Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 21 appraisals
African journal of reproductive health
How school-community cultural norms shape young people's reproductive health behaviors: Evidence from educational and behavioral research in China
This study systematically examines how school-community cultural norms shape young people's reproductive health behaviors in China. Using the PRISMA 2020 framework, a systematic review of empirical studies published between 2010 and 2022 was conducted to synthesize evidence from educational and behavioral research. Multiple international and Chinese databases were searched to identify qualitative, quantitative, and mixed-methods studies examining the influence of cultural norms within school and community settings on youth reproductive health knowledge, attitudes, and behaviors. Thematic synthesis, guided by the Social Ecological Model, was employed to integrate findings across studies. The review reveals that school-community cultural norms-particularly norms of silence, stigma, and gendered expectations-play a critical role in shaping reproductive health behaviors and in moderating the effectiveness of school-based interventions. Schools function both as reinforcers of prevailing community norms and as potential agents of change when culturally sensitive education is implemented. The findings underscore the need for context-specific, community-engaged reproductive health interventions tailored to the Chinese socio-cultural environment. Cette étude explore la relation complexe entre les normes culturelles et les comportements en matière de santé reproductive chez les jeunes en Chine, en se concentrant sur l'impact des environnements culturels école-communauté dans la formation de ces comportements. Elle examine comment les valeurs traditionnelles et les attentes sociales influencent les attitudes, les décisions et les actions des jeunes liées à la santé reproductive. En utilisant une approche de recherche qualitative, l'étude s'appuie sur des données secondaires à travers une revue approfondie de la littérature existante et de recherches antérieures, employant l'analyse de contenu pour extraire des insights détaillés. Les résultats soulignent que les normes culturelles école-communauté façonnent significativement les comportements en matière de santé reproductive, imposant souvent des effets restrictifs, les valeurs traditionnelles influençant profondément les décisions et les résultats de santé. L'étude met en lumière le besoin urgent d'interventions culturellement sensibles et spécifiques au contexte, conçues pour les jeunes Chinois. Elle souligne que les solutions efficaces doivent considérer l'interaction nuancée entre les normes culturelles, les contextes éducatifs et les pratiques de santé. En définitive, la recherche appelle à des programmes sur mesure capables de traiter ces complexités afin d'améliorer le soutien et les résultats en santé reproductive pour les jeunes en Chine.
31 May 2026
Read appraisal →The Science of the total environment
Ambient and personal air monitoring using low-cost sensors to identify elevated air pollution in vulnerable communities
In the United States, regulatory air monitoring networks are designed to assess regional air quality but do not capture neighborhood-level variability in pollutant concentrations. Low-cost air monitors may be one approach to address these gaps. The objective of this study was to evaluate whether neighborhood-level and personal monitoring identified increased concentrations of fine particulate matter (PM2.5) exposures in the neighborhood of Lower Price Hill (LPH), Cincinnati, Ohio, compared with regional regulatory monitors. We deployed a network of 12 PurpleAir monitors across LPH from April-June 2022 and calibrated measurements to a nearby U.S. EPA regulatory monitor. PM2.5 concentrations and Air Quality Index (AQI) values measured by the PurpleAir sensors were compared with two EPA monitoring sites. Additionally, three residents conducted 7-day personal monitoring using wearable AirBeam devices. Calibrated PurpleAir data demonstrated significantly increased PM2.5 concentrations at four of the 12 PurpleAir sites and increased AQI at 11 of the 12 PurpleAir sites in LPH compared to EPA regulatory sites. PurpleAir data also found that LPH experienced up to six days where AQI exceeded healthy levels (>50) but the EPA regulatory monitor did not exceed 50. Personal monitoring revealed substantial variability, with two of three participants exceeding the EPA 24-hour outdoor PM2.5 standard (>35 μg/m3) on all study days, indicating exposures not measured by outdoor stationary monitoring. Overall, regulatory monitoring may underestimate neighborhood-level and personal PM2.5 exposures in LPH. Community-based and personal monitoring provides novel insights into localized exposure disparities and may improve risk communication and inform interventions in vulnerable communities.
