This study aimed to compare how healthcare professionals and laypeople from the UK engaged with and confronted misinformation about masks on social media and some of the barriers encountered, applying connectivism as a theoretical lens to interpret findings. Using thematic framework analysis, 12 in-depth interviews were conducted with participants consisting of seven healthcare professionals and five laypeople who actively use the social media website Twitter (now known as X). Interviews were recorded, transcribed verbatim and analysed iteratively using constant comparison and line-by-line coding. After coding of the first few interviews a working analytical framework was developed by comparing codes and grouping them together into categories. This was later applied to the subsequent interview transcripts. Analysis revealed six key categories: social capital (e.g., celebrity status), emotion (e.g., fear, anger, and burnout), culture (e.g., politics and toxic social media culture), social media dynamics (e.g., information overload), communication (e.g., managing cognitive load), and belief (e.g., beliefs being fixed and difficult to change). Our study suggests that healthcare professionals must actively engage with the public on social media by providing clear, evidence-based information, correcting false claims, and fostering trust through transparent communication. Interpreting our findings through a connectivist perspective highlights how digital networks shape trust and learning in online health discourse. Wider society, including tech companies and policymakers, should implement stronger fact-checking mechanisms, promote digital literacy, and support regulations that curb the spread of harmful health misinformation.
The use of advertising in healthcare is regulated strictly worldwide by ethical and legal regulations, yet its implications remain a matter of constant debate. This qualitative study examined the perceptions, approaches, and knowledge of private hospital managers in Istanbul concerning Türkiye’s healthcare advertising ban. In-depth interviews were used as the data collection method. Semi-structured, open-ended interviews were conducted with 12 managers working in private hospitals selected via purposive sampling. The participant group consisted of 4 general managers, 4 public relations managers, and 4 corporate communications and marketing manager. In terms of educational background, six participants held bachelor’s degrees, while the remaining six held postgraduate degrees. Data analysis was structured around an inductive thematic framework. As a result of the analysis, six main themes were identified: views on healthcare advertising bans; feelings about healthcare advertisements; views on healthcare advertising risks; willingness to advertise their own hospitals; knowledge of advertising regulations; comments on the distinction between promotion, information, and advertising. The findings indicated that most managers strongly support regulating healthcare advertising through legal frameworks. However, a major concern was identified as the uncontrolled rise of social media advertising and ethical breaches. Managers stressed that this trend complicates the distinction between advertising, promotion, and informational activities, thereby hindering patients’ access to accurate information. They emphasized that all hospital communication must strictly remain within ethical promotion and informational boundaries. Overall, the study highlights the critical importance of providers safeguarding patients’ right to accurate, unbiased information while avoiding misleading content. The findings offer valuable implications for policymakers to establish a more ethical and transparent healthcare communication environment.
'Positive Health' and 'recovery' seem to cover similar multidimensional health perspectives focussing on capabilities instead of incapabilities. The My Positive Health questionnaire and Individual Recovery Outcomes Counter were initially developed as dialogue tools, but nowadays also used as self-reported questionnaires. Structural validity of these dialogue tools was assessed in earlier research resulting in the 42-items Positive Health questionnaire (PH42) and 12-items Individual Recovery Outcomes Counter (I.ROC12). As a next step, we investigated their construct validity. An observational cross-sectional study was conducted in a representative general Dutch population (LISS-panel) determining (1) Coherence between the PH42 and I.ROC12 using correlation coefficients; (2) Convergent validity by testing hypotheses for PH42 and I.ROC12 with external health-related questions using correlation coefficients; (3) Discriminative validity for subgroups gender, age, educational level and healthcare use. (1) Nine out of twelve correlations between PH42 and I.ROC12 factors were substantial (> 0.5). (2) Hypotheses for PH42 and I.ROC12 factors with health-related questions were confirmed for 80% and 75%, respectively. (3) Scores on all factors increased (i.e., better health) from low to high educational level and decreased from no healthcare use to healthcare received from (medical) specialists. Only the factor physical health and functioning showed a continuous decrease in scores with increasing age. Women scored lower only on physical health and functioning. Convergent validity is adequate and discriminative validity is adequate for educational level and healthcare use supporting the conclusion that the PH42 and I.ROC12 are useful instruments to measure Positive Health in a general population.
