Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While research often prioritizes generalizability or recruiting a specific community, a tailored approach is essential to recruit and retain diverse communities. This study aims to illustrate the depth and breadth of existing community-engaged research methods that have been used to increase recruitment and retention of diverse communities. Semi-structured interviews were conducted to identify common themes and best practices of inclusive research with 48 principal investigators and their study staff who had successfully engaged with different diverse communities from research institutions in the United States. Data were analyzed using a rapid qualitative analysis approach and organized thematically. Six key themes related to conducting community-engaged research emerged: research team as community health advocate, community-academic partnership characteristics, best practices for conducting research with diverse communities, incurred financial costs, sustainability of inclusive research efforts, and system-related challenges. Participants emphasized the role of research teams to uplift community voices, build authentic and collaborative partnerships, prioritize cultural practices of the community, and use data to inform policy. Best practices included providing incentives, offering bilingual materials and having bilingual staff, and using multi-pronged recruitment and retention strategies. Financial costs included both tangible costs such as transportation and honoraria, while intangible costs such as time and trust-building were also highlighted. Sustainability required early planning, capacity-building, and continuous fiscal support. Challenges included insufficient institutional support, burnout, and staff turnover, stressing the need for multi-level strategies and solutions integrated into the research environment to support inclusive research practices. A general research approach that tailors to specific communities' preferences and fosters collaborative partnerships will better enhance representation in research. However, the research environment requires attention to multi-level strategies to minimize challenges to conducting community-engaged research.
Qualitative research offers key insights into enablers and obstacles of healthcare-seeking behavior, and the credibility of findings depends on methodological quality. This study aims to critically appraise the methodological quality of existing qualitative studies on delayed medical consultation in obstructive sleep apnea (OSA) patients, thereby identifying common limitations and offering recommendations for future improvements. A systematic search was conducted in EMBASE, MEDLINE, and CENTRAL databases, covering literature from inception to February 2026. Inclusion criteria were qualitative studies (e.g., phenomenological, ethnographic, or grounded theory paradigms) on medical consultation delays in adult OSA patients, excluding single-case studies or narrative reports with very small samples. Two reviewers independently assessed studies against five dimensions, with disagreements resolved by discussion. Three studies were included, from which eight methodological issues were identified: (1) potential "survivorship bias" from including only diagnosed patients; (2) recall bias in retrospective designs; (3) insufficient consideration of the role of comorbidities in the healthcare-seeking process; (4) unclear directionality between cognitive factors and delayed behavior; (5) lack of in-depth analysis of deviant cases; (6) oversimplified view of family/friend support; (7) insufficient transparency in reporting interview guides and data saturation; and (8) absence of researcher reflexivity during data collection and analysis. Current qualitative studies on delayed medical consultation in OSA patients have several methodological flaws that may affect their validity. Future research should prioritize prospective, community-based studies targeting high-risk OSA populations not yet seeking medical help, and comprehensively document the entire trajectory of their medical consultation delay. This will enhance research rigor and provide clearer guidance for developing more actionable intervention strategies.
The rapid integration of Large Language Models (LLMs) into health research presents a dual promise: to serve as an epistemic equalizer by lowering barriers to scientific participation, and a significant governance challenge, risking a "validity gap" where output volume outpaces integrity. Research Ethics Committees (RECs), tasked with safeguarding research, face a critical "purview weakness" in evaluating these opaque technologies. This tension is most acute in African contexts, where the need for innovation intersects with vulnerability to algorithmic colonization and where empirical data on REC preparedness is absent. A qualitative study employing in-depth, semi-structured interviews was conducted with a purposively sampled cohort of 14 REC chairs, members, and research ethics office staff from health science institutions across South Africa. Data were collected between January and July 2024, transcribed verbatim, and analysed using inductive thematic analysis. Analysis yielded five central themes namely: (1) understanding of LLMs, (2) perceived benefits of LLMs use in health research, (3) perceived challenges and concerns in the use of LLMs in health research, (4) human oversight - augmentation, not automation, and (5) fragmented AI literacy within the research. Respondents recognized significant benefits in administrative efficiency, research lifecycle support, and democratizing writing skills. Crucially, there was unanimous consensus that LLMs must only augment, not automate, ethics review. Human oversight was deemed irreplaceable for contextual understanding, empathy, and complex moral deliberation qualities respondents implicitly aligned with relational, Ubuntu-informed ethics. South African ethics gatekeepers perceive LLMs as powerful but risky tools. Their insistence on human-centric governance, rooted in contextual and communal values, provides a vital counter-narrative to purely technocratic oversight models. These findings provide an urgent empirical foundation for developing context-specific AI governance guidelines in African and other LMIC health research systems.
OBJECTIVE: To describe the lived experiences and health care perspectives of people with femoroacetabular impingement (FAI) syndrome to help guide patient-centered care. DESIGN: Preregistered (CRD42024581726) systematic review of qualitative studies followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. LITERATURE SEARCH: Embase, CINAHL, MEDLINE, PsycINFO, and Cochrane Library were searched from inception to June 24, 2024, using key subject and free-text terms, updated on November 8, 2024. STUDY SELECTION CRITERIA: We included English-language qualitative and mixed-methods studies that explored the experiences, beliefs, attitudes, perspectives, and/or needs of individuals aged ≥12 years with FAI syndrome. Studies with ≥5 participants were included; there were no publication date restrictions. We used the Critical Appraisal Skills Program (CASP) qualitative and mixed-methods checklist to assess methodological quality. DATA SYNTHESIS: We conducted a hybrid framework and thematic synthesis using the Common-Sense Model of Self-Regulation. Certainty of findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) framework. RESULTS: Eight studies (4 qualitative, 4 mixed-methods) with 409 participants were included. Four key themes were identified: (1) physical and psychosocial effects of FAI syndrome and its care, (2) preference for surgery based on pathoanatomical and biomechanical beliefs, (3) unmet needs and expectations, and (4) varied perceptions of physical therapy. CONCLUSION: This review highlighted the physical and psychosocial impacts of FAI syndrome. Patient education and support may be valuable to set realistic treatment expectations and improve surgical and nonsurgical treatment outcomes. J Orthop Sports Phys Ther 2026;56(7):413-426. Epub 7 October 2025. doi:10.2519/jospt.2025.13404.
Use of telehealth for behavioral health services has rapidly expanded with potential to reduce rural health disparities. Applying evidence-based treatments for problematic sexual behavior (PSB) among youth via telehealth can prevent further sexual harm of children. Successful implementation of telehealth in rural communities requires examining the acceptability, understanding, barriers, and facilitators of the approach. Using a qualitative approach, this study explores family and clinician perception of the utility of telehealth to enhance access to PSB cognitive behavioral group treatment (PSB-CBT) services. Results revealed telehealth provided opportunities to address internal (e.g., shame, stigma) and external barriers (e.g., time, transportation, childcare), as well as impact of unique rural communities' characteristics. Privacy, safety, reduced isolation and shame, and enhanced sense of community among members were noted as benefits of group telehealth, while technology literacy, device accessibility, and group appropriateness were reported obstacles. Strategies to enhance success included telehealth orientation, loaning secure devices, integrated therapeutic activities, focused efforts on building relationships among members, and augmenting with family sessions. Future research on implementation and treatment outcomes of group telehealth for PSB is recommended.
Policymakers increasingly aim to scale up healthcare interventions to a national scale to maximise reach and impact. However, scaling complex interventions presents challenges, particularly in balancing national standardisation with flexibility in local implementation across contexts. This study investigates how leaders experience and manage the national implementation of Proactive Health Support, a large-scale self-management support intervention in Denmark. The study employed a single-case study design with embedded units to examine the national implementation of the Proactive Health support intervention. Data were collected through 10 semi-structured interviews with leaders from the five Danish regions, over 25 hours of participant observation of leadership meetings and workshops, and a document analysis of 468 pages of leadership meeting minutes and reports. Implementing Proactive Health Support required leaders to balance the tension between fidelity and adaptation within a standardised framework. While the national framework provided stability, leaders leveraged the flexibility of implementation strategies to preserve the core intervention components while enabling local adjustments to fit diverse contexts. Reflexive practices, characterised by real-time adjustments and operating through feedback loops, both reinforcing and self-correcting, were pivotal for balancing standardisation with flexibility. Vertical leadership mediated alignment between national and regional levels, while horizontal collaboration fostered shared learning across regions. This study demonstrates the complexity of scaling healthcare interventions across diverse contexts, underscoring the non-linear and dynamic nature of such processes and the significant ongoing leadership engagement required to navigate complexity and manage uncertainty. The findings highlight collaborative leadership as crucial for enabling real-time responsiveness, fostering alignment across levels, and balancing fidelity and adaptation in national implementations. They further suggest that fidelity and adaptation are not opposing forces but complementary in practice, with adaptation in implementation strategies supporting fidelity by allowing interventions to be applied meaningfully across diverse contexts. Finally, the findings suggest that successful national implementation processes rely less on strict adherence to standardised guidelines and more on a co-adaptive process within a standardised yet flexible framework, where intervention and context are co-constructed through ongoing, leadership-driven negotiation. Part of a research programme including a registered randomised controlled trial (ClinicalTrials.gov, NCT03628469). Not applicable to this study.
ObjectiveOlder adults living with mental illness experience significant physical health inequities and premature mortality. The Equally Well (EW) framework promotes integrated, person-centred care to address these disparities, yet its application in older adult mental health services remains underexplored.MethodUsing a phenomenological approach, focus groups with nine allied health clinicians working in a community-based older adult mental health service explored understanding and implementation of EW. Data were thematically analysed using the Theoretical Domains Framework.ResultsClinicians endorsed EW's holistic intent but reported variable understanding, discipline-specific role ambiguity, administrative burden, and fragmented primary care as barriers, particularly in the context of frailty and multimorbidity. Facilitators included documentation prompts, multidisciplinary collaboration, and targeted training.ConclusionsAllied health clinicians support EW principles but emphasise the need for organisational investment, practical training, streamlined documentation, and stronger primary-care links. Findings highlight the importance of age-sensitive adaptation of EW to ensure equitable physical health care for older adults with MI.
Diabetes is a major public health issue, especially in low-and middle- income countries (LMICs) where barriers to care are common. Despite insulin's critical role, access remains limited due to market concentration, weak policies, poor availability, and lack of trained staff. This study evaluated the implementation of an insulin use manual in Tumbes, Peru, focusing on healthcare workers training and systemic barriers. This was a two-phase descriptive mixed-methods study conducted in Tumbes, Peru. In the first phase (March-June 2023), a virtual course on insulin use followed by an on-site workshop was implemented for healthcare workers, with quantitative assessments of knowledge and satisfaction. In the second phase (October 2023), qualitative interviews were carried out with these healthcare workers as well as patients and caregivers to evaluate both the implementation process and the local health system using the Rapid Assessment Protocol for Insulin Access, Medical Research Council for Process Evaluation, and the World Health Organization (WHO)'s Six Building Blocks framework. Data were analyzed with descriptive statistics and thematic coding. The virtual course registered 193 participants, but only 44 completed all units, the median knowledge median scores rose from 15.3 to 19.1). In the on-site workshop, 28 participants attended. Median scores increased from 14 (IQR 10-16) at baseline to 15 (IQR 10-16) in the post-test. Feedback highlighted the course's flexibility and practical relevance, though participants suggested more hands-on components and patient education tools. Interviews revealed systemic barriers across WHO's Six Building Blocks framework, including limited training and confidence among healthcare workers in insulin management, shortages of insulin and related supplies at the primary care level, weak health information systems without proper tracking of insulin users; high out-of-pocket costs that undermine adherence, inadequate patient education, and insufficient leadership and supervision to ensure consistent diabetes care. This study shows that while targeted training can improve healthcare workers' knowledge on insulin use, systemic gaps continue to hinder quality diabetes care. Broader implementation of insulin protocols in LMICs requires not only training, but also a comprehensive reinforcement of the health system at all levels.
The emerging literature about parenthood indicates specific differences in autistic individuals' experiences compared with non-autistic ones. We conducted a systematic search of the literature across PubMed, Embase, Web of Science, and CINAHL Complete to identify articles related to pregnancy, childbirth, and parenthood in autistic individuals. The search was completed on March 5, 2024, and identified 35,581 records. Inclusion criteria included the use of semistructured interviews or focus groups for data collection and interpretative phenomenological analysis or thematic analysis for data analysis as the best methods for exploring our subject. After applying inclusion and exclusion criteria, six articles were included in the systematic review and underwent thematic synthesis. Each study comprised between 7 and 24 autistic participants (all females except three). Their methodological quality was assessed with the Critical Appraisal Skills Programme tool for qualitative studies. We identified three key themes as follows: 1. Parental Challenges and Adaptations; 2. Social Relations and Support; and 3. Identity and Personal Growth. Our analysis identified that autistic individuals face diverse challenges in becoming parents and parenting, including primarily sensory and communication difficulties, which impact their ability to interact with professionals and to manage daily tasks, requiring the implementation of diverse strategies and adaptations to cope. Autistic adults reported a strong emotional connection they build with their children, the need to advocate for them when they are also neurodivergent, and the difficulty in finding formal and informal support fulfilling their specific needs. The educational approach of autistic parents seems influenced by their autism, bringing both strengths and challenges to create, ultimately, a supportive parenting environment. The experience of becoming a parent and raising a child is described as a key step in their personal development. These findings will help autistic parents by promoting a better understanding of their experiences, challenges, and strengths by health care professionals and social workers. Why is this an important issue?: Many people are diagnosed autistic as adults, and some autistic children want to become parents when they grow up. However, there are few specific supports for autistic parents. Research shows that their experience of parenthood has unique aspects, which can be both strengths and challenges.What was the purpose of this study?: We conducted a comprehensive review of the literature on pregnancy, childbirth, and parenthood in autistic adults. Our goal was to identify, synthesize, and analyze qualitative studies to pinpoint the strengths, challenges, and specific needs of autistic adults in this area and to propose supportive interventions.What did the researchers do?: We performed a thorough search across four scientific databases to find relevant articles. We selected the applicable studies and analyzed their data by coding the results line by line. We reused codes from previous studies and created new ones as necessary. We then organized these codes into related areas to develop descriptive themes and combined them into analytical themes.What were the results of the study?: We identified three key themes as follows: 1. Parental Challenges and Adaptations; 2. Social Relations and Support; and 3. Identity and Personal Growth. We found that autistic individuals encounter several challenges in becoming parents and raising children, mainly due to sensory and communication difficulties. These issues affect their interactions with professionals and their management of daily tasks. Despite this, autistic adults report deep emotional connections with their children, a strong need to advocate for them, and difficulties in finding adequate support. Their parenting style, shaped by their autistic traits, presents both strengths and challenges. They view parenthood as a major milestone in their personal growth.What do these findings add to what was already known?: Our work identifies and describes the unique strengths, challenges, and needs of autistic adults in their parenting journey. It allows us to propose interventions to support autistic parents and highlights areas for future research.What are the potential weaknesses in the study?: As a qualitative literature review, our study did not include data from quantitative or mixed-method studies. By focusing on studies using the most adequate methodology, we may have missed some other qualitative studies offering new insights. Some participants were included based on self-reported diagnoses rather than confirmed by a mental health professional. In addition, the studies included very few men and no autistic parents with intellectual disability or borderline intellectual ability, which limits the generalizability of our findings to these populations.What do the authors recommend for future research on this topic?: Study the parenting experiences of autistic men, focusing on how sensory challenges affect their involvement with their children. Assess the importance of support from relatives and strategies to mobilize it. Describe the parenting style of autistic parents to enhance professional understanding and reduce bias. Identify obstacles to parenthood for autistic adults to develop suitable support. Examine the prevalence of autism in the children of autistic adults, which appears significant but remains unexplored.How will these findings help autistic adults now or in the future?: These findings highlight the challenges autistic adults face in parenting and suggest interventions to support them. They also help counteract biases among health care professionals and society, fostering better understanding and support for autistic parents.
