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. 2025 Jun 7;26(1):194.
doi: 10.1186/s12875-025-02845-7.

Patients' and clinicians' experiences of DIALOG+ in primary health care in Bosnia and Herzegovina: a qualitative interview study using thematic analysis

Nejra Selak  1   2 , Hana Sikira  3 , Meliha Kiseljaković  4   5 , Francois van Loggerenberg  6 , Stefan Priebe  7   8 , Alma Džubur Kulenović  9   10
Affiliations

Patients' and clinicians' experiences of DIALOG+ in primary health care in Bosnia and Herzegovina: a qualitative interview study using thematic analysis

Nejra Selak et al. BMC Prim Care. .

Abstract

Background: DIALOG + is a low-cost intervention proven to improve the subjective quality of life in patients with psychosis and anxiety disorders in low- and middle-income countries. In a recent study, DIALOG + was shown to be feasible for patients in primary care settings with long-term physical conditions and to result in an improvement in patient outcomes. The aim of this qualitative study was to explore the experiences of patients and clinicians using DIALOG + in Bosnia and Herzegovina to gain a better understanding of its impact in this setting.

Methods: In-depth semi-structured interviews were conducted with 11 patients and 4 physicians, as well as two focus groups with 5 patients in each, all of whom participated in the intervention. Specific life and treatment domains discussed during the sessions between patients and clinicians were also analysed to determine which domains were most frequently addressed and where patients needed the most support. The interviews were audio-recorded, transcribed, and analysed using thematic analysis.

Results: Four qualitative themes were identified: (1) DIALOG + structure and solution-oriented approach are helpful; (2) DIALOG + allows space for conversation; (3) Therapeutic relationship is improved, and (4) The intervention has its limitations.

Conclusions: DIALOG + is a novel primary care intervention with positive effects on patients' lives, which enhance primary care. Nevertheless, it presents a new challenge in this setting. It is necessary to make adjustments in primary care, such as providing clinicians with more extensive training and ongoing support, as well as providing more time for the intervention's implementation.

Trial registration: Study was registered prospectively within the ISRCTN Registry: ISRCTN17003451, 02/12/2020.

Keywords: Mental health service; Primary health care; Psychosocial interventions; Quality of life; Solution-focused.

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Conflict of interest statement

Declarations. Human ethics and consent to participate: All the methods in the study have been carried out by relevant human subjects research guidelines and regulations. The original study, including this, received positive ethical opinions from the relevant ethics committees both in B&H and the UK: The Clinical Centre University of Sarajevo School of Medicine Research Ethics Committee (Etički komitet Kliničkog centra Univerziteta u Sarajevu), approval received on 21/07/2020 and Queen Mary Ethics of Research Committee, ref: QMERC20.101, approval received on 27.01.2021. All participants who were contacted by a researcher were provided with a written information about the study and those patients who provided written informed consent proceeded to eligibility screening. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

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