This review synthesizes global trends, persistent challenges, and actionable pathways for overhauling public mental health systems, with a particular focus on low- and middle-income countries (LMICs). Thematic analysis of our review revealed that mental health disorders now affect nearly one in eight people worldwide, yet up to 75% of those in LMICs receive no treatment due to stigma, underfunding, workforce shortages, and fragmented systems, perpetuating a widening "treatment and care gap." Social inequities, harmful cultural norms, conflict, climate change, and gender disparities further amplify the risk and economic burden, projected to exceed US$6 trillion by 2030. Innovative financing approaches, including public-private partnerships and models from countries such as Norway and Australia, offer promising strategies for sustainable investments. The COVID-19 pandemic intensified mental health challenges but also raised global awareness, with leaders such as the United Nations Secretary-General and the United States Surgeon General foregrounding mental health crises in the public consciousness. Advocacy initiatives, including the FundaMentalSDG campaign, Lancet Commissions, Global Mental Health Action Network, and Global Mental Health Peer Network, have been pivotal in elevating mental health within the Sustainable Development Goals (SDGs) and linking it to social determinants. Emerging solutions include rights-based frameworks that emphasize participation and anti-discrimination, scaling up task-sharing and expanded roles for non-specialists through programs such as the World Health Organization's Mental Health Gap Action Programme, community-based interventions like Zimbabwe's Friendship Bench, and integration of mental health into primary care with dedicated counsellors, structured referral pathways, and digital innovations promising improved access and personalization. Sustained progress requires intersectoral collaboration across health, education, labor, and social sectors; embedding mental health into national health information systems; and investing in culturally adapted promotion and prevention interventions throughout the life course. Strengthening political commitment, global-local leadership, financing frameworks, and workforce capacity, particularly through continuous professional development and lived-experience participation, will accelerate progress toward the SDGs, underscoring the imperative for equitable financing and sustained political will globally.
Investments in public health and education are usually examined independently, but in developing countries, both are relevant to Sustainable Economic Development (SED). Within an integrated policy framework, this study aims to examine the complementary relationship between investments in health and education and their relationship with SED. A mixed-method approach was employed, consisting of 465 questionnaire responses from participants, including government officials, and 96 semi-structured interviews. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), quantitative data were analyzed, and to contextualize the statistical results, qualitative findings were involved. Results indicate that healthcare infrastructure, coupled with investment in health and education, communicable disease reduction, mental health services, and coordinated public investment, is positively and statistically related to SED. Explained variance is (R² = 0.100), showing that there is a moderate but meaningful contribution in the broader institution context. Findings contribute to existing literature by incorporating cross-sectoral modeling with qualitative institutional-level findings. It provides a more holistic understanding of the relation between coordinated human capital investments and developmental outcomes. These insights recommend integrating policies between the health and education sectors to support inclusive and sustainable development in low- and middle-income countries.
Experiencing meaning and fulfillment in healthcare work is recognized as important for those in nursing, medicine, respiratory therapy, social work, and other health disciplines. Critically, moral distress, compassion fatigue, staff burnout, and individual health have all been linked as related phenomena when such experiences are compromised. And yet, we may question whether we truly understand the meaning of meaningfulness and fulfillment. What calls health providers to come to work, again and again, despite the complex and difficult situations that they have to deal with? What are sources of meaning and fulfillment? How do we understand these phenomena? The context of newborn intensive care deserves special consideration as healthcare providers manage clinical acuity, respond to infant illness, support stressed families, navigate ethical decision-making, and work through complex team dynamics. In this paper, we explore and reflect on anecdotes of meaning and fulfillment as described by healthcare providers to explicate these phenomena.
