Policy Points Public health has lost political influence because of a mismatch between the forms of power primarily deployed in this field-knowledge and moral authority-and the forms of power that currently shape societal rules and health outcomes-economic, political, ideological, and physical. Rebuilding the influence of public health requires a strategy shift that returns the field to its roots: building people power through partnerships with labor and community organizing groups; strengthening ideological power through the development of narrative infrastructure; and in moments of institutional breakdown, deploying nonviolent disruptive power to protect population health. Public health is inherently political, yet it has struggled in recent decades to influence the societal decisions that shape population health. Despite strong evidence supporting policies across domains such as environmental protection, infectious disease control, labor conditions, and reproductive health, the field has faced growing political backlash and policy retrenchment. This Perspective argues that these challenges reflect a mismatch between the forms of power public health primarily deploys and the forms of power that currently shape societal rules and health outcomes. This Perspective draws on an established typology of power to conceptually analyze the forms of power available to public health practitioners and to actors advancing policies and institutional arrangements detrimental to public health. Public health has relied primarily on knowledge and moral power, whereas actors advancing policies detrimental to health increasingly wield economic, political, ideological, and physical power within a neoliberal political economy. Under conditions of polarization, disinformation, and institutional capture, knowledge and moral power alone are structurally insufficient to shape the societal rules that determine health. The analysis identifies additional forms of power available to public health-including people, ideological, and nonviolent disruptive power-that could strengthen the field's political influence while remaining consistent with health equity values. The analysis suggests a strategic shift for public health: rebuilding people power through partnerships with labor and community organizing groups, strengthening ideological power through sustained investment in narrative infrastructure, and, when democratic institutions fail to protect health, joining with others in the strategic use of nonviolent disruptive power. More broadly, advancing population health will require public health to engage more deliberately with power and politics rather than relying on evidence alone.
Hong Kong is experiencing rapid population aging, with the population of older adults expected to reach 36.0% by 2046. The rise in life expectancy is often accompanied by increased chronic diseases and mental health challenges. The healthcare system remains heavily focused on tertiary care, leading to increased system burden and suboptimal health outcomes. Strengthening engagement with primary care for older adults, particularly through community-based services such as District Health Centers, is essential for improving long-term health outcomes. This approach promotes early detection, better management of chronic conditions, and prevention of unnecessary hospitalizations. This pilot study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a hybrid intergenerational home-based and AI-generated digital intervention for increasing the proportion of District Health Center members among older adults in Hong Kong. This is a two-group parallel cluster randomized controlled trial, involving 180 older adults recruited from 6 clusters. Participants will receive home-based DHC intervention by trained students, followed by 1-month of AI-generated digital interventions, including infographics, videos, and messages on the introduction and promotion of DHC, via WhatsApp. The feasibility indicators include recruitment rate, retention rates, dose delivered, dose received, and participant engagement. Acceptability outcomes are workshop and digital intervention satisfaction. The primary outcome is to increase the proportion of District Health Center members. Secondary outcomes include the proportion of participants utilizing DHC, health status, behavioral modifiable risk factors, eHealth literacy, infectious disease prevention behaviors, and feasibility metrics. Data will be collected via surveys at baseline and follow-ups (1, 3, and 6 months). This proposed pilot study aims to use hybrid intergenerational home-based and AI-generated digital intervention to improve primary healthcare engagement among older adults in Hong Kong. By promoting awareness and utilization of primary healthcare services like District Health Centers, the study seeks to promote healthier aging, improve health outcomes, alleviate hospital strain, and provide a framework for addressing the needs of aging populations. https://clinicaltrials.gov/, NCT07252934.
While clinical medicine essentially concentrates on the human body and its parts, public health focuses on the health of human populations and their social and environmental determinants. Integrated approaches to health extend the focus of attention to humans in their socio-cultural and ecological environment and their mutual interdependencies, paying attention to inter-species interdependencies. Since the beginning of the 21st century, ecosystem approaches to health (EcoHealth), One Health and Planetary Health have emerged as integrated approaches that relate to and expand public health and related fields. In this article, we aim at clarifying their respective definitions, philosophical foundations and methodological positions. This clarification is important because the way we define integrated approaches to health shapes research, teaching methods and their translation into policy and practice. Key methods and case studies are summarized and compared. Among the three integrated approaches, EcoHealth and Planetary Health operate largely in academic networks and non-governmental organizations (NGOs). One Health is currently operationalized at the level of international organizations, regional organizations and national governments. Integrated approaches to health require urgent adoption and implementation, as they are pivotal for complex problem-solving regarding challenges such as pandemic prevention, climate change, biodiversity loss and antimicrobial resistance.
