Purpose This paper introduces the concept of intersectional deprivation to explain how overlapping structural, psychological and relational disadvantages shape refugee women's entrepreneurial intentions in deprived UK contexts. Drawing on Crenshaw's intersectionality and place-based marginalization, the study addresses the absence of an integrated mechanism-based framework by focusing on Middlesbrough, a paradigmatic asylum-dispersal city in the North East of England, shaped by austerity, immigration policy and spatial stigma. Design/methodology/approach The study adopts a co-production methodology and an interpretive case-study design. Data were generated through fifteen semi-structured interviews, focus groups and storytelling workshops with refugee women. Analysis followed Braun and Clarke's reflexive thematic approach, incorporating iterative coding, memo writing, participant feedback and constant comparison to ensure theoretical depth, credibility and epistemic justice. Findings The analysis identifies three mutually reinforcing mechanisms of intersectional deprivation: (1) psychological erosion, where trauma, uncertainty, language barriers and caregiving responsibilities undermine self-efficacy; (2) structural and institutional inertia, including bureaucratic opacity, credential devaluation, fragmented support systems and financial exclusion; and (3) relational load and collective coping, where community-based networks provide emotional and material support while simultaneously reproducing unpaid care work and limiting access to formal entrepreneurial ecosystems. These mechanisms form a cyclical process that both constrains and generates situated, collective forms of agency. Originality/value The study offers a novel mechanism-based framework that extends the 5 M model, Mixed Embeddedness and epistemic-injustice perspectives by integrating intersectionality with spatial deprivation and psychological experiences of exclusion. It centres refugee women's lived experiences through co-production and provides actionable insights for policy, ecosystem development and gender-just entrepreneurship support in overlooked UK regions and comparable international contexts.

Dengue fever is a growing global health concern, especially in regions like the United Arab Emirates (UAE), where environmental factors and high levels of international travel increase the risk of outbreaks. Despite this, public awareness and adoption of preventive measures remain understudied. This cross-sectional study aimed to assess the public's knowledge, attitudes, and practices (KAP) regarding dengue fever and its prevention. A validated online questionnaire was distributed to 1106 individuals using convenience sampling. The results revealed significant knowledge gaps, with only 24.6% correctly identifying dengue as a viral infection and 24.5% recognizing mosquito transmission. Median knowledge scores were higher among participants with elementary education (median = 13, IQR: 13-18), postgraduate degrees (median = 12, IQR: 8-15) than among those with other education levels, and higher among those with health insurance (median = 11, IQR: 10-13) than among those without insurance. Attitudes varied significantly based on education and residency, while regression analysis showed that male gender, older age, and smoking were associated with higher practice scores. These findings emphasize the need for targeted educational campaigns and public health interventions to improve awareness and engagement with dengue prevention, particularly in vulnerable demographic groups.

Background: Growth standards and growth references serve different purposes. The WHO Child Growth Standards for ages 0–5 years describe growth under specified optimal conditions, whereas the WHO 5–19-year curves are a reference reconstructed from historical NCHS data. This study aimed to develop sex-specific growth reference curves for Jordanian children and adolescents and compare selected centiles descriptively with WHO growth standards and references. Methods: Retrospective anthropometric records collected between 2019 and 2025 through the Ministry of Health’s Hakeem National E-Health Program were used. Following medical eligibility screening, 63,187 measurement records were selected before analytical cleaning using proportionate stratified random sampling by sex and governorate, with age balancing across four broad age groups. Analytical cleaning excluded 506 boys’ and 1084 girls’ records, producing a final height-for-age and BMI-for-age sample of 61,597 measurement occasions from 33,170 Jordanian children and adolescents (27,933 occasions from 14,594 boys and 33,664 occasions from 18,576 girls). Weight-for-age used 16,071 occasions from 9537 boys and 16,185 occasions from 10,214 girls aged 2–10 years. LMS/BCPE-based centile modeling was conducted within GAMLSS, and the 3rd, 15th, 50th, 85th, and 97th centiles were compared with WHO values. Results: Separate sex-specific models were developed, and the Jordanian curves differed descriptively from WHO curves at several ages and centiles. Conclusions: The population-proportionately stratified Jordanian curves provide direct local context for describing attained anthropometric distributions. Future studies should compare both the Jordanian and WHO curves against Jordan-specific outcomes and classification decisions to determine their respective clinical roles.