Programs to support mental health in workplaces, particularly those using digital methods, show promise for increasing appropriate use of services. However, it is unclear which factors influence the successful implementation of such programs. Implementation outcomes from a cluster randomised trial (cRCT) of a digital single-session intervention (Helipad program) for improving mental health help seeking in employees were explored using both qualitative interviews (n = 16) and quantitative data collected at post-test during the cRCT (N = 344). Linear regression analyses tested predictors of participation (uptake) by workplace, and predictors of participant views about the acceptability, appropriateness, and feasibility of both the Helipad program and the control (static psychoeducation only). Qualitative data were thematically analysed to summarise feedback and recommendations around implementing the program, based on the Consolidated Framework for Implementation Research. The Helipad program performed better than the control program for participant implementation outcomes, with significantly superior acceptability, appropriateness, and feasibility. More intensive methods to encourage participation such as additional emails, meetings, and delivery via a learning management system were associated with significantly greater uptake. There were few differences in acceptability ratings between workplace types indicating that the program may be useful and acceptable in a broad range of settings. Qualitative data indicated that the Helipad program was easy-to-use and contained a broad range of information on workplace mental health. A challenge identified by participants was how to best engage people with less interest or low perceived need for mental health support. Recommendations for implementation included ensuring workplace leader investment, allowing time during work to complete the program and modelling positive attitudes and behaviours towards mental health and help seeking. Implementation of workplace mental health interventions can be enhanced by clear communication with workplace leaders about its benefits, and by facilitating engagement of employees with the program during work time. Partnerships with stakeholders such as insurance companies or industry bodies may improve reach.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617.
The increasing reliance on online platforms for health information establishes the need to understand people's engagement and attitude towards Online Health Information Seeking (OHIS). The current study aims to develop and validate a comprehensive multidimensional Online Health Information Seeking Scale (OHISS). Items were generated using both inductive and deductive approaches, followed by multiple content and face validity screenings that incorporated qualitative and quantitative evaluations. Data were collected in two stages: Study 1 (N=364) for item development and identifying the preliminary factor structure using Exploratory Factor Analysis (EFA) and Study 2 (N=236) for validating the obtained factor structure using Confirmatory Factor Analysis (CFA). Following the descriptive analysis, EFA using Promax rotation yielded a 20-item scale comprising three dimensions: Perceived Benefits and Engagement (11 items), Perceived Risks (6 items), and Social Influences on OHIS (3 items), collectively accounting for 51.1% of the total variance. This three-factor structure was subsequently confirmed through CFA with DWLS estimator (χ²(167)=271.55, χ²/df=1.63, CFI=0.986, TLI=0.984, RMSEA=0.052, SRMR=0.071, and GFI=0.978). The scale has good internal consistency as demonstrated by Cronbach's alpha (α=.833), McDonald's omega (⍵=.824), Spearman brown split-half (rxx=.886), Guttman's lambda (λ=.885) and test-retest (ICC2,1=.728) coefficient. Construct validity was supported by significant correlations with the Attitude towards Online Health Information and Information-Seeking subscales, as well as Average Variance explained, Composite Reliability, and the Heterotrait-Monotrait Ratio. The scale demonstrated measurement invariance across male and female groups. The results conclude that the OHISS is a psychometrically standardized measure. The OHISS may be used by health practitioners to assess individuals' attitudes toward online health information, identify barriers in accessing digital health content, and support both health-related communication and research.
Incarceration in the United States disproportionately affects individuals with mental illness and substance use disorders and often exacerbates mental health conditions due to the trauma of arrest, separation, disrupted care, and stigma. Forensic Peer Support (FPS) can improve recovery outcomes by building unique trust and rapport that supports community reintegration and recovery outcomes. This paper describes findings from a qualitative study of 22 participants who are a sub-sample of the larger Recovery Finance study, a multi-level community based participatory research study designed to reduce financial hardships of individuals involved in criminal justice with mental health challenges through system level interventions as well as an individual intervention (randomized control trial testing one-on-one financial capability support (FCS) versus FCS plus forensic peer support). The focus of this paper is the mental health and peer support experiences of the qualitative sub-sample. Thematic analysis of in-depth qualitative interviews revealed the following themes: 1. The Impact of Incarceration, Trauma, and Mental Health, 2. Systemic Failings in Mental Health Care in Prison and Post-Release, 3. The Cycle of Financial Strain and Mental Health, and 4. The Unique Value of Shared Lived Experience through Peer Support. Results highlight the trauma and psychological impact of incarceration, systemic failures in treatment, financial stress as a dominant source of anxiety, often perpetuating cycles of poverty and criminal activity, and the critical role of supportive relationships, in particular FPS. These findings point to the need for integrated models in which forensic peer support is embedded within financial wellness and reentry services.
Background: This paper aims to understand whether and how the Italian healthcare context has embraced sustainability accounting and reporting practices. Specifically, it investigates if the sector has developed institutional pressures that drive public healthcare organisations toward the adoption of sustainability disclosure.Methods: The researchers employed document analysis as a qualitative research method for data collection and analysis. The research team analysed a total of 80 institutional and corporate documents, divided into 10 documents from the regional programming phase and 70 from the corporate monitoring phase.Results: The analysis shows that Italian healthcare organisations are lagging in adopting sustainability documents. Furthermore, the analysed disclosures do not refer to the United Nations Sustainable Development Goals (SDGs), as they are compiled according to national legislation designed well before the introduction of the SDGs framework.Discussion & Conclusion: The lack of institutional pressures across public sector organisations has hindered the development of a solid culture of sustainability reporting in the public healthcare sector. This research contributes at two levels: practically, it advances the accounting and reporting literature by examining the availability of such practices in the public sector; theoretically, it sheds light on the development and role of institutional pressures for sustainability reporting in Italian public hospitals.
Qualitative methods are now central to implementation science, but they are used to do different kinds of work that are not always clearly distinguished. Some studies are designed to develop contextual or conceptual understanding, while others are expected to inform near-term decisions about rollout, adaptation, or implementation strategies. When these differences remain implicit, qualitative studies may be designed and evaluated against expectations they were never intended to meet, particularly around the role of theory, openness to unanticipated findings, and what counts as rigor. In this debate paper, we argue for a more explicit way of thinking about qualitative inquiry in implementation science. Rather than treating qualitative methods as a single approach, we suggest they are being configured in different ways in response to study purpose, time and resource constraints, the state of knowledge about the phenomenon or context, and stakeholder expectations. To make these differences visible, we propose a positioning framework that locates qualitative inquiry along a continuum of three orientations: Generative, Pragmatic, and Action-oriented. Generative inquiry prioritizes contextual depth and conceptual development; Action-oriented inquiry is organized to produce timely, decision-relevant findings; Pragmatic inquiry occupies the space between these poles. We then introduce a positioning guide and an accompanying table to show how these orientations shape key aspects of qualitative design, including question formulation, the role of theory, sampling, data collection, analysis, and reporting. The contribution of this paper is a framework for describing what qualitative studies in implementation science are trying to produce and how they should be assessed. Qualitative rigor cannot be reduced to a single standard when studies are making different kinds of claims. Making methodological positioning more explicit may help reduce mismatched expectations in study design and peer review, and support more consistent judgments about the contribution of qualitative work in implementation science.
