Abstract India has rapidly built one of the world's largest digital health ecosystems through the Ayushman Bharat Digital Mission (ABDM). More than one billion health records are linked to the Ayushman Bharat Health Account (ABHA), and a standardised, longitudinal, interoperable Electronic Health Records (EHR) built on ABHA as the common patient identifier is now being consolidated. Safe and equitable use of artificial intelligence (AI) in health therefore depends on first building and governing this record, then the secondary use of health data for research and AI, and finally the AI tools before deployment. This narrative review synthesised Government of India policy documents, statutory instruments, programme reports, and peer-reviewed literature from PubMed and official sources published between 2018 and 2026, identified using the terms digital health, electronic health records, artificial intelligence governance, and India, and synthesised into a three-layer governance framework. The framework proposes three sequential governance layers. The first establishes a standardised, interoperable EHR on ABHA, supported by legal and interoperability standards. The second governs the secondary use of health data for research and AI through risk-based classification, consent, and access controls. The third governs AI tools through risk-proportionate validation and oversight before deployment. Recent national initiatives, including Strategy for Artificial Intelligence in Healthcare for India (SAHI) and Benchmarking Open Data Platform for Health AI (BODH), have strengthened this enabling infrastructure. India has a valuable and timely opportunity to align governance with deployment as these technologies mature. A governance-first, whole-of-government approach, supported by public and private health systems, can strengthen trust, enable responsible innovation, and offer a scalable model for other countries.
Abstract Background: Early-pregnancy metabolic risk markers are useful in the identification of women at increased risk of developing gestational diabetes mellitus (GDM), and hepatic steatosis is one of the established predictors of GDM. This study aims to assess the role of Fatty Liver Index (FLI), a noninvasive screening tool for hepatic steatosis, during the first trimester of pregnancy and its association with the incidence of GDM. Methods: This prospective cohort enrolled 368 first-trimester pregnant women from seven primary health centres in Puducherry, South India, after excluding women with pre-existing or baseline-detected diabetes mellitus. FLI was calculated from body mass index, waist circumference, triglycerides, and gamma-glutamyl transferase. GDM was defined by DIPSI criteria as a 2-hour glucose value ≥140 mg/dL after a 75-g oral glucose load, irrespective of fasting status. Adjusted relative risks (aRRs) were estimated by binomial regression. Results: Fourteen pregnancies ended in abortion before outcome assessment, and 354 women completed testing. GDM developed in 90/354 (25.4%): 36/88 (40.9%) among women with elevated FLI (FLI >32) and 54/266 (20.3%) among those with normal FLI. Elevated FLI remained significantly associated with GDM after adjustment (aRR 1.80, 95% CI 1.29–2.52). Each 10-point increase in FLI was associated with higher adjusted risk (aRR 1.11; 95% CI 1.04–1.17). Conclusions: Elevated first-trimester FLI was associated with subsequent GDM incidence. Incorporating FLI as a noninvasive screening tool in primary care can enable early metabolic risk stratification and guide timely interventions to prevent GDM and associated adverse maternal and neonatal outcomes, but its modest discriminative power does not support replacing universal GDM testing.
Abstract Background: Patient satisfaction reflects the overall experience of individuals seeking care, especially in government hospitals. The government tertiary care hospital in Haldwani serves as a primary referral center for the Kumaon region, attracting patients from remote areas. The aim is to study patient satisfaction and its associated factors among outpatient department (OPD) attendees at a government tertiary care hospital in Haldwani. Material and Methods: A cross-sectional study was conducted among 3,662 OPD attendees across nine specialties from February to April 2025. The validated Patient Satisfaction Questionnaire-18 (PSQ-18) was used via face-to-face interviews. Statistical Analysis Used: Data were analyzed using descriptive statistics, Chi-square tests, and binary logistic regression; significance was set at P < 0.05. Results: Of the participants, 54.6% were female and 70.8% were urban residents. Overall satisfaction was 79.2%, highest for doctors’ communication and behavior and lowest for accessibility, consultation time, and financial aspects. Satisfaction significantly varied by age, OPD type, residence, and visit purpose ( P < 0.001). Logistic regression revealed reduced satisfaction in patients aged 41–60 years (adjusted odds ratio [AOR] = 0.69), rural residents (AOR = 0.71), and lower satisfaction across several OPDs; patients from other districts had higher satisfaction odds (AOR = 1.70). Conclusions: While overall experience was positive, improvements in accessibility and consultation time are needed. Targeted, department-specific interventions are crucial to enhance patient-centered care.
Abstract Background: In India, Sexual Health Education (SHE) faces barriers such as cultural taboos and a lack of engaging methodologies, often leading to poor knowledge among school-going adolescents. The present study was undertaken to compare the effectiveness of gamification and traditional health education in improving sexual health knowledge and to assess post-intervention differences in motivation, attitude, and engagement among school-going adolescents in Perambalur district, Tamil Nadu. Methods: A quasi-experimental comparative study was conducted among 100 adolescents aged 12–14 years from two schools in Perambalur district, Tamil Nadu. Two schools were selected randomly from the district, and one school was allocated to the gamification arm while the other was allocated to the traditional health education arm. Pre- and post-intervention knowledge was assessed using a structured and pre-tested questionnaire. Post-intervention assessment also included motivation, attitude, and engagement. Statistical Analysis: Between-group post-intervention scores were compared using analysis of covariance (ANCOVA). Within-group change was assessed by a paired t -test. Effect sizes (Cohen’s d) and 95% confidence intervals are reported alongside every P value. Results: After baseline adjustment, individual-level ANCOVA showed a higher composite knowledge score in the gamification arm (adjusted mean difference 2.97, 95% CI 1.17 to 4.77, P = 0.002; Cohen’s d 0.73). Domain-level ANCOVA showed statistically significant adjusted advantages for gamification in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) (adj. diff 0.55, 95% CI 0.05 to 1.05, P = 0.032), good touch/bad touch (adj. diff 0.94, 95% CI 0.27 to 1.62, P = 0.006), and puberty (adj. diff 1.42, 95% CI 0.49 to 2.36, P = 0.003); the peer-pressure adjusted difference was borderline (adj. diff 0.62, 95% CI −0.04 to 1.29, P = 0.067). Conclusions: A short, school-delivered gamified intervention improved adolescent sexual health knowledge, motivation, engagement, and attitude beyond a matched-content lecture programme. Given the single-cluster-per-arm design, these findings should be interpreted as complementary evidence supporting scaled evaluation of digital gamified modules within the existing National AIDS Control Organisation’s Adolescent Education Programme (NACO AEP) framework.
Abstract Background: The escalating burden of Non-Communicable Diseases (NCDs) in low- and middle-income countries like India and their substantial contribution to global mortality and morbidity, necessitate the need to assess primary healthcare delivery systems. This study evaluates the capacity of Primary Health Centers-Health and Wellness Centers (PHC-WHC) in Jehanabad district, Bihar, to deliver NCD services. Materials and Methods: A cross-sectional facility assessment was conducted across 21 randomly selected PHC-HWCs (10, 24×7 PHCs and 11, non-24×7 PHCs) out of 35 total operational facilities (representing 60% of the centers) in Jehanabad district. A 60% sampling fraction provides a robust estimate with an acceptable margin of error.) for domain-wise descriptive assessments, aligning with the World Health Organization (WHO)’s Service Availability and Readiness Assessment (SARA) sampling guidelines for subnational facility surveys. A piloted structured facility assessment checklist was developed based on standard tools like the Indian Public Health Standards (IPHS), WHO Package of Essential Non-communicable Diseases (PEN), and the Service Availability and Readiness Assessment tool by WHO. Descriptive statistical analysis was performed using Jamovi 2.2.2 software. Results: The study found that around 2/3 of the 24×7 PHCs serve a population above the recommended 30,000 norm. None of the PHCs had adequate manpower. There was no separate NCD clinic in any of the PHCs. The most commonly available diagnostic services in primary health centers were the estimation of blood sugar (90.5%) and hemoglobin estimation (71.4%). Ambulances were not present in two-thirds of the PHCs, thus posing a challenge to providing referral services. Conclusion: This study proposes evidence-based recommendations to enhance the services offered by PHCs. PHCs should be strategically distributed based on population norms to ensure equitable access. To offer quality healthcare services, staffing must align with the IPHS guidelines.
