Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 28 appraisals
Current obesity reports
A Systematic Review of Community-based Interventions to Promote Physical Activity or Reduce Sedentary Behavior among Adults in Low- and Middle-Income Countries
PURPOSE OF REVIEW: Community-based interventions (CBIs) are widely used to address behavioral risk factors for non-communicable diseases, yet evidence of their effectiveness in low- and middle-income countries (LMICs) remains limited. This study systematically reviewed evidence on the effectiveness of CBIs promoting physical activity (PA) and/or reducing sedentary behavior (SB) among community-dwelling adults in LMICs. We searched PubMed, Embase, Scopus, and the Cochrane Library (2000-2024) for CBIs in LMICs. Primary outcomes were changes in PA and/or SB. Descriptive and graphical depictions were used to draw inferences. RECENT FINDINGS: We selected 24 studies (11 RCTs) from 15,396 for review. Most studies (n = 16) reported significant improvements in PA outcomes. Changes were observed in Metabolic Equivalents (+ 100 - +2,700), moderate-to-vigorous PA (+ 7 to + 60 min/week), and steps/day (+ 3,000). Broadly, interventions were delivered using digital/technology format (n = 10), peer-led/community health worker-facilitated (n = 8), and Environmental restructuring (n = 6), with the digital interventions depicting the most consistent significant improvements. Two studies directly measured SB as a primary outcome. Short- (≤ 6 months; n = 11) and medium-duration (6-12 months; n = 4) interventions more frequently reported significant PA improvements than long-duration interventions (> 12 months; n = 9). PA/SB-focused CBI demonstrated proportions of significant effects similar to those of broader lifestyle interventions (88.9% and 53.3%, respectively). CBIs can be effective in improving PA in LMICs, although evidence is heterogeneous and SB is less addressed. Digital interventions show more consistent positive signals, but high heterogeneity in studies precludes firm conclusions. The impact of duration on effectiveness looks counterintuitive but underscores the need for more rigorous evaluation of longer-duration interventions and SB outcomes. PROSPERO registration number: CRD42024579461.
23 July 2026
Read appraisal →BMJ paediatrics open
Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised pilot feasibility trial from Guatemala
OBJECTIVE: To test the feasibility of a smartphone app, BebeApp, that provides evidence-based early childhood development (ECD) guidance in rural Guatemala and pilot procedures for an adequately powered randomised controlled trial. DESIGN: We conducted an individually randomised pilot feasibility trial to compare BebeApp to printed ECD guidance. SETTING: This trial was conducted in Tecpán, Chimaltenango, a semi-rural community that is 95% Kaqchikel Indigenous Maya. PATIENTS: First-time primary caregiver-infant (0-28 days) dyads. INTERVENTIONS: BebeApp provides age-dependent, evidence-based caregiver guidance for breastfeeding and complementary feeding, sleep and developmental support. MAIN OUTCOME MEASURES: A mixed-methods evaluation of BebeApp's implementation and acceptability using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. App usability, usefulness and satisfaction were assessed via questionnaires, semi-structured interviews and app interaction data. RESULTS: 41 infant-caregiver dyads were enrolled with 40 completing the study. Engagement was high with caregivers opening BebeApp a median (IQR) 11 (6-21) times per month. Usability was found to be acceptable but no difference was found between pre-measurements and post-measurements. In interviews, caregivers expressed some initial difficulty using BebeApp but were able to gain confidence with a training session. App usefulness and satisfaction responses were positive. Caregivers often noted that BebeApp was their only source of ECD information outside of their family. CONCLUSIONS: We found that caregivers in rural Guatemala responded positively to a smartphone ECD app and engaged with it throughout the trial. Given the urgent need for ECD programmes in low- and middle-income settings, smartphone apps may be a method to deliver services directly to caregivers.
