To explore how pre-existing conditions affect the diagnostic process for potential cancer in primary care patients.

Qualitative interview study using thematic analysis underpinned by a critical realist approach.

Primary care practices recruited through four Clinical Research Networks and UK health charities across England.

Interviews were conducted with 75 patients with one or more pre-existing conditions (anxiety/depression, diabetes, obesity, chronic obstructive pulmonary disease, Parkinson’s disease or multiple long-term conditions (four or more)) and 28 primary care professionals (general practitioners and nurses).

The study identified legitimacy as a central theme influencing patient trajectories in the health system while trying to receive a diagnosis for symptoms with which they presented to primary care. Patients engaged in self-triage to determine whether symptoms were ‘legitimate’ enough to seek care. Subsequent triaging steps (by receptionists, nurses and online systems) acted as gatekeepers, with decisions influenced by effectiveness of describing the symptom and subjective impressions. During consultations, clinicians relied on a mix of symptom narrative clarity, medical history and objective ‘metrics’ (eg, blood results, family history) to determine legitimacy for further investigations. Pre-existing conditions could either lower the threshold for referrals or obscure potential cancer symptoms. The stigma associated with mental health diagnoses often undermined perceived legitimacy and contributed to delays.

Legitimacy is continuously negotiated throughout the diagnostic pathway. It is shaped by social, moral and biomedical judgements. To promote early cancer diagnosis for patients with pre-existing conditions, clinicians must make legitimacy assessments explicit, reduce stigma especially around mental health and standardise triage processes.

This study aims to assess the level of cardiovascular disease (CVD) risk and its associated determinants among hypertensive patients in Jigjiga, Somali Region, Ethiopia using the WHO 10-year CVD risk score.

An institution-based cross-sectional study design was employed.

Hypertensive patients aged 40–74 years in two public hospitals in Jigjiga, Somali Region, Ethiopia, from 20 December 2023 to 20 February 2024.

Randomly selected 344 hypertensive patients aged 40–74 years with a duration of 1 year or more from the time of diagnosis and at least having 6-month follow-up.

10-year CVD risk level was assessed by using WHO 10-year CVD risk score. Risk levels were categorised as low (

Associated factors influencing CVD risk.

The study included 341 hypertensive individuals, with a 99.1% response rate. Of the respondents, 58.9% were men. The overall prevalence of CVD risk within the coming 10 years was 134 (39.3%; 95% CI: 34.1% to 44.5%). Multivariable logistic regression analysis identified age, khat chewing, smoking and comorbid conditions as significant independent predictors of CVD risk. Specifically, individuals aged 60–69 years had an adjusted OR (AOR) of 3.97 (95% CI: 1.94 to 8.16) and those aged 70–74 years had an AOR of 2.99 (95% CI: 1.57 to 5.71). Khat chewers had an AOR of 2.58 (95% CI: 1.22 to 5.46), smokers an AOR of 3.44 (95% CI: 1.59 to 7.48) and individuals with comorbidities an AOR of 2.42 (95% CI: 1.47 to 3.99).

There is a significant increase in 10-year CVD risk among hypertensive patients in the study area. Age, khat chewing, smoking and comorbidities were independent predictors. Regular CVD risk screening for older patients, focused health education to reduce khat and tobacco use and integrated management of comorbidities are essential to lower future cardiovascular risk.