ArticleBMJ public health2026
Application of the CLEAR toolkit in healthcare settings to address the social determinants of health: a facility-based interventional exploratory study in Khyber Pakhtunkhwa, Pakistan.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: The social determinants of health play a significant role in posing numerous health challenges for individuals and causing health disparities at the societal level. This study aims to outline evidence-based interventions that are practical and easy to use for frontline healthcare workers as part of routine practice. These interventions were derived from the Community Links Evidence to Action Research (CLEAR) toolkit and adapted to the sociocultural context of Khyber Pakhtunkhwa (KPK), Pakistan. Methods: This facility-based interventional exploratory qualitative study was conducted at Mardan Medical Complex, KPK, Pakistan, between January 2021 and November 2022. Using a three-phase design (pre-intervention, intervention and post-intervention), purposive sampling was used to recruit 16 healthcare workers (nine doctors and seven nurses) for in-depth semi-structured interviews conducted before and after the intervention. During the intervention phase, 115 healthcare workers received structured CLEAR toolkit training delivered through small-group, interactive sessions. Interview data were analysed using thematic analysis following Consolidated Criteria for Reporting Qualitative Research guidelines. Results: In the pre-intervention phase, healthcare workers identified three major barriers faced when addressing patients' social needs: distrust in sharing social life issues, cultural barriers in symptom communication and fear of privacy breaches. In the post-intervention phase, six major themes emerged: (1) Breaking Barriers, Building Bridges: Addressing Sociocultural Barriers in Patient Care; (2) Patient Counselling Sessions as Catalysts for Personal Growth; (3) Community Awareness Campaigns by Healthcare Workers; (4) Strategies to Address Financial Issues of Patients; (5) Healthcare Workers as Pillars of Organisational Support; and (6) Challenges in Addressing Social Determinants. Conclusion: The application of the CLEAR toolkit training in healthcare settings enables healthcare workers to better identify and address the social problems underlying poor health outcomes, particularly in developing countries such as Pakistan. Incorporating such training fosters a holistic and patient-centred approach to healthcare delivery.
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