BackgroundAccess to credible health information is critical for health literacy and informed health behaviors. Although digital platforms are widely used, limited technology access and lower eHealth literacy may constrain online health information seeking in some communities. Black and low-income individuals, in particular, may rely less on internet-based sources and more on in-person channels, including social networks and community-based organizations.AimsThis study examined community-based sources of health information used by Black individuals living in a low-income, urban area.MethodsSemi-structured interviews (n = 27) completed 4-weeks post a community education program were transcribed verbatim. Of these, interview transcripts (n = 25) that identified sources of health information or advice were included in the analytic sample. Two coders categorized responses describing sources of health information and advice using inductive content analysis.ResultsHeath information sources that were identified included health care services, community organizations and networks, media, national organizations, commercial pharmacies, and workplaces. Health care services were most frequently cited, with over half of participants naming physicians, clinics, hospitals, insurance carriers, or other providers, followed by community organizations and networks.DiscussionBlack individuals in low-income, urban areas access health information through diverse in-person and media-based sources. Identifying trusted and accessible community channels can inform targeted outreach efforts to improve health literacy and reduce health disparities.
The aim of this work was to explore the rate of and factors associated with the use of mental health services and supports (MHSS) in a Canadian cohort of children and adolescents during the coronavirus disease 2019 (COVID-19) pandemic. We analyzed data from 1,554 parent-child dyads participating in the CHILD COVID-19 Add-on Study, surveyed between January 2021 and March 2022. The overall rate of self-reported access to MHSS over 15 months was 17% among 1,100 participants. Bivariate analyses identified multiple predictors associated with MHSS use. After adjustments in the logistic regression models, the following factors were significantly associated with MHSS use: accessing COVID-19-related income support [adjusted odds ratio (aOR), 0.56; 95% confidence interval (CI), 0.35-0.89]; missed school (aOR, 1.74; 95% CI 1.16-2.61); being slightly worried (aOR, 1.86; 95% CI 1.15-3.00) or very/extremely worried (aOR, 5.25; 95% CI 2.38-11.56) in the past 2 weeks compared with not worried; and having a chronic health condition (aOR, 2.78; 95% CI, 1.85-4.19). In contrast, having a mental health rating of very good (aOR, 0.45; 95% CI, 0.28-0.73; p < 0.01) or excellent (aOR, 0.30; 95% CI 0.17-0.52; p < 0.001) compared with good before COVID-19 was protective against MHSS use. Subanalysis comparting participants with a chronic health condition found similar effect sizes for being very/extremely worried (aOR, 5.67 vs. aOR 4.98) compared with not worried in the past 2 weeks, in relation to MHSS use. Mental health service use was notable during COVID-19, particularly among children with chronic health conditions. Further research on the use of MHSS is needed to provide effective mental healthcare for children.
Calls for cultural change in health services often remain confined to managerial or ethical discourse, lacking critical depth and operational clarity. This article develops the concept of health care cultures (HCCs) as an analytical category in its own right: dynamic configurations of power, knowledge and practice that actively shape how care is conceived, delivered and governed. Drawing on a Gramscian framework, feminist care theory, and the literature on structural competency, I conceptualise HCCs as sites of tension between hegemonic and subaltern forms of knowledge and practice. This reframing has direct implications for how community health and mental health services are analysed, evaluated and transformed: it moves beyond treating culture as a background variable to be managed, or as a property of patients and professional encounters, to examining how the institutional organisation of care itself produces and reproduces inequalities. On this theoretical basis and drawing on three research projects conducted in Brazil and Spain, I propose a five-criteria framework for analysing and transforming HCCs: structural competency, community participation, recognition of experiential knowledge of illness, shared and supported decision-making and the safeguarding of users' rights. These criteria are interdependent rather than parallel. Structural competency provides the conditions of possibility for the other four, which together constitute a way of asking what kind of institution a community health service is and what kind it might become.
Traditional site-based clinical trials impose substantial logistical burdens that limit participation among individuals with geographic, mobility, transportation, and socioeconomic constraints, thereby undermining research equity and generalizability. Although pragmatic and decentralized trial designs seek to address these barriers, many health systems lack a mobile clinical workforce capable of conducting in-person research activities in community settings. Mobile Integrated Health (MIH) and Community Paramedicine (CP) programs, which leverage community paramedics and EMTs (MIH-CPs) to provide field-based care, may provide scalable infrastructure to support decentralized research delivery. We describe an institutional model that cross-trains and integrates MIH-CPs into research teams. Using study protocols, training materials, operational procedures, and implementation documents from five studies, we analyzed staffing models, credentialing and training processes, workflow integration, fidelity monitoring, and ethical and safety considerations. The included studies spanned pragmatic randomized and hybrid trials, and observational cohort studies across diverse clinical populations. MIH-CPs conducted recruitment, consent, assessments, intervention delivery, and data collection. Structured training, defined communication pathways, and integration with established clinical workflows supported protocol fidelity, participant safety, and operational feasibility. Embedding mobile community-based clinicians within research teams represents a pragmatic, equity-oriented strategy to expand decentralized trial capacity, reduce participant burden, and accelerate translation of evidence into real-world practice.
We compare African-American and White clients receiving services at 13 rural and semi-rural community mental health agencies (CMHAs) and the impact of Medicaid on the use of crisis and outpatient services. SEM was utilized to model the indirect effect of crisis services between the association of Medicaid and total hours of outpatient services. We modeled the moderating effects of race using mixture modeling and latent class. The base model showed a non-significant indirect effect between having Medicaid and total hours of services through the use of crisis services (Indirect effect = 0.01, p = .98). African-American clients who received Medicaid were more likely to use crisis services (β= .155, p < .05, a path), which was associated with increased hours of outpatient services (β= .224, p < .05, b path). In general, Medicaid was not related to increase service or crisis service usage. However, African-American clients access crisis services significantly more than White clients.
Background Acceptance of medical artificial intelligence (AI) is critical for successful implementation, yet its acceptance may vary by clinical application and stakeholder group. Whether routine use of generative AI (GAI) is associated with acceptance of medical AI remains unclear. Methods A cross-sectional web survey was conducted in Japan in November 2025 using web-panel convenience sampling from an online research panel. The small analytic sample comprised 200 participants aged 20-69 years, including 100 healthcare workers and 100 non-healthcare workers. GAI use was assessed using two five-point items (GAI use at work and in daily life) and dichotomized as at least monthly use in either daily life or work versus less than monthly use in both settings, based on prespecified criteria. Acceptance of medical AI was measured for five scenario-based applications - AI-assisted imaging interpretation, AI-based health risk prediction, AI-based treatment recommendations, AI-enabled triage guidance, and AI-assisted robotic surgery - using a four-point acceptability scale; responses were dichotomized as acceptable versus not acceptable. Calibration weights were constructed to approximate Japanese internet users by raking on sex-by-age group and household income, normalized to the analytic sample size, and truncated at prespecified bounds. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression with robust standard errors, stratified by occupation; covariates were selected a priori using a modified disjunctive cause criterion. This study was exploratory; therefore, adjustments for multiple comparisons were not performed. Results Among healthcare workers, the lower-use group had a higher prevalence of non-acceptance of AI-based health risk prediction (aPR 6.980, 95% CI 1.412-34.506) and AI-based treatment recommendations (aPR 4.364, 95% CI 1.331-14.305), whereas estimates for imaging interpretation, triage guidance, and robotic surgery remained statistically uncertain. Among non-healthcare workers, the lower-use group had a higher prevalence of non-acceptance of AI-assisted imaging interpretation (aPR 13.906, 95% CI 1.624-119.052), AI-based health risk prediction (aPR 4.861, 95% CI 1.133-20.862), AI-based treatment recommendations (aPR 6.288, 95% CI 1.386-28.530), and AI-assisted robotic surgery (aPR 6.173, 95% CI 1.435-26.561); the adjusted estimate for AI-enabled triage guidance was not statistically supported (aPR 1.840, 95% CI 0.521-6.505). Several estimates had wide confidence intervals, indicating substantial imprecision. Conclusions In this small exploratory web-panel convenience sample, lower-frequency GAI use was associated with higher non-acceptance of several medical AI applications. Associations were observed across more applications among non-healthcare workers than among healthcare workers. Because the study was cross-sectional, used convenience sampling, and included imprecise estimates with wide confidence intervals, the findings should not be interpreted causally. Larger studies using longitudinal or interventional designs are needed to clarify temporality and mechanisms.
The objective of this scoping review is to identify how adolescent mental health is assessed and the psychological factors it has been associated with young people in education in Low- and Middle-Income Countries (LMICs). A review of the published academic literature was conducted to explore the breadth, scope, and nature of research using the eligibility criteria of school/college-attending young people (aged 4-22 years) from LMICs with use of standardized measures. Three databases were searched: Medline, EMBASE, and PsycINFO, covering the period from 1970 to September 30, 2025. A logic grid using relevant population, construct, and context search terms guided the search. The six-stage scoping review methodological framework by Arksey and O'Malley was used. The search yielded 1,493 records, of which 498 duplicates were removed and 995 were screened. Thirty six studies met the inclusion criteria. Thirty-two of these studies were conducted in middle-income countries. Ten of the articles described intervention studies and most of the studies were cross sectional. Mental health outcomes assessed were depression, anxiety, trauma, suicidality, eating disorder symptoms, psychological distress and general mental health screening. Assessed psychological factors associated with mental health outcomes included self-esteem, self-efficacy, resilience, coping, perceived social support, school connectedness, emotional intelligence and emotional regulation, mastery, and life satisfaction. Findings show that depression was the most commonly assessed mental health outcome and self-esteem was the most frequently researched psychological factor. The study revealed considerable variability in how mental health was assessed, underscoring the need for greater consistency and contextual sensitivity. These findings highlight the importance of developing interventions tailored to local contexts in LMICs to more effectively support youth mental health. The need for measurement consistency and contextual adaptation of intervention in this literature is indicated.
Shift work is the norm in modern industrialised societies and is associated with disruptions in circadian rhythms as well as adverse mental health and sleep outcomes. However, many studies have examined sleep-related and mental health outcomes independently, limiting understanding of their interrelationship. This systematic review aimed to evaluate the association between shift work exposure and both sleep-related and mental health outcomes among adult workers. A systematic review was conducted using a predefined and structured methodology for study identification, selection, and reporting. A comprehensive search of PubMed, Cochrane CENTRAL, Europe PMC, PsycINFO, and ClinicalTrials.gov was performed for studies published between January 2016 and January 2026. Eligible studies included adult shift-working populations that reported both sleep-related and mental health outcomes. Observational studies and randomized controlled trials were included. Study selection, screening, and quality appraisal were performed using established methodological assessment approaches appropriate to the included study designs. A total of 386 records were identified, of which 36 duplicates were removed. Following screening and full-text assessment of 80 articles, 11 studies met the inclusion criteria. Included studies were conducted across Europe, North America, Asia, and Australia and involved diverse occupational groups, including healthcare workers, correctional officers, and industrial workers. Across studies, shift work exposure was associated with sleep-related outcomes such as insomnia, poor sleep quality, and shift work sleep disorder, as well as mental health outcomes including depression, anxiety, stress, and fatigue. Overall methodological quality was moderate to high. Shift work exposure is associated with adverse sleep-related and mental health outcomes among adult workers. These findings support the need for integrated occupational health strategies addressing both sleep and psychological well-being in shift-working populations.
This study investigated the impact of the COVID-19 pandemic on homecare service use among individuals with physical disabilities, stratified by age, sex, and mental health conditions. Monthly utilization of personal support and nursing services was assessed using linked health administrative databases from ICES in Ontario, Canada, over two periods: pre-pandemic (March 2015 to February 2020) and during the pandemic (March 2020 to June 2022). Predictive Autoregressive Integrated Moving Average (ARIMA) models were used to estimate changes in service use. During the pandemic, personal support service use declined significantly across multiple subgroups with some groups experiencing greater impacts. Significant decreases were observed in 78.5% of months for males, 14.3% for females, 78.5% for individuals aged 65 years and younger, 17.9% for those older than 65 years, and 78.5% for individuals with mental health conditions. In contrast, nursing service use increased significantly, with significant increases observed in 85.7% of months for males, 60.7% for females, 60.7% for those aged 65 years and younger, 17.9% for those older than 65 years, 85.7% for individuals with mental health conditions, and 28.6% for those without mental health conditions. The findings highlight substantial variation in the pandemic's impact across subpopulations, with certain groups disproportionately affected. Targeted strategies are needed to mitigate these disparities and ensure equitable access to homecare services. Further research is warranted to explore the long-term implications and the underlying factors contributing to these differences.
Human health and the health of our planet are inextricably linked. The accelerating loss of global biodiversity represents one of the most profound health threats of the 21st century. With species extinction rates estimated to be 10-100 times higher than natural baselines, biodiversity decline is no longer solely an environmental concern. This narrative review synthesizes evidence suggesting that biodiversity decline is increasingly relevant as a determinant of human health and survival rather than solely an environmental concern. The six pillars of lifestyle medicine, offer a coherent framework for interventions that can simultaneously prevent and improve lifestyle related illness outcomes while improving planetary health by reducing environmental pressures that drive species extinction and biodegradation. The review examines evidence synthesized from peer-reviewed databases (MEDLINE, PubMed, CINAHL, Joanna Briggs, SCOPUS, ScienceDirect, and GreenFILE), primarily 2010-2025, organized across seven thematic domains: infectious disease ecology, ecosystem services, microbiome dynamics, lifestyle medicine interventions, One Health integration, behavioural change, and clinical/policy implications. The review argues that lifestyle medicine must evolve from individual-focused clinical practice to also explicitly address structural drivers of ecological degradation, including food systems, transport, and urban design, thereby operationalizing planetary health principles in clinical care.
Colorectal cancer (CRC) is an important cause of cancer-related morbidity and mortality in both Sub-Saharan Africa (SSA) and Uganda. Despite national progress in cancer awareness and policy development, CRC care remains limited by resource constraints. CRC serves as an ideal lens for assessing health system resiliency, as it spans the care continuum. This review searched PubMed from inception through December 2025 for Uganda specific articles on CRC and analyzed 13 peer-reviewed articles to describe the current state of CRC care in Uganda, with insights from a health needs assessment (HNA) conducted at Mbarara Regional Referral Hospital (MRRH).Across Uganda, CRC diagnosis and treatment are hindered by insufficient endoscopic and pathology capacity, medication stockouts, and inconsistent access to immunohistochemistry and molecular testing. Screening programs remain underdeveloped due to inadequate resources for follow-up diagnostics. At MRRH, chemotherapy and surgery are available but constrained by equipment shortages, long wait times, and limited workforce despite rising patient volumes. Palliative care remains a strength, supported by national morphine availability and the efforts of Hospice Africa Uganda, though integration within oncology clinics remains incomplete. Improvement to CRC care will require expanding diagnostic infrastructure, digitizing health records, workforce development, and strengthening supply-chain management. Addressing chemotherapy and medication stockouts represents a tangible, near-term step toward improving quality of care. Experience from MRRH demonstrates both the challenges and opportunities to scaling cancer care in resource-limited settings and provides an illustrative example, albeit limited as a single-institution review, for addressing CRC systems across Uganda. Main findings: Colorectal cancer care in Uganda remains limited by inadequate diagnostic capacity, medication stockouts, and workforce shortages, although palliative care integration and national policy support represent key strengths.Added knowledge: This narrative review synthesizes Uganda’s colorectal cancer evidence through a health-systems lens, combining published literature from Uganda and an institutional health needs assessment to identify feasible, context-specific interventions.Global health impact for policy and action: Expanding endoscopic and pathology capacity, digitizing health records, and strengthening supply-chain management are actionable strategies to improve equity and quality of cancer care in low-resource settings.
The quality and accessibility of end-of-life (EOL) care are sensitive indicators of health equity, yet these services remain profoundly unequal worldwide. The challenge is especially acute in emergency and critical care, where clinicians must reconcile time-pressured medical decisions with emotionally charged communication. Branching-scenario games, serious games built on clinical decision trees, have emerged as a promising educational tool for rehearsing such competencies in a safe, repeatable virtual environment. However, their effectiveness is not a matter of simple technology transfer: it depends heavily on cultural fit and on an explicit commitment to health equity. In this mini-review, we examine branching-scenario games in acute EOL care education through a public health implementation lens. We synthesise evidence on their value and limitations, review principles and practise of cultural adaptation, situate them within debates on health equity and barriers to equitable care, and consider how they might be scaled from discrete educational projects to system-level public health interventions. We then summarise academic controversies, identify research gaps, and outline future directions, including participatory design, mixed-methods evaluation, and AI-driven adaptive learning. We argue that, with rigorous cultural adaptation and equity-by-design, these games can evolve from a novel teaching technology into a lever for advancing equitable EOL care.
Occupational therapy students and novice occupational therapists often face considerable challenges when entering acute mental health settings, particularly within South Africa's culturally diverse and resource-constrained contexts. This study explored the preparedness of University of KwaZulu-Natal (UKZN) occupational therapy students and novice practitioners for acute mental health practice within KwaZulu-Natal's complex healthcare landscape. A qualitative, exploratory design was used with purposive sampling to recruit 15 participants. Ten fourth-year students and five novice occupational therapists participated in focus group discussions and individual interviews. Data were analysed thematically to identify key patterns related to preparedness, challenges and experiential learning. Three overarching themes emerged: (1) educational preparation gaps, (2) practice readiness challenges and (3) systemic and transition constraints. Participants demonstrated strong theoretical knowledge but reported limited practical readiness, particularly regarding culturally responsive care, emotional regulation and evidence-based intervention in acute settings. The findings emphasise the need to strengthen occupational therapy education through earlier and more intensive acute mental health exposure, enhanced clinical supervision and greater emphasis on cultural competence and acute care interventions. Grounded in experiential learning theory (ELT), improved experiential learning opportunities may better prepare graduates for effective, contextually relevant practice in South Africa's acute mental health environments.
Hospitals across the United States face growing operational and financial strain, resulting in closures that threaten healthcare access and system resilience. This study aimed to identify significant predictors of hospital total facility expenditures and to evaluate the performance of multiple imputation methods for incomplete data in the American Hospital Association (AHA) Annual Survey Database. The de-identified 2022-2023 AHA survey data (n=12,359) comprising 34 financial, structural, and operational features was analyzed. Missing data were addressed using the Multivariate Imputation by Chained Equations (MICE) framework, comparing regression-based and machine learning-based algorithms. Random Forest (RF) imputation was selected for its superior accuracy based on fivefold cross-validation. Linear regression models were fitted on five RF-imputed datasets to identify key determinants of total facility expenditure (EXPTOT). RF-based imputation achieved the lowest error and highest consistency across variable types. Regression results identified full-time registered nurses (FTRNTF), facility size (GFEET), and property and equipment costs (PLNTA) as the strongest predictors of hospital expenditure (p<0.001). Hospitals with community designations, oncology or research services, and Joint Commission accreditation had significantly higher expenditures, whereas rural and community trauma centers reported lower costs. Geographic visualization revealed substantial disparities in hospital resources and expenditures, especially in rural areas. Machine learning-based multiple imputation improves data completeness and modeling accuracy for hospital operations research. Findings highlight critical cost drivers and geographic inequities, informing data-driven policymaking and resource allocation in health system management.
Cardiovascular diseases (CVD) remain the leading cause of mortality and disability worldwide. In Italy, individuals at very high cardiovascular risk may encounter fragmented care pathways and territorially uneven access to preventive, specialist, and post-discharge services. Although patient engagement is recognized as a key determinant of long-term outcomes, limited qualitative evidence is available on how it develops across the cardiovascular care pathway. This thematic analysis explored how patient engagement is experienced across the cardiovascular care pathway among individuals at very high cardiovascular risk in Italy, with particular attention to psychosocial, relational, and organizational factors. A qualitative descriptive analysis using five participatory workshops was conducted with 24 patients and 5 caregivers across four Italian regions. Audio-recorded sessions were transcribed verbatim and analyzed thematically through an iterative hybrid inductive-deductive process, in addiction structured observational notes were recorded by the research team during workshops. The Patient Health Engagement (PHE) Model was used as an interpretive lens for higher-order analysis. Four phases across the cardiovascular care pathway were examined: diagnosis, hospital management, post-discharge, and adaptation to post-event life. Across these phases, engagement emerged as a dynamic process shaped by emotional disruption, therapeutic understanding, communication quality, and continuity of care. The transition from hospital to home was the most fragile phase, characterized by insufficient guidance, limited psychological support, and fragmented follow-up. Participants also described territorially situated differences in access to specialist referral, rehabilitation, and supportive services. Cross-cutting themes included inadequate doctor-patient communication, limited psychosocial support, caregiver burden, and the supportive role of patient associations. Patient engagement in cardiovascular care is co-produced by individual, relational, and organizational factors. Strengthening discharge preparation, follow-up continuity, psychosocial support, and equitable access to rehabilitation may help sustain engagement over time. Future research should examine engagement trajectories longitudinally and investigate caregiver perspectives more systematically.
Community-based palliative care has been widely studied worldwide, yet the developmental trajectory of this field remains unclear. In this study, we aimed to elucidate current research focuses, emerging hotspots, and trends in community-based palliative care through bibliometric and visual analyses. This study involved bibliometric analysis, combined with visual knowledge mapping of the retrieved literature. Data were retrieved from the Web of Science Core Collection for publica1tions from 2015 to 2025. Bibliometric networks were visualized using CiteSpace and VOSviewer. The reporting framework for this study complies with the Preferred Reporting Items for Bibliometric Analysis guidelines. Overall, 1,180 publications on community-based palliative care were examined. Annual publication output showed a continuous upward trend, with the United States contributing the largest number of publications (330 articles). The institution with the highest research output was the University of Edinburgh. BMC Palliative Care was the most productive journal. Four core research topics were identified: (a) community-based palliative care services and practice; (b) palliative care and health outcomes among older adults with chronic diseases in the community; (c) advance care planning and decision-making; and (d) barriers to and training in palliative care among community health workers. Publications on community-based palliative care have increased steadily since 2015, indicating growing academic interest in the field. The United States and Western Europe lead this domain, supported by strong presence of prominent researchers and leading research institutions. Several cohesive, high-output author groups have emerged, reflecting the development of well-connected research collaborations. Although existing research primarily centers on four core topics, "interviews," "framework," "family physicians," "lung," and "dementia" may represent emerging research frontiers.
Biobanks are designed to provide researchers with biological materials and associated data; however, the perspectives of their users have not been sufficiently examined. This study aims to investigate researchers' needs, expectations, and experiences related to biobanking services. To this end, an online survey was developed to collect information on participants' demographic characteristics, their experience in usage, and views on key aspects such as application procedures, data accessibility, access costs, and the return of research results. The findings collected from Montenegro offer valuable insights for biobanks and relevant stakeholders, supporting the development of effective engagement strategies, improving alignment with user needs, and funding opportunities.
Pakistan is a party to the WHO Framework Convention on Tobacco Control and has enacted comprehensive tobacco control legislation, yet implementation remains weak. A mixed-methods study was conducted to explore implementation challenges, community response, and the health impact of this initiative among adult males in Hyderabad, Sindh. A convergent parallel design included 600 male adults (18-60 years) selected through multistage stratified random sampling and 15 in-depth interviews. Quantitative data were analyzed using structural equation modeling (SEM); qualitative data were analyzed thematically, guided by the Consolidated Framework for Implementation Research (CFIR). The prevalence of tobacco use was 67% (402/600). Among users, 52% had attempted to quit, while 0% had accessed cessation services despite wanting to quit. Low policy awareness: 16% were aware of cessation services, and 46% were aware of the smoke-free law. Most believed minors could easily obtain tobacco (74% thought enforcement was weak). The health burden also tended to be high: 76% of users showed tobacco-related symptoms, compared with only 43% of non-users (p < 0.001). The model fit the data well (CFI = 0.94, RMSEA = 0.048). Weak policy implementation directly predicted higher tobacco use (β = -0.41, p < 0.001), which in turn predicted poorer self-reported general health (β = 0.53, p < 0.001). Qualitative themes identified enforcement failures, the cultural normalization of noncompliance with public health laws, constructs within the healthcare system that enabled noncompliance, and economic constraints on enforcement. The male population in Hyderabad faces a significant implementation gap, with the most severe failure being the absence of cessation services. Limitations, including male-only sampling, self-reported data, and a single-district focus, prevent generalization to women and to the whole of Pakistan. Immediate policy action is required to establish accessible cessation support, strengthen enforcement mechanisms, and integrate tobacco control into routine healthcare.
As care for old adults increasingly shifts to the home, integrating everyday health data into clinical practice remains a major challenge. Current solutions based on passive sensors or wearable data often lack contextual understanding, leaving clinicians disconnected from the lived experience at home. To address this gap, we propose a user-centered, natural language-based, asynchronous platform enabling patients to communicate relevant health events and contextual insights in their own words. Developed through a participatory design process, our web-based prototype integrates a large language model with interfaces visualizing health and sensor data, and facilitates communication with hospital care teams. The system supports real-time data sharing, thereby contributing to bridging the hospital-home divide. Early feedback has informed iterative technical refinements, and a real-world user study is in progress. This approach represents an important step toward empowering older adults as active partners in their care and enabling more individualized, responsive clinical decision-making.
This is a descriptive case study of a public engagement group of people who have used alcohol care services. Involvement of people with lived and living experience is increasingly recognized as essential in health and social care policy. However, in alcohol care services, such involvement remains underdeveloped and sometimes tokenistic. This community case study outlines the establishment, development, and impact of the ACTIVE (Alcohol Care Team InVolvement and Engagement) group-a pioneering public and patient involvement and engagement (PPIE) initiative in alcohol care services across Merseyside and Cheshire (UK). The group was established through collaboration between the Programme for Alcohol Care and Treatment (PROACT, a regional public health network bringing together all alcohol care providers), public health commissioners (Champs Public Health Collaborative), and the Comensus PPIE model at the University of Lancashire. It was designed to create safe spaces for meaningful coproduction and deliberative democratic communication between people with lived experience, practitioners, and commissioners. ACTIVE has contributed to service design and evaluation. Additional impacts include supporting digital innovation, strengthening regional networks, influencing innovation, and enhancing workforce education. Members reported enhanced confidence, sense of value, and shared ownership of service development. The approach illustrates the replicable potential of sustained, well-resourced involvement of people with lived experience in alcohol care, having implications for policy, research, innovation, and service delivery nationally and internationally. The case study has been collectively authored utilizing notes of meetings and drawing upon contributions within a series of reflective meetings and exchanges of drafts.