Globally, disability affects over 1.3 billion people and is associated with poorer health outcomes, limited service access, and structural exclusion. The World Health Organization identifies disability inclusion as central to Universal Health Coverage and Primary Health Care (PHC), promoting integrated, people-centred services and hub-and-spoke models to bring specialist care closer to communities. Kenya’s constitutional and policy frameworks align with this vision, recognising disability assessment and certification as statutory public services. However, in practice, assessment has remained facility-based, sequential, and medically oriented, resulting in delays, high costs, and attrition, especially in rural areas. In Nakuru County, these gaps prompted piloting a PHC-aligned, multidisciplinary outreach model to deliver integrated, end-to-end disability assessment.Between October and December 2025, Nakuru County piloted a multidisciplinary PHC hub-and-spoke disability outreach across 13 sites in four sub-counties. Mobile community hubs enabled single-encounter medical, functional, and social assessment by integrated teams, supported by Community Health Promoters. Of 2,098 assessments, 1,670 were completed through outreach, compared with 428 routine facility-based assessments pending certification during parallel hospital-based service delivery period.Integrated multidisciplinary PHC assessments improved completion, equity, and access, but sustainability requires dedicated financing, appropriate infrastructure, advanced diagnostics, and planned workforce support to institutionalise community-based disability assessment.This experience demonstrates that community-anchored, multidisciplinary PHC disability assessment advances equity by reducing geographic, financial, and procedural barriers that disproportionately exclude persons with disabilities. Bringing assessment closer to communities improved completion, reduced caregiver burden, and enabled timely access to services. While system constraints persist, the model shows equity gains when disability assessment is treated as an integrated PHC function.As health systems advance toward UHC through PHC, disability assessment must be integrated by design and financed sustainably. This case shows hub-and-spoke models improve equity. Embedding assessments within the Social Health Authority benefits package enables reimbursement, supports scale-up, and institutionalises inclusive disability services.

France ranks among European countries with the highest perceived racial discrimination (Defender of Rights, 2025). Individuals reporting discrimination are 1.9 times more likely to have poor health (INSEE, 2024), yet few studies explore their health experiences.To explore how individuals experiencing racial discrimination perceive their health, identify their coping strategies, and examine discrimination’s effects on healthcare experiences.Phenomenological qualitative study. Population: 12 participants (11 women, 1 man, mean age 33 years), recruited via social media, self-reporting racial discrimination. Semi-structured interviews (average duration: 47 minutes) conducted between December 2023 and February 2024, audio-recorded and transcribed. Analysis: Interpretive phenomenological approach with experiential labeling, data triangulation by two researchers. Approval from the CNGE Ethics Committee, GDPR compliance, informed consent obtained.Participants described persistent hypervigilance, sleep disturbances, and anxiety, directly attributing these to repeated experiences of racial discrimination. Many reported intrusive memories of discriminatory events and a pervasive sense of alertness across professional, social, and healthcare settings. Coping strategies included self-censorship, overperformance to counter negative stereotypes, and linguistic or vestimentary adjustments to mitigate racial bias, all of which contributed to chronic psychological fatigue and emotional exhaustion. While most reported good physical health, some associated somatic symptoms like chronic pain or digestive issues with prolonged stress.Findings align with racial trauma theory (Carter, 2007), where chronic discrimination acts as a stressor causing psychological distress. The stereotype threat (Ka-Sy, 2013) and racial burden (Soumahoro, 2020) were evident in coping strategies like overperformance, reflecting the emotional labor of navigating bias. Distrust in healthcare mirrors studies showing racial biases in diagnosis and pain management (Benard, 2023; Fau, 2021). Preference for racialized physicians highlights the need for culturally concordant care (Saha et al., 1999). The link between stress and physical symptoms (e.g., fibromyalgia) supports frameworks of embodied inequality (Krieger, 2005), though the young sample (mean age 33) may limit physical health findings.Racial discrimination significantly affects perceived health, particularly mental well-being, and undermines trust in healthcare. Patient-centered approaches and provider training on unconscious bias are critical to address these inequities. Further research should explore long-term physical health effects and scalable interventions.