Perinatal mental health (PMH) is a critical component of overall maternal well-being, yet the provision of PMH services remains challenging in Ghana and other settings. More crucially, there is limited data on healthcare providers' perspectives on PMH care delivery to inform efforts to improve service provision and mental health outcomes. This study explored healthcare providers' perspectives on current practices, gaps, and strategies to improve PMH care delivery in Ghana, a West African country. An exploratory qualitative design with a needs assessment orientation was adopted, and data were collected from focus group discussions with 32 nurses and midwives involved in perinatal healthcare service delivery in the Greater Accra Region of Ghana. Data were analysed using the six steps of reflexive thematic analysis. Four main themes were developed: Providers' Understandings of Perinatal Mental Health and its Intersection with Reproductive Health; Integrated Approaches to Perinatal Mental Health Care; Barriers and Challenges in Perinatal Mental Health Care; and Enhancing/Strengthening Perinatal Mental Health. Participants demonstrated knowledge of PMH and had adopted task-shifting and collaborative care approaches to provide PMH services. Key barriers to service provision include healthcare provider factors (e.g., stigma, inadequate training) and institutional challenges (lack of standardised tools, limited private consultation spaces, increased workload). Proposals to improve PMH outcomes include enhanced training, provision of resources and tools, and strengthened collaborative efforts. The findings highlight the need for comprehensive system reforms in PMH care delivery, including the provision of training and assessment tools and coordinated action across policy, institutional, and individual levels, supported by appropriate resource allocation and infrastructure development.
Climate extremes, conflict, and population displacement converge in the Horn of Africa to accelerate outbreaks of climate-sensitive infectious diseases, whereas existing health surveillance systems remain fragmented and largely reactive. This Perspective examines the potential of artificial intelligence (AI) to strengthen climate-health early warning by integrating satellite earth observations, routine disease surveillance, and mobility-based vulnerability indicators into anticipatory decision support systems. Drawing on global experience and region-specific constraints, we identified critical barriers to implementation, including data fragmentation, infrastructure gaps, workforce shortages, governance silos, and unresolved ethical risks. We propose a five-layer conceptual framework for an AI-enabled Climate-Health Early Warning System (CHEWS) tailored to fragile and conflict-affected settings, alongside a phased regional policy roadmap anchored within the Intergovernmental Authority on Development (IGAD). Emphasizing data sovereignty, participatory governance, and privacy-by-design, this study positions AI-CHEWS as a feasible pathway for shifting the region from reactive outbreak responses to anticipatory public health actions that enhance climate resilience and equity.Clinical Trial Number: The authors declare that they have no competing interests.
Climate change is a long-standing natural process that has been significantly accelerated in recent decades by anthropogenic activities, resulting in profound shifts in climate patterns and escalating risks to human health. Iran, characterized by predominantly arid and semi-arid conditions, chronic water scarcity, and complex socio-economic constraints, is highly vulnerable to climate-related hazards, including droughts, floods, heatwaves, air pollution, and climate-sensitive diseases. In this context, health systems have a dual responsibility: to strengthen adaptive capacity and resilience while simultaneously reducing their own carbon footprint. This study aimed to develop the National Strategic Plan for a Climate-Resilient and Environmentally Sustainable Health System in Iran (2023-2027) using a participatory action research approach. A multi-sectoral national committee conducted a Strengths, Weaknesses, Opportunities, and Threats analysis to assess internal and external determinants of climate resilience within Iran's health system. Quantitative scoring of strategic factors indicated a mean score of 2.47/4 for internal factors and 2.12/4 for external factors, positioning the health system within a precautionary strategic quadrant, characterized by limited internal capacity and substantial external threats. Based on these findings, a strategic plan was formulated, including a clearly defined vision, mission, values, seven strategic goals, twenty objectives, and a set of 181 prioritized actions. The findings demonstrate that while Iran's health system possesses important structural strengths, particularly in primary health care, it faces critical challenges related to financing, workforce preparedness, and environmental pressures. This study presents a set of strategies and actions to strengthen the climate resilience of Iran's health system by 2027, emphasizing governance, financing, workforce capacity, infrastructure, information systems, and service delivery. This strategic plan provides an evidence-informed and context-specific roadmap to guide policy-makers and health managers in strengthening climate resilience and environmental sustainability, with potential relevance for other middle-income countries confronting similar climate vulnerabilities.