Introduction Gastric cancer is a major cause of cancer-related mortality worldwide, and early detection through screening can improve outcomes. In the United Arab Emirates (UAE), incidence is relatively low, but late-stage diagnosis, limited public awareness and no dedicated national screening programme remain concerns. This study examined knowledge, attitudes, perceived barriers and factors associated with screening uptake among UAE residents.Theory The study was informed by public health approaches to cancer prevention and early detection, focusing on how knowledge, attitudes, perceived risk, physician recommendation and access shape screening behaviour and engagement with screening.Methods A cross-sectional bilingual online survey was conducted between October 2024 and February 2025 using convenience sampling. In total, 959 UAE residents aged 18 years or older completed the questionnaire. Data were analysed using descriptive statistics and binary logistic regression.Results Participants had moderate knowledge of gastric cancer, with a median score of 18 out of 29, and generally positive attitudes towards screening. However, only 21.5% had undergone screening. Key barriers included lack of interest, absence of physician advice, fear of results and limited awareness.Discussion Findings highlight the need for culturally tailored education, stronger clinician engagement and more accessible screening pathways to improve participation.

Introduction:Diabetes prevalence in Iraq is high, yet culturally adapted and psychometrically validated health literacy (HL) tools for people with diabetes remain limited. The Jordanian Diabetic Health Literacy Questionnaire (JDHLQ) assesses informational and communicative HL but omits numeracy. Purpose:To adapt and validate the Iraqi Diabetic Health Literacy Questionnaire (IDHLQ), based on the JDHLQ, which incorporates a numeracy domain, for use among adults with type 2 diabetes in Iraq. Patients and Methods:A cross-sectional study recruited 473 adults with type 2 diabetes from endocrinology clinics across Iraq. Participants were 52.7% female with a median age of 50 years (IQR: 31-60). The 11-item IDHLQ was validated using exploratory factor analysis, Rasch modeling, and Cronbach's alpha. Linear regression examined sociodemographic predictors. Results:A three-factor model emerged, representing informational, numeracy, and communicative health literacy, with internal consistency ranging from α = 0.70 to 0.86. Rasch analysis showed item separation reliability of 0.87-0.95 and person reliability of 0.65-0.82. The median score was 33 (IQR: 28-36) out of 44. Monthly income predicted HL (β = 0.16, p = 0.003), while age, gender, education, and marital status were nonsignificant. Conclusion:The adapted IDHLQ is a reliable and valid instrument for assessing multidimensional diabetic health literacy among Iraqi adults. Its use in clinical and public health settings could inform patient education strategies and guide policy development to reduce disparities in diabetes outcomes.

OBJECTIVE:Parental numeracy skills, reflecting a quantitative domain within health literacy, may be relevant to pediatric asthma management. However, the association between parental numeracy skills and the asthma-related quality of life (QOL) of children with asthma remains insufficiently examined. This study aimed to assess the QOL of Jordanian children with asthma and to examine its association with parental numeracy skills. METHODS:A cross-sectional study was performed on a sample of 400 parents (66.5% mothers) of children with asthma (59.5% male) undergoing treatment at the University of Jordan Hospital. The Arabic version of the Asthma Numeracy Questionnaire (Ar-ANQ) was utilized to evaluate parental numeracy skills, while the parent-report version of the Pediatric Quality of Life Inventory (PedsQL) Asthma Module was employed to assess QOL. Quantile regression analyzed associations between parental numeracy skills, asthma control, and QOL. RESULTS:The median Ar-ANQ score was 3 (IQR: 1-4) out of 4, and the median QOL score was 60 (IQR: 50-67) out of 100. Higher parental numeracy skills were significantly associated with better asthma-related QOL among children (β = 1.99, 95% CI [0.81, 3.18], p = 0.001). Children with uncontrolled or partially controlled asthma had significantly lower QOL scores (β = -9.70, 95% CI [-15.57, -3.82], p = 0.001; β = -10.06, 95% CI [-15.83, -4.29], p = 0.001). CONCLUSIONS:Higher parental numeracy skills were associated with better asthma-related QOL among children with asthma. Given the cross-sectional design, this finding should be interpreted as an association rather than evidence of a causal effect.

Objectives: We aimed to evaluate the reliability and validity of the Arabic version of the Chronic Heart Failure Health-Related Quality of Life Questionnaire (CHFQOLQ-20) among patients with heart failure in Jordan. Methods: A cross-sectional study was conducted among 399 adults with heart failure recruited from a tertiary hospital in Jordan (median age 68 years; 55.9% male). The CHFQOLQ-20 was translated using forward-backward procedures. Construct validity was examined using confirmatory factor analysis (CFA) and a multidimensional Partial Credit Model. Differential item functioning by sex and internal consistency were assessed. Results: CFA supported the original four-domain structure (physical, cognitive, mental, and general health), with all items showing significant factor loadings. Item-level analyses demonstrated acceptable model fit, ordered response thresholds, and minimal sex-related bias. Physical health scores were lower than other domains. Conclusions: The Arabic CHFQOLQ-20 is a valid, reliable, and multidimensional measure of HRQoL in patients with heart failure, supporting its use in clinical practice and research.

Background/Objectives: The Global Lung Initiative (GLI) 2022 race-neutral spirometry reference equations were introduced to improve interpretability across populations; however, their performance in Middle Eastern adolescents remains insufficiently validated. This study evaluated the applicability of GLI-2022 among healthy Jordanian adolescents. Methods: Healthy adolescents were recruited from secondary schools across multiple Jordanian cities (July-November 2025). Spirometry was performed according to ATS/ERS standards using a single device and standardized procedures. GLI-2022 predicted values and z-scores were derived for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC. Calibration was assessed using mean (SD) z-scores and the proportion below the lower limit of normal (LLN; z < -1.645). Agreement between measured and predicted values was examined using Bland-Altman methods. LLN-based pattern classifications were compared with those obtained using the local reference equation and GLI-2012. Results: A total of 921 adolescents (482 males, 439 females; mean age 15.7-16.0 years) were included. GLI-2022 produced positive mean z-scores for FEV1 (0.51-0.73) and FVC (0.51-0.69), with low proportions below LLN for both indices (<2% in each sex), indicating underestimation of predicted lung volumes. Exact binomial testing confirmed that the observed proportions below LLN for FEV1 and FVC were significantly lower than the expected 5% in both sexes (all p < 0.001). The FEV1/FVC ratio showed smaller deviations (mean z 0.07-0.19), with 4.1% of females and 5.8% of males below LLN, and these proportions did not differ significantly from 5% (female p = 0.444; male p = 0.402). Mean observed-minus-predicted biases for FEV1 were +0.185 L in females and +0.306 L in males, and for FVC were +0.224 L and +0.351 L, respectively; FEV1/FVC bias was -0.15 percentage points in females and +0.60 percentage points in males. LLN-based pattern classification showed 98.7% overall agreement with the local equation and 99.7% with GLI-2012; concordance for obstructive and possible restrictive patterns was 93.5% and 100.0%, respectively. Conclusions: In healthy Jordanian adolescents, GLI-2022 appears to underestimate predicted FEV1 and FVC, yielding upward-shifted z-scores and fewer volume indices below LLN, while the ratio is less affected. Although LLN-based pattern classification was largely preserved, population-specific validation remains necessary before routine clinical adoption of GLI-2022 in Jordanian adolescents; extrapolation to other Middle Eastern adolescent populations should await additional regional validation.

BACKGROUND:Community pharmacists are well placed to support pain management, yet evidence on their knowledge, attitudes, and practices remains limited in some settings, including Jordan. OBJECTIVES:This study examined pharmacists' knowledge, attitudes, practices, perceived barriers, and training needs related to pain management among pharmacists working in patient-facing pharmacy settings in Jordan. METHODS:A cross-sectional survey was conducted among 408 licensed pharmacists working in community and hospital pharmacies in Jordan. A structured, self-administered questionnaire assessed pain management knowledge, counseling practices, perceived competence, regulatory knowledge, barriers to practice, and training preferences. Descriptive statistics and regression analyses were performed. RESULTS:Pharmacists demonstrated generally good foundational knowledge and high levels of engagement in patient counseling. However, gaps were identified in pediatric pain perception, analgesic safety, and the integration of nonpharmacological approaches. Fear of dispensing opioids and uncertainty around controlled substance regulations were the commonly reported barriers. Counseling frequency was positively associated with both objectively assessed knowledge and self-rated knowledge, with perceived competence showing a stronger association. CONCLUSIONS:Pharmacists in patient-facing pharmacy practice in Jordan play an active role in pain management but face gaps in applied clinical understanding and regulatory confidence. Practice-focused, guideline-based training may help strengthen pharmacists' contribution to chronic pain care.

Multiple sclerosis (MS) is a chronic neurological condition that often results in language and communication difficulties, significantly affecting patients' quality of life. While several tools have been developed internationally to assess these impairments, few are validated for Arabic-speaking populations. This study aimed to translate, culturally adapt, and validate the Arabic version of the Communication and Language Assessment for Multiple Sclerosis (CALMS) questionnaire, designed to evaluate communication difficulties in individuals with MS. A cross-sectional study was conducted with 307 MS patients recruited from Al-Bashir Hospital in Amman, Jordan. Participants completed the Arabic CALMS (A-CALMS) via an online survey. Psychometric evaluation included Rasch analysis and Confirmatory Factor Analysis (CFA). Model fit, internal consistency (Cronbach's alpha), person/item reliability, threshold ordering, and Differential Item Functioning (DIF) by sex were assessed. The partial credit model (sign) provided a better fit than the rating scale model. After reordering, all threshold parameters were properly ordered, and item/person fit statistics were acceptable. Internal consistency was excellent (α = 0.935); CFA supported a one-factor solution with good model fit (χ2/df = 1.82, RMSEA = 0.052, CFI = 0.987, TLI = 0.984). No significant DIF was found across sexes. A moderate positive correlation was observed between CALMS and MSIS-29 scores (r = 0.534, p < .001), supporting construct validity. The A-CALMS demonstrated strong psychometric properties and cultural relevance, making it a reliable, valid instrument for assessing communication and language difficulties in Arabic-speaking individuals with MS. Its use in clinical and research settings may enhance diagnostic precision and inform tailored interventions.

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes mellitus (DM). Data on the clinical characteristics of DKA patients and factors affecting length of hospital stay (LOS) in Jordan are limited. This study aimed to assess the clinical profiles of patients admitted with DKA to public hospitals in Jordan and to identify determinants of LOS. A validated questionnaire was used to collect demographic, clinical, biochemical, and treatment-related data from hospital records and patient verification. Data were analyzed using SPSS version 25.0. Most patients admitted with DKA had few comorbidities, with a mean LOS of 4.8 days. Male sex and newly diagnosed diabetes were associated with longer LOS. In contrast, higher educational level, regular glucose monitoring, and the use of injectable antidiabetic medications were significantly associated with shorter LOS. Additionally, acetone breath and generalized weakness were linked to reduced LOS. Routine glucose monitoring significantly shortened LOS (p = 0.006). Several clinical and behavioral factors significantly influenced LOS in patients with DKA. Early diagnosis, patient education, and consistent glucose monitoring may reduce hospitalization duration, while injectable therapies may be beneficial in recurrent DKA cases.

Purpose:The COVID-19 pandemic has led to long COVID-19, a condition characterized by persistent, multisystemic symptoms. This study validated the Arabic version of the Post-COVID-19 Symptom Scale (PCSS-Ar) to assess long COVID-19 severity in Jordan. Patients and Methods:A cross-sectional online survey was conducted with 582 Jordanian adults (aged ≥18 years), recruited via social media. The PCSS-Ar underwent content validity evaluation by an expert panel, followed by confirmatory factor analysis (CFA) and Rasch analysis to assess its psychometric properties. Results:The final 24-item, five-factor model demonstrated an excellent fit (CFI = 0.95, TLI = 0.95, SRMR = 0.02) and strong internal consistency (Cronbach's α ≥ 0.97). Rasch analysis confirmed the tool's ability to differentiate symptom severity levels effectively. Key findings indicated that higher frequencies of COVID-19 infection were significantly associated with more severe long COVID-19 symptoms, whereas mild initial infections were linked to lower symptom severity. Notably, lower income was associated with higher PCSS-Ar scores, suggesting socioeconomic disparities in post-COVID-19 recovery. Female participants had lower PCSS-Ar scores, contrasting with previous studies, indicating a potential population-specific effect. Conclusion:The PCSS-Ar is a validated and reliable tool for assessing long COVID-19 symptoms in Arabic-speaking populations. Its application in both clinical and research settings can help monitor symptom progression and guide targeted interventions.