25 May 2026
Read appraisal →BMC psychology
Single-exposure messages for child sexual abuse prevention: a randomized controlled online trial testing educational and humanizing approaches
BACKGROUND: Child sexual abuse and exploitation, including online material depicting such acts, constitute a major public health concern. Prevention efforts likely benefit from public understanding and destigmatization, yet communication strategies on this topic face persistent misconceptions and strong emotional reactions. This randomized controlled online study examined whether brief educational and humanizing communication interventions influenced knowledge, attitudes, and behavioral intentions related to prevention, while avoiding adverse emotional or ethical effects. METHODS: A total of 2,019 adults from Spain and Portugal were recruited via an online panel and randomly assigned to one of four conditions: an educational message, a humanizing message with empathy focus, a humanizing message with prevention focus, or a neutral control message. Each intervention consisted of a short video and accompanying text presented as part of a health information campaign. Measures included affective state, stigma-related attitudes, literacy about therapeutic options, openness toward the topic, and behavioral intention to seek information. RESULTS: Exposure to any intervention message led to short-term changes in affective responses, with lower positive valence and slightly higher arousal compared to the control group (medium effect for valence, small for arousal). No significant differences emerged for stigma dimensions, knowledge, openness, or behavioral intentions. All three intervention formats performed similarly. The study did not identify measurable short-term adverse or rebound effects on stigma. Dropout rates did not differ across conditions, but languages. CONCLUSIONS: Brief communication interventions elicited short-term affective responses without evidence of increased stigma or avoidance on the measured outcomes. While the present single exposures appear insufficient to change attitudes or behavior, such formats may serve as a foundation for repeated, multi-channel prevention messaging integrated into broader educational efforts. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00038927, retrospectively registered on 09/01/2026.
25 May 2026
Read appraisal →PloS one
A collaborative approach to applying Natural Language Processing (NLP) to Domestic Homicide Reviews (DHRs): A study protocol
Since 2011, there has been a statutory requirement in England and Wales to conduct a Domestic Homicide Review (DHR) into any domestic abuse-related death: a multi-agency review into the death of a person aged 16 or over that appears resulting from violence, abuse or neglect from an intimate partner, family member or household member. However, analyses of large numbers of DHRs are rare. One of the core challenges is the time and effort required to analyse narrative text within reports. Doing so manually is both time-consuming and resource-intensive and is a primary reason why researchers typically focus on only a portion of the available data. Natural Language Processing (NLP)-a sub-branch of artificial intelligence that enables computers to interpret and process natural language-provides a viable and scalable alternative by offsetting much of the heavy data processing to a computer. This protocol outlines a study to assess the feasibility of applying NLP to DHRs. The study will take a collaborative approach which balances the speed and scale of automation with the embedded knowledge and expertise of practitioners. This approach helps to ensure that outputs of NLP are sensitive and transparent about the biases common within datasets on violence and abuse. Based on initial consultations, we identify the priority research questions for investigation. In addition, we outline details of an ongoing collaboration with one partner, Imkaan. The protocol describes the data access, and retrieval and analysis stages before summarising how feasibility will be evaluated. We anticipate that several challenges will emerge within this study and identify strategies for mitigation. We suggest that working with practitioners who hold deep contextual knowledge about the social realities of violence and abuse, including language, risks, and experiences, mean that tools can be developed that are accountable to communities and appropriately applied to real-world problems.
22 May 2026
Read appraisal →BMC public health
Little All Children in Focus (Little ACF) - evaluation of a parenting support programme for parents of children aged 1-2 years in Sweden: a randomised controlled trial
INTRODUCTION: The first two years of life affect health over the life course. Universal parenting support programmes may promote child health during these years but there is a lack of such evidence-based programmes. Our aim was to study the direct effects of a structured 4 sessions universal parenting programme for parents with children 1-2 years old, Little All Children in Focus, in Sweden. METHODS: A two-arm parallel randomised controlled superiority trial with 832 Swedish-speaking parents was conducted to evaluate the effectiveness of the Little All Children In Focus programme in comparison with an active control receiving four digital lectures on child development and parenthood. The participants completed questionnaires at baseline and post intervention measuring the primary outcomes: parenting self-efficacy and stress, coparenting quality, emotion regulation for parents and emotion regulation strategies for their children, and secondary outcome: child socioemotional development. A third research question concerned whether the intervention could engage and retain parents in groups. An intention-to-treat approach was applied using linear mixed models for analysing the effectiveness of the programme. RESULTS: Parents who participated in the programme demonstrated greater improvements in supportive emotion regulation strategies compared to the active control (β = 3.0, CI = 0.9 - 5.0), while no notable group differences emerged across the remaining outcome measures. The program demonstrated high levels of parental engagement and retention in group settings. CONCLUSIONS: Little All Children in Focus demonstrates potential in promoting supportive parenting emotion regulation strategies among Swedish speaking parents to 1-2-year-olds. The intervention also seems to have potential to engage parents. However, further evaluations must be conducted to provide a deeper understanding of the long-term impact of this universal parenting support programme. TRIAL REGISTRATION: The study protocol https://rdcu.be/eAxn2 was published at www. CLINICALTRIALS: gov with registration number: NCT05445141 (registered on July 06, 2022).