PurposeOnline directories play an important apomediary role in shaping how older adults find and compare potential providers. However, little is known about how this type of health information represents older adult needs and aging-related mental health expertise. This study examines how mental health professionals represent older adults and age-related care in their Psychology Today profiles.MethodsWe conducted a mixed-methods content analysis of 281 Psychology Today provider profiles across 8 U.S. cities. We used frequency counts and descriptive statistics to characterize provider attributes and areas of expertise. Using thematic analysis, we examined how providers describe their approach to serving older adults and aging-related mental health care. Quantitative findings informed and contextualized the qualitative analysis.ResultsWe identified one overarching theme "Older Adults at the Limits of Apomediated Visibility" and four subthemes: "Absent Narratives of Aging," "Token Mentions of Older Adults", "Misaligned Descriptions of Expertise", and "Generalist Framings Obscure Age-Specific Care". These results suggest that apomediary signals of relevance may not consistently match substantive descriptions of provider expertise in older adult mental health care.ConclusionsFindings reveal gaps between platform filters and profile narratives that may undermine the directory's apomediary role, making "older adult" care appear searchable while obscuring the age-relevant information older adults need to make informed health decisions. Better alignment between structured search criteria and narrative self-representation would strengthen informed decision-making and advance equitable access to age-responsive mental health services.
Erectile dysfunction (ED) is a common but under-discussed complication among men living with diabetes (MLWD), particularly in African contexts where sexual health is culturally sensitive. Despite major psychosocial and relational consequences, ED is often inadequately addressed within routine diabetes care. This study explored perceptions, impacts, and management practices related to sexual weakness among MLWD, alongside healthcare providers' experiences managing the condition in Ghana. We conducted an exploratory qualitative study across five public healthcare facilities in four regions of Ghana. In-depth interviews were conducted with 26 MLWD and 14 healthcare providers involved in diabetes care. Participants were purposively recruited, and data were analysed using thematic analysis supported by ATLAS.ti. Participants attributed sexual weakness to multiple causes, including diabetes-related complications, medication effects, and spiritual factors. Divergent explanatory models between patients and providers shaped management decisions and care-seeking. Many men reported using herbal remedies, aphrodisiacs, energy drinks, and spiritual interventions, often delaying biomedical care. Sexual weakness was associated with distress, reduced confidence, and relationship strain, and disclosure was selective, shaped by stigma, secrecy, and trust. Providers expressed concern about misconceptions, unregulated treatment use, and structural constraints within overcrowded diabetes clinics that limited meaningful engagement on sexual health.
The EQ Health and Wellbeing (EQ-HWB) is a new, generic instrument designed to evaluate quality-of-life across health, public health, and social care settings. The short form comprises nine items (EQ-HWB-9) and validation across diverse populations and contexts is required. We aimed to investigate the validity of the EQ-HWB-9 in an international sample of adults experiencing poor mental health who downloaded a meditation app. We further examined the impact of four item-level modifications on psychometric performance, including investigating a potential ordering effect for the 'activities' item (hypothesised in prior studies) and three minor changes to response options. The current study was embedded in a larger trial examining engagement with meditation via a free, downloadable app. Participants were randomised to complete the original (2022) and modified (2024) experimental version of the EQ-HWB-9. Psychometric evaluation included analyses of item distribution, known group and convergent validity, and responsiveness to change. There were no differences in demographic characteristics between the EQ-HWB original and modified versions at baseline (n = 865) or follow-up (n = 130). All psychometric tests supported the validity of the EQ-HWB-9 in this population. We found an ordering effect for the activities item, where the activities item showed a greater level of difficulty and a wider distribution over response options when asked before the mobility item, rather than after. There were no observable differences between versions for the other modifications. These findings add to growing literature supporting the EQ-HWB-9 as a suitable instrument for measuring quality-of-life across a range of settings. When the 'activities' item was presented first, as in the modified version, participants appeared to interpret the item more broadly, in line with the developers' intentions. Accordingly, our results support changing the item order of the first two items. Other modifications had little impact on outcomes, suggesting that further qualitative research will be required to inform decisions about their inclusion. Results from this study provide support towards finalisation of the instrument. The development of country-specific value-sets is now critical to support its application in economic evaluation.
