Živanović Srđan, Pavlović Jelena, Hadživuković Natalija, Perkhofer Susanne, Podgorica Nertila
Department of Nursing, Faculty of Medicine, University of East Sarajevo, Studentska 5, Foca, 73300, Bosnia and Herzegovina.
Health University of Applied Sciences Tyrol, Innsbruck, Austria.
BMC Health Serv Res. 2025 Jul 1;25(1):845. doi: 10.1186/s12913-025-12958-5.
Dementia is a growing public health problem, particularly in low- and middle-income countries. Bosnia and Herzegovina (BiH), as a post-conflict LMIC with a complex administrative structure, currently lacks national guidelines, epidemiological data, and systematic approaches for dementia care. This study investigates healthcare workers’ attitudes toward dementia care and identifies both obstacles and practical opportunities for improving practice within BiH’s unique healthcare system.
A qualitative cross-sectional study was conducted in primary healthcare settings across Bosnia and Herzegovina, with 25 participants, including family medicine doctors ( = 10), nurses ( = 10), and psychologists ( = 5). The data were analyzed using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR).
Dementia care in BiH is predominantly reactive, with healthcare professionals typically responding only after families have expressed concerns. Participants reported inconsistent use of cognitive screening tools (e.g. MMSE, MoCA), largely due to insufficient training, lack of clear national guidelines, and varying institutional practices. Many clinicians felt unprepared and unsupported in managing dementia cases. Cultural stigma and widespread misperceptions of dementia as a normal part of aging contribute to delays in diagnosis and reduce the likelihood that families will seek help early. These barriers are exacerbated by a lack of national prevalence data and fragmented care pathways.
The findings of this study indicate the need to change the approach to dementia care in BiH through concrete and realistic measures within the existing systemic frameworks. Practice-based guidelines, culturally adapted tools for early detection, reactivation of community-based care, accessible education, a pragmatic approach to prevention, and local initiatives for awareness-raising and multidisciplinary care are recommended.
The online version contains supplementary material available at 10.1186/s12913-025-12958-5.
痴呆症是一个日益严重的公共卫生问题，在低收入和中等收入国家尤为如此。波斯尼亚和黑塞哥维那（波黑）作为一个冲突后低收入和中等收入国家，行政结构复杂，目前缺乏关于痴呆症护理的国家指南、流行病学数据和系统方法。本研究调查了医护人员对痴呆症护理的态度，并确定了在波黑独特的医疗系统中改善实践的障碍和实际机会。
在波斯尼亚和黑塞哥维那的基层医疗环境中进行了一项定性横断面研究，有25名参与者，包括家庭医生（10名）、护士（10名）和心理学家（5名）。数据采用基于实施研究综合框架（CFIR）指导的主题分析进行分析。
波黑的痴呆症护理主要是被动反应式的，医护人员通常只在家庭表达担忧后才做出回应。参与者报告认知筛查工具（如MMSE、MoCA）的使用不一致，主要原因是培训不足、缺乏明确的国家指南以及机构做法各异。许多临床医生在管理痴呆症病例时感到没有准备且缺乏支持。文化污名以及将痴呆症普遍误解为衰老的正常部分导致诊断延迟，并降低了家庭早期寻求帮助的可能性。缺乏国家患病率数据和护理途径碎片化加剧了这些障碍。
本研究结果表明，需要通过现有系统框架内具体且切实可行的措施来改变波黑的痴呆症护理方法。建议制定基于实践的指南、文化适应性强的早期检测工具、恢复社区护理、提供可及的教育、务实的预防方法以及提高认识和多学科护理的地方倡议。
在线版本包含可在10.1186/s12913-025-12958-5获取的补充材料。
