Keywords: Male circumcision, primary care, systematic review, weighted trend analysis

Background:

Male circumcision is nearly universal in Türkiye and represents a culturally embedded practice with important public health implications. Historically, circumcision has often been performed outside formal healthcare settings by non-medical practitioners. However, long-term population-level evidence describing changes in provider type and care setting is limited, and methodological guidance on synthesising heterogeneous retrospective data in primary care research remains scarce.

Research questions:

How have male circumcision practices in Türkiye changed between 1996 and 2026 with respect to provider type (physician vs non-physician) and care setting (healthcare facility vs non-medical environment), and how can participant-weighted analyses be applied to long-term primary care practice transformations?

Method:

A systematic review (1996–2026) was conducted in Türkiye following established reporting standards and presented as an applied methodological example for primary care research. Eligible studies reported denominator-based proportions for circumcision provider and/or setting; outcome-defined clinical series and single-centre surgical case series were excluded to reduce selection bias. Data were pooled by publication year and analysed with participant-weighted linear regression (weights = sample size), interpreted within a public health and primary care framework.

Results:

Male circumcision practices in Türkiye have shifted from non-medical, community-based settings toward physician-led, healthcare facility-based care over the past three decades. Participant-weighted trend analyses showed a overall increase in physician-performed circumcision and facility utilisation across studies, robust across large population-based samples. Nevertheless, several studies reported persistent reliance on non-medical providers in rural and socioeconomically disadvantaged settings, indicating uneven integration into formal healthcare services and highlighting challenges in interpreting long-term, heterogeneous care data.

Conclusions:

Circumcision practices in Türkiye have substantially medicalised over time, yet gaps remain. Beyond its substantive findings, this study provides a practical example of addressing bias, weighting, and incomplete demographic reporting in long-term primary care research. Primary care plays a pivotal role in ensuring continuity, equity, and integration of culturally rooted practices into regulated health systems.

Points for discussion:

How can primary care better address culturally embedded procedures while ensuring patient safety and continuity of care?

What role should family physicians play in reducing rural disparities in access to minor surgical services?

Can participant-weighted trend analyses be extended to other long-term primary care transformations when individual-level demographic data are unavailable, and how can study-level normally distributed age data be responsibly integrated into regression models?