21 May 2026
Read appraisal →BMC public health
Interventions against loneliness and social isolation in older adults- a systematic review.
BACKGROUND: Loneliness is a growing health and social challenge. The COVID-19 pandemic boosted feelings of loneliness for many people. To combat loneliness, a wide range of interventions have been developed and evaluated for their efficacy and effectiveness. As a result, many new interventions to alleviate loneliness have been developed, especially technological interventions. Therefore, the objective of this study was to conduct a comprehensive and up-to-date systematic review to identify interventions aimed at loneliness and social isolation among adults, 60 years and older published during or post-pandemic. METHODS: A comprehensive literature search was conducted for studies between 2020 and 2024 across five online databases: MEDLINE via PubMed, Web of Science, Scopus, Cochrane Library, and CINAHL. Title and abstract screening, critical appraisal of the studies, and data extraction were performed by two independent reviewers. A narrative approach was adopted to assess and integrate the diverse findings from the research. RESULTS: Ultimately, 79 studies were included in this systematic review. The results are structured based on the categorization of the interventions, which includes differentiation between analogue interventions, technological interventions and multicomponent (analogue and technological) interventions. The effectiveness of analogue interventions, particularly community-based interventions such as group meetings, social participation programs, and educational or psychological interventions, tended to be superior to that of technological interventions. CONCLUSIONS: The combination of analogue and technological interventions in particular produced promising results regarding a decrease of loneliness. Specific interventions must be tailored to the target group and setting and regularly reevaluated. The aim now should be to implement these interventions comprehensively and monitor their effectiveness over several years. Future research should focus on differentiating the circumstances under which various forms of intervention are effective. TRIAL REGISTRATION: PROSPERO systematic review registration: CRD42024538755.
20 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Perinatal mental health training and supervision for primary care and community-based staff: a systematic review
BACKGROUND: Perinatal mental health problems are common yet often under-detected and under-treated in primary care and community services. International guidelines call for integration of mental health into perinatal care, but clarity is lacking on how best to equip non-specialist providers. Training and supervision programmes exist but vary widely in content and delivery, and their effectiveness and feasibility across settings are not comprehensively synthesised. AIM: To evaluate the effectiveness of perinatal mental health training for primary care and community-based providers on provider competence, maternal outcomes, and implementation in routine care. METHOD: Seven databases and grey literature were systematically searched to September 2025. Eligible studies evaluated training delivered to health or community providers involved in perinatal care. Due to heterogeneity, findings were narratively synthesised. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence appraised using GRADE. RESULTS: Of 707 citations screened, 39 studies were included, spanning high- and low-income countries and involving over 10,000 providers. Interventions varied in intensity and modality, including novel approaches such as extended reality simulation and cascade 'train-the-trainer' models. Training consistently improved provider knowledge, skills, attitudes, and confidence, and was associated with increased screening and referral, particularly when supported by supervision or system-level integration. Patient outcomes were less frequently assessed; where reported, some studies showed reductions in depressive symptoms and improvements in broader maternal outcomes, though findings were mixed. CONCLUSION: Training enhances provider capacity in perinatal mental health, but evidence on patient impact, sustainability, cost-effectiveness, and equity remains limited, highlighting priorities for future research and policy.
16 May 2026
Read appraisal →Journal of medical Internet research
Leveraging Text Messaging and Behavior Theory to Improve Colorectal Cancer Screening in Federally Qualified Health Centers: Cohort Study
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Despite recommendations for screening to begin at the age of 45 years, significant disparities persist, particularly among medically underserved populations. OBJECTIVE: This study examines the effectiveness of SMS text messaging reminders in improving CRC screening rates across 2 large federally qualified health centers (FQHCs) serving vulnerable populations. METHODS: The study included 4822 adults aged ≥45 years, receiving care at 2 large FQHC networks in Texas and California. Participants were assigned to one of four groups: (1) control (no SMS text messages), (2) single-outreach SMS text overdue message, (3) three-week SMS overdue and reminder text messages, and (4) six-week SMS text messages that were informed by behavior theory. Data were collected from May 2023 to July 2024. The outcome measure was a binary indicator of whether the participant underwent 1 of 3 CRC tests, fecal immunochemical test, colonoscopy, and Cologuard, within 90 days of completing the SMS text messaging reminders. Independent variables included demographic, geographic, clinical, and primary care access variables. Multivariate logistic regression models were used to examine associations between CRC screening completion and the SMS text messaging reminder groups, adjusting for covariates. Adjusted odds ratios (aORs) and 95% CIs were reported. RESULTS: In the combined 3-test model, patients in the single-outreach SMS text message (aOR 1.22, 95% CI 1.00-1.47) and the 3-week SMS text message (aOR 1.27, 95% CI 1.05-1.53) groups had higher odds of completing the screening test compared to those in the control group. Within the fecal immunochemical test-only model, patients in the 3-week SMS text message group (aOR 1.25, 95% CI 1.00-1.56) were more likely to complete the screening test. Within the Cologuard-only model, patients in the 3-week SMS text message group (aOR 7.01, 95% CI 1.96-25.07) and the 6-week SMS text message group (aOR 5.75, 95% CI 1.53-21.61) had significantly higher odds of CRC screening completion. CONCLUSIONS: The findings highlight that moderate-frequency SMS text messaging reminders can effectively increase CRC screening rates in FQHCs; however, critical factors include the timing and frequency of these reminders. The 3-week intervention was associated with improved screening uptake, whereas the 6-week theory-informed intervention did not demonstrate a significant advantage over the control group, potentially reflecting a ceiling effect or message fatigue associated with more frequent messaging. Additionally, the study highlights unique screening patterns that contradict previous literature, underscoring the importance of a tailored approach for vulnerable communities.
15 May 2026
Read appraisal →International health
Systematic narrative review on Menstrual health and hygiene (MHH) in Nigeria, Ghana, Liberia and The Gambia
Menstrual health and hygiene (MHH) are critical components of women's well-being, yet they continue to be overlooked in many low-resource settings. Addressing MHH issues in West Africa is crucial due to their widespread impact on education, health and gender equality, particularly among adolescent girls and women of reproductive age. This systematic narrative review consolidates the existing literature on MHH practices, knowledge, barriers and interventions in Nigeria, Ghana, Liberia and The Gambia. A comprehensive search was conducted across four databases (PubMed, Scopus, CINAHL Plus and Africa Journals Online) for studies published from 2000 to 2024. The search terms were related to menstruation, hygiene and the four West African countries. Both peer-reviewed articles and grey literature (Google Scholar, policy documents) were included to capture a broad spectrum of findings. Studies were selected based on their relevance to MHH in the target countries and data were extracted and analysed thematically. Of 345 articles identified, 26 studies met the inclusion criteria. Key findings highlighted the widespread lack of adequate MHM resources, such as sanitary products and functional sanitation facilities. Socio-economic disparities, cultural stigma and insufficient educational resources were major barriers to effective MHM. The review also found a strong link between inadequate MHM and adverse outcomes, including school absenteeism, psychological distress and increased vulnerability to infections. This review underscores the pressing need for comprehensive interventions to address MHH as a public health and human rights issue in Nigeria, Ghana, Liberia and The Gambia. Ensuring access to sanitary products, improved sanitation facilities and robust educational programs can help empower girls and women to manage menstruation with dignity, thereby improving their health, education and social participation.
12 May 2026
Read appraisal →Journal of epidemiology and community health
Children's views of obesity, body size and weight: systematic review of UK qualitative evidence
BACKGROUND: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap. METHODS: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data. RESULTS: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities. CONCLUSION: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health. PROSPERO REGISTRATION NUMBER: CRD42025650306.
