{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:09:41Z","timestamp":1784038181189,"version":"3.55.0"},"reference-count":52,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Afr. j. prim. health care fam. med."],"abstract":"<jats:p>Background:\u00a0Patients diagnosed with cancer require holistic care that covers the physical, psychosocial and spiritual aspects of wellbeing.Aim:\u00a0To describe the spiritual needs, practices, association between spirituality, using Traditional Health Practitioners (THPs), ancestral belief, with socio-demographic and clinical characteristics, and examine the association between spiritual interventions and spiritual characteristics.Setting:\u00a0Palliative Care units at two tertiary hospitals in Johannesburg.Methods:\u00a0An observational retrospective study used routinely collected data of patients older than 18 years, diagnosed with cancer, having complete records on spiritual questions, and enrolled between January 2021 and December 2023. Data were analysed using STATA V18.Results:\u00a0Most participants (n\u00a0= 2465) were female (70.5%), with a mean age of 53.6 (s.d.: 22.7). Half were unemployed, 40.1% married\/partnered, and 54.4% living with HIV. Many participants were religious (94.1%) and spiritual (96.3%), Christian (84.3%), 11.3% consulted a TPHs, and 20.0% had ancestral beliefs. Most (94.7%) relied on their faith for comfort, their faith grew stronger (84.9%,) and 79.7% needed forgiveness. Receiving spiritual interventions was associated with the need for forgiveness, relying on faith for comfort and receiving support from the faith community.Conclusion:\u00a0The study confirms that patients with cancer are spiritual and religious; some have ancestral beliefs, need forgiveness, and rely on their faith and faith communities to cope. The study further highlights the need for culturally relevant tools and interventions to address these needs.Contribution:\u00a0The article highlights the unique spiritual beliefs and practices among patients with cancer that may influence planning for palliative care and cancer programmes.<\/jats:p>","DOI":"10.4102\/phcfm.v17i1.5009","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T09:07:52Z","timestamp":1759136872000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Spiritual needs, practices and associated factors among patients with cancer at two teaching hospitals"],"prefix":"10.4102","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-3562","authenticated-orcid":false,"given":"Mpho","family":"Ratshikana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4985-048X","authenticated-orcid":false,"given":"Daynia","family":"Ballot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4562-6413","authenticated-orcid":false,"given":"Hellen","family":"Myezwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3020-8895","authenticated-orcid":false,"given":"Mary- Lou","family":"Galantino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0606-9669","authenticated-orcid":false,"given":"Sonti","family":"Pilusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Shah SC, Kayamba V, Peek RM, Heimburger D. Cancer control in low- and middle-income countries: Is it time to consider screening? J Global Oncol. 2019;(5):1\u20138. https:\/\/doi.org\/10.1200\/JGO.18.00200","DOI":"10.1200\/JGO.18.00200"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Sharma R, Aashima, Nanda M, et al. Mapping cancer in Africa: A comprehensive and comparable characterization of 34 cancer types using estimates from GLOBOCAN 2020. Front Public Health. 2022;10:839835. https:\/\/doi.org\/10.3389\/fpubh.2022.839835","DOI":"10.3389\/fpubh.2022.839835"},{"key":"ref2","unstructured":"WHO Cancer Report [homepage on the Internet]. Available from: https:\/\/www.quotidianosanita.it\/allegati\/allegato4849716.pdf."},{"key":"ref3","unstructured":"National Department of Health [Internet]. [cited 2024 Oct 23]. Available from: https:\/\/www.health.gov.za\/wp-content\/uploads\/2020\/11\/national-cancer-strategic-framework-2017-2022-min.pdf."},{"key":"ref4","unstructured":"National Department of Health [Internet]. [cited 2024 Oct 23]. Available from: https:\/\/www.health.gov.za\/wp-content\/uploads\/2020\/11\/NationalPolicyFrameworkandStrategyonPalliativeCare20172022.pdf."},{"key":"ref5","unstructured":"Traditional Health Practitioners Act 22 of 2007 | South African Government [homepage on the Internet]. [cited 2025 Apr 13]. Available from: https:\/\/www.gov.za\/documents\/traditional-health-practitioners-act."