14 June 2026
Read appraisal →BMC geriatrics
The association between smart elderly care and subjective well-being among older adults in China: the mediating roles of health status and social activities
BACKGROUND: Under the initiative of China's "Internet+" strategy, smart elderly care reflects the government's capacity to bridge the digital divide and provide inclusive care services for older adults. Though studies have identified positive associations between smart elderly care and health outcomes, empirical research examining its impact on older adults' subjective well-being remains limited. METHODS: This study utilizes data from the 2021 Chinese Longitudinal Healthy Longevity Survey (CLHLS, N = 8,950), which includes multifaceted information on individuals aged 65 and above, covering their personal characteristics, health status, family information, and community elderly care services. A logit model is employed to investigate the association between smart elderly care and SWB. The mediating effects are tested using the bootstrap resampling method. To address endogeneity concerns, instrumental variable (IV) approaches including IV-Probit and 2SLS are applied as robustness checks. RESULTS: The results reveal a positive correlation between smart elderly care and older adults' subjective well-being (β = 0.101, p < 0.01). This association is partially mediated by both health status (proportion mediated: 38.47%) and social activities (proportion mediated: 2.65%). Heterogeneity analyses show that this positive association holds consistently across both rural and urban older adults, and is more pronounced among those with lower digital literacy. CONCLUSIONS: This study challenges the prevailing assumption that the "digital divide inevitably isolates the older adults from participating in a digitized society." By integrating digital technologies into older adults care services, we demonstrate that smart elderly care is positively associated with bridging technological barriers and addressing the unmet needs of aging populations. These findings further propose a synergistic mechanism-policy innovation, technological adaptation, and service optimization, to build an inclusive older adults care ecosystem, offering evidence-based insights for policymakers in aging societies to balance equity and efficiency in digital transformation.
14 June 2026
Read appraisal →Global health action
mHealth-supported tuberculosis contact investigation by community health workers in high-burden countries: a scoping review
Mobile health (mHealth) implementation strategies in tuberculosis (TB) contact investigations are intended to increase community health workers' (CHWs) engagement in TB contact investigations and case detection. This scoping review aimed to map and synthesize existing evidence on the design and development of acceptable and feasible mHealth implementation strategies for CHW-led TB contact investigations. We conducted a scoping review following the Arksey and O'Malley framework and PRISMA-ScR guidelines. We searched PubMed, Scopus, Cochrane Library, Web of Science, and Google Scholar for English-language studies published through October 2024 on mHealth interventions for TB contact investigation by CHWs. Eligible studies included empirical studies conducted in high-burden countries (HBCs) for TB, HIV-associated TB, and MDR/RR-TB. Studies were screened, and data were extracted using Rayyan AI-assisted software. We mapped implementation strategies, barriers, facilitators, acceptability, and feasibility of mHealth interventions. Quantitative findings were described, and qualitative data were synthesized thematically. Nine studies were included. Most interventions used hybrid mHealth technologies for communication, case registration, health records, and decision support. Implementation strategies specified actors, actions, targets, temporality, dose, and justifications. Barriers were related to CHWs, digital systems, service implementation, and TB-affected persons. Facilitators included stakeholder support, CHW training, mHealth design, community engagement, and patient-centered approaches. Overall, CHWs perceived mHealth interventions as acceptable and feasible. Successful implementation in HBCs requires strengthened CHW capacity, reliable technology, optimizing interaction between CHWs and digital tools, and continuous monitoring and evaluation throughout implementation. Main findings: Health interventions for tuberculosis contact investigation by community health workers in three global lists of high-burden countries for tuberculosis, human immunodeficiency virus-associated tuberculosis, and multidrug-resistant/rifampicin-resistant tuberculosis are generally acceptable and feasible, but their effectiveness depends heavily on a clear implementation strategy and the ability to address multilevel barriers at the individual, technology, and service system levels.Added knowledge: Given the ongoing development of digital health interventions for TB contact investigation by community health workers, this review provides a novel contribution by systematically mapping seven dimensions of implementation strategies, classifying barriers and facilitators at multiple levels, and highlighting the importance of synergies between human actors and digital systems in determining implementation success.Global health impact for policy and action: These findings confirm that strategic integration of mHealth into national tuberculosis policies and programs – with sustained funding, community health worker capacity building, digital system interoperability, and implementation-based monitoring – is crucial for closing the contact investigation gap and accelerating the achievement of the global tuberculosis elimination target.
11 June 2026
Read appraisal →JMIR research protocols
Evaluating the Effectiveness of an Enhanced Early Childhood Development Program Integrated Into Primary Health Care in China: Protocol for a Cluster Randomized Controlled Trial
BACKGROUND: Early childhood development (ECD) programs refer to policies and programs aimed at protecting young children's rights to achieve their full potential. Parenting interventions are effective at improving children's cognitive development and overall well-being. However, there is limited evidence on how to effectively implement and integrate such programs into routine service delivery at scale. The Government of China launched the ECD program in 2013 and the ECD scale-up program in 2023. OBJECTIVE: Our study aims to design, implement, and evaluate an enhanced ECD program embedded in the primary health care system in order to provide ECD policy recommendations for future national scale-up. METHODS: This study involves a multicenter cluster randomized controlled superiority trial in 3 counties with different levels of socioeconomic development in China. Fifty-eight clusters will be randomly assigned in a 1:1 ratio to intervention and control groups, stratified by county. In each cