Background Public health experts deal with the assessment of the health needs of the population and provide professional expertise to decision-makers regarding the prioritization of health problems, the distribution of resources, and the design of health policies. Aim The aim of this research is to measure and increase the performance of the National Institute of Public Health (NIPH) of as well as design strategic plann based on SWOT analysis. Methodology The research is cross-sectional analysis and prospective planning. The triangulation method regarding the self-assessment of work achievements was carried out. The micro and meso levels of analysis were used for evaluation. SWOT analysis was used at the departmental level as well as the nominal group technique with the board of National Institute of Public Health (NIPH). Results SWOT analysis enabled the development of strategic plans to achieve SMART goals. The activities were categorized into four groups: human resources (HR), continuous professional development (CPD), organizational issues (OI), and material resources (MR). Three OI activities were prioritized at the top level because they were high impact-low effort. The MR activity 'Provision of means of transport' was labeled a fourth-level priority, being low impact-high effort, while all other activities were labeled second-level priorities, being high impact-high effort. Conclusion: Continuous investment in public health is necessary for a functional health system because it is a key factor influencing disease prevention and life extension.

Objective Our objective was to assess the level and sociodemographic correlates of health literacy (HL) among university students of health sciences in Kosovo.Methods A cross-sectional study was conducted in Kosovo during February-April 2024, including 470 students of health sciences from the universities of Prishtina and Gjakova (approximate to 86% females; mean age: 20.7 +/- 2.7 years; response rate: 70%). The internationally standardised European Health Literacy Survey Questionnaire (HLS-EU-Q) was self-administered, along with information on sociodemographic factors. Binary logistic regression was used to assess the independent sociodemographic correlates of HL.Results Only 7% of the students exhibited "inadequate and/or problematic" HL, whereas about 93% of participants displayed "sufficient and/or excellent" HL. In multivariable-adjusted binary logistic regression models, "inadequate and/or problematic" HL was strongly and positively associated with the male gender only (OR=3.6, 95%CI=1.5-8.9).Conclusions We evidenced a relatively high general HL level among university students of health sciences in Kosovo, especially among females. Enhancing HL among future health professionals could guide policies that prioritise embedding health education and resources into higher education institutions, potentially improving students' health behaviours and health outcomes, as a major prerequisite for their future work with patients and communities. Cilj Na & scaron; cilj je bil oceniti stopnjo in sociodemografske korelate zdravstvene pismenosti med univerzitetnimi & scaron;tudenti zdravstvenih ved na Kosovu.Metode Med februarjem in aprilom 2024 smo na Kosovu izvedli prese & ccaron;no & scaron;tudijo, ki je vklju & ccaron;evala 470 & scaron;tudentov zdravstvenih ved na univerzah v Pri & scaron;tini in & Dstrok;akovici (approximate to 86% & zcaron;ensk; povpre & ccaron;na starost: 20,7 +/- 2,7 leta; stopnja odziva: 70 %). Uporabili smo mednarodno standardiziran samoocenjevalni vpra & scaron;alnik European Health Literacy Survey Questionnaire (HLS-EU-Q), skupaj s podatki o sociodemografskih dejavnikih. Za ocenjevanje neodvisnih sociodemografskih korelatov smo uporabili binarno logisti & ccaron;no regresijo.Rezultati Samo pri 7 % & scaron;tudentov smo zaznali >> nezadostno in/ali problemati & ccaron;no << zdravstveno pismenost, pribli & zcaron;no 93 % udele & zcaron;encev pa je izkazalo >> zadostno in/ali odli & ccaron;no << zdravstveno pismenost. V modelih multivariatne prilagojene binarne logisti & ccaron;ne regresije je bila >> nezadostna in/ali problemati & ccaron;na << zdravstvena pismenost mo & ccaron;no in pozitivno povezana samo z mo & scaron;kim spolom (RO = 3,6, 95-% IZ = 1,5-8,9).Zaklju & ccaron;ki Med univerzitetnimi & scaron;tudenti zdravstvenih ved na Kosovu, zlasti pri & zcaron;enskah, smo dokazali razmeroma visoko splo & scaron;no zdravstveno pismenost. Pove & ccaron;anje zdravstvene pismenosti med bodo & ccaron;imi zdravstvenimi delavci bi lahko postalo vodilo politik, ki dajejo prednost vklju & ccaron;itvi zdravstvenega izobra & zcaron;evanja in virov v visoko & scaron;olske ustanove, kar bi lahko izbolj & scaron;alo z zdravjem povezano vedenje in zdravstvene izide & scaron;tudentov, ki so pomemben pogoj za njihovo prihodnje delo z bolniki in skupnostmi.

Aim To assess the behavioral correlates of health literacy (HL) among university students of health sciences in Kosovo, irrespective of their sociodemographic characteristics. Methods This cross-sectional study, carried out in Kosovo in 2024, enrolled 470 students of health sciences from the universities of Prishtina and Gjakova (86% women; mean age: 20.7 +/- 2.7 years; response rate: 70%). We gathered HL data with the European Health Literacy Survey Questionnaire, as well as information on behavioral characteristics and sociodemographic factors. General linear model and binary logistic regression were used to assess the independent behavioral correlates of HL. Results In multivariable-adjusted general linear models controlling for all sociodemographic factors and behavioral characteristics, lower HL scores were positively associated with alcohol consumption (36 vs 38 in non-drinkers, P=0.024), low levels of physical exercise (36 vs 39 among students with high level of physical activity, P<0.001), obesity (35 vs 39 among normal-weight individuals, P=0.011), and a poorer health status (36 vs 37 among students with a better self-rated health status, P=0.031). Furthermore, fully adjusted logistic regression models revealed a positive and strong relationship of "inadequate and/or problematic HL" (scores: 0-33) with physical inactivity (OR=7.6, 95%CI=1.8-31.9) and especially obesity (OR=21.4, 95%CI=3.8-119.8). Conclusions Students with low HL may be more likely to engage in behaviors detrimental to health. There is need to enhance HL among future health professionals.

We aimed to assess the prevalence and sociodemographic correlates of selected dietary habits among students of health sciences in Kosovo. A cross-sectional study was conducted in Kosovo in 2024, including 470 students of health sciences (≈86% females; mean age: 20.7±2.7 years; response rate: 70%). Information on selected dietary habits and sociodemographic factors of the students was gathered. Independent positive correlates of a lower fruit intake (<1 time/day) included male gender (OR=2.3, 95% CI =1.3-4.2) and a lower economic level (OR=1.5, 95% CI =1.0-2.3). Furthermore, positive independent correlates of a higher frequency of consumption of fried foods (≥1 time/day) included male gender (OR=2.2, 95% CI =1.2-4.1), urban residence (OR=1.6, 95% CI =1.0-2.6) and a lower economic level (OR=1.7, 95% CI =1.0-2.7). Conversely, excessive salt intake was positively and strongly correlated to a lower economic level (OR=3.5, 95% CI =2.1-6.0), but inversely related to students’ age (OR=0.4, 95% CI =0.2-0.9). Male gender and particularly a lower economic level were strong correlates of poor dietary habits among university students in Kosovo. Targeted interventions are needed to address dietary habits among youths, with a focus on providing support and resources to economically disadvantaged individuals.

This study aimed to assess the prevalence and selected correlates of dry eye disease (DED) among patients with type 2 diabetes in Kosovo. A case-series study was conducted in Kosovo from July 2023 to July 2024, including a consecutive sample of 400 patients with type 2 diabetes aged ≥18 years seeking healthcare services at the Eye Clinic of the Clinical University Center of Kosovo in Prishtina (51% females; overall mean age: 62.4±9.7 years; response rate: 80%). Data collection consisted of a detailed clinical examination and a structured questionnaire. Almost 70% of the patients had DED (standalone or combined with retinopathy, which, in turn, had a separate prevalence of 3%). Significant positive correlates of autonomous and/or combined DED and retinopathy included older age, unhealthy dietary patterns, sedentary lifestyle, high blood pressure, and treatment of diabetes with insulin and pills. Our findings indicate a high prevalence of DED among type 2 diabetes patients in Kosovo. DED and retinopathy were strongly associated with a range of demographic factors, behavioral characteristics, and preexisting conditions pertinent to type 2 diabetes patients in this population.

Kosovo has the lowest life expectancy in the Western Balkans, where cardiovascular disease (CVD) accounts for over half of all deaths. Depression also contributes to disability in the country, with a prevalence of moderate to severe symptoms reported as high as 42% in the general population. Although the mechanisms are not yet well understood, evidence suggests that depression is an independent risk factor for CVD. Our study assessed the prospective association between depressive symptoms and blood pressure (BP)-related outcomes among primary healthcare users in Kosovo to understand the role of BP in the relationship between depression and CVD. We included 648 primary healthcare users from the KOSCO study. The presence of depressive symptoms was defined as moderate to very severe depressive symptoms (DASS-21 depressive symptoms score ≥14). Multivariable censored regression models assessed prospective associations between baseline depressive symptoms and changes in systolic and diastolic BP while taking hypertension treatment into consideration. Multivariable logistic regression models assessed prospective associations between baseline depressive symptoms and hypertension diagnosis among normotensive patients (n = 226) as well as uncontrolled hypertension in hypertensive patients (n = 422) at follow-up. Depressive symptoms were associated with attenuated diastolic BP (β = -2.84, 95%-CI -4.64 to -1.05, p = 0.002) over a year of follow-up in our fully adjusted model, although the association with systolic BP (β = -1.98, 95%-CI -5.48 to 1.28, p = 0.23) did not meet statistical significance. We found no statistically significant association of depressive symptoms with hypertension diagnosis among initially normotensive people (OR = 1.68, 95%-CI 0.41 to 6.98, p = 0.48), nor with hypertension control among initially hypertensive people (OR = 0.69, 95%-CI 0.34 to 1.41, p = 0.31). Our findings are not consistent with increased BP as an underlying mechanism between depression and elevated CVD risk and contribute valuable evidence to cardiovascular epidemiology, where the mechanisms between depression, hypertension and CVD are yet to be elucidated.

Background: Some years ago, chronic diseases were considered to be a problem for the wealthy and elderly population. Today, chronic conditions affect the poor, young, and middle-aged people in high-income countries. The global prevalence of diabetes mellitus (DM) has been continuously growing for over half a century and has reached pandemic proportions. In the present study, we aimed to estimate the trends in prediabetes and DM prevalence and to determine related risk factors among Kosovo people from 2011 to 2019. Methods and Results: A population-based survey was conducted among people aged 18-69 from April 2018 to June 2019 and those aged 15-64 using the WHO STEPs instrument. Detailed findings on the magnitude of DM and impaired fasting blood glucose (FBG) are presented in this paper. Prevalence of prediabetes in 2011 at 15-64 years was 6.0% (95% CI, 4.6% - 7.9%), and in 2019 at 18-69 years was 6.1% (95% CI, 5.3% - 7.1%), not a significant difference (P>0.05). To avoid bias from different ages, we compared prevalence by age groups. Only in the age group of 35-44 we found a significant difference in the prevalence of prediabetes. In this age group, the prevalence of prediabetes was 2.4% (95% CI, 0.9%-6.1%) in 2011 and 2.7% (95%CI, 0.9%-6.1%) in 2019. In 2019, the prevalence of prediabetes was higher among males than in 2011, when females prevailed. Prevalence of DM in 2011 at 15-64 years was 7.7% (95% CI, 6.0% - 9.7%), and in 2019 at 18 – 69 years was 7.9% (95% CI, 6.9% - 9.0%), not a significant difference (P>0.05). In the age groups of 45-54 and 55-64, we found a significant difference in the prevalence of DM by years. The prevalence of DM at 45-54 years was 13.5% (95% CI, 9.2% - 19.5%) in 2011 and 7.8% (95%CI, 6.0%-10.2%) in 2019 (P=0.032). The prevalence of DM at 55-54 years was 21.6% (95% CI, 15.8% - 28.9%) in 2011 and 13.2% (95%CI, 10.6%-16.3%) in 2019 (P=0.015). The prevalence of DM was higher among females in 2011 and 2019. Conclusion: Results from 2 STEPS in Kosovo show that we have no significant increase in the prevalence of prediabetes and DM in total. At the same time, we found a significant decrease in DM in the age group 45-64.

Background: The aim of our study was to assess selected sociodemographic correlates of satisfaction among hospitalized patients in Kosovo. Methods and Results: A cross-sectional study was conducted in May-June 2022, including a representative sample of 508 hospitalized patients (58.1% women and 41.9% men) aged ≥18 years. A structured 19-item questionnaire about patient satisfaction with hospital services was used for data collection. Each item was measured on a Likert scale ranging from 1 (very satisfied) to 5 (very unsatisfied). A summary score was calculated for all 19 items related to the level of satisfaction among hospitalized patients ranging from 19 (highest level of satisfaction) to 95 (lowest level of satisfaction). Binary logistic regression was used to assess the association of the summary score of satisfaction (19-item instrument, dichotomized in the analysis into “satisfied” vs. “unsatisfied” based on the median value of the summary score) with sociodemographic factors, general health status, and duration of hospitalization. In multivariable-adjusted logistic regression models controlling in a backward stepwise procedure for all sociodemographic factors, health status, and duration of hospitalization, patients’ unsatisfaction was significantly associated with urban residence (OR=1.52, 95%CI: 1.00-2.31), income level (OR[low vs. high income]=2.44, 95%CI: 1.18-5.06) and health status (OR[poor vs. good health]=7.95, 95%CI: 4.43-14.24. Conclusion: Our findings indicate a significantly higher unsatisfaction level among urban and low-income patients. Healthcare providers and policymakers in Kosovo and other similar countries should be aware of the importance of continuous quality improvement of hospital services to increase, among other things, the satisfaction level of hospitalized patients.

Background Prevalent physical inactivity and poor nutrition contribute to high non-communicable disease (NCD) morbidity and mortality in Kosovo. To improve health services for patients with NCD the Accessible Quality Healthcare project developed behaviour change interventions following the principles of the WHO Package of Essential NCD (PEN) protocol. They were implemented into the public primary healthcare (PHC) system of five early-stage implementation municipalities (ESIM, 2018) and seven late-stage implementation municipalities (2020).Objective To assess the effect of the behaviour change interventions; motivational stages of behaviour change for physical activity and nutrition; and body mass index (BMI).Design Prospective cohort study.Data collection and analysis We included 891 public PHC users aged 40 years and above, who were enrolled in the KOSCO (Kosovo Non-Communicable Disease Cohort) cohort in 2019 and followed-up biannually until February 2021. The PHC users who consulted for themselves any health service were approached and recruited for cohort participation. Each participant contributed up to four self-reports of nutrition and physical activity, and up to three reports of motivation to change for a better lifestyle. These outcomes were modelled prospectively with robust mixed-effects Poisson regressions. The association between behaviour change interventions and BMI was quantified using linear regression.Results There was a high rate of smokers 20.5% and obesity 53.1%, and high rates of self-reported diagnoses of diabetes: 57.1%; hypertension 62.6%. We found no effect of residing in an ESIM, but adherence to both guidelines was higher in ESIM at the latest follow-up time point. ESIM residence was also associated with a twofold increase in the probability of reporting a high motivation for a better lifestyle and with a statistically non-significant decrease in BMI of −0.14 kg/m2 (95% CI: −0.46 to 0.19) at the latest follow-up.Conclusion The longitudinal results extend evidence on the effect of WHO PEN protocol in promoting physical activity and nutritional behaviour in the Kosovo context.

Background In a cohort of primary health care users across Kosovo (KOSCO cohort), high rates and poor control of diabetes and hypertension were observed. These conditions can be prevented and better controlled by adapting to a healthy lifestyle. Physical activity is an important target, as inactivity and related obesity were very prevalent in the KOSCO cohort. This qualitative study aims to identify individual and structural barriers to physical activity perceived by patients with diabetes and/or hypertension so as to inform health care providers and policy-makers in Kosovo on strategies for promoting physical activity. Methods Interviews were conducted from July to October 2020 with 26 public primary health care users from five municipalities of Kosovo (Mitrovica, Vushtrri, Fushe Kosova, Gjakova, and Malisheva). The qualitative study was nested into the KOSCO cohort. KOSCO was implemented in 2019 and recruited consecutive patients visiting the public primary health care centres in these municipalities. Participants of this qualitative sub-study were selected if they had a doctor’s diagnosis of diabetes and/or hypertension. The interview guide consisted of questions related to physical activity barriers these patients are facing, despite having received motivational counselling sessions in primary healthcare centres. Data were analysed using a framework methodology. Results Three main themes moderating physical activity behaviour were identified: 1) neighbourhood built environment, 2) health-related problems, and 3) social support. The barriers to physical activity related to the first theme were structural features of the neighbourhoods such as: crowded sidewalks, lack of green spaces, lack of proper lighting in public spaces, as well as dense traffic. In regards to the second theme, the main health reasons for study participants to delay physical activity were related to: physical discomfort as well as stress, worry, and lack of energy. An additional barrier to exercise was lack of social support specifically from friends. Conclusion The study identifies structural and individual targets for integrated and inter-sectoral physical activity promotion efforts.

Objectives Kosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms. Methods PHC users (n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models. Results Poor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00–1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00–1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91–1.00). Conclusions Continued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap.

Aim: Brain tumors (BT) are neoplasms developed in intracranial tissues and the meninges. The purpose of this study was to describe the epidemiological features of brain tumors diagnosed and treated at the University Clinical Center of Kosovo (UCCK), the only healthcare institution in Kosovo that diagnosis and treats malignancies. Methods: A 3-year retrospective study (2019-2021) was carried out in the Neurosurgical Clinic, Radiology Clinic, and Institute of Pathology, of UCCK. Mann-Whitney test was used to compare age distribution between males and females. Results: A total of 227 patients were treated for BT at the UCCK during the three-year period under investigation (that is 2019-2021). There were 119 males (52.4%) and 108 (47.6%) females. The incidence rate of BT for the year 2021 was 4.7/100,000 inhabitants. BT were most common in the age groups: >50 years (n=178, 78.4%), 25-50 years (n=33, 14.6%), whereas 13 cases (5.7%) were children from the age-group ≤14 years. Almost one third of the patients (33.9%) were from Prishtina region, followed by Peja region (18.5%) and Mitrovica region (13.2%). From the overall number of cases (n=227), 31.3% (n=71) were benign and 66.1% (n=150) were malignant tumors. The average age of brain tumor patients was 58.4±18.3 years. The most prevalent histological type of BT was meningioma WHO gr. I (n=57, 25.1%) followed by glioblastoma WHO gr. IV (n=43, 18.9%) with similar appearances in both genders. Most often, tumors had supratentorial/intra-axial localization (63.4%). Conclusion: Adults over 50 years old represent the most affected age-group for BT in Kosovo. Meningioma, and glioblastoma were the most frequent BT in Kosovo adults. Further studies are needed to assess the long-term outcome of patients with BT in Kosovo.

Background Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. Their prevention is a priority to relieve the health system of from costly non-communicable disease treatments. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate change in the domains of smoking, diet, alcohol consumption and physical inactivity for at-risk patients. This study quantitatively assesses the uptake of motivational counselling and the distribution of health behaviours and stages of health behaviour change of the participants according to the intervention, as well as qualitatively describes experiences and perceived benefits of motivational counselling. Methods Study participants ( n = 907) were recruited consecutively in 2019 from patients visiting the Main Family Medical Centres in 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study as part of the Accessible Quality Healthcare project. For the quantitative study, we used baseline and first follow-up data on smoking status, physical inactivity, obesity, fruit and vegetable as well as alcohol consumption, uptake of counselling, and stages for behavioural change. For the qualitative study, in-depth interviews were conducted with a subset of 26 cohort participants who had undergone motivational counselling. Results Motivational counselling was obtained by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours are high even in persons who underwent counselling (of whom 13% are smokers; 86% physically inactive; 93% with inadequate fruit and vegetable consumption; and 61% are obese); only the rate of smoking was lower in those who obtained counselling. Among smokers, over 80% were still in the pre-contemplation phase of behaviour change. More advanced stages of behaviour change were observed among the highly prevalent group of inactive persons and participants with poor dietary habits, among the 5 intervention municipalities. According to the qualitative study results, the participants who obtained motivational counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation. Conclusions More tailored and additional primary health care approaches in accordance with patients’ views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change.

Aim: The National Institute of Public Health of Kosovo (NIPHK) considered the challenge of assessing the availability and performance of critical public health services in Kosovo. To this end, support was requested from the World Health Organization (WHO) European Regional Office, through the WHO office in Pristina, for an action-oriented process. The systematic process of the self-assessment of public health operations aimed to generate sufficient empirical evidence to identify the strengths and weaknesses of the country’s health services and functions to provide recommendations for future public health actions in Kosovo.Methods: The NIPHK team followed the systematic self-assessment methodology of the Essential Public Health Operations (EPHO) model that the WHO’s regional office for Europe developed. The appraisal was conducted throughout 2018 and the first quarter of 2019 and involved a broad spectrum of public health actors. It also followed a participatory, interdisciplinary, and inter-sectoral approach. It was developed in three phases: preparation and collection of information, analysis and interpretation of the data, and critical recommendations for the Kosovo health authorities’ consideration. Results: The assessment resulted in an overall score of 48% sufficiency for the set of public health operations (core and enablers). The most in need of development were EPHO 6, which is related to governance (only 20% of what is needed in this dimension as a whole), followed by EPHO 3, which considers vital aspects of health protection (35%), and EPHO 10, which is related to research capacities (40%). Based on the EPHO assessment results, the specialized teams developed a set of priority recommendations to strengthen the implementation of the EPHOs in Kosovo.Conclusion: The self-assessment revealed that, despite ongoing initiatives and measures to strengthen public health, the application of EPHOs has much room for improvement. We believe that decision-makers can use this method and the findings that it reveals to implement the most effective interventions to protect and promote the population’s health. In addition, the methodology and experience can be used for educational and training purposes.

Abstract Background Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate lifestyle behaviour change. This study assesses the uptake of counselling and the impact on health behaviours and participants’ stages of health behaviour change as well as describes experiences and perceived benefits of motivational counselling. Methods Study participants (n = 907) were recruited from 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study. For the quantitative study, data on lifestyle behaviours, use of counselling, and stages for behavioural change were used. For the qualitative study, in-depth interviews were conducted with 26 cohort participants who had undergone motivational counselling. Results Motivational counselling was received by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours remain high even in persons who underwent counselling (of whom 13% are smokers; 86% are physically inactive; 93% with inadequate fruit and vegetable consumption; 61% are obese). According to the qualitative study results, the participants that received counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation. Conclusions More tailored and additional primary healthcare approaches in accordance with patients’ views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change. Key messages • The following tailored approaches are suggested: a) strengthened referral mechanism b) specialized services for smoking cessation; c) delivery of group physical activity sessions. • More tailored and additional primary health care approaches in accordance with patients’ views need to be considered for the motivational counselling intervention.

Aim: The aim of this study was to assess the level and socio-demographic correlates of satisfaction with services among adult primary health care users in Kosovo. Methods: A cross-sectional study was conducted in Kosovo during the period May-June 2022 including a representative sample of 510 adult users (238 men and 272 women) of primary health care services in Kosovo (mean age: 44.6±19.2 years). In addition to socio-demographic data, a structured 23-item questionnaire aiming at assessing the level of satisfaction with primary health care services was administered to all participants (each item ranging from 1 [high] to 5 [low]). A summary score was calculated for all 23 items related to satisfaction level ranging from 23 (the highest satisfaction level) to 115 (the lowest satisfaction level). General linear model was used to assess the association between the summary score of satisfaction level with primary health care services and socio-demographic factors of study participants. Results: Mean summary score of the 23 items related to the satisfaction level with primary health care services was 49.8±13.0; median score was 49 (interquartile range: 41-57). In multivariable-adjusted models, the level of satisfaction with primary health care services was significantly higher among participants with a lower educational attainment, individuals with e lower income level, and ethnic Albanian participants. Conclusion: This study identified important socio-demographic correlates of the level of satisfaction with primary health care services in the adult population of Kosovo. Findings from this study should raise the awareness of policymakers and decision-makers in Kosovo and elsewhere in order to improve the quality of primary health care services.

Introduction With the lowest life expectancy in the Balkans, underlying causes of morbidity in Kosovo remain unclear due to limited epidemiological evidence. The goal of this cohort is to contribute epidemiological evidence for the prevention and control of non-communicable diseases such as depression, hypertension, diabetes and chronic respiratory disease in Kosovo as the basis for policy and decision-making, with a spotlight on the relationships between non-experimental primary healthcare (PHC) interventions and lifestyle changes as well as between depression and the course of blood pressure. Methods and analysis PHC users aged 40 years and above were recruited consecutively between March and October 2019 from 12 main family medicine centres across Kosovo. The data collected through interviews and health examinations included: sociodemographic characteristics, social and environmental factors, comorbidities, health system, lifestyle, psychological factors and clinical attributes (blood pressure, height, weight, waist/hip/neck circumferences, peak expiratory flow and HbA1c measurements). Cohort data were collected annually in two phases, approximately 6 months apart, with an expected total follow-up time of 5 years. Ethics and dissemination Ethical approvals were obtained from the Ethics Committee Northwest and Central Switzerland (Ref. 2018-00994) and the Kosovo Doctors Chamber (Ref. 11/2019). Cohort results will provide novel epidemiological evidence on non-communicable diseases in Kosovo, which will be published in scientific journals. The study will also examine the health needs of the people of Kosovo and provide evidence for health sector decision-makers to improve service responsiveness, which will be shared with stakeholders through reports and presentations.

BACKGROUND:The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date.OBJECTIVE:To assess the association between body mass index (BMI) and HL among Albanian adults.METHODS:A cross-sectional study was conducted in Tirana, Albania, in 2012-2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors.RESULTS:One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3-3.1) among inadequate HL individuals compared with excellent HL participants.CONCLUSION:Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.

Aim: The objective of this study was to assess predictive factors for patient satisfaction with healthcare services as a measure of the quality of hospital care in public and private hospitals in Kosovo. Methods: A cross-sectional study was conducted in Kosovo during 2015-2016 including a representative sample of 2585 patients older than 18 years [1010 (48.6%) males and 1069 (51.4%) females from public hospitals; and 240 (47.4%) males and 266 (52.6%) females from private hospitals]. Patient satisfaction dimensions such as satisfaction with medical care, nursing care, organization, and overall impression were the main variables measured. A risk-adjusted multivariate analysis was applied. Results: Multiple linear regression analysis revealed as independent significant predictors of the total satisfaction of patients from public hospitals the following factors: age, length of stay in hospital in days, education, payment for additional analyzes during hospitalization and buying medications for hospital treatment. These five independent significant predictors accounted for 7.3% of the change in the total patients’ satisfaction (stepwise method - R2 = 0.073). Conversely, there were only four predictors of the total satisfaction of patients from private hospitals: length of stay in hospital in days, number of hospitalizations in the last 12 months, paying for hospitalization, and cost of hospitalization exceeds received services. Only the variables “length of hospital stay” together with “cost of hospitalization exceeds received services” as independent predictors, explained 5.3% of the variability of total satisfaction. Conclusion: Structural and qualitative characteristics of hospitals have a significant impact on patients’ satisfaction. Age, length of stay, education, payment for additional analyzes during hospitalization and the cost of hospitalization in public hospitals and length of stay, paying for hospitalization, and cost of hospitalization in private hospitals are useful predictors for total satisfaction of patients in Kosovo.