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Bai M, Lazenby M. A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med. 2015;18(3):286\u2013298. https:\/\/doi.org\/10.1089\/jpm.2014.0189","DOI":"10.1089\/jpm.2014.0189"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Puchalski CM, King SDW, Ferrell BR. Spiritual considerations. Hematol Oncol Clin N A. 2018;32(3):505\u2013517. https:\/\/doi.org\/10.1016\/j.hoc.2018.01.011","DOI":"10.1016\/j.hoc.2018.01.011"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. J Palliat Med. 2009;12(10):885\u2013904. https:\/\/doi.org\/10.1089\/jpm.2009.0142","DOI":"10.1089\/jpm.2009.0142"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Fitch MI, Bartlett R. Patient perspectives about spirituality and spiritual care. Asia-Pacific J Oncol Nurs. 2019;6(2):111\u2013121. https:\/\/doi.org\/10.4103\/apjon.apjon_62_18","DOI":"10.4103\/apjon.apjon_62_18"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Tavares AP, Martins H, Pinto S, Caldeira S, Pont\u00edfice Sousa P, Rodgers B. Spiritual comfort, spiritual support, and spiritual care: A simultaneous concept analysis. Nurs Forum. 2022;57(6):1559\u20131566. https:\/\/doi.org\/10.1111\/nuf.12845","DOI":"10.1111\/nuf.12845"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Ferrell BR, Twaddle ML, Melnick A, Meier DE. National consensus project clinical practice guidelines for quality palliative care guidelines, 4th Edition. J Palliat Med. 2018;21(12):1684\u20131689. https:\/\/doi.org\/10.1089\/jpm.2018.0431","DOI":"10.1089\/jpm.2018.0431"},{"key":"ref12","unstructured":"Selman LE, Harding-Swale R, Agupio G, et al. Spiritual care recommendations for people receiving palliative care in sub-Saharan Africa: With special reference to South Africa and Uganda [homepage on the Internet]. London: Cicely Saunders International; 2010 [cited 2024 Nov 30]. Available from: https:\/\/www.kcl.ac.uk\/lsm\/research\/divisions\/cicelysaunders\/attachments\/Spiritual-care-Africa-Full-report.pdf."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: A systematic review. BMJ Glob Health. 2018;3(5):e000895. https:\/\/doi.org\/10.1136\/bmjgh-2018-000895","DOI":"10.1136\/bmjgh-2018-000895"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"James PB, Asiimwe JB, Wardle J, Mwaka AD, Kasilo OMJ. African culture, traditional medicine, and cancer care. Lancet Oncol. 2022;23(6):705\u2013706. https:\/\/doi.org\/10.1016\/S1470-2045(22)00157-7","DOI":"10.1016\/S1470-2045(22)00157-7"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Asuzu CC, Akin-Odanye EO, Asuzu MC, Holland J. A socio-cultural study of traditional healers role in African health care. Infect Agents Cancer. 2019;14(1):15. https:\/\/doi.org\/10.1186\/s13027-019-0232-y","DOI":"10.1186\/s13027-019-0232-y"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Ezeome ER. Delays in presentation and treatment of breast cancer in Enugu, Nigeria. Niger J Clin Pract. 2010;13(3):311\u2013316.","DOI":"10.4103\/1119-3077.86775"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Mwaka AD, Abbo C, Kinengyere AA. Traditional and complementary medicine use among adult cancer patients undergoing conventional treatment in sub-Saharan Africa: A scoping review on the use, safety and risks. Cancer Manage Res. 2020;12:3699\u20133712. https:\/\/doi.org\/10.2147\/CMAR.S251975","DOI":"10.2147\/CMAR.S251975"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Vallurupalli M, Lauderdale K, Balboni MJ, et al. The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. J Support Oncol. 2012;10(2):81\u201387. https:\/\/doi.org\/10.1016\/j.suponc.2011.09.003","DOI":"10.1016\/j.suponc.2011.09.003"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Chen J, Lin Y, Yan J, Wu Y, Hu R. The effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness: A systematic review. Palliat Med. 2018;32(7):1167\u20131179. https:\/\/doi.org\/10.1016\/j.suponc.2011.09.003","DOI":"10.1177\/0269216318772267"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Ratshikana-Moloko M, Ayeni O, Tsitsi JM, et al. Spiritual care, pain reduction, and preferred place of death among advanced cancer patients in Soweto, South Africa. J Pain Sympt Manage. 2020;60(1):37\u201347. https:\/\/doi.org\/10.1016\/j.jpainsymman.2020.01.019","DOI":"10.1016\/j.jpainsymman.2020.01.019"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"VanderWeele TJ. Effects of religious service attendance and religious importance on depression: Examining the meta-analytic evidence. Int J Psychol Religion. 2021;31(1):21\u201326. https:\/\/doi.org\/10.1080\/10508619.2020.1748932","DOI":"10.1080\/10508619.2020.1748932"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Pearce MJ, Coan AD, Herndon JE, Koenig HG, Abernethy AP. Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Support Care Cancer. 2012;20(10):2269\u20132276. https:\/\/doi.org\/10.1007\/s00520-011-1335-1","DOI":"10.1007\/s00520-011-1335-1"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Astrow AB, Wexler A, Texeira K, He MK, Sulmasy DP. Is failure to meet spiritual needs associated with cancer patients\u2019 perceptions of quality of care and their satisfaction with care? J Clin Oncol. 2007;25(36):5753\u20135757. https:\/\/doi.org\/10.1200\/JCO.2007.12.4362","DOI":"10.1200\/JCO.2007.12.4362"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Crawford GB, Dzier\u017canowski T, Hauser K, et al. Care of the adult cancer patient at the end of life: ESMO clinical practice guidelines. ESMO Open. 2021;6(4):100225. https:\/\/doi.org\/10.1016\/j.esmoop.2021.100225","DOI":"10.1016\/j.esmoop.2021.100225"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Osman H, Shrestha S, Temin S, et al. Palliative care in the global setting: ASCO resource-stratified practice guideline. J Global Oncol. 2018;(4):1\u201324. https:\/\/doi.org\/10.1200\/JGO.18.00026","DOI":"10.1200\/JGO.18.00026"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Puchalski CM, Sbrana A, Ferrell B, et al. Interprofessional spiritual care in oncology: A literature review. ESMO Open. 2019;4(1):e000465. https:\/\/doi.org\/10.1136\/esmoopen-2018-000465","DOI":"10.1136\/esmoopen-2018-000465"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https:\/\/doi.org\/10.1016\/j.jbi.2019.103208","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) \u2013 A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u2013381. https:\/\/doi.org\/10.1016\/j.jbi.2008.08.010","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Schildmann EK, Groeneveld EI, Denzel J, Brown A, Bernhardt F, Bailey K, et al. Discovering the hidden benefits of cognitive interviewing in two languages: The first phase of a validation study of the Integrated Palliative care Outcome Scale. Palliat Med. 2016 Jun;30(6):599\u2013610.","DOI":"10.1177\/0269216315608348"},{"key":"ref30","unstructured":"Palliative care Outcome Scale (POS) \u2013 POS downloads [homepage on the Internet]. [cited 2025 Jun 12]. Available from: https:\/\/pos-pal.org\/maix\/pos-downloads.php"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Pargament K, Feuille M, Burdzy D. The brief RCOPE: Current psychometric status of a short measure of religious coping. Religions. 2011;2(1):51\u201376. https:\/\/doi.org\/10.3390\/rel2010051","DOI":"10.3390\/rel2010051"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. J Pain Sympt Manage. 2010;40(2):163\u2013173. https:\/\/doi.org\/10.1016\/j.jpainsymman.2009.12.019","DOI":"10.1016\/j.jpainsymman.2009.12.019"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Zuma T, Wight D, Rochat T, Moshabela M. The role of traditional health practitioners in Rural KwaZulu-Natal, South Africa: Generic or mode specific? BMC Complement Altern Med. 2016;16(1):304. https:\/\/doi.org\/10.1186\/s12906-016-1293-8","DOI":"10.1186\/s12906-016-1293-8"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Cheng Q, Xu X, Liu X, Mao T, Chen Y. Spiritual needs and their associated factors among cancer patients in China: A cross-sectional study. Support Care Cancer. 2018;26(10):3405\u20133412. https:\/\/doi.org\/10.1007\/s00520-018-4119-z","DOI":"10.1007\/s00520-018-4119-z"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Balboni TA, VanderWeele TJ, Doan-Soares SD, et al. Spirituality in serious illness and health. JAMA. 2022;328(2):184. https:\/\/doi.org\/10.1001\/jama.2022.11086","DOI":"10.1001\/jama.2022.11086"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Cheng L, Chen H, Lin L, Li H, Zhang F. Spiritual needs of older adults with cancer: A modified concept analysis. Asia Pac J Oncol Nurs. 2023;10(11):100288. https:\/\/doi.org\/10.1016\/j.apjon.2023.100288","DOI":"10.1016\/j.apjon.2023.100288"},{"key":"ref37","unstructured":"Masola NJ, Sigida ST. Chronic diseases and medical pluralism: The case of faith healers in Limpopo, South Africa. Indilinga Afr J Indigenous Knowl Syst. 2021;20(2):194\u2013208."},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Caldeira S, Carvalho EC, Vieira M. Spiritual distress-proposing a new definition and defining characteristics. Int J Nurs Knowl. 