type 2 diabetes patients\u2019 adherence to treatment: A qualitative analysis of barriers and solutions","volume":"6","author":"Wens","year":"2005","journal-title":"BMC Fam Pract"},{"key":"2026010703082054000_3.2.e003126.11","unstructured":"Office of the Registrar General & Census Commissioner, India . District Census Handbook: Akola. New Delhi: Government of India, 2011."},{"key":"2026010703082054000_3.2.e003126.12","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-021-01182-y"},{"key":"2026010703082054000_3.2.e003126.13","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12913-019-3866-y","article-title":"Care providers\u2019 perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study","volume":"19","author":"Al-Alawi","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2026010703082054000_3.2.e003126.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2017-000519","article-title":"Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India","volume":"2","author":"Elias","year":"2017","journal-title":"BMJ Glob Health"},{"key":"2026010703082054000_3.2.e003126.15","doi-asserted-by":"crossref","first-page":"260","DOI":"10.4103\/ijmr.ijmr_3248_21","article-title":"Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India","volume":"156","author":"Kaur","year":"2022","journal-title":"Indian J Med Res"},{"key":"2026010703082054000_3.2.e003126.16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/kleuhsj.kleuhsj_232_18","article-title":"Assessment of implementation of the national programme for the prevention and control of cancer, diabetes, cardiovascular diseases, and stroke at subcenters of Belagavi taluka: A cross-sectional study","volume":"12","author":"Kashyap","year":"2019","journal-title":"Indian J Health Sci Biomed Res"},{"key":"2026010703082054000_3.2.e003126.17","doi-asserted-by":"crossref","first-page":"3667","DOI":"10.4103\/jfmpc.jfmpc_2281_21","article-title":"Assessment of National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)","volume":"11","author":"Meena","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"2026010703082054000_3.2.e003126.18","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/09720634221079084","article-title":"Assessment of Workload of ASHAs: A Multi-stakeholder Perspective Study for Task-sharing and Task-shifting","volume":"24","author":"Manjunath","year":"2022","journal-title":"J Health Manag"},{"key":"2026010703082054000_3.2.e003126.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-073743","article-title":"Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh","volume":"13","author":"Xie","year":"2023","journal-title":"BMJ Open"},{"key":"2026010703082054000_3.2.e003126.20","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4103\/2230-8210.159016","article-title":"Strengthening diabetes management at primary health level","volume":"19","author":"Kalra","year":"2015","journal-title":"Indian J Endocr Metab"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:11:42Z","timestamp":1767784302000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,12,17]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjph-2025-003126"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003126","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}