12 May 2026
Read appraisal →American journal of speech-language pathology
Parental Roles in Language Intervention: A Systematic Review
BACKGROUND: Children with language delays (LDs) or language disorders face persistent challenges in their development. Speech and language therapy is vital, and within it, parental involvement is recognized as a key factor in therapeutic success. Although many parent-implemented interventions exist, little is known about the specific roles parents assume, particularly across different diagnostic groups: LD, developmental language disorder (DLD), and language disorder associated with other conditions (LD + X). OBJECTIVE: The aim of this study was to review and synthesize evidence on parental roles in language interventions for children with LD, DLD, and LD + X. METHOD: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42023452616), this systematic review analyzed studies from four databases. Eligible studies involved parent participatory language interventions reporting child language outcomes. Two independent reviewers conducted screening, quality appraisal, and data extraction. RESULTS: Across 37 studies, parents most frequently assumed the roles of Learner, Implementer, and Informer, highlighting their functions in acquiring knowledge, applying strategies, and providing feedback on children's progress. Less common roles included Adaptor and Collaborative Decision-Maker, suggesting that although caregivers are increasingly active, their engagement rarely extends to shared decision making with professionals. The studies reviewed here demonstrated considerable variability in intervention dosage, total duration, delivery format, and strategies taught. In contrast, less variability was observed in the identity of the parents/caregivers (most often the mother) and the trainer (typically a speech-language therapist) as well as in the type and mode of delivery. CONCLUSIONS: Parental engagement in language interventions continues to be largely determined by professional guidance, positioning parents as learners and implementers rather than full collaborators. Strengthening adaptive roles and promoting shared decision making can enhance family-centered practice. Future programs could consider the specific needs of each context, encourage parental involvement, and explore telepractice to expand access. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32060328.
11 May 2026
Read appraisal →JMIR human factors
Identifying Skill and Usability Barriers to Digital Health Tool Use Among Older Adult Patients in US Safety Net Clinics: Mixed Methods Study
BACKGROUND: Despite their benefits, digital health tools often face adoption barriers because of the digital divide. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers is essential to addressing disparities in use. OBJECTIVE: This study aimed to identify the skill and usability barriers to using digital health tools. METHODS: This study included English-, Spanish-, or Cantonese-speaking patients, aged ≥50 years, who received care at an urban safety net health system in the United States. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital health care tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant's preferred language. Video recordings were thematically coded to identify the fundamental skills needed for effective digital tool use and usability barriers in the design of digital tools. We examined whether task independence was associated with participant demographics and thematic categories using Kruskal-Wallis, χ2, and Fisher exact tests. RESULTS: In total, 74% (34/46), 52% (31/60), 71% (44/62), and 70% (43/61) of participants (N=64) independently completed digital tasks 1, 2, 3, and 4, respectively. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to cellular data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task (P<.001, except for older age [P=.004]). The qualitative coding of video recordings identified 3, 4, and 6 categories of typing, navigation, and human-computer interaction (HCI) skills, respectively, as fundamental skills required to independently complete digital tasks. χ2 and Fisher exact tests indicated significant associations between most typing, navigation, and HCI categories and independent task completion. We coded usability barriers as one of 6 learnability challenges or 3 operability challenges. CONCLUSIONS: This study identified that independent use of digital health tools requires fundamental typing, navigation, or HCI skills as well as high usability of digital tools. The inclusion of 4 different digital tasks added specificity to the type of skills and usability considerations necessary to ensure accessibility of digital health tools to diverse older adults. This study underscores the need for vendors to cocreate digital health tools with historically excluded end users in mind. As health care systems expand digital tool adoption, they must distinguish fundamental skill gaps from usability barriers, as each may require different intervention strategies.
10 May 2026
Read appraisal →BMJ mental health
Using electronic health records to evaluate a children and young people's social prescribing service: challenges and implications for research and practice
BACKGROUND: Preliminary evidence indicates that social prescribing (SP) can improve children and young people's (CYP) well-being but is limited by small non-representative samples and often relies on descriptive statistics. Given the wide implementation of SP in the UK, administrative records provide a unique opportunity to understand current practice and assess impacts on well-being. OBJECTIVES: (1) To understand the quality of data captured in SP administrative records. (2) To explore which CYP are currently receiving SP and what SP entails in practice. (3) To assess the impact of SP on well-being. METHODS: We used administrative records from one CYP SP service in England. Records were extracted from Joy, an online platform for managing SP. Over 18 months, 770 age-eligible CYP were referred to SP, 203 of whom were successfully discharged and completed two pre-post measures of well-being (the short Warwick-Edinburgh Mental Wellbeing Scale; SWEMWBS) at least 7 days apart. We used descriptive statistics, a paired t-test to assess changes in well-being and linear regressions with interactions to test effect modification. FINDINGS: Missing data was the largest issue, with ethnicity missing for 94% of CYP. A lack of detail and inconsistent recording for both individual characteristics and SP practices also presented challenges. Despite this, we identified that most CYP were referred by their GP, followed by their school, with 97% referred because of their mental health. The most common pathway was to receive SP for around 90 days, with 10-15 link worker contacts and 6 contact hours. Following SP, SWEMWBS scores improved by 3.72 points (t(202)=17.50, 95% CI 3.30 to 4.14, p<0.001), a 20% relative increase. Exploratory analyses suggested that this increase was greater for those with lower baseline well-being. CONCLUSIONS: Despite numerous challenges with missing data and data quality, we found that CYP well-being increases following SP (as it is currently implemented). The moderate effect size was consistent with larger studies of adults. CLINICAL IMPLICATIONS: Further development of online platforms is needed to monitor access to, nature of and efficacy of SP. For those working in SP, we recommend more training, implementation of standardised guidelines and designated time to update records.
27 Apr 2026
Read appraisal →Journal of medical Internet research
Effectiveness of Digital Serious Games on Knowledge and Attitudes in Public Health Education: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Inadequate health literacy and low engagement challenge public health education. Digital serious games show potential to enhance health knowledge and attitudes. However, the comparative effectiveness of different game formats is unclear. OBJECTIVE: This study aimed to evaluate and compare the effectiveness of different digital serious game formats in improving public health knowledge and attitudes. METHODS: This systematic review and Bayesian network meta-analysis followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Seven databases (PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, Scopus, and Web of Science) were searched from January 2000 to October 2025. An updated search in February 2026 identified no additional studies. Eligible studies were randomized controlled trials (RCTs) involving nonprofessional participants comparing digital serious games with traditional or noninteractive education. Standardized mean differences and 95% credible intervals were pooled using Bayesian network models with random effects. Subgroup analyses examined population characteristics, intervention duration, health topic, and delivery format. Risk of bias was assessed using the Cochrane risk-of-bias tool, and evidence certainty was rated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Forty randomized controlled trials from 19 countries (N=8764 participants) were included. Digital serious games significantly improved knowledge (standardized mean difference 0.66, 95% CI 0.32-0.99; I²=89.1%) and attitudes (standardized mean difference 0.50, 95% CI 0.27-0.76; I²=80.7%) compared with traditional education. Multisession interventions showed larger effects than single-session interventions for knowledge (0.76 vs 0.43) and attitudes (0.53 vs 0.30), with greater improvements among adolescents, nonpatient populations, and Asian studies. Network meta-analysis showed low heterogeneity (I²=8% for knowledge; 3% for attitudes). Mobile app-based, computer-offline, and web-based games ranked highest for knowledge; computer-offline, web-based, and virtual reality games ranked highest for attitudes. Evidence certainty was moderate for knowledge and low-to-moderate for attitudes. CONCLUSIONS: Digital serious games improve public health knowledge and attitudes across diverse contexts. Using a Bayesian network meta-analysis of randomized controlled trials, this review compares the relative effectiveness of different game formats. Mobile app-based, computer-offline, and web-based games most improved knowledge; computer-offline, web-based, and virtual reality formats most improved attitudes. Multisession interventions were more effective than single-session ones, particularly for adolescents and nonpatient populations. These findings guide scalable digital health education strategies. Future research requires adequately powered trials, longer follow-up, and standardized frameworks.
