This study investigates how different formative-summative assessment weight configurations affect evaluation validity and discriminatory power in a landscape architecture planning and design course, in the context of contemporary undergraduate education evaluation reforms in China. A randomized controlled experiment with 90 landscape architecture students at a provincial university in eastern China implemented three weight allocation schemes: 30%:70%, 50%:50%, and 70%:30% (formative: summative). Validity analysis, discrimination analysis, and curve fitting were used to examine the effects of weight configuration on assessment quality. The findings indicate that (1) weight configuration has a pronounced nonlinear effect on evaluation validity: the balanced configuration (50%:50%) yielded higher validity (r = 0.845) than both the traditional (30%:70%, r = 0.723) and process-oriented configurations (70%:30%, r = 0.776), with validity approaching its optimum near a formative weight of approximately 53%; (2) the effect of weight configuration on discriminatory power exhibits diminishing marginal returns: the process-oriented configuration produced the highest discrimination index (D = 0.435), followed by the balanced configuration (D = 0.412), both substantially exceeding the traditional configuration (D = 0.325)-when validity and discriminatory power are considered jointly, a formative weight of approximately 55% yielded stronger overall performance; and (3) different competency dimensions respond differentially to assessment approaches-site analysis and design thinking showed higher validity under formative assessment, whereas spatial composition and communication skills were more effectively captured by summative assessment. This study provides empirical evidence and an adaptable methodological framework for evidence-based refinement of assessment systems in design courses.
Formative evaluation is widely used in implementation science to anticipate barriers and facilitators prior to the deployment of health technologies, typically relying on stakeholders' reported beliefs collected before real-world exposure. This approach has proven informative for many digital health tools; however, its application to immersive and embodied technologies such as extended reality (XR) warrants closer scrutiny. Most XR interventions in health care are delivered through head-mounted displays, which depend on spatial perception and sensorimotor engagement. Several implementation-relevant properties, including comfort, perceived intrusiveness, safety, and workflow disruption, often become apparent only through direct interaction. At the same time, large segments of the health care workforce remain XR-naive, such that preuse judgments are frequently shaped by anticipation rather than experience. Drawing on concepts from implementation science, grounded cognition, and human-computer interaction, this Viewpoint examines a plausible interpretive problem in XR adoption and argues that perception-based formative evaluation, when applied through frameworks developed for screen-based technologies, may misclassify barriers and facilitators. Rather than questioning formative evaluation as a methodological approach, we identify a boundary condition for its interpretability in experience-dependent technologies and propose a pragmatic refinement: incorporating brief experiential familiarization before eliciting stakeholder perceptions to strengthen early-stage assessment and improve alignment with real-world implementation decisions.
Providing high-quality family planning services is one of the cornerstones for improving maternal and child health outcomes, and the intrauterine contraceptive device (IUD) is among the most cost-effective contraceptive methods available. Despite this, IUD use among women in Meghalaya remains very low. There is a strong need to understand the gaps in our system and monitor the delivery of services in order to optimize the existing services and ensure that the right impact is achieved in the community. To address this gap, a multiphase implementation research project, which included a Formative phase, Co-Implementation phase, and Iteration and Dissemination phases, was undertaken to increase IUD uptake. The formative phase of the study aimed to assess knowledge, attitudes, and practices (KAP) related to IUD use and to identify key barriers to its uptake. This research study has been planned to facilitate the coming together of all stakeholders across the broad spectrum of health systems to ensure maximizing the beneficial impact of using the IUCD as a spacing device. The Formative phase utilized a mixed-methods design combining a quantitative method via a cross-sectional KAP survey (n = 1,064), along with the qualitative methods (49 in-depth interviews and three focus group discussions). A KAP survey assessed KAP; qualitative interviews and focus group discussions (FGDs; guided by the WHO Health Systems Framework) explored barriers and facilitators to IUD uptake. East Khasi Hills and Ri Bhoi districts were chosen, covering urban, semiurban, and rural settings across Subcenters, Primary Health Centers, Community Health Centers, and a tertiary hospital. A KAP survey assessed KAP; qualitative interviews and FGDs explored barriers and facilitators to IUD uptake. Awareness of contraception was high (1,015 (95.4%) and 959 (90.1%) specifically for IUDs), but only 141 (13.3%) had ever used an IUD. Common barriers included fear of side effects, myths/misconceptions, spousal/family disapproval, and inadequate counseling. IUD use was more frequent among women with more than two children and an older youngest child. Despite widespread awareness, IUD uptake remains low due to persistent sociocultural barriers and health system gaps. Targeted counseling, strengthened provider training, and male engagement are essential to overcome these barriers and improve IUD uptake. Bridging this divide requires context-specific strategies that strengthen provider competence, foster community trust, and engage both men and families in open dialogue.
Legitimacy is defined as the generalized perception that an entity's actions are appropriate within a socially constructed system of norms, values, and beliefs. While this concept is well established in organizational literature, consumer perceptions of food quality labels' legitimacy remain underexplored. To address this gap, we adapted the organizational legitimacy framework-cognitive, regulative, pragmatic, and moral dimensions-to the context of quality labels and developed a corresponding measurement instrument. Perceived legitimacy was conceptualized as a second-order formative construct composed of four first-order formative dimensions. Using a mixed qualitative-quantitative approach, we designed and validated indicators for each dimension. Our methodology involved: • Qualitative exploration to generate indicators aligned with each legitimacy dimension. • Quantitative validation through a survey of 600 French consumers. • Partial Least Squares (PLS) modeling to test reliability and validity. This article details the development process and validation of the proposed instrument. Despite some contextual limitations, the model offers a novel framework for understanding the multifaceted nature of legitimacy in consumer evaluations of labels. The results confirm the relevance of legitimacy as a construct in label studies and provide useful insights for consumer behavior research. The method can be replicated in other labeling or geographical contexts.
As telehealth has become an increasingly common mode of care delivery, older adults may face structural, technological, and interactional barriers that limit their ability to engage with video-based care. Although digital ageism, defined as the presence of age-related stereotypes, lowered expectations, or assumptions about older adults' technology-related competence, has been described in prior literature, less is known about how such dynamics surface during real-time telehealth encounters and how they may shape participation in technology-focused clinical trials. This formative ethnographic study aimed to (1) document real-world barriers encountered by older adults immediately before and during video telehealth visits and (2) inform recruitment and implementation procedures for a subsequent telepharmacy randomized controlled trial. We conducted in-home, real-time ethnographic observation of 20 community-dwelling veterans aged ≥65 years participating in pharmacist-led video visits for medication management. Recruitment occurred over approximately 6 to 10 months using mailed invitation letters (>300 sent), supplemented with outbound telephone calls. Data sources included structured field notes completed independently by an in-house anthropologist and the remote clinical pharmacist, as well as observational documentation of previsit preparation, visit navigation, and postvisit reflections. Data were analyzed using qualitative rapid analysis, with iterative team review and triangulation across data sources. Participants had a mean age of 74 (SD 3.18) years; 19 of 20 (95%) were male, and 18 of 20 (90%) identified as White. All participants completed a video visit with technical support as needed. Structural barriers (eg, broadband access and device availability) and usability challenges (eg, audio-video setup and navigation) were common. Although digital ageism was not a predefined analytical category, age-related assumptions about technology emerged during observation, including participants attributing anticipated or experienced difficulties to age and expressing surprise or pride following successful completion of the visit. These age-related interpretations were analytically distinct from access and usability barriers and were interpreted as manifestations of digital ageism, particularly as internalized age-based expectations. Formative ethnographic observation provided critical insights into how older adults experience telehealth encounters in real-world contexts and informed adaptations to recruitment and implementation procedures for a subsequent randomized controlled trial. Although digital ageism was not an original study aim, age-related assumptions about technology emerged as an important interpretive factor shaping engagement with video-based care. Incorporating ethnographic methods prior to trial implementation may help identify otherwise overlooked barriers and improve the inclusivity and feasibility of technology-focused clinical research involving older adults.
Hispanic people with HIV who smoke cigarettes experience unique stressors (eg, stigma), which contribute to health disparities. Anxiety sensitivity (AS) may worsen mood management problems, which are a leading barrier to smoking cessation. Interventions targeting AS can improve HIV-specific outcomes and smoking cessation. However, no prior research has culturally tailored an AS reduction program to improve quality of life among Hispanic people with HIV who smoke. The research team previously developed a mobile health (mHealth) intervention addressing AS reduction, smoking cessation, and HIV care management for Black people with HIV who smoke. Building on this work, this study represents a formative, exploratory phase to develop culturally tailored mHealth content for Hispanic people with HIV across 3 distinct regions (Mexico, Central America, and South America), which share many similarities but differ in some cultural and linguistic respects. This work will inform the refinement of materials for these groups and the future development of an integrated mHealth app for smoking, AS, and HIV among this population (ie, VITAL). This study aimed to culturally tailor evidence-based smoking cessation content targeting AS reduction and HIV management among Hispanic adults to inform the development of the VITAL mHealth program. Intervention content was culturally adapted using a theory-informed intervention adaptation framework that integrated a cultural considerations document derived from existing literature on smoking cessation and HIV care among the Hispanic population, along with iterative consultation with a Community Research Advisory Board. This resulted in linguistically tailored content in English and Spanish. The pilot study consisted of Hispanic people with HIV who smoke (N=80), divided into 3 subgroups: Mexican/Mexican American, Central American, and South American. Participants completed self-report assessments and a semistructured interview assessing the treatment videos for content relevance, appropriateness, and ease of understanding. Interviews were conducted online in Spanish or English by trained interviewers. Interview transcripts will be coded by a multidisciplinary qualitative team using a 2-pass approach: initial coding of the interview question followed by higher-level concepts. Themes will be reviewed by another member of the team to assess trustworthiness, saturation, and triangulated with quantitative data, then analyzed by geographic subgroup. Three linguistically tailored versions of the intervention materials were developed. Data collection began August 19, 2024, and finished June 26, 2025. Data cleaning is ongoing, and analyses will begin in April 2026. Content refinement and app integration are anticipated to be completed by September 2026. Upon completion of analysis, data will be used to further refine culturally tailored intervention content for Hispanic adult subgroups. This formative pilot study will inform the cultural adaptation and refinement of an mHealth app, VITAL, which will be tested in a subsequent randomized controlled trial to improve health disparities and assist Hispanic people with HIV in quitting smoking.
Outdoor secondhand smoke (SHS) remains a public health concern, particularly around designated outdoor smoking areas where nonsmokers may pass through or remain nearby. Although prior studies have quantified outdoor SHS concentrations, fewer have examined how many people may be present within a plausible exposure setting. Estimating the exposure-opportunity level requires methods that are feasible, scalable, and minimally intrusive. This study aimed to evaluate the feasibility of using passive Wi-Fi packet sensing, calibrated with brief on-site observation, to estimate the number of smokers and passersby within a plausible SHS exposure range at a public outdoor smoking area in Japan. We conducted a formative field study at a designated outdoor smoking area at the Asia Pacific Trade Center in Osaka, Japan. A passive Wi-Fi packet sensor collected timestamps, anonymized device identifiers, organizationally unique identifiers, and received signal strength indicator (RSSI) values from October 13 to 29, 2023. The main analysis focused on October 28, 2023, a high-footfall event day selected for direct calibration. Episodes were classified using empirically derived RSSI thresholds, and class-specific calibration ratios were applied to estimate day-level counts. Of 128,313 anonymized detections recorded on October 28, 90.3% (115,950/128,313) occurred during business hours. Among these, 8.6% (n=11,068) identifiers were detected more than once. Dwell time could be calculated for 1.4% (n=1817) of the identifiers, and 0.5% (n=659) eligible presence episodes remained after preprocessing. During a 30-minute validation window, smokers and passersby were counted manually within a 25-m radius. During the validation window, 6230 signal records formed 104 stays, with a mean stay duration of 9.89 (SD 7.89) minutes. During the validation window, direct observation recorded 14 smokers and 207 passersby within the 25-m radius. Applying the rule-based classification and calibration ratios to business hours data yielded estimated day totals of 262 smokers and 3907 passersby within the plausible SHS exposure range. Estimated smoker counts showed 2 peaks, around noon and 4 PM, whereas passerby volume peaked around midday. In an exploratory analysis, a random forest model using stay duration, mean RSSI, and RSSI variability achieved an accuracy of 0.95, sensitivity of 0.75, specificity of 0.97, and area under the receiver operating characteristic curve of 0.99. This formative field study suggests that passive Wi-Fi packet sensing, combined with brief on-site observation, can be used to estimate population-level exposure opportunity around an outdoor smoking area. The method identified substantial numbers of potentially exposed passersby in a high-footfall public setting. Although the findings are site specific and preliminary, they indicate that exposure-count metrics may complement concentration-based and survey-based SHS research. Further studies incorporating repeated validation, direct pollutant monitoring, and multiple sites are needed to refine the method and strengthen its usefulness for tobacco control and public health decision-making.
The authors posit that the distinction between formative and reflective measures in healthcare research has not been adequately explored. As researchers examine how to demonstrate the value and impact of nursing, it is important to recognize that selecting the right measures is essential for substantiating nursing's economic contribution and for supporting safe, evidence-based practice changes.
BackgroundMany patients with incurable cancer are expected to live for a considerable period of time, yet with the knowledge of their disease's inevitable end-of-life outcome. This duality can lead to existential concerns. A single one-hour meaning-making conversation was developed in which a patient explores their sources of meaning together with a spiritual counselor.AimTo explore how patients experience and benefit from a conversation aimed at supporting meaning-making, in order to inform further refinement of this intervention.DesignWe conducted a formative mixed method pilot study. Evaluation interviews assessed patients' experience and reported benefits. A reflexive thematic analysis was conducted. Key themes were compared and contrasted by intervention timing and patients' experience of existential concerns. Validated questionnaires were administered to assess patients' existential wellbeing, problems, and needs pre- and post-intervention.Setting/ParticipantsTwenty-one patients with advanced solid malignancies and a prognosis >1 year participated at two different hospitals.ResultsAll patients experiencing existential concerns appreciated the meaning-making conversation and reported benefits, such as reflection, validation, insight and actions related to sources of meaning. Half of the those not experiencing existential concerns reported no benefits, and some reported a negative experience. Quantitative data suggest a decrease in most existential problems and needs post-intervention. Existential wellbeing increased post-intervention.ConclusionsA meaning-making conversation can support the process of meaning-making for patients living long-term with incurable cancer. Refinement of the intervention should focus on targeting patients experiencing existential concerns.
Stigmatized women's health issues, such as polycystic ovary syndrome (PCOS) and endometriosis, are often marginalized or dismissed in traditional clinical settings. This drives individuals to seek peer support in anonymous online communities such as Reddit. While these digital platforms host critical discussions, they are often designed as static information repositories, failing to account for the complex emotional, temporal, and cultural dynamics that shape users' support needs. There is a disconnect between the lived experiences of users-particularly feelings of clinical dismissal and the need for culturally specific advice-and the design of the sociotechnical systems they rely on. This study aimed to deconstruct support practices in online women's health forums to provide a formative basis for designing more responsive digital health systems. We analyzed the intersections of discussion topics, emotional expression, temporal shifts (specifically the impact of the COVID-19 pandemic), and culturally situated discourse to identify unmet user needs and effective peer-support patterns. We conducted a large-scale, mixed-methods analysis of 4995 posts and 460,317 comments from 5 major women's health subreddits (r/WomensHealth, r/TwoXChromosomes, r/BirthControl, r/Endometriosis, and r/PCOS). Computational methods included Latent Dirichlet Allocation for topic modeling, Valence Aware Dictionary for Sentiment Reasoning for sentiment analysis, and the NRC Emotion Lexicon for granular emotion classification. We segmented the data into pre-, during-, and post-COVID-19 periods to analyze temporal shifts. This quantitative analysis was complemented by a 2-phase qualitative thematic analysis to identify and characterize engagement patterns within 147 validated culturally situated threads. Our analysis revealed that the most prevalent and emotionally negative topic was "Pain & Doctor Visits," which was uniquely characterized by high levels of fear and sadness linked to systemic clinical dismissal. The COVID-19 pandemic triggered a significant topical "turn inward," with discussions shifting away from social or political issues and toward somatic concerns (eg, "PCOS" "Pain & Doctor Visits"). Paradoxically, this period saw a simultaneous rise in both negative emotions (eg, fear and sadness) and expressions of community trust. Critically, our qualitative analysis of culturally situated discourse uncovered a consistent three-stage "playbook" for effective support: (1) Affirmation to establish psychological safety and validate cultural experiences; (2) Information Scaffolding to provide actionable, culturally tailored advice; and (3) Intercultural Bridging to facilitate community-wide learning and empathy. Online health forums operate as essential, resilient sociotechnical infrastructures that actively compensate for failures and gaps in formal health care. The "Affirmation-Scaffolding-Bridging" model identified in our research provides a clear, formative framework for designing future digital health interventions. These findings can guide the development of new platforms that are emotionally aware, culturally responsive, and adaptive to user needs and external crises.
Assessment is a critical component of teaching and learning and serves as the foundation for how learners demonstrate success in achieving learning objectives. Formative assessments (FAs) and timely feedback play a crucial role in integrated curricula, whereas basic and clinical sciences are taught in a coordinated manner. Feedback-based FA supports student learning, and teachers can determine learning gaps to monitor progress in learning. Based on existing evidence, limited literature compared the effect of online versus onsite FA on summative performance in a fully integrated curriculum. This study aimed to examine the effectiveness of online versus on-site FAs and feedback on summative assessment in the integrated medical curriculum. This study used an exploratory mixed methods approach to delving into students' experiences with face-to-face versus online FA and feedback, and its effect on their summative performance in the integrated Bachelor of Medicine, Bachelor of Surgery program. This study was conducted at Fakeeh College for Medical Sciences in Jeddah, Saudi Arabia. A total of 143 consenting students were recruited into the study. The students in the study were distributed voluntarily into 2 groups regardless of age, sex, or academic performance. Group 1 (n=92) was assigned to receive online FAs and immediate online feedback throughout the module using the Speedwell system. However, Group 2 (n=51) was assigned to receive onsite FAs and face-to-face feedback throughout the module in the examination hall in the college. The quantitative part of the study involved analyzing student scores of summative assessments in 2 groups exposed to online and onsite FA and feedback. The qualitative part aimed to explore students' perceptions of FA and feedback. The passing rate in summative examinations (quiz, midmodule, and final) was higher in the onsite group (61.2%, 51%, and 62.7%, respectively) compared with the online group (53.3%, 48.3%, and 45.7%, respectively). However, the difference was statistically significant only in the quiz examination. Four key themes were identified from the qualitative analyses regarding participants' different experiences of FA and feedback: the accessibility of the examination format facilitates flexibility in learning; FA is a means of recognizing learning opportunities; FAs help shift student attitudes toward learning; and the last theme is opportunities for discussion and personalized feedback. This research sheds light on the intricate interplay between assessment modalities and student learning outcomes by demonstrating that onsite FA followed by onsite feedback is more effective than online FA and feedback in fostering student engagement and promoting deep understanding and improving students' performance in summative examinations. Thereafter, this study contributes to the ongoing discourse surrounding effective assessment practices in contemporary educational settings.
Despite its focus on preventing human fecal matter from entering the environment, Community-Led Total Sanitation (CLTS) places little emphasis on animal feces management. Integrating safe management of animal waste into an existing community-level program to safely manage human feces may substantially reduce overall exposure to feces and improve both human and animal health. We conducted formative research to inform the development of an animal-inclusive CLTS intervention in rural Mali. Across five villages eligible for the national CLTS program, we conducted focus group discussions and individual interviews with livestock owners, child caregivers, and other community stakeholders, unstructured observations of households with young children, a household-level survey, and community workshops. Our results highlight the close interactions between men, women, boys, and girls with a range of domestic animals, animal products, and animal waste, including fecal waste. We documented animal husbandry practices beyond feces management that may impact human, animal, and/or environmental health, including unhygienic milking and slaughtering practices, and the management of sick animals, along with generally low awareness and knowledge about zoonotic diseases. Integrated interventions, like an animal-inclusive approach to CLTS, should be informed by both WASH and animal health sectors, and would benefit from a One Health perspective, where human, animal, and environmental health are accounted for. An animal-inclusive intervention should consider the types of animals present; gender- and age-specific roles that household members play in animal husbandry; potential interventions at critical control points; and context-specific practices, perceptions, and priorities that will influence intervention content and delivery.
Population Health Management (PHM) is a UK priority for Integrated Care Systems (ICSs), aiming to deliver proactive, preventative, person-centred care using integrated health and care datasets. However, evidence on implementation in primary care remains limited. This comparative case study used embedded researchers, ethnography, interviews, and observations to formatively evaluate a 24-month PHM programme across 31 Primary Care Networks in one ICS. Data were thematically analysed using Excel and NVivo, with findings fed back to participants to guide programme delivery. Around 200 stakeholders participated in Action Learning Sets, fostering cross-sector collaboration within four localities. Few innovations, developed using integrated datasets, progressed to delivery, limiting their impact on patient health. While PHM infrastructure was established, delivery was constrained by operational pressures, data governance challenges, limited resources, lack of strategic integration and the nature of local relationships. Effective PHM implementation requires more than infrastructure and governance. It depends on developing system-wide soft skills (facilitation, co-production), motivating stakeholders, and investing in processes that support insight generation, innovation piloting, and evidencing of impact. The study highlights the need for stronger strategic integration, sustained resourcing, coordination, and co-production to realise PHM's potential at system, place and neighbourhood levels in addressing health inequalities and improving population outcomes.
Hypertension remains a leading global health challenge, particularly in low- and middle-income countries (LMICs), where limited health care infrastructure and resources restrict effective management. Community health workers (CHWs) are critical in delivering care in these settings, and when equipped with mobile health (mHealth) apps, they can greatly enhance chronic disease management. Involving CHWs in the design and development at all stages is essential for the success of such programs. However, relatively little research discusses CHW feedback on mHealth interventions. This study aims to evaluate CHW feedback on a hypertension program using a novel tablet-based mHealth tool designed for CHW hypertension diagnosis and management in rural Guatemala. We conducted a mixed-methods analysis as part of a pilot study in San Lucas Tolimán, Guatemala, involving 6 CHWs over a 6-month period. Quantitative data were collected using the System Usability Scale and Likert-scale surveys before and after study completion. Qualitative data were gathered through written surveys and focus group interviews conducted in Spanish by bilingual team members. These methods assessed the app's ease of use, workflow integration, and cultural appropriateness. CHWs provided detailed perspectives on technical challenges, training adequacy, and patient engagement, which guided iterative refinements to both the mHealth app and the hypertension management program. The mHealth app was generally well-received. Average System Usability Scale scores exceeded 70, surpassing established usability thresholds. Likert scale data revealed CHWs found the app to be useful and easy to use, but identified training protocols as areas for improvement. Qualitative analysis of focus groups and written surveys revealed 3 dominant themes. First, CHWs identified practical short-term needs, including slower and more comprehensive training sessions, simplified medication dosing regimens to reduce pill burden, and streamlined survey questions to shorten patient visit times. Second, CHWs raised larger structural concerns, including retention challenges related to financial compensation and misalignment between required clinical data collection and the cultural appropriateness of certain app questions. Third, CHWs highlighted program benefits, including improved patient care and hypertension management, empowerment through educational tools, and increased pride and community trust associated with the program. Our findings suggest that iteratively integrating user feedback into the development of mHealth interventions is key to improve usability, cultural appropriateness, and overall effectiveness of chronic disease management in resource-constrained settings. Due to the small number of CHW participants, as well as a reliance on self-reported perceptions, these findings should be interpreted as exploratory and hypothesis-generating rather than generalizable. This study contributes to the growing literature on mHealth apps for noncommunicable diseases in LMICs and provides insights into CHW experiences. Addressing the technical barriers and systemic challenges identified in this study can help improve future implementations of mHealth-enabled chronic disease programs in LMICs.
Real-time force feedback is essential in many surgical specialties. While previous research has focused on force measured at the tool-tissue interface, little work has explored the benefits, limitations, or opportunities of measuring force at the surgeon-tool interface. This study aims to explore scenarios in which surgeons from different medical specialties and experience levels could benefit from receiving feedback on the force exerted at the surgeon-tool (or surgeon-tissue) interface. Exploratory qualitative research was conducted through interviews with medical practitioners (N=15). This study explored perceptions of a conceptual novel force-sensing surgical glove that could provide real-time feedback in terms of usability, utility, value, and limitations. Opportunities and barriers to implement a sensor of this type in clinical practice were also explored. Participants had experience in anesthetics, dental surgery, plastic and dermatological surgery, general surgery, and obstetrics and gynecology, as these surgical fields all require precise feedback on exerted forces. Participants identified two key areas where a force sensor could yield significant benefits: (1) it could enhance surgical training through objective skill assessment and quantifiable feedback, and (2) it could provide valuable insights into the forces applied during practice, particularly in scenarios where other sensory feedback is masked. Participants appreciated that a sensorized glove that can provide real-time force sensing at the surgeon-tool interface would allow for continued feedback irrespective of the instrument, and integrate seamlessly into their current surgical workflow. Furthermore, as surgeons in some specialisms, for example, dental or obstetrics and gynecology, perform manual tasks, having a sensorized glove would provide feedback in instances where they are physically manipulating tissue. However, participants expressed concerns about accurately defining safe force ranges due to the variability in patients' anatomical structures and the potential interference with tactile sensation. Surgeons from various clinical practices agreed that force sensing at the surgeon-tool interface could be valuable and provide them with optimal versatility as to when they would adopt force sensing. A sensorized glove could improve decision-making and surgical outcomes when other sources of information guiding force exertion are masked. Conversely, it could be detrimental when the organic information to guide force exertion is distorted when using the sensor. While the choice between interaction modalities is dependent on the accessibility of different senses during surgery, design suggestions as to where sensors are best placed on a sensorized glove are dependent on the instrument used or the type of manual procedure conducted.
To create and validate a rubric to rate the quality of narrative feedback on technical and non-technical skills given to general surgery residents using a workplace-based assessment tool. Instrument development and validation study using a focused literature review, modified Delphi process, stakeholder survey, and psychometric testing of narrative feedback comments from a mobile assessment application. A single academic general surgery residency program using the System for Improving and Measuring Procedural Learning (SIMPL) application for operative assessment. Panel of faculty and education specialists (modified Delphi); general surgery faculty and residents at the institution (stakeholder survey); and attendings who completed 1903 SIMPL evaluations between July 2020 and April 2024. A subset of 200 comments was double-coded for reliability and validity testing. The final rubric included four domains: clarity, specificity, actionability, and tone. In the stakeholder survey (50 faculty, 29 residents), all domains were rated as important or very important for effective feedback, with a median rating of 5 on a 5-point Likert scale and no significant differences between groups. For 200 double-coded comments, intraclass correlation coefficients for nontechnical skill comments were 0.847 (clarity), 0.845 (specificity), 0.903 (actionability), and 0.950 (tone). For technical skill comments, coefficients were 0.733 (clarity), 0.790 (specificity), 0.763 (actionability), and 0.979 (tone). Cohen's kappa for classifying comment focus (technical, nontechnical, both, neither) was 0.808. Global usefulness ratings were strongly correlated with clarity (ρ = 0.775), specificity (ρ = 0.772), and actionability (ρ = 0.908; all p < 0.001), but not with tone. This study presents a validated rubric that reliably rates the quality of narrative feedback on both technical and non-technical skills in operative assessment. The tool may support quality assurance, faculty development, and research focused on improving everyday feedback given to surgical residents.
HIV testing is the gateway to the HIV prevention continuum and offers an important opportunity to provide HIV prevention services. TakeMeHome.org is an online program that enables state and local health departments to offer free in-home HIV and sexually transmitted infection self-testing. As few TakeMeHome users have used pre-exposure prophylaxis (PrEP), there is an opportunity to link TakeMeHome users to PrEP information and services. The aim of this study is to develop an implementation strategy to link HIV or sexually transmitted infection self-testers from online orders to PrEP services via direct digital linkage to a novel SMS text messaging navigation program. PrEPmate is an evidence-based bidirectional text-messaging platform that has demonstrated increased PrEP retention and adherence. We developed a novel program to link TakeMeHome testers to mobile SMS text messaging PrEP navigation via PrEPmate. We conducted focus groups among TakeMeHome users to elicit preferences for linkage from TakeMeHome to PrEPmate. Based on these focus groups, we revised the content and functionality of this linkage intervention. In October 2023, we launched a pilot implementation study in 2 US Ending the HIV Epidemic jurisdictions: Sacramento, California, and Tarrant, Texas. Thirteen TakeMeHome users participated in 4 focus groups (mean age 31.5 years; n=4, 31% Latinx, n=2, 15% Black; n=9, 69% never used PrEP). When shown wireframes of the TakeMeHome or PrEPmate linkage, most thought they were easy to navigate and user-friendly. They liked the privacy of connecting with a PrEP navigator using SMS text messaging. Participants recommended providing a clear description of PrEP and PrEPmate services and indicating that PrEP is low or no cost on the TakeMeHome website. On the PrEPmate landing page, they recommended adding language on confidentiality and the partnership with TakeMeHome to show that both services are connected. Once enrolled, they recommended weekly or biweekly check-ins to assist with PrEP navigation. Overall, 92% (12/13) of focus group participants were likely to use PrEPmate to learn more about PrEP and/or link to PrEP services. From October 2023 to May 2024, among 537 individuals who ordered test kits and were not on PrEP, 169 (31%) were linked to the PrEPmate page, and 86 (16%) enrolled in PrEPmate. PrEP navigation was provided via SMS text messaging or phone, with 46 (53%) receiving PrEP education and 26 (30%) in various stages of starting PrEP. In exit interviews, participants found the intervention easy to use and appreciated being connected with an experienced PrEP navigator who helped them access PrEP. Through user-centered design, we successfully developed a program to link TakeMeHome testers to PrEP navigation via PrEPmate, with high feasibility and acceptability of the intervention and a substantial number of clients starting PrEP. The next steps will involve evaluating the effectiveness of this program on a larger scale and, if successful, expanding PrEPmate navigation to all Ending the HIV Epidemic jurisdictions using TakeMeHome.
[This corrects the article DOI: 10.1371/journal.pone.0322592.].
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally, with low-resource settings, including Ethiopia facing challenges due to limited early diagnostic services. AI-powered electrocardiography (ECG) interpretation has the potential to improve diagnostic accuracy, decentralize care, and support timely clinical decisions, but evidence on healthcare providers' perspectives and adoption determinants is limited. This exploratory descriptive qualitative study employed 31 in-depth interviews with healthcare providers. Healthcare providers (cardiologists, internists, cardiac and critical care nurses, critical care specialists, and general practitioners) were purposively selected through maximum variation sampling from ten hospitals in four regions of Ethiopia. Data were transcribed verbatim, coded inductively, and analyzed thematically. The data analysis identified six themes: perceived benefit of AI-powered ECG interpretation CDSS, trust development, workflow integration, ethical concerns, functionality, and adoption determinants. Participants emphasized AI's potential to enhance accessibility, consistency, and diagnostic accuracy while reducing subjectivity and unnecessary referrals. Acceptance relied on high accuracy, reliable data, and rigorous validation, with the technology seen as supportive rather than replacing clinicians. Material resources, human resource readiness, and leadership engagement were key factors for adoption. Recommendations included phased implementation, continuous training, and model expansion to ensure sustainability and clinical utility. The AI-powered ECG interpretation CDSS was viewed as a valuable adjunct for strengthening cardiovascular care in Ethiopia, highlighting the need for context-sensitive strategies, ethical safeguards, and multi-level system readiness for successful adoption.
In October 2022, the Nutrition Now (NN) e-learning resource was implemented within Maternal and Child Healthcare centers and Early Childhood Education and Care centers of a southern Norwegian municipality. The e-learning resource targets expectant parents, parents of children aged 0-2 years, and Early Childhood Education and Care staff, aiming to promote healthy dietary behaviors during the first 1000 days of life. This study aimed to explore parental perceptions related to the acceptability, appropriateness, feasibility, and reported use of the NN e-learning resource among parents. From October 2022 to May 2023, expecting parents and parents of children aged 0-2 years were recruited from 2 Norwegian municipalities, one intervention group receiving access to the NN e-learning resource, and one control. Participants in the intervention group received a web-based follow-up questionnaire 7 months after gaining access to the NN e-learning resource. Data were analyzed using descriptive statistics. Of the 179 participants in the NN study intervention group, 48 completed the web-based follow-up questionnaire administered 7 months after enrollment. Parents rated the e-learning resource positively on items assessing whether they liked and appreciated the resource, perceived it as an appropriate source of information, and found it doable and easy to use. Most respondents reported visiting the resource (38/48, 79%), although only 21% (10/48) reported frequent visits. Less than half of the participants answering the web-based follow-up questionnaire reported having watched the theme films (20/48, 42%), the recipe films (17/48, 35%), or making food using recipes provided in the e-learning resource (20/48, 42%). Parents rated the NN e-learning resource positively but reported limited use. These findings point to the need for strategies that enhance engagement with self-guided digital interventions among expectant parents and parents of young children. Future efforts should focus on identifying how to maximize potential adoption of the e-learning resource and evaluate its impact to promote healthy dietary behaviors during the first 1000 days of life.