2013;24(2):77\u201384. https:\/\/doi.org\/10.1111\/j.2047-3095.2013.01234.x","DOI":"10.1111\/j.2047-3095.2013.01234.x"},{"key":"ref39","unstructured":"Adedini SA, Sello M, Thaele D, Madhi SA. Patterns of healthcare utilisation and barriers affecting access to child healthcare services in low-income urban South African settings [homepage on the Internet]. [cited 2025 Mar 18]. Available from: https:\/\/scielo.org.za\/scielo.php?pid=S1999-76712020000100004&script=sci_abstract"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Hughes GD, Aboyade OM, Beauclair R, Mbamalu ON, Puoane TR. Characterizing herbal medicine use for noncommunicable diseases in urban South Africa. Evidence-Based Complement Alternat Med. 2015;2015(1):736074. https:\/\/doi.org\/10.1155\/2015\/736074","DOI":"10.1155\/2015\/736074"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Asiimwe JB, Nagendrappa PB, Atukunda EC, et al. The meaning of caring for patients with cancer among traditional medicine practitioners in Uganda: A grounded theory approach. PLOS Glob Public Health. 2023;3(7):e0001764. https:\/\/doi.org\/10.1371\/journal.pgph.0001764","DOI":"10.1371\/journal.pgph.0001764"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Okyere Asante PG, Tuck CZ, Atobrah D. Medical pluralism, healthcare utilization and patient wellbeing: The case of Akan cancer patients in Ghana. Int J Qual Stud Health Well-Being. 2023;18(1):2238994. https:\/\/doi.org\/10.1080\/17482631.2023.2238994","DOI":"10.1080\/17482631.2023.2238994"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Ong\u2019udi M, Mutai P, Weru I. Study of the use of complementary and alternative medicine by cancer patients at Kenyatta National Hospital, Nairobi, Kenya. J Oncol Pharm Pract. 2019;25(4):918\u2013928. https:\/\/doi.org\/10.1177\/1078155218805543","DOI":"10.1177\/1078155218805543"},{"key":"ref44","unstructured":"Edwards Stephen. The role of ancestors in healing [homepage on the Internet]. Available from: https:\/\/hdl.handle.net\/10520\/EJC61564"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"White P. The concept of diseases and health care in African traditional religion in Ghana. HTS Teologiese Studies\/Theol Stud. 2015;71(3):1\u20137. https:\/\/doi.org\/10.4102\/hts.v71i3.2762","DOI":"10.4102\/hts.v71i3.2762"},{"key":"ref46","unstructured":"Pew Research. Faith among Black Americans [homepage on the Internet]. Available from: https:\/\/www.pewresearch.org\/religion\/2021\/02\/16\/faith-among-black-americans\/"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Wierstra IR, Liefbroer AI, Post L, Tromp T, K\u00f6rver J. Addressing spiritual needs in palliative care: Proposal for a narrative and interfaith spiritual care intervention for chaplaincy. J Health Care Chaplaincy. 2023;29(1):64\u201377. https:\/\/doi.org\/10.1080\/08854726.2021.2015055","DOI":"10.1080\/08854726.2021.2015055"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Quinn B. Making sense of pain and loss: Searching for meaning while living with cancer. Cancer Nurs Pract. 2018;17(5):29\u201336. https:\/\/doi.org\/10.7748\/cnp.2018.e1521","DOI":"10.7748\/cnp.2018.e1521"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Canada AL, Murphy PE, Stein K, Alcaraz KI, Leach CR, Fitchett G. Assessing the impact of religious resources and struggle on well-being: A report from the American Cancer Society\u2019s Study of Cancer Survivors-I. J Cancer Surviv. 2023;17(2):360\u2013369. https:\/\/doi.org\/10.1007\/s11764-022-01226-8","DOI":"10.1007\/s11764-022-01226-8"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Thabede D. The African worldview as the basis of practice in the helping professions. Soc Work. 2014;44(3):1\u201313. https:\/\/doi.org\/10.15270\/44-3-237","DOI":"10.15270\/44-3-237"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Farooqui M, Hassali MA, Shatar AKA, et al. Use of complementary and alternative medicines among Malaysian cancer patients: A descriptive study. J Trad Complement Med. 2016;6(4):321\u2013326. https:\/\/doi.org\/10.1016\/j.jtcme.2014.12.008","DOI":"10.1016\/j.jtcme.2014.12.008"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"link":[{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8682","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8683","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8684","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8681","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8685","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/5009\/8685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:35:06Z","timestamp":1759278906000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/5009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,6]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v17i1.5009","relation":{},"ISSN":["2071-2936","2071-2928"],"issn-type":[{"value":"2071-2936","type":"electronic"},{"value":"2071-2928","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}