ArticleBMC primary care2026
Implementing WHO PEN in primary health in Moldova: a qualitative evaluation of barriers, enablers, and lessons for scale-up.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
backgroundThe WHO Package of Essential Noncommunicable (PEN) disease interventions is promoted to strengthen NCD prevention and management in primary health care (PHC), particularly in low-resource settings. Moldova initiated PEN implementation in 2017. Prior quantitative monitoring showed mixed performance across sites.
objectiveTo identify practical strategies to improve implementation and inform national scale-up.
methodsWe conducted a qualitative study (June–August 2018) in five family medicine centers purposively selected for prior PEN performance (two high, one medium, two low). Two trained interviewers per site conducted semi-structured, face-to-face interviews with clinicians. Interviews were audio-recorded, transcribed verbatim (Romanian), anonymized, and analyzed using the framework analysis approach by a six-member team. Findings were discussed iteratively with the evaluation team.
resultsTwenty-eight participants were interviewed (15 doctors, including five managers and 13 nurses). Participants valued PEN for structuring consultations and clarifying team roles. Implementation barriers included staff shortages and workload, duplicate documentation, limited ongoing training (especially for risk communication and motivational interviewing), inconsistent use of cardiovascular risk to guide treatment, referral bottlenecks, and patient-level barriers (costs, limited preventive care use among working-age men, migration). Enablers included joint doctor-nurse training, clear role delineation, simple embedded tools (checklists), local reorganization of patient flow, and leadership engagement.
conclusionsTo sustain impact during scale-up, national efforts should streamline documentation, institutionalize refresher training focused on counseling and risk-based care, address access and referral gaps, and deliver community outreach to under-reached groups. These actions can strengthen PHC and advance national NCD goals.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.