Academic Journal
Health System Integration and Equity in Type 2 Diabetes Prevention: A Comparative Policy Analysis of Seven National Guidelines.
| Τίτλος: | Health System Integration and Equity in Type 2 Diabetes Prevention: A Comparative Policy Analysis of Seven National Guidelines. |
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| Συγγραφείς: | Marfo R; Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA., Miezah D; Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA., Ansong R; Louisiana State University, Baton Rouge, Louisiana, USA., Abubakari M; Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA., Kyei EF; Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA. |
| Πηγή: | Journal of evaluation in clinical practice [J Eval Clin Pract] 2026 Sep; Vol. 32 (6), pp. e70591. |
| Τύπος έκδοσης: | Journal Article; Comparative Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford, England : Wiley-Blackwell, c1995- |
| Ιατρικοί όροι (MeSH): | Diabetes Mellitus, Type 2*/prevention & control , Health Equity*/organization & administration , Practice Guidelines as Topic* , Health Policy*, Health Services Accessibility/organization & administration ; Humans ; Policy Making |
| Περίληψη: | Rationale: Type 2 diabetes mellitus affects more than 500 million adults worldwide, yet up to 80% of related complications are preventable through evidence-based 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. Aims and Objectives: 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. Methods: 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-rater reliability testing achieved substantial agreement (Cohen's kappa 0.68). Results: All guidelines converged on evidence-based clinical content, yet integration scores varied threefold (range 2 to 5). High-integration systems (United Kingdom, Australia; scores 5) achieved prevention medication access rates exceeding 80% among eligible populations through unified financing and zero cost-sharing. Partial-integration 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 ρ = 0.89, p < 0.01). Financing structure emerged as the primary equity determinant. Countries with fragmented payment systems preserved disparities despite equity language in guidelines. Conclusions: 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-sharing for preventive therapies, and mandatory equity monitoring in quality frameworks. (© 2026 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.) |
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| Contributed Indexing: | Keywords: comparative policy analysis; health equity; health policy; health system integration; prevention; type 2 diabetes mellitus |
| Entry Date(s): | Date Created: 20260908 Date Completed: 20260908 Latest Revision: 20260910 |
| Update Code: | 20260910 |
| PubMed Central ID: | PMC13552933 |
| DOI: | 10.1111/jep.70591 |
| PMID: | 42709956 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1365-2753 |
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| DOI: | 10.1111/jep.70591 |