Walking through the wards of a crowded public hospital and seeing suffering and tragedy from easily preventable conditionsmakes one wonder what it takes for a facility to change the outcomes. The evidence is there, and guidelines have beendeveloped from it; yet practices remain difficult to change—whether in screening, prevention, treatment, or rehabilitation.

Recently, the Department of Health has put up a compendium of clinical practice guidelines (CPG) crafted accordingto the standards set by the Manual for Clinical Practice Guideline Development of DOH-Philhealth.Guidelines stipulatethat dissemination and implementation be considered, and applicability issues are discussed. The uptake of the guidelinesshould be evaluated, and facilitators and barriers should be identified. Thus, there is a need for implementation andapplicability studies to assess how effective guidelines are. For breast cancer, the Philippine Guidelines were published in 2022and updated in 2026.Identified as barriers against implementation are financial constraints and out-of-pocket costs. Actahas since responded to these concerns by publishing articles on financing cost assessment, and in this issue, by Mondragonand co-authors, an “Assessment of Out-of-Pocket Expenditure of HER2-Positive Breast Cancer Patients in a Tertiary CancerCenter and Private Clinics in the Philippines.”

These types of studies are necessary in the translation of evidence to practice, allowing organizations to adopt, scale,and sustain recommendations to real-world settings.

Where CPGs on malnutrition cite resource constraints as the only significant barrier for implementation, the article byde Luna and co-authors on the “A Qualitative Program Evaluation Study on the Perceived Impact of Health and NutritionPrograms among Beneficiaries of a Civil Society Organization in the Philippines” in this issue of the Acta add fear ofsustainability by families and competition from readily accessible instant food of poor nutritional value as barriers in implementingsuch programs.

These studies help us go beyond information dissemination of evidence-based practice to create pathways for impactfulintegration of recommended interventions. Implementation studies sharpen our analysis and focus our efforts on strategies thatcan help pilot, roll out, and scale up guidelines.

New modalities to carry out recommendations can also be part of how guidelines are implemented in the communitysetting. Where the Philippine Academy of Rehabilitation Medicine (PARM) recommends early home-based rehabilitation,the Stroke Society of the Philippines recommends telerehabilitation to augment the efforts of care providers.The articleby Laxamana and co-authors in this issue on “The Acceptance of Stroke Telerehabilitation among Rehabilitation Providersand Consumers in Two Tertiary Hospitals in the Philippines” not only identifies but also provides suggestions to addressimplementation barriers.

We support and encourage articles on implementation science. These works provide tools to convert evidence into outcomes.These transform organizations and help us accomplish meaningful, lasting structural change that should come withoutany delay to provide relief to our patients in our crowded public wards.

BACKGROUND AND OBJECTIVE

Access to healthcare remains a challenge in most areas in the Philippines. Fifty-three percent (53%) of the Philippine population do not have access to a rural health unit (RHU) within a 30-minute travel t ime. As a response, the Department of Health (DOH) needs to construct an additional 2400 RHUs by 2025. This paper uses the Philippine Health Facility Development Plan 2020-2040 (PHFDP) as a reference to present a solution for locating sites for RHU placement in under-served areas using neural networks to meet the 30-minute travel time by maximizing population accessibility.

RHU accessibility was measured using geographic attributes as inputs to a back propagation neural network (BPNN) and a recurrent neural network (RNN): (1) land coverage and hazard data, representing geographical limitations; (2) population density and distribution, indicating demand for healthcare services; and (3) infrastructure-related features, such as road networks, points of interest, and the locations of existing RHUs, which influence healthcare accessibility. The models were trained to identify underserved areas and were implemented on a nationwide scale, excluding NCR, to locate candidate areas to increase population access to the new RHUs. The models were validated using a healthcare facility accessibility index (HCFAI) to assess RHU coverage improvement.