The French healthcare system should guarantee accessible, effective healthcare for all, regardless of their social level. This system is currently facing numerous challenges and the structural fragmentation between community-based general practice and hospital care contributes to difficulties in health system navigation for service users, disproportionately affecting populations facing the greatest barriers to care. As part of the creation of shared community-hospital positions, several general practitioners (GPs) split their time between a multidisciplinary healthcare center (HCC) and a public hospital in Paris.The objectives of this study were to assess the socio-demographic characteristics of patients managed at the HCC as part of this scheme and the factors associated with this management.Two physicians working part-time at the public hospital and part-time at the HCC saw patients who were not registered with a GP, referred by other hospital departments, in an inpatient assessment consultation. The aim was to set up a community-based follow-up within a HCC located near the hospital, where the same physicians would practice as GPs. Patients were included between November 2018 and November 2022. A retrospective, descriptive and analytical study of the medical files was conducted, with collection of the patients' medical and social data.Of 1,175 eligible patients, 725 were managed at the HCC. Patients starting to be followed at the HCC were significantly more likely to benefit from a state social protection scheme, reflecting a precarious social situation. The adjusted odds ratio was 2.13 [1.29-3.45] for the social protection of people in an irregular situation and 1.82 [1.16-2.78] for the means-tested social protection.This study was the first French study to assess the shared community-hospital position scheme. The large sample size allowed obtaining robust results in the multivariate analyzes.This study showed the importance of this innovative scheme for access to primary care for precarious patients, and the benefits of the collaboration between community medicine and hospitals.This innovative scheme, connecting the community and the hospital, attractive to physicians and ultimately allowing a more integrated healthcare system shows its relevance and needs to be financed and sustained, along with the implementation of measures with social and medico-economic impacts.

People experiencing social vulnerability face major barriers to healthcare access, and fragmented care pathways. Strengthening patients’ autonomy in health is essential in reducing social health inequalities. *** is a multidisciplinary care‑coordination and patient‑support programme implemented in * to assist adults experiencing social vulnerability and chronic conditions in acquiring autonomy in health. Given the diversity of user profiles and the multi‑level nature of its interventions, no existing standardised tool can adequately capture the multifaceted benefits of e.CARE’s accompaniment.To develop a co‑constructed evaluation tool measuring the level of health autonomy among adults experiencing social vulnerability.We used an innovative participatory design combining two qualitative approaches. (1) Nominal Group Technique—a structured consensus method—with health and social care professionals to generate, clarify, and prioritise evaluation items. (2) Think Aloud individual interviews with service users to assess item comprehension, identify ambiguities, and refine wording. Data were analysed thematically and triangulated to produce a consensual, user-validated tool.From 46 initial propositions, 22 were clarified, and 15 priority items were selected during the Nominal Group session. Think Aloud interviews revealed lexical barriers and the importance of concrete, accessible language. Based on user feedback, several items were reformulated or merged. The final tool comprises 13 items, capturing three interconnected dimensions: • Health literacy (understanding illness, treatment, rights) • Empowerment (self-efficacy, decision-making, perceived respect) • Navigation of the healthcare system (booking appointments, anticipating renewals, planning care).The participatory design is a major strength, combining a structured consensus method with direct user feedback to ensure relevance and acceptability. The small number of service users included in the Think Aloud phase remains a limitation. Importantly, completing the grid requires human accompaniment, as it fosters dialogue, clarifies misunderstandings, and supports users with low literacy. This co‑constructed tool offers a promising way to document changes in health autonomy and to evaluate the contribution of programmes such as e.CARE.This co-constructed tool, adapted for primary care, provides a practical way to assess health autonomy among vulnerable adults. Future work is needed to evaluate its acceptability and feasibility across diverse programmes supporting people in situations of social vulnerability.