Long COVID is a condition that arose during the COVID-19 pandemic in individuals who developed the multi-system chronic condition after a COVID-19 infection. During the pandemic in the United States (U.S.), these "COVID long-haulers" navigated a complex and overburdened health care system in pursuit of diagnoses and treatments. This qualitative secondary analysis used the 2013 Levesque et al. Conceptual Model of Healthcare Access to examine multidimensional health care access issues faced by 29 COVID long-haulers in the U.S. Our analysis showed that long-haulers faced complementary issues from both individual and health systems perspectives related to the inability to get diagnoses or treatments, long waiting times for providers and difficulty reaching services, underinformed providers and biased interpersonal experiences, and struggles with the financial costs of treating the condition, which impacted care decisions. Interviewees also described relying on alternative medicine to provide symptom relief. Overall, this study extends international research by offering a comprehensive examination of Long COVID health care access issues in the U.S. and identifying specific insights related to health care access that made obtaining Long COVID care difficult, such as the mismatch between individual expectations of what health care should look like and how it actually operates. Our use of the full Conceptual Model of Healthcare Access provides new insights into the overlap across layers of access issues and offers suggestions for how public health and clinical health practitioners can collaborate to meet the needs of vulnerable populations such as these in future health emergencies.
The US healthcare system is characterized by a persistent deadlock, where high costs, low efficiency, and inequity resist fundamental reform. This stalemate is rooted in deep ideological divides, political polarization, a fragmented fiscal structure, and the power of entrenched interest groups. This article analyzes how recent trade protectionist policies, specifically tariffs on pharmaceuticals and their inputs, intersect with this domestic gridlock. It posits a central paradox: a political system incapable of enacting major domestic health reform can simultaneously deploy assertive trade interventions in the same sector. The article argues that these tariffs should not be misconstrued as flawed instruments of healthcare reform. Instead, they represent the application of a distinct sovereigntist and protectionist logic, driven by national security concerns. The consequence is not a failed attempt at a solution, but a collision of policy agendas that actively exacerbates the healthcare system's core dysfunctions. By increasing costs, destabilizing supply chains, and creating new arenas for interest group conflict, tariffs intensify partisan strife and further entrench the reform deadlock. This process, marked by the "securitization" of the pharmaceutical industry, signals a critical shift in global health governance, where geopolitical strategy now overrides and complicates the pursuit of domestic public health goals.
Frailty is a major concern for healthy ageing, reflecting declining functional capacity and increased vulnerability. Beyond clinical implications, frailty raises questions about how health systems recognise vulnerability, allocate responsibilities, and ensure equitable care. These challenges align with the Sustainable Development Goals (SDGs). Health system readiness refers to the capacity of health systems to adapt policies, infrastructure, and operational processes to integrate frailty care into routine service delivery. In low- and middle-income contexts, frailty remains insufficiently embedded within health system frameworks, limiting coordinated responses. This study examines how readiness for frailty care is understood and enacted by frontline healthcare professionals. Using a qualitative design, five focus group discussions were conducted (March-July 2024) across healthcare settings in Indonesia and Malaysia. Nineteen participants, representing nursing, medicine, physiotherapy, and pharmacy, were purposively recruited. Data were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis supported by NVivo. Analytical rigour was enhanced through investigator triangulation, team-based coding, and member checking. Four interrelated themes reveal systemic gaps. Frailty remains largely invisible in policy and clinical frameworks; professional roles are fragmented and weakly coordinated; care responsibilities are displaced to families and communities; and structural resource constraints limit implementation. These findings indicate uneven readiness. Strengthening readiness requires alignment across governance, service delivery, and workforce capacity to address inequities in the distribution of care responsibilities. Frailty thus emerges as a critical lens for evaluating health system governance in ageing societies.
Voice biomarker research is fueling a growing health-tech market, largely driven by start-ups. Yet, there is limited scholarship on how start-ups navigate the legal uncertainty surrounding voice data protection and the rising expectations for responsible AI. This study reviews the ethical, legal and regulatory practices as stated on the websites of 27 start-ups using voice as a biomarker in health-tech. The review reveals substantial disparities in the availability, readability and content of the information disclosed, especially regarding privacy policies, with only a few websites offering product-specific, transparent, and comprehensive privacy policies. Significant differences also emerged in the start-ups' terms of use and regulatory compliance statements, likely reflecting the novelty of the field, disparity in legal and regulatory requirements, and the absence of sector-specific ethical guidance. For example, while most start-ups reference compliance with data protection frameworks (e.g., HIPAA, GDPR), many fall short of best practices for transparency, accountability, and user-centered communication. We argue that the success of start-ups in health-tech depends on their capacity to capture and retain the attention of potential end-users and investors. By adopting accessible, transparent and forward-looking communication on how they frame their legal and ethical responsibilities in practice, start-ups can not only ensure legal and regulatory compliance but build trust and support sustainable innovation. This work identifies key best practices for voice AI start-ups to consider and lays the foundation for future research, including surveys and longitudinal tracking, to better understand the evolving landscape of ethical and legal practices in voice biomarker and voice AI health-tech.
This study presents a four-step methodology to analyze and improve the provision of high-complexity healthcare services (HCHS) at national level: (i) data analysis and identification of municipalities with a concentration of HCHS provision, referred to as supplier municipalities; (ii) measurement of accessibility to supplier municipalities; (iii) identification of new facility locations through optimization techniques; and (iv) determination of the level of service provision required at the new locations. The proposed methodology is applied to the case of Colombia, where 65.25% of deaths occur in medical facilities. An analysis of the national database shows that in supplier municipalities, 92.8% of residents die in the same municipality, whereas in other municipalities this proportion decreases to 55.2%, indicating travel patterns among critically ill patients to supplier municipalities. Optimization methods are then used to identify locations for new HCHS facilities; the addition of 10 new locations improves coverage for 3,842,920 inhabitants within a 120 km range of HCHS.
Third-party consent, while common in medical practice, presents complex ethical dimensions and intricate legal connotations. In Malaysia, the absence of comprehensive legislation governing third-party consent for adults lacking decision-making capacity due to temporary conditions creates profound dilemmas for healthcare professionals. This article critically examines these challenges through a compelling case study of an 18-year-old female with respiratory failure who required immediate invasive intervention but did not receive consent from her mother. Despite medical urgings and a favourable prognosis, the mother's refusal highlights the difficulties healthcare providers face when navigating between their ethical obligations to act in the patient's best interests and the patient's family's wishes. Employing a dual analysis from ethical and Malaysian legal perspectives, the study explores the tensions between universal medical ethics-particularly the principles of autonomy, beneficence, and non-maleficence-and the existing Malaysian legal framework. It reveals contradictions between the Malaysian Medical Council's guidelines, which appear to grant decision-making authority to family members, and English common law principles that emphasise acting in the patient's best interests, especially in emergency situations. This inconsistency generates significant uncertainty for healthcare professionals, potentially compromising patient care and exposing physicians to litigation when acting without explicit consent. Through systematic examination of both emergency and non-emergency scenarios, the article underscores the urgent need for comprehensive legislation in Malaysia to address third-party consent, particularly for patients not covered by the Mental Health Act 2001. It advocates for laws that clearly differentiate between emergency and non-emergency situations, delineate the authority of relatives and legal guardians, and align with international practices and fundamental medical ethics principles. By harmonising legal statutes with ethical imperatives, Malaysia can resolve the contradictions that currently jeopardise patient welfare and physician security. These findings have important implications for healthcare policy development and clinical practice, emphasising the necessity for ethical and legal coherence in medical care in Malaysia.
The COVID-19 pandemic presented unprecedented challenges for health and social care practice worldwide. Ensuring effective collaboration between health and social care is essential to meet population health needs- especially during crisis. Interprofessional education for collaborative practice (IPECP) during students' pre-licensure education is an important primer for collaboration in practice. Within IPECP, students are provided opportunities to learn about, with, and from each other, lending to professional and interprofessional socialization and processes of developing an interprofessional identity. Few studies have followed health professions graduates longitudinally from pre-licensure into professional practice to understand how IPECP supports new professionals' readiness for collaborative practice. The COVID-19 pandemic coincided with the timing of this longitudinal study of students' experiences of IPECP and collaboration upon entry to practice. This interpretive, narrative analysis provides novel insights to how collaboration was experienced during the pandemic and implications for interprofessional identity development. The participant narratives provide insight into the contexts, settings, and experiences that were critical catalysts for connection and collaboration between professionals. Findings support a need for IPECP throughout pre-licensure and into practice and provides important direction for innovative curricula, policy and practice development to prepare future collaborative practitioners and interprofessional teams.
This article examines how the platformization of medical work has been reconfiguring the ethical, relational, and subjective dimensions of healthcare in the Brazilian context. Drawing on contributions from economic sociology, it argues that the growing mediation of medical practice by digital platforms, managerial protocols, and market-oriented rationalities exceeds strictly technological or organizational changes, constituting a sociotechnical reorganization of care. Based on the concepts of disembedding, contested markets, and emotional labor, the article examines how the fragmentation of labor ties, the intensification of emotional demands, and contractual instability affect professional autonomy, therapeutic continuity, and the construction of trust between physicians and patients. In Brazil, these transformations become particularly relevant given the accelerated expansion of the medical workforce, regional inequalities, and the increasing incorporation of managerial mechanisms and digitally mediated infrastructures in both the private sector and the Unified Health System (SUS). It is argued that the contemporary precarization of medical work affects not only labor conditions but also weakens the ethical and relational foundations that guide healthcare. Finally, the article argues for strengthening stable institutional ties, conditions for attentive listening, and forms of work organization capable of preserving the relational, collective, and ethical character of medical practice.
This mixed-methods study examines the push-pull factors influencing physician emigration from Turkey and assesses the feasibility of reverse brain drain, framing physician migration as a challenge for health governance rather than merely an individual career choice. Quantitative data from 1331 physicians (700 specialists, 631 interns) across 19 provinces and qualitative interviews with 32 emigrated physicians in four destination countries reveal that violence against healthcare workers (81.6%), low salary (74.3%), and challenging working conditions (59.8%) constitute the primary push factors. A statistically significant negative correlation between job satisfaction and brain drain attitudes (r = - 0.132, p < 0.01) confirms an association but explains only limited variance, indicating that structural and systemic conditions matter beyond individual satisfaction alone in shaping migration orientations. The qualitative findings identify professional burnout, performance system dysfunction, and sociopolitical instability as additional drivers. Only 2 of 32 emigrated physicians were considering return, and no female participant expressed return intention. Drawing on the ethics of health workforce governance, the study argues that when the state fails to protect physicians from violence and provide sustainable professional conditions, the normative responsibility for brain drain shifts from the emigrating individual to the institutional structures that render emigration rational. Policy interventions targeting salary alone are insufficient; comprehensive reforms in professional safety, meritocratic career pathways, workload standards, and sociopolitical stability are required.
The recent tragic death of UnitedHealthcare CEO Brian Thompson has renewed public scrutiny of the US health care system and reignited debate over why Americans face disproportionately high health care costs. This essay examines both the widely recognized drivers of excessive costs and the deeper systemic issues that often remain unaddressed yet continue to sustain the crisis. It highlights two critical challenges: the need to target structural barriers and misaligned economic incentives in order to design sustainable reforms, and the persistent political polarization that impedes long-term, meaningful change. The paper concludes by outlining short-term strategies that can generate immediate improvements while laying the foundation for comprehensive and enduring reform.
Integrating artificial intelligence (AI) in healthcare has sparked innovation but exposed vulnerabilities in regulatory oversight. Unregulated "shadow" AI systems, operating outside formal frameworks, pose risks such as algorithmic drift, bias, and disparities. The Comprehensive Algorithmic Oversight and Stewardship (CAOS) Framework addresses these challenges, combining risk assessments, data protection, and equity-focused methodologies to ensure responsible AI implementation. This framework offers a solution to bridge oversight gaps while supporting responsible healthcare innovation. CAOS functions as both a normative governance model and a practical system design, offering a scalable framework for ethical oversight, policy development, and operational implementation of AI systems in healthcare.
Contemporary health care discourse increasingly recognises the need to move beyond purely functional and optimisation-based models of health. Yet prevailing approaches often fragment the human person into biological, psychological, and-when included-spiritual domains, without a coherent anthropological basis capable of integrating them. This article introduces Holostasis as an anthropological framework in which health is understood as personal orientation sustained through change-a stability-in-change proper to personal existence, distinct from equilibrium-based or functional conceptions. Rather than proposing a physiological mechanism or an operative clinical model, Holostasis is articulated at a pre-clinical and epistemological level, offering a conceptual criterion for rethinking health and illness from the unity of the person. Drawing on philosophical anthropology and the philosophy of medicine, the paper distinguishes Holostasis from regulatory notions such as homeostasis and allostasis, as well as from additive holistic and integrative approaches. It develops an account of health as continuity of meaning, orientation toward truth, and relational integrity, including conditions of vulnerability, illness, and functional limitation. By foregrounding the therapeutic relationship and the limits of optimisation paradigms, Holostasis is proposed as an open interpretative contribution to contemporary debates on personhood, health, and person-centred care.
While ethnic disparities in appendicitis outcomes have been previously documented, limited data exist regarding their influence on the incidence of complicated appendicitis within population covered by universal health insurance. This study aimed to assess whether ethnicity (Israeli Jewes vs. Israeli Arabs) is independntly accosioated with the risk of complicated appendicitis in the context of Israel’s universal healthcare system. All adult patients who underwent appendectomy at our institution between January 2010 and December 2021. The primary outcome was appendicitis severity, categorized as complicated or uncomplicated based on pathology reports. Secondary outcomes included length of hospital stay and rehospitalization within six months. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complicated appendicitis. A total of 2,943 patients were included. In the multivariable logistic regression analysis, prolonged in-hospital delay before surgery exceeding 12 h increased the risk of complicated appendicitis (OR = 1.41; 95% CI: 1.14–1.75; p = 0.002). Age over 60 years doubled the risk of complicated appendicitis compared to younger patients (OR = 2.42; 95% CI: 1.81–3.24; p < 0.001). Although Jewish patients were older and had higher rates of complicated appendicitis, ethnicity was not independently associated with complicated appendicitis after adjustment for age, comorbidities, and surgical delay. Ethnicity was not an independent risk factor for complicated appendicitis in a population with universal health coverage. Older age and prolonged in-hospital delay were the primary predictors of complicated disease.
There are numerous ways to improve the quality of healthcare services, and Quality Improvement (QI) tools play a central role in this. These tools are essential for identifying problems, reducing errors and costs, modifying practices, generating innovative ideas, acquiring and analysing data, visualising issues, and supporting decision-making. Using them effectively promotes healthcare quality, patient safety, and optimal resource utilisation. Despite the importance of QI tools, the lack of systematic and comprehensive data on the frequency and purpose of their use in healthcare facilities constitutes the main problem area of this study. This descriptive and cross-sectional study examines the frequency and purpose of QI tool usage among quality managers in hospitals across Türkiye. The study population comprised quality managers from 248 hospitals who fully completed the survey. It focused on the use of 18 widely recognised QI tools, including Brainstorming, Fishbone Diagram, Five Whys, Flowchart, Control Chart, PDCA Cycle, FMEA, Histogram, Scatter Diagram, Process Mapping, and others. The results indicated that the least known tools were the Swiss Cheese Model, Spaghetti Diagram, Six Thinking Hats, House of Quality, Mapping the Last Ten Patients, Tree Diagram, and Pareto Chart. Conversely, Brainstorming, Fishbone Diagram, Five Whys, and Flowcharts were the most frequently used. QI tools were primarily used for generating ideas, visualisation, identifying problems, and analysing them. Significant differences in tool usage were observed based on experience in healthcare and quality roles. The findings underscore the complementary nature of QI tools and the need for enhanced training and awareness.