As artificial intelligence (AI) technologies become increasingly integrated into healthcare systems, understanding their impact on healthcare professionals is essential. This study provides a comprehensive examination of dietitians' perspectives, experiences, and future projections regarding AI in Türkiye. The research elucidates how artificial intelligence may affect professional identity, patient-dietitian interactions, and ethical boundaries, drawing on direct insights from practitioners. This qualitative research was conducted with 16 dietitians working in different institutions (hospitals, universities, and counselling centres) in Türkiye, selected through purposive sampling. Data were collected via a semi-structured interview (face-to-face/online) and analysed using inductive thematic analysis. The analysis indicates that dietitians' perspectives on artificial intelligence are influenced by both perceived opportunities and risks. Participants described artificial intelligence as a valuable assistant that enhances information retrieval and efficiency yet expressed concerns regarding misinformation and the erosion of professional boundaries. A prevailing view among participants is that artificial intelligence can perform technical calculations but cannot replicate essential human attributes in dietetics, such as empathy, emotional connection, and personalized care. Furthermore, participants highlighted that information pollution generated by artificial intelligence may undermine client trust, with data privacy identified as the most significant ethical concern. Dietitians maintain a cautious yet optimistic perspective regarding artificial intelligence technologies. Participants generally do not view technology as a competitor that will replace dietitians, but rather as a complementary tool that supports guidance and coaching beyond information provision. To maximize the benefits of artificial intelligence and mitigate associated risks, revising educational curricula to include digital literacy and promptly establishing professional ethical standards are essential.
Healthcare workers (HCWs) may have a higher risk of developing long COVID due to greater exposure to COVID-19, with symptoms extending beyond the acute phase impacting their daily living activities and job performance. To systematically map the existing literature on the impact of long COVID on HCWs' job performance, focusing on their time to return to work and work ability. A scoping review following PRISMA-ScR guidance included peer-reviewed studies in English or Spanish (January 2020-December 2024). Four databases were searched. Experimental, epidemiological and qualitative studies were eligible. Two reviewers independently screened records. Methodological quality was appraised using the Mixed-Methods Appraisal tool (MMAT). Nineteen studies were included, mainly European and predominantly cross-sectional. Long COVID was most often defined as symptoms lasting ≥ 3 months. Among HCWs with prior infection or whole-staff samples, prevalence ranged from 10% to 74%, with multiple reports above 50%. Thirteen studies evaluated RTW, with 19-63% resumed work within six months, commonly with restrictions, while around one in five remained unable to work in some cohorts. Full-time employment decreased markedly (e.g., 57% pre-infection vs 31% at follow-up). Between 16% and 40% required workplace adjustments such as reduced hours, reassignment, or avoidance of night shifts. Sixteen studies reported diminished work ability compared with pre-infection or unaffected peers. Greater symptom burden, particularly cognitive impairment and fatigue, consistently predicted poorer outcomes. One study estimated a mean of 223 days to reach current work-ability levels. Older age, depression, comorbidity, and acute disease severity were recurrent associated factors while evidence for gender and job category was inconsistent. Long COVID delays RTW and reduces work ability in HCWs. Health services should plan long-term occupational follow-up, flexible reintegration pathways, and targeted accommodations while higher-quality longitudinal research refines risk and prognosis.
Innovative qualitative methods are important in nursing research for understanding perspectives that are often under-heard, including those of adolescents. This methodological article draws on a focused ethnographic study of 11 urban adolescents aged 12-18 years to examine the use of photo elicitation in nursing research on greenspace, health and place. Using disposable cameras, participant-led photo tasks, semi-structured interviews and integrated visual-verbal analysis, the study explored how photo elicitation supported adolescent engagement while generating insight into how young people perceived and used urban greenspaces. This article discusses the methodological and ethical issues that arose in the study, including camera training, timely return of cameras, assent and parental consent, privacy and image ownership, and the interpretation of photographs alongside interview and fieldnote data. It also reflects on the integration of emic and etic perspectives and on the role of reflexivity in analysing adolescent-generated visual data. Trustworthiness was supported through verbatim transcription, audit trails, NVivo analysis and team triangulation, with analysis informed by the approach of Braun and Clarke (2006) . Photo elicitation supported reflection, participant-led discussion and richer contextual understanding of adolescents' experiences. This article offers practical guidance for nursing researchers using visual methods with adolescents, with an emphasis on study design, ethical planning, and integrated analysis of visual and verbal data. These methodological lessons are relevant to adolescent health, community health and nursing research using participatory qualitative approaches.