27 Apr 2026
Read appraisal →Vaccine
Impact of pharmacy-based interventions on vaccination coverage among vulnerable and underserved populations: a systematic review and meta-analysis
BACKGROUND: Vaccination coverage remains suboptimal among vulnerable and underserved adult populations. We investigated the effectiveness of pharmacy-based interventions in improving vaccine uptake in high-risk groups and the most effective strategies. METHODS: A systematic search (PubMed/MEDLINE, Embase, Scopus; 26 July 2025) identified experimental and observational studies evaluating pharmacy-led vaccination interventions targeting adults ≥65 years or individuals aged 18-64 years with chronic conditions or limited healthcare access. The primary outcome was vaccination coverage. Odds ratios (ORs) were pooled using fixed- and random-effects models. Sensitivity analyses were conducted by intervention type and setting. Risk of bias was assessed using ROBINS-I, RoB 2, and NOS tools. RESULTS: A total of 35 studies were included, encompassing over 1.3 million participants. In pre-post comparisons, pharmacy-based interventions nearly doubled vaccination uptake (random-effects OR = 1.88; 95% CI: 1.68-2.12). In case-control analyses, individuals exposed to pharmacist interventions were almost five times more likely to be vaccinated (random-effects OR = 4.87; 95% CI: 2.23-10.64). Multicomponent strategies and direct vaccine administration by pharmacists produced the most consistent improvements. CONCLUSIONS: Pharmacist-led vaccination interventions significantly increase vaccine uptake among vulnerable adults. The most effective approaches involved pharmacists included eligibility assessment, counselling, administration, and documentation, integrated within routine care workflows.
11 Apr 2026
Read appraisal →Sexual health
Resilience of STI service delivery in community-based organizations during the 2024 armed conflict: insights from Lebanon.
This study explores the potential impact of war on STI services in Lebanon. Programmatic STI service data from Lebanon were analyzed, alongside a targeted review of the literature on conflict-affected settings, using public health databases covering the period 2014-2024. Evidence-based STI service packages for conflict settings remain limited. Drawing insights from the COVID-19 crisis, periods of emergencies are associated with an elevated risk of STI surges among key populations. Programmatic data from the conflict further demonstrated this increased risk, reflected in reductions in prevention and early detection activities compared with pre- and post-conflict periods. Self-care and outreach service packages could be critical in these contexts. Community-based organizations (CBOs) should adapt STI services to the wartime environment and evaluate the effectiveness of these interventions post-conflict. CBOs are encouraged to prioritize the implementation of self-care modalities for STI prevention and early detection, expand the availability of telehealth services, and deploy mobile clinics to maximize service continuity. This editorial analyzes STI service delivery within the specific context of the Lebanese war.
9 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Effectiveness of a Telecare-Based Intervention Program in Supporting Informal Caregivers of Community-Dwelling Older Adults in Reducing Stress Levels: Randomized Controlled Trial
BACKGROUND: Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers' emotional and informational needs. Telecare-the remote delivery of health and social care via digital technologies-offers a promising approach to provide accessible, personalized, and timely support. OBJECTIVE: This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. METHODS: A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. RESULTS: Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy (t=1.98; P=.04) and lower depression (t=-2.24; P=.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. CONCLUSIONS: This study provides novel evidence that a digitally delivered, nurse-led telecare program-integrating health and social services-can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems.
9 Apr 2026
Read appraisal →Psychological medicine
Maternal communication and attachment following a group singing intervention for postnatal depression: findings from the SHAPER-PND trial
BACKGROUND: Postnatal depression (PND) can disrupt maternal communication during early interactions, affecting infant socioemotional development. Singing is a natural form of caregiver-infant communication and a promising intervention to enhance maternal well-being and bonding. However, its effects on observed communication and perceived attachment in clinical PND populations remain underexplored. METHODS: Within the Scaling-Up Health-Arts Programs: Postnatal Depression trial, 199 mothers with PND were randomized 2:1 to a 10-week group singing intervention (Breathe Melodies for Mums) or a non-singing community activity. One hundred participants (singing = 70; control = 30) completed video-recorded interactions at baseline, week 10, and week 36. Maternal speech was coded using the Parental Cognitive Attributions and Mentalization Scale (PCAMS) for mentalization, affective tone, and attentional focus. Perceived maternal attachment was assessed separately via self-report using the Maternal Postnatal Attachment Scale. RESULTS: At week 10, singing mothers showed greater improvement in communication with their infants than controls, with about 1.7-fold higher proportions of mentalizing comments (p = 0.01), 1.4-fold more infant-focused speech (p < 0.001), 2.4-fold less parent-focused speech (p < 0.001), and fivefold less negative speech (p < 0.001). These effects were maintained at week 36. Perceived attachment improved significantly across both groups (p < 0.001), but only singing mothers showed further gains from week 10 to week 36 (p = 0.02), indicating continued strengthening of attachment perceptions. CONCLUSIONS: Group singing enhanced maternal communication and perceived attachment in mothers with PND. Findings support community-based, arts-informed interventions as accessible approaches to strengthen early relational health and complement perinatal mental healthcare.