The BPNN showed stronger generalization across regions, achieving 79.1% average accuracy in distinguishing low from high accessible areas on Region 1 and identifying 1668 out of 3305 locations in the region as candidate sites. The RNN, better capturing unique regional characteristics, required separate training: 77.2% average accuracy on Region 1, identifying 1593 candidate sites. Our findings suggest expanding the use of land improves population access to healthcare facilities. Both models found more than the needed number of RHUs by 2040. The BPNN was more consistent than RNN to improve a region’s overall accessibility by increasing the HCFAI. The BPNN can increase population access to an RHU from 2.5-98.5% from its original population with access to an RHU.

The study demonstrates the usage of geographic attributes and neural networks to improve healthcare accessibility. The BPNN and RNN are adequate algorithms to find under-served areas and candidate sites for RHU construction to maximize population accessibility. The HCFAI metric validates the locations to highlight which neural network maximizes more of the region’s populat ion. The study contributes to ongoing efforts to improve healthcare infrastructure and accessibility, offering datadriven recommendations for RHU locations.

BACKGROUND

Access to prison healthcare and healthcare equity remains poorly understood in the Philippines. With Philippine jail health systems subjected to budgetary restrictions, optimization of efficient mechanisms in healthcare delivery is warranted. This makes understanding how PDLs’ utilization to healthcare services more relavant and of high importance.

This study sought to determine healthcare accessibility and explored what influences healthcare access by Persons Deprived of Liberty (PDLs). Additionally, the study looked into whether healthcare was equally accessible to different PDL subgroups.

A descriptive-correlational design was employed in recruiting 261 PDLs utilizing stratified random sampling in two jail facilities in Dumaguete City from May to June 2023. Data on healthcare accessibility and availability from self-report survey questionnaires were analyzed using SPSS version 25.

Hierarchical linear regression analysis shows that, collectively, predisposing factors (age, sex) F=200.82, enabling resources (availability of health services) F=52.52, and perceived needs (physical activities, sleep, diet, and mental health) F=30.24 significantly predict healthcare accessibility, having the availability of healthcare services as the strongest predictor with an R2 change of 43.7% followed by percieved needs (3.9%) and predisposing factor (1.4%), respectively. Furthermore, ordinal logistic regression analysis shows that healthcare by age groups 18-34 (OR=0.379) and 35-54 (OR=0.449) are less likely to be available and accessed than those aged 55 and above. Additionally, availability and accessibility of healthcare are less likely for males (OR=0.24) than females while PDLs with average physical activities (OR=0.87), good (OR=50.7) to average sleep (OR=27.4), and average mental health (OR=0.35) have higher odds of availing and accessing healthcare than their poor counterparts.

These findings indicate that PDLs tend to access healthcare services based predominantly on availability rather than their desired needs warranting strategies that allow catering to a wide range of health needs in PDL subgroups which ultimately lead to better prison health outcomes.

A singular medical incident can alert health officials to an emerging, if not widespread, but possibly undetected publichealth concern.

Our issue contains a remarkable case of a ruptured hepatic abscess in a 3-year-old, which turned out to be MethicillinresistantStaphylococcus aureus (MRSA) by authors Torrico and Tarnate.The concern is that the infection is communityacquired,and the patient was immunocompetent. This sounds the alarm for the occurrence of antimicrobial resistance (AMR)in the communities and calls for a response from health authorities to investigate, analyze, and propose solutions for sucha sentinel event.

We need to support these efforts and, in this issue, we publish such work from our investigators. Antimicrobial resistanceis an urgent global health concern.The impact is magnified in low to middle-income countries where health risks are high,and health infrastructure is weak. Thus, it is imperative that determinants of AMR are scrutinized to allow crafting offocused strategies to combat the problem.

The article by Dela Cruz and Hernandez on the prevalence and practices of antibiotic misuse among adult residents ofRodriguez, Rizal, contributes to this analysis.The paper reveals a disturbing prevalence of self-medication and identifiesbarriers to accessing proper health education and care. This is a global problem, and the paper from Brazil relates the observationof community pharmacists of antibiotic misuse to the rise of antimicrobial resistance.

Dela Cruz and Hernandez recommend stricter antibiotic regulation, and this falls squarely into the scope of concernof another article in this issue, the “Research Needs in Philippine Pharmaceutical Sciences: A Qualitative Perspective fromRegulatory and Clinical Research Sectors of the Pharmaceutical Industry” by Pena and co-authors.Interestingly, whiledrug registration and clinical trials were the focus of the paper, it may be a desired expansion of the regulatory reach of theindustry to temper the use of antibiotics as it is being dispensed to end users.Antimicrobial stewardship involves ethicalpromotion of use and equitable access to appropriate treatment, and these concerns require the responsible participation of thepharmaceutical industry.

Health challenges are complex. The analysis of these challenges requires surveillance of literature for sentinel events, useof community-based research to investigate phenomena, and system mapping to identify relevant sectors to improve strategyand to involve relevant stakeholders.

We support this type of scholarship, which seeks to expand the focus from isolated clinical interventions towards placinga spotlight on relevant work that will lead to impactful reform of broad health ecosystems.

Introduction: Type I diabetes mellitus (T1DM) is the most common form of diabetes diagnosed in childhood. The Diabetes in Children and Adolescents Registry (Di-CARE) in Malaysia reported that many of these patients are between 10 and 19 years old. However, little is known about the association of their health literacy and numeracy with their glycemic control. Methodology: A cross-sectional study among T1DM patients aged 12 to 19 years old who attended Paediatric Endocrine Clinic at Hospital Tunku Ampuan Besar Tuanku Aishah Rohani and Hospital Tunku Azizah was conducted from March 2025 to March 2026. Participants answered 14 questions on the Diabetes Numeracy Test (DNT-14) and completed a 29-item health literacy questionnaire (myMOHLAA-Q). Data analysis was performed using SPSS version 30. The relationship of health literacy and numeracy with glucose control (HbA1c) was analyzed using Spearman’s rank order correlation. Results: A total of 43 adolescents with T1DM were recruited with a median age of 15.2 years (IQR: 13.2–17.2 years). There were 22 female (51.2%) and 21 male (48.8%) participants. The majority of the participants (n = 27, 62%) had moderate glycemic control with a median HbA1c of 8.3% (IQR: 7.5–9.6%). A Spearman’s correlation revealed a negative relationship between mean HbA1c and knowledge on blood glucose monitoring, rs (43) = −0.34, p <0.05. Additionally, positive relationships were found of knowledge on blood glucose monitoring and knowledge on insulin with total DNT-14 score, rs (43) = 0.54, p <0.001 and rs (43) = 0.78, p <0.001, respectively. The small sample size may have limited the ability to detect other significant relationships. Conclusion The majority of T1DM adolescents have moderate glycemic control. Active intervention in improving knowledge on blood glucose monitoring and insulin helps to improve glycemic control, reiterating the importance of diabetes education in the long-term management and glycemic control in adolescents with type 1 diabetes.
Adolescent ; Humans ; Diabetes Mellitus, Type 1 ; Glycemic Control ; Health Literacy

Databases, Bibliographic ; Evidence-based Practice ; Health Services Needs And Demand

BACKGROUND AND OBJECTIVE

Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them.

A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized.

Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month.

Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

BACKGROUND

Sugar-sweetened beverages (SSBs) are a common part of Filipino meals. Increased SSB consumption is linked to weight gain and increased risk of noncommunicable diseases (NCDs). Previous studies have shown that health literacy (HL) is associated with positive health outcomes. However, there are limited studies examining its relationship with specific dietary behavior, including SSB consumption.

The study aims to investigate the association between HL and SSB consumption among Filipinos aged 15 to 70 years.

An analytic cross-sectional study using secondary data from the 2018-2019 National Health Literacy Survey (NHLS) was conducted. A total of 1,765 study participants (15 to 70 years old) were included. Socio-demographic information, daily SSB consumption (33 was considered "sufficient." Multivariate logistic regression was conducted to estimate adjusted odds ratios and confidence intervals for daily SSB consumption.

Out of the 1,765 study participants, 64.14% reported consuming (≥1 SSB drink per day, of whom majority (57.52%) were adults (31 to 59 years old), females (72.21%), married or in common-law partnership (65.70%), living in the Luzon region (47.23%), urban residents (71.94%), high school graduates (30.52%), have an annual household income of PhP 100,000–249,999 (37.03%), and employed (92.61%). Among those consuming ≥1 SSB drink per day, 51.89% had limited HL. Age, sex, and subnational level (National Capital Region, Luzon, Visayas, and Mindanao) were found to be significantly associated with the consumption of ≥1 SSB drink(s) per day. A weak association was found between HL and SSB consumption (aOR: 0.9591; 95% CI: 0.7832, 1.1747), that is, the adjusted odds of having limited HL were found to be slightly lower among those consuming ≥1 SSB drink(s) per day than those who consume

There was a high prevalence of daily SSB consumption among Filipinos. Among the variables considered, only age, sex, and subnational level were found to be significant determinants of SSB consumption. The findings of the study may provide valuable insights for targeted health promotion and education interventions in reducing SSB consumption among Filipinos such as workplace wellness programs, nutrition education, and the provision of healthier beverage alternatives. Priority should be given to younger individuals, males, and residents of the National Capital Region. This research also fills a gap in the literature regarding the role of HL in SSB consumption within the Philippine context. Findings of this study support adopting the Health Literacy Universal Precautions to ensure accessible health information and services for all, regardless of HL level.

BACKGROUND AND OBJECTIVE

Community-based rehabilitation (CBR) represents a multifaceted social intervention designed to tackle issues related to access, equity, and service quality. Within the framework of CBR, participation stands as a pivotal principle, albeit one that frequently goes unnoticed, particularly concerning children with disabilities. Consequently, this realist synthesis embarks on an exploration of the present landscape, participation mechanisms, and resulting outcomes within CBR initiatives tailored for children with disabilities in low and low-middle-income countries.

The realist approach is utilized to explain the causal mechanisms and explore the context, mechanism, and outcome of participation in CBR programs. A systematic search was conducted across ten databases up to April 2021. Studies were included if they involved children with disabilities aged 17 years and below, were implemented in World Bank-classified low-income or low-middle-income countries, discussed implementation mechanisms and community participation, and described outcomes. No language restrictions or publication type limitations were applied. The search process employed double screening of title, abstract, and full-text levels, followed by a snowballing technique. Quality assessment followed the RAMESES standards for realist reviews. Data extraction and analysis yielded context-mechanism-outcome configurations.

Thirteen articles were included in the synthesis, from which three context-mechanism-outcome configurations were identified: (1) family-facilitated intervention through training in the immediate environment of children with disabilities leads to knowledge translation of caregivers, (2) inaccessible healthcare services require establishing a referral system and augmenting human resource to ensure the system’s capacity to accommodate the magnified need, and (3) established collaboration of researcher, professionals, and community with stakeholder involvement in the CBR management leads to program adoption and documented effectiveness. Both training and establishing referral systems as implementation mechanisms pose sustainability challenges due to dependency on funding. Overall, participation as a form of agency is more often an implied concept. Training is a common mechanism of implementation, where women play a critical role as proxies of children with disabilities, being their caregivers and advocates. Positive and negative outcomes focus on the condition of children with disabilities and the trainees’ knowledge and awareness.

A critical analysis of children's and community's participation in the context, mechanism, and outcome unravels the non-participation of children with disabilities and tokenism of the community stakeholders in the CBR programs. Maximizing the contribution of children with disabilities and community stakeholders is called for, aligned with the ladder of participation, toward their democratic participation. Study limitations include the paucity of published CBR programs reporting participation mechanisms in low and low-middle-income countries and the exclusion of studies from economically disadvantaged communities in high-income countries.

BACKGROUND

The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem.

This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices.

This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation.

Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p=0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage.

Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.