High blood pressure (BP) prevalence is increasing in low- and middle-income countries, leading to increased morbidity and mortality. This compromises Sustainable Development Goal number 3-to ensure healthy lives for all people. Most BP patients do not attain normal BP despite treatment. Uncontrolled BP causes cardiovascular diseases, kidney disease and early death. It is therefore prudent to know the facilitators of BP control among treated patients. The aim of this study was to explore the facilitators of BP control among treated patients in two public primary healthcare (PHC) clinics in Gaborone, Botswana. Participants were purposively selected to ensure the selection of participants with good knowledge of high BP. These were patients with more than 1 year experience of BP treatment, healthcare workers (HCWs) with more than 3 years' experience of treating BP patients, and district health managers. Semi-structured interviews were used to collect data until saturation, from BP patients, nurses, doctors and district health managers. Interviews were audio recorded, transcribed and then coded by three authors. The codes were iteratively grouped and regrouped into themes several times to produce a codebook. The codebook and transcripts were uploaded into NVivo for analysing all the transcripts. Eighteen participants (six patients, four nurses, four doctors and four district health managers) were interviewed. The themes that were extracted from the data included health system, HCW, patient and socio-economic related factors. The perceived facilitators of BP control among patients receiving BP treatment included central government, local government and public PHC clinic level factors. Perceived facilitating factors also included patient, and HCW components. The study findings present a firm base from which more extensive qualitative and quantitative studies can be made to confirm or disprove the generalisability of these findings to all the public PHC clinics in Botswana.
People with severe mental illness (SMI) represent up to 6% of the population and experience a high burden of physical comorbidity and premature mortality. Despite longstanding international calls to develop integrated care, the optimal organisational approaches for this population remain poorly defined, and health systems lack guidance on how to redesign care pathways. This review aimed to characterise the core components, reported impacts, and implementation challenges of existing integrated care programmes for individuals with SMI and physical health conditions. This umbrella review was reported in accordance with the PRISMA 2020 and PRIOR statements. PubMed, Scopus, PsycINFO, and Cochrane were initially searched from inception to February 2025, with an updated search performed on 5 May 2026, for review studies of integrated care programmes for people with SMI and comorbid physical conditions or social vulnerabilities. Methodological quality was appraised using AMSTAR-2, and the most mature programmes were synthesised narratively using the SELFIE framework for multimorbidity-oriented integrated care. The review was registered on OSF (https://osf.io/se2u4). Seventeen review studies met the inclusion criteria, identifying 20 distinct integrated care programmes. Although heterogeneous, these programmes most commonly integrated physical healthcare within mental health services, relied on case managers, and emphasised proactive, individualised, and continuous care. Coordination with social care services and involvement of service users in programme design was limited. Governance and financing arrangements were weak, the use of digital tools was scarce, and effects on physical health and social outcomes remained modest. Evidence on effective and scalable integrated care programmes for people with SMI and physical comorbidity remains limited. These findings inform the next phase of the European Mental and Physical Health Initiative for People with Severe Mental Disorders (EU-MIND), which will use a Delphi process with key stakeholders to guide the implementation of sustainable integrated care across diverse European health systems. This study was funded as part of the EU-MIND initiative under the 2024 European Partnership on Transforming Health and Care Systems (THCS).
Undocumented migrant women face significant healthcare challenges yet they are seldom given a voice. This study aims to explore the experiences of undocumented migrant mothers in accessing maternal and infant healthcare across Switzerland. In this exploratory qualitative study, data were collected through semi-structured interviews and analysed using thematic analysis. 29 pregnant women and mothers of children aged ≤2 years participated in this study. They discussed their pregnancy and postpartum access to care. In these discussions, the important role of social workers and midwives in facilitating continuous access to healthcare services was evident. Declined support after childbirth exacerbated challenges in securing infant care. Of particular concern was the affordability of health insurance. Many participants reported that insurance debt accumulation and financial instability adversely affected healthcare-seeking potential and subsequent quality of healthcare received. The findings underscore the critical influence of federal healthcare insurance, the provision of services at the cantonal level and the roles of gatekeepers such as social workers and midwives. Strengthening continuity of care and allocating increased resources to address the needs of pregnant and newly born undocumented migrants are vital steps towards achieving health equity for this vulnerable group.
Leprosy patients with grade 2 disability (G2D) in Bangladesh continue to experience diminished well-being despite effective multidrug therapy. Community-based rehabilitation (CBR) integrated with primary health care could offer accessible, comprehensive services addressing their needs, but its acceptability and implementation challenges in Bangladesh remain poorly documented. This mixed-methods study, conducted February-July 2023, examined CBR acceptability and delivery barriers among leprosy patients with G2D. The quantitative component used a cross-sectional design, conveniently sampling 356 leprosy patients with G2D from government and private hospitals across three divisions; face-to-face interviews captured sociodemographic characteristics, disability status, CBR acceptability, and service challenges. The qualitative component comprised 15 key informant interviews with leprosy service personnel and five focus group discussions involving 8-10 G2D patients each, analyzed using deductive thematic analysis. Participants were predominantly male (65.2%) (mean age: 48.0 ± 13.7 years) with majority having foot disability (50.8%). CBR acceptability was remarkably high, with universal agreement on rehabilitation services at health complexes and community clinics, assistive technology, counseling facilities, and self-help groups. Nearly all agreed counseling would improve quality of life (99.4% [95%CI: 97.9-99.9]) and community awareness would reduce emotional distress (99.7% [98.4-99.9]), though only 67.4% [62.3-72.3] could independently perform ulcer self-care despite disability management training. Major challenges included healthcare workers' reluctance (78.4% [73.7-82.5]), inadequate equipment (59.5% [54.3-64.7]), and insufficient training (5.6% [3.5-8.5]). Qualitative findings corroborated these results, highlighting infrastructural deficiencies, discontinuous training, competing health priorities, long travel distances, poor coordination with social welfare authorities, resource constraints, and misconceptions about transmission. Both patients and providers strongly supported CBR integration into primary health care, citing grassroots accessibility, peer learning, and stigma reduction, and recommended multi-level strategies engaging local government, religious institutions, media, and schools. Strong community acceptability supports CBR integration into primary health care, though achieving zero disability goals requires stigma reduction, healthcare worker capacity building, resource allocation, and intersectoral coordination.
Women face unique and diverse mental health challenges and therefore require tailored interventions that address their specific needs and lived realities. Research has shown a lack of digital interventions designed for and with women from marginalized backgrounds, such as minority racial/ethnic backgrounds or with low socioeconomic status. If Digital Mental Health Interventions (DMHI) are not designed with active involvement of women from diverse backgrounds, they may fail to reach their public health objectives, which potentially exacerbates existing health disparities. How Human-Centered design methods are applied and reported, and whether women from diverse backgrounds are involved in the design and development of Digital Mental Health Interventions (DMHI), is under-researched. This study examined the methods and frameworks used in the design and development processes of DMHIs, whether and how studies include women from diverse backgrounds, and whether they tailor to their diverse needs related to intersectional identities (e.g., race/ethnicity, socioeconomic status, age) in the design and development process. We conducted a scoping review following the PRISMA-ScR guidelines. The databases included are Scopus, PubMed and IEEE Xplore, and the databases are searched from the inception until the 31st of May 2026. We included 77 articles that described the design process of digital mental health solutions for women. Among the 77 reviewed studies, 18 (23.4%) did not explicitly state their design methods, and most of them provided limited information on the characteristics of the included populations. Only 16 (20.8%) studies consistently involved users across all design stages. Intersectional identities were considered in only 26 (33.8%) studies. We observed an overrepresentation of research in higher-income countries, an underrepresentation of women from racial/ethnic minority backgrounds, a narrow age range of participants, and a lack of consideration of intersectional identities. Our findings reveal critical gaps in the development of DMHIs for women, including the superficial reporting and application of Human-Centered Design methods in the design process, limited user involvement, and a lack of consideration of diversity, inclusivity and intersectionality. Future research should emphasize active involvement of end-users from the earliest design phases onwards and adopting an intersectional lens in their design processes. We propose a research agenda for better reporting and applying HCD methods in future DMHI research, towards designing diverse, inclusive and equitable digital solutions for all women. A protocol of this study is pre-registered at Open Science Framework (DOI 10.17605/OSF.IO/WC79P).
Japan has developed one of the world's most established population-based gastric cancer screening systems through more than six decades of continuous refinement in public health policy, technological innovation, and quality assurance. This review summarizes the historical development, technological evolution, quality assurance framework, and future perspectives of gastric cancer screening in Japan, while providing comparisons with major gastric cancer screening programs and prevention initiatives worldwide. Japanese gastric cancer screening can be traced to the postwar adaptation of mass tuberculosis radiographic screening systems, followed by the nationwide implementation of double-contrast upper gastrointestinal radiography. Subsequent advances in gastrointestinal endoscopy, including high-resolution imaging, magnifying endoscopy, and image-enhanced endoscopy, have facilitated the transition toward endoscopic screening and improved early gastric cancer detection. Japan has also established highly standardized quality assurance systems, including structured training, credentialing, standardized examination protocols, defined quality indicators, and continuous program monitoring of screening performance. These efforts have supported the standardization and continuous quality improvement of population-based gastric cancer screening programs. The incidence and risk-factor profile of gastric cancer are changing rapidly because of declining Helicobacter pylori prevalence, population aging, and increasing recognition of Helicobacter pylori-naïve gastric cancer. Consequently, future screening systems will likely require greater incorporation of personalized risk stratification, optimized allocation of endoscopic resources, and emerging technologies such as artificial intelligence-assisted endoscopy and structured digital quality assurance systems. Japan's experience provides a valuable case study illustrating how quality assurance, technological innovation, and public health infrastructure can be integrated to support population-based gastric cancer screening. Gastric cancer remains a major health problem in many parts of the world. Japan has one of the longest-running and most successful national gastric cancer screening programs, developed through more than 60 years of continuous improvement. This review explains how the program has evolved, why it has been successful, and what lessons it may offer to other countries. Japan first introduced gastric cancer screening by adapting X-ray screening programs that had originally been created to detect tuberculosis. As medical technology advanced, screening gradually shifted from X-rays to endoscopy, a procedure in which a small camera is used to examine the inside of the stomach. Improvements in imaging technology have made it easier to find cancer at an earlier and more treatable stage. An important reason for the success of the Japanese program is its strong focus on quality. Healthcare professionals receive standardized training, follow carefully designed examination procedures, and regularly monitor the quality of screening. These measures help ensure that people receive accurate and reliable examinations. The population at risk of gastric cancer is now changing. Fewer people are infected with Helicobacter pylori, a bacterium that has long been the main cause of stomach cancer, while the population is aging and new types of gastric cancer are being recognized. As a result, future screening programs will need to better match screening methods to each person's level of risk, use medical resources more efficiently, and take advantage of new technologies such as artificial intelligence. Japan's experience demonstrates how long-term public health planning, technological advances, and careful quality management can work together to improve cancer screening and may provide useful guidance for countries seeking to strengthen their own screening programs.
The aim of this study is to identify the types and disposal methods of household healthcare waste (HHW) in Türkiye. This cross-sectional study was carried out between December 15, 2023, and March 15, 2024. A structured survey was administered to 1243 patients or accompanying relatives who received outpatient care or were discharged from a tertiary healthcare institution in Türkiye, ensuring only one respondent per household. Descriptive statistical methods including frequencies, percentages, means, standard deviations, and minimum-maximum values were used to analyze the data. The most common pharmaceutical HHWs in the past year were: 89.1% tablets, 56.5% syrups, 52.5% ointments, and 33.6% drops. The most common infectious HHW was 25% blood-contaminated dressing waste. The most common sharps HHWs were 20.7% blood glucose measurement needles/kits, 19.4% syringes, and 11.3% broken light bulbs. 43.1% of participants reported disposing of infectious HHWs, 37% of sharps HHWs, and 67.6% of pharmaceutical HHWs in household waste. Findings highlight substantial gaps and challenges in HHW disposal practices in Türkiye. A significant proportion of HHWs is disposed of together with household waste, and most individuals lack adequate information regarding safe disposal methods. These results underscore the urgent need for legislative frameworks and public education initiatives to improve HHW management, protect public health, and promote environmental sustainability. Cite this article as: Yalçın Irmak, A. , Perim Ketenciler, A. , & Metinoğlu, M. (2026). Disposal of household healthcare waste: A cross-sectional analysis from Türkiye. Florence Nightingale Journal of Nursing, 34, 0313, doi: 10.5152/FNJN.2026.25313.
Community health workers (CHWs) serve as bridges between clinical care and community-based social support, yet they are often excluded from the design of the health interventions they implement. User Journey Mapping (UJM) is a tool that can enhance health behavior interventions and their implementation. As part of formative planning for the Philadelphia Community Engagement Alliance (Philly CEAL), we employed UJM methods to engage CHWs as co-designers in the implementation of an adapted chronic disease self-management intervention to promote heart health while addressing social needs. We conducted semi-structured interviews (n = 8) with seven CHWs and one supervisor from Philadelphia's Office of Community Empowerment and Opportunity. During the interviews, participants co-created visual workflow maps documenting daily tasks, emotional experiences, pain points, and opportunities. Individual maps were synthesized into comprehensive team maps and validated through follow-up sessions with the CHW team. Analysis revealed a four-part CHW process: community-based responsibilities, individual case management, in-office duties, and supervisory functions. Themes were identified related to the specialized skills and strengths associated with the CHW role, systemic challenges related to service workflows, and persistent emotional and psychological role-related stressors. UJM methods used in this formative work generated actionable insights for intervention refinement while positioning CHWs as expert co-designers rather than solely as the implementers of the intervention. The findings underscore the importance of integrating frontline expertise early in intervention planning to ensure programs are operationally efficient, emotionally attuned, and contextually grounded. We propose a set of methodological recommendations for embedding UJM within future public health planning, implementation, and evaluation efforts.
Hantaviruses are emerging rodent borne zoonotic pathogens of increasing global public health concern because of their high mortality, expanding ecological distribution, and potential for international dissemination. Although traditionally associated with sporadic rural outbreaks, recent ecological disruption, climate variability, urbanization, and increased global mobility have heightened concerns regarding hantavirus risks in mass gathering settings. This review critically examines the epidemiology, transmission uncertainty, diagnostic and surveillance challenges, and preparedness strategies related to hantavirus infections in the context of mass gatherings, including religious events, refugee settlements, cruise tourism, sporting events, and temporary accommodations. Particular emphasis is placed on the 2026 multinational cruise ship associated outbreak linked to the MV Hondius, which highlighted vulnerabilities related to delayed diagnosis, international passenger dispersal, and uncertainties surrounding possible human to human transmission of Andes virus. Current evidence indicates that hantavirus transmission occurs primarily through inhalation of aerosolized rodent excreta; however, controversies regarding limited interpersonal transmission, environmental persistence, and asymptomatic infections continue to complicate risk assessment and outbreak preparedness. Diagnostic limitations, underreporting, insufficient environmental surveillance, and lack of mass gathering specific preparedness frameworks remain major public health challenges, especially in resource limited settings. Strengthening proactive preparedness through integrated One Health approaches, ecological surveillance, genomic monitoring, AI driven epidemic intelligence, and coordinated international response systems is essential for mitigating future risks. The review emphasizes the urgent need for multidisciplinary research and evidence based policy development to improve global preparedness against emerging hantavirus associated threats in increasingly interconnected mass gathering environments.
The issue of insufficient physical activity in adolescents (defined by the World Health Organization as those aged 10-19 years) is a significant worldwide health concern, as 81% do not achieve the suggested levels of physical exercise. Although digital health interventions (DHIs) present promising scalable solutions, their actual performance in practical environments often falls short of anticipated outcomes. This systematic review provides a critical analysis of the existing research on digital strategies aimed at enhancing physical activity among adolescents, emphasizing the factors that contribute to their success, user engagement, and equitable access. This systematic synthesis compiles findings from scholarly articles released from 2020 to 2026. The primary outcome was physical activity, measured by daily step counts or minutes of moderate-to-vigorous physical activity (MVPA). Secondary outcomes included engagement, adherence, motivation, psychological factors, equity, and other health-related measures. We included randomized controlled trials, cohort studies, cross-sectional studies, mixed-methods studies, systematic reviews, and meta-analyses. By examining research on a range of digital health technologies-including wearable devices (e.g., fitness trackers, smartwatches), mobile applications, gamified platforms, chatbots, and AI-driven tools-the analysis integrates quantitative data with qualitative insights from co-design studies to provide comprehensive insight into the effectiveness, timing, and target audiences of digital interventions. Methodological quality and risk of bias were assessed using study-design-specific tools: RoB 2 for randomized controlled trials, ROBINS-I for non-randomized interventional studies, AMSTAR 2 for systematic reviews and meta-analyses, NOS for cohort and longitudinal studies, AXIS for cross-sectional studies, CASP for qualitative studies, and MMAT for mixed-methods studies. The results reveal a persistent disparity between effectiveness and user involvement: while 63% of the examined DHIs demonstrated positive results in their initial assessments, adherence levels dropped from 73% at the start to just 14% by the fifth month. (The 63% = 29/48 studies reporting a significant positive effect on PA. The adherence rates are from a single cohort study tracking device usage over time, not pooled across studies). The success of these interventions is not solely dependent on advanced technology but rather on the integration of three interconnected factors: (1) developmental suitability, where younger adolescents (approximately 10-13 years) are more responsive to playful, sensorimotor activities, whereas older adolescents (approximately 14-19 years) prefer goal-setting and tracking their own progress. (2) relational design, features like team challenges, empathetic AI characters, and customizable avatars can boost confidence by 50% and motivation by 120%; and (3) contextual relevance, data indicates that moderate to vigorous physical activity (MVPA) peaks between 5 and 8 p.m., highlighting the critical difference between screen time (which can hinder activity) and the frequency of physical engagement (which encourages it). Ongoing disparities in equity-such as digital literacy gaps exceeding 35% and reduced engagement among racial and ethnic minorities-emphasize the need for intentional structural and cultural alignment to prevent digital interventions from widening existing inequalities. Effective digital solutions prioritize the needs of adolescents rather than focusing solely on technology. They emphasize tailored experiences instead of fixed features, foster meaningful connections rather than relying on precise algorithms, and adapt to specific contexts instead of aiming for one-size-fits-all scalability. Future developments should shift away from merely measuring screen time and instead embrace approaches that are rich in experience, affirm individual identities, and promote social justice while incorporating physical activity into the everyday lives of young people. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261415756.
The global population is ageing at an unprecedented rate, creating substantial pressures on healthcare systems to deliver personalised, proactive, and cost-effective care for older adults. Digital twin (DT) technology, where dynamic virtual replicas of physical entities are continuously updated through real-time data, has emerged as a transformative tool in precision medicine. Despite its growing application across clinical specialties, its specific utility within geriatrics and gerontology remains underexplored in the academic literature. This narrative review aims to synthesise existing evidence on the applications of digital twin technology in geriatric and gerontological care, examine associated challenges and identify future research priorities. A narrative review methodology was employed, with a systematic search of PubMed, Scopus, Web of Science, and IEEE Xplore databases covering publications from January 2014 to December 2025. Studies were selected based on relevance to digital twins, ageing populations, or geriatric clinical domains, with data synthesised thematically. Digital twins demonstrate significant potential benefit across multiple geriatric domains, with use in cardiovascular monitoring, fall prevention, dementia management, polypharmacy optimisation, and chronic disease self-management. Key enablers include advances in Internet of Things (IoT), artificial intelligence, and electronic health records. Persistent challenges include data privacy concerns, interoperability deficits, computational costs, and ethical questions surrounding autonomy and consent in cognitively impaired populations. Digital twin technology holds considerable promise for revolutionising geriatric and gerontological care, by enabling hyper-personalised clinical decision-making, predictive risk management, and remote patient monitoring. Translating this potential into practice requires focused investment in regulatory frameworks, equitable access infrastructure, and interdisciplinary collaboration. Future research should prioritise standardisation, caregiver integration, and longitudinal validation studies within older adult populations.
There is increasing recognition of the challenge of representativeness in data, including economic, social, and ethnic diversity, in biological mental health research. This is a particular challenge in adolescence, where brain and body development are impacted by the environment. The first step in addressing this is understanding the scale of the challenge. As such, this scoping review aims to explore existing literature to identify and understand the needs, barriers, and facilitators in collecting biological data in adolescent mental health research. A systematic search identified papers recruiting participants aged 11-18, collecting biological data, and focussing on mental health/related psychopathology. Screening was performed in duplicate, and data charting was iterative. The initial search identified 13,752 papers. After removal of duplicates and screening exclusions, 962 papers were included; 892 were explored for recruitment, retention, and engagement. Sample sizes <99 were most common (54.4%), and health settings (45%) were the most frequent recruitment source. As labels for 'barriers', 'facilitators', and 'needs' were rarely used, information on recruitment, retention, and engagement (e.g. strategies for stakeholder engagement) were explored as a proxy. Only 8.6% of papers reported engagement strategies; fewer evaluated their efficacy. Less than half (45.6%) reported retention data, with reasons for lost data mostly relating to the nature of the data collection. Papers do not adequately report the methods used to ensure sufficient collection of representative data. Limited reporting challenges whether or not facilitators are being implemented. Advancing the field requires detailed guidelines. We present recommendations that serve as a first step towards this development.
Young Black children experience poorer sleep health than children from other racial/ethnic groups. Tailored family-centered interventions are needed to improve sleep health among young Black children. Tailoring requires information about parent perceptions, practices and context. The purpose of this study was to (1) understand the contextual definition of sleep health for Black families; (2) bedtime routines and sleep practices among Black families; and (3) parent preferences that may inform intervention design. We engaged 30 Black parents of 3-8-year-old children with mild sleep problems (e.g., child takes >30 min to fall asleep at bedtime) in this study. Parents completed three ratings scales about sleep health practices and child bedtime behavior and a semi-structured interview. Statistical analysis included descriptive statistics and correlations. We used an implementation science rapid qualitative analysis approach to analyze qualitative data from the interviews. The final sample identified as 52% African-American, 14% Jamaican, 10% Haitian, and 26% mixed multi-ethnic groups. Parent mean age was 41 years and child mean age were 5 years old. About 80% of responders were women. About one-third of the sample held a doctoral degree, and half the sample had a bachelor's or Master's degree. Parents answered 56% of sleep knowledge questions accurately (ranging from 32 to 100%) and reported an average of two sleep problems. Parents described healthy sleep as involving flexibility in sleep timing and bedtime routines. More than half of parents reported co-sleeping practices, with reasons ranging from a strategy to address night wakings, to a way to preserve bonding. Later child bedtime (after 9 pm) was associated with bedtime resistance, permissive parenting, and parent stress. Many parents reported that they had poor sleep quality and duration. Findings elucidate a range of factors to consider in tailoring sleep health interventions for Black families of young children. These include the common practice of co-sleeping, parents' value for flexibility related to bedtime and bedtime routines, and parents' own challenges with getting enough and good quality sleep. Tailored family-centered interventions will benefit from considering these factors.
The concept of nursing innovation remains inconsistently defined across the literature. This conceptual ambiguity impedes the advancement of nursing innovation scholarship. To advance conceptual clarity of nursing innovation within global health ecosystems as a heuristic to support the knowledge base of the nursing discipline. The Innovation in NurSIng for Global Health ecosystems Transformation (INSIGHT) study applies Rodgers' evolutionary concept analysis. The search was performed in February 2025 across five databases, supplemented by hand-searching of reference lists. Rodger's core components (attributes, antecedents, consequences, surrogate terms, and related concepts) were identified and analyzed using a hybrid deductive-inductive thematic analysis. The synthesized findings were subsequently interpreted through a nursing philosophical lens. A conceptual model was developed and illustrated through an exemplar of nursing innovation. A total of 10,540 records were screened, with 43 articles included. Four defining attributes were identified: innovation characteristics, innovator capabilities, innovation process, and solution dimensions. Antecedents comprised contextual conditions (unmet needs, opportunity identification, and emerging demands) and structural conditions (innovation education, professional capabilities, leadership support, and organizational systems). Consequences included value generation and delivery, as well as unintended consequences. The analysis yielded a proposed definition of nursing innovation. As nursing and health systems face unprecedented challenges, a shared understanding of nursing innovation among nursing stakeholders is essential to support the design and implementation of solutions that advance the well-being of individuals, populations, and global health ecosystems. Continued theoretical and empirical inquiry is warranted to further refine this evolving concept and advance nursing innovation scholarship.