8 Apr 2026
Read appraisal →PloS one
Caregivers' early stimulation behaviors on early child development outcomes in Northern Ghana
Despite the government prioritizing Early Childhood Development (ECD) in Ghana, data on responsive caregiving is limited. This study examined the type and extent of Early Stimulation Activities (ESAs) practiced by mothers, and other caregivers and the associations between ESAs and children's development by caregiver type in Northern Ghana. Data were from a cluster-randomized controlled trial with mother-child dyads that evaluated the impact of an integrated maternal mental health and early childhood intervention program. The primary outcome was measured by the Developmental Milestone Checklist (DMC-II). Covariates included maternal report of ESAs performed by herself, child's father, and other caregivers. Linear regression analyses with cluster-adjusted standard errors were performed. Nearly 15% of mother-participants (n = 313) reported 4 + ESAs in the past 3 days. Within the last 3 days, on average, women reported 2.5 activities for themselves, 1.2 activities by the child's father, and 2 activities by other caregivers. The associations between ESAs and children's development varied by caregiver type. Maternal stimulation was positively associated with children's total development and personal-social development, early stimulation by other caregivers was positively associated with children's total development and language development, and paternal stimulation was not associated with any development domain. Other associations included receipt of postnatal care and presence of household toys. While maternal stimulation seemed particularly important, findings regarding non-primary caregivers suggest that ECD programming could also benefit from their inclusion.
5 Apr 2026
Read appraisal →BMJ global health
Risk and protective factors of depression among caregivers of children with disabilities in rural Rwanda
BACKGROUND: Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. METHODS: This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. RESULTS: Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. CONCLUSIONS: Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.
5 Apr 2026
Read appraisal →Annals of medicine
An explainable online frailty prediction model for community-dwelling older adults based on machine learning algorithms: a cross-sectional study based on retrospective health data
BACKGROUND: Frailty is a significant health concern associated with diminished physiological reserves and increased healthcare burdens. Currently, effective models for predicting frailty risk are lacking. This study utilizes machine learning-based models to early identify community-dwelling older adults, enhancing risk assessment accuracy and guiding targeted interventions to slow frailty progression. METHODS: A cross-sectional analysis of data from 1,156 older adults across 31 community health centers in Nanjing, conducted between January and October 2024, was performed. Independent predictors of frailty were identified using univariate analysis and the least absolute shrinkage and selection operator. The dataset was divided into 70% training and 30% testing subsets. Six machine learning (ML) models were developed and their performances compared. The SHapley Additive exPlanations (SHAP) method was applied to interpret the models, and a web-based risk calculator was created. RESULTS: Our dataset showed that 22.3% of older adults were frail. Significant predictors of frailty were identified as age, education, medicine, vegetable, cognitive status, number of diseases, hemoglobin, total cholesterol, and neutrophil-to-lymphocyte ratio. Among the six ML models, Categorical Boosting (CatBoost) exhibited the highest performance, attaining an AUROC of 0.886 in the training set and 0.831 in the testing set. CONCLUSIONS: The developed CatBoost model and web calculator can be employed by general practitioners to proactively identify high-risk community-dwelling older adults, thereby enabling timely interventions to mitigate the progression of frailty. The tool's simplicity and replicability effectively facilitate the promotion and management of frailty prevention within the community. An effective model was developed to predict frailty risk in community-dwelling older adults.The integration of biomarkers and self-reported data enhances frailty prediction and optimizes risk-based intervention strategies.The CatBoost model demonstrates superior predictive performance compared to other models.The web-based tool integrates a frailty prediction model for proactive risk management.
5 Apr 2026
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