In XXX, closed detention centres are administrative facilities for people with irregular migration status. Although not part of the penal system, they operate through carceral logics : surveillance, restricted movement, and institutional opacity. General practitioners (GPs) occasionally intervene in these settings despite the absence of a defined first-line mandate. The clinical encounter thus unfolds at the intersection of healthcare, migration control, and structural vulnerability.To explore and analyse how GPs and other external caregivers experience, understand and navigate the ethical, practical and emotional tensions involved in providing care within XXX closed centres.A qualitative, inductive approach grounded in the principles of in-home or insider ethnography. Fieldwork consisted of five visits to closed centres between May 2023 and May 2025 during voluntary GP missions. Data sources included a field journal, observation of clinical encounters and institutional routines, a recorded multidisciplinary focus group (GPs, psychologists, psychiatrists, lawyers), and documentary analysis. A reflexive thematic analysis was conducted.Six major tensions emerged. Practitioners described an emotional shock linked to the carceral environment and detainees’ distress. External GPs occupied an ambiguous position, moving between caregiver, evaluator and witness to institutional violence. Material and organisational constraints (limited access, scarce equipment, reduced confidentiality) strained the therapeutic relationship. Practitioners adopted adaptive strategies such as relational caution and selective engagement. Small acts of care served as micro-resistances that helped preserve a sense of ethical agency.These tensions reflect structural effects of a system oriented toward surveillance rather than care. Institutional configurations reshape the therapeutic relationship, constrain clinical judgment, and fragment the GP’s role. Closed centres create a significant “ethical burden" and the study highlights how context can fundamentally alter core principles of primary care such as continuity, confidentiality, and patient-centredness.Providing care in closed centres exposes GPs to significant ethical and emotional challenges. These results highlight the need for clearer institutional frameworks, specialised training on detention health and broader debate on the limits of healthcare within migration enforcement systems. Beyond clinical implications, this study also contributes to medical anthropology by documenting how institutional settings shape moral experience, professional identity and the possibilities of care within coercive environments.

Underrecognition of occupational diseases is a multifactorial phenomenon, beginning with insufficient reporting. Farmers are particularly vulnerable to health inequalities notably due to their specific relationship with healthcare. For them, the general practitioner is often the first and only point of contact, including for occupational health issues. This study explores the factors contributing to the underreporting of occupational diseases encountered by general practitioners (GPs) in their care of farmers.To identify the barriers perceived by general practitioners to the reporting of occupational diseases among farmers.A self-administered questionnaire was distributed to general practitioners working in rural or semi-rural areas within the five Territorial Professional Health Communities (CPTS) of northern XXX, excluding the urban areas of XXX and XXX. Data collection took place from October 2024 to May 2025. Descriptive analysis of frequencies and percentages was performed.Forty-five physicians participated, and thirty-eight questionnaires were included in the analysis. None of the respondents had received continuing medical education related to farmers’ occupational health within the past five years. 63.2% felt able to answer occupational health questions from their farming patients. 39.5% had never issued an Initial Medical Certificate (CMI) for an occupational disease. The most frequently reported obstacle was the existence of other possible etiological factors (81.6%), while the most limiting barrier was the lack of knowledge of the official occupational disease tables and their criteria. 86.8% of participants reported being unaware of the role of the Regional Committees for the Recognition of Occupational Diseases (CRRMP)Findings highlight a significant lack of training and resources among GPs regarding agricultural occupational health. Combined with regulatory complexity, this lack of means contributes to persistent underreporting, despite GPs’ central role in identifying potential occupational diseases.Although general practitioners are on the front line for farmers’ occupational health, they are not adequately equipped for this responsibility. Strengthening both initial and continuing education, improving collaborative and surveillance mechanisms, and developing practical consultation tools are key to enhancing recognition of occupational diseases in the agricultural sector.

The availability of specialist care is limited in underserved areas, like in the department of Lozère. Patients are compelled to seek consultations outside of Lozère, and sometimes they forego care altogether.This study aims to explore the factors that influence patients in underserved areas (example: Lozère) in their choice of specialist healthcare professional within their care pathway.This is a qualitative study. A thematic analysis was conducted based on semi-structured individual interviews with patients from Lozère, carried out from May 2023 to November 2024. The sampling was purposive with maximum variation. Triangulation of the analysis allowed for the identification of 7 themes and the achievement of data saturation after 10 interviews.The factors influencing a patient's choice are trust, the central role of the treating physician, the practitioner's reputation, the patient's self-management skills, and the anticipation of their specific needs. There is a limitation of available alternatives and a lack of knowledge about the healthcare options to make a choice.The choice of specialist physician is multifactorial and complex. The results highlight the need to improve information and access to specialist care in Lozère. The study emphasizes the importance of a patient-centered approach, while taking into account local specificities and the challenges related to medical desertification.Choosing a secondary care professional for a patient involves various determining factors. A patient-centered approach with AI assistance could help patients choose their practitioner.