Background:Pharmacists increasingly play clinical roles, yet patients often continue to view them primarily as dispensers. Misalignment in role expectations may undermine communication and the effective use of pharmacy services. Aim:This study aimed to examine the extent to which pharmacists and patients in Jordan share similar perceptions of their respective roles in the pharmacist-patient relationship. Methods:A cross-sectional survey was conducted from October 2024 to May 2025 with 403 pharmacists and 806 patients recruited from community pharmacies across Jordan. Participants completed parallel role perception questionnaires assessing multiple domains of pharmacist and patient roles, including information sharing and responsible behavior. Mann-Whitney U-tests were used to compare mean ranks between groups. Results:Pharmacists generally assigned higher mean ranks to both pharmacist and patient roles than patients did. For example, pharmacists reported greater agreement than patients on discussing medication side effects (mean rank 669.50 vs. 572.75, p < 0.001), helping patients manage medications (672.84 vs. 571.08, p < 0.001), and greeting patients at the prescription counter and collecting prescription information (640.53 vs. 587.23, p = 0.007). Pharmacists also rated patients' willingness to collaborate in medication management more highly than patients rated themselves (704.63 vs. 555.19, p < 0.001), indicating a consistent perception gap across the assessed roles. Conclusion:The findings highlight clear perceptual gaps between pharmacists and patients in Jordan regarding their respective roles, particularly in response behavior and information sharing. These gaps may influence pharmacist-patient interaction and collaboration, highlighting areas for further research and targeted interventions.

Three-dimensional (3D) printing offers new possibilities for producing personalized medicines within pharmacy practice. Given the United Arab Emirates' (UAE) status as a leader in healthcare innovation, understanding pharmacists' perspectives in this region is important for anticipating the potential factors that may hinder or facilitate the adoption of this technology in community pharmacy practice. Data were gathered through a cross-sectional survey of 423 licensed pharmacists practicing in community pharmacies across the UAE who were recruited through a convenience sampling approach. Respondents filled out a validated survey instrument assessing their awareness, attitudes, readiness to adopt 3D printing technology, and perceived barriers to its implementation. Recruitment took place both online and in person. The findings revealed high levels of awareness, positive attitudes, and strong readiness among participants regarding the use of 3D printing technology. Regression analysis revealed that pharmacists with medium (OR: 2.661; 95% CI: 1.176-6.022; p < 0.05) or high (OR: 5.4264; 95% CI: 2.517-11.009; p < 0.001) levels of perceived workload were more likely to fall into the high-awareness group compared with those reporting low workload. Moreover, those who were in charge of or owned the pharmacy were more likely to exhibit high awareness toward 3D printing (OR: 3.037; 95% CI: 1.758-5.246; p < 0.001). Conversely, longer working hours were linked to a decreased probability of being classified as having high attitudes (OR: 0.882; 95% CI: 0.832-0.935). Similarly, a moderate perceived workload increased the likelihood of high readiness toward 3D printing when compared with a perceived low workload (OR: 2.281; 95% CI: 1.117-4.661; p < 0.05), while spending more time with patients was linked to lower readiness (OR: 0.399; 95% CI: 0.169-0.529; p < 0.001). To conclude, pharmacists in the UAE demonstrated a strong inclination to integrate 3D printing technology into community pharmacy practice. However, barriers to adoption remain. Wider implementation is likely to require training, clear professional guidance, and practical strategies that address the concerns identified in this study.

Background Medication adherence is a vital element in the management of chronic diseases such as asthma, yet nonadherence remains a persistent challenge, particularly in regions with suboptimal health literacy (HL) levels. In the Middle East, where asthma prevalence is substantial, the association between asthma-related numeracy and adherence behaviors has not been sufficiently studied. This study aimed to assess the association between asthma-related numeracy, as one aspect of health literacy, and adherence to prescribed treatments among adult asthmatic patients. Methods A cross-sectional survey was administered to 400 adults with physician-diagnosed asthma attending a pulmonary clinic at a major Jordanian hospital. Asthma-related numeracy was measured using the Arabic Asthma Numeracy Questionnaire (Ar-ANQ), while adherence was assessed with the MARS-5 scale, with total scores >= 24 classified as high adherence. Asthma control was assessed using four symptom-control items. Logistic regression models estimated the odds of high adherence after adjustment for sociodemographic, medication, clinical, and numeracy-related variables. Results A total of 45.3% of the patients were classified as having high adherence. Higher Ar-ANQ scores were significantly associated with higher odds of high adherence (OR = 2.924, 95% CI: 2.249-3.801, p < 0.001). Low income (OR = 0.289, p = 0.001) and older age (OR = 0.966, p = 0.021) were significantly associated with lower odds of high adherence, while lower educational attainment showed a borderline association (OR = 0.518, p = 0.067). Conclusion Inadequate asthma-related numeracy was associated with lower adherence in Jordanian adults. Addressing disparities tied to age and income, while using numeracy-sensitive communication, may support medication adherence and asthma management.

INTRODUCTION:Communication difficulties are a common but under-recognized feature of multiple sclerosis (MS) and can affect quality of life, social participation, and engagement with health care. The extent to which communication functioning is associated with health literacy, medication beliefs, and adherence in MS remains poorly understood. METHODS:This cross-sectional study included 307 adults with MS recruited from Al-Bashir Hospital in Amman, Jordan. Participants completed validated Arabic versions of the Communication and Language Assessment Questionnaire for Multiple Sclerosis (CLAMS), the Health Literacy Survey-12 (HLS-Q12), the Beliefs about Medicines Questionnaire (BMQ), and the Medication Adherence Report Scale (MARS-5). Sociodemographic data were collected. Quantile regression analysis was used to examine associations between communication functioning and health literacy, medication beliefs, adherence, and sociodemographic factors. RESULTS:Communication difficulties were commonly reported, particularly problems with word finding, maintaining a train of thought, remembering information, and following conversations. Lower health literacy scores were significantly associated with higher CLAMS scores, indicating greater communication difficulties. Higher medication concern scores were also independently associated with poorer communication functioning. Lower educational attainment was linked to higher CLAMS scores. Medication adherence, necessity beliefs, age, sex, employment status, and income were not significantly associated with communication functioning in the adjusted model. CONCLUSION:Communication difficulties are prevalent among adults with MS and are closely linked to health literacy and medication-related concerns. Addressing these factors may support more effective communication, improved self-management, and better engagement with care.

AIMS:This study examined the association of health literacy with quality-of-life outcomes among Jordanian adults with chronic diseases using two patient-reported outcome measures, the Long-Term Conditions Questionnaire (LTCQ) and the EuroQol five-dimension, three-level questionnaire (EQ-5D-3L). It also compared conventional regression and machine-learning (ML) approaches for modelling these relationships. MATERIALS AND METHODS:In this cross-sectional online study, Arabic-language questionnaires were completed by Jordanian adults aged 18 years or older with at least one chronic physical, mental, or neurological condition. The survey, designed to take 10-12 minutes, included the LTCQ, EQ-5D-3L, Medication Adherence Report Scale (MARS-5), and 12-item Health Literacy Scale (HLS-Q12). A total of 901 complete responses were analyzed. Data were split into training (n = 633) and test (n = 268) sets. Multiple linear regression was used for LTCQ, Tobit regression for EQ-5D-3L index scores, and ML models were trained to explore nonlinear associations. RESULTS:Health literacy and medication adherence were positively associated with both LTCQ (beta = 3.923 and 2.219, respectively; both p < 0.001) and EQ-5D-3L index scores (beta = 0.025, p = 0.001; beta = 0.020, p = 0.009). Number of medications was inversely associated with both outcomes. In 10-fold cross-validation, Extreme Gradient Boosting (XGBoost) showed the lowest average root mean square error (RMSE) for LTCQ (9.18; coefficient of determination [R²] = 0.384) and EQ-5D-3L (0.172; R² = 0.193), although differences between the leading models were modest. CONCLUSION:LTCQ and EQ-5D-3L showed overlapping but distinct association patterns. LTCQ was more strongly linked with psychosocial and self-management variables, whereas EQ-5D-3L was more closely aligned with medication burden and clinical comorbidity. These findings should be interpreted as associative rather than causal and as differences in captured dimensions rather than evidence of instrument superiority.

Objective To assess diabetes mellitus-related knowledge, attitudes, risk perception, and preventive understanding among non-diabetic adults in Iraq. Methods This cross-sectional study used convenience, voluntary sampling to recruit adults aged 18 years or older without a prior diagnosis of diabetes mellitus from different regions of Iraq between June and October 2025. Participants completed a culturally adapted questionnaire assessing sociodemographic characteristics, diabetes mellitus knowledge, attitudes, information sources, and beliefs regarding prevention. Descriptive statistics, Mann–Whitney U tests, quantile regression, and binary logistic regression were used. Results The study included 874 participants. Nearly half (48.4%) reported a family history of diabetes mellitus. Common symptoms, such as frequent urination (89.9%) and excessive thirst (84.2%), were widely known, whereas less obvious symptoms, such as unexpected weight loss, were less well recognized. Awareness of some complications, such as loss of consciousness (94.2%) and amputation (93.8%), was high, while awareness of others, such as kidney damage (69.5%) and eye disorders (78.3%), was moderate. Quantile regression analysis showed significantly lower knowledge scores among participants without a medical background (β = −4.214, p < 0.001). In addition, higher knowledge scores were significantly associated with more positive attitudes toward diabetes mellitus (odds ratio = 1.179, 95% confidence interval: 1.108–1.255, p < 0.001), whereas older age was associated with less favorable attitudes (odds ratio = 0.545, p < 0.001). Conclusions Adults without diabetes in Iraq demonstrated a good basic understanding of diabetes mellitus; however, important gaps remain in knowledge of symptoms, complications, and key risk factors. These findings highlight the need for practical, evidence-based public health education to support prevention efforts and reduce the future burden of diabetes mellitus.

Background:The UAE's rapid economic growth and adoption of advanced healthcare technologies necessitate understanding pharmacists' perspectives on large language models (LLMs) to address implementation challenges and align with the nation's digital health initiatives. Aim:This study explored UAE pharmacists' perceived benefits, concerns, and barriers to LLM adoption, as well as factors contributing to heightened concerns in community pharmacies. Methods:A survey-based cross-sectional study was conducted among 528 community pharmacists (51.3% female) in the UAE between October and November 2024. Pharmacists completed a validated questionnaire assessing socio-demographic information, perceived benefits, concerns, and barriers related to LLM use. Binary logistic regression was applied to identify factors associated with concerns about LLMs. Results:The least-perceived benefits of LLMs included providing around-the-clock support (37.3%), designing personalized care plans (74.4%), and improving patient outcomes (77.0%). Barriers included the need for human supervision (54.7%), insufficient training (32.4%), lack of pharmacy-focused LLM programs (28.4%), and inadequate resources (28.4%). Key concerns were technical failures or downtime (97.5%), hacking vulnerabilities (97.2%) and limited capacity for empathy, cultural understanding, or ethical considerations in healthcare (95.6%). Increased age was significantly associated with greater concerns (OR = 1.124, p < 0.001). Conversely, pharmacists with master's or doctoral degrees (OR = 0.483, p = 0.008) and those likely to use LLMs in the future (OR = 0.357, p < 0.001) expressed fewer concerns. Conclusion:The integration of LLMs into community pharmacy practice faces challenges, including hacking risks, security vulnerabilities, insufficient empathy, and technical failures. Targeted interventions such as enhanced training, robust security measures, and tailored LLM solutions are essential to address these barriers and support safe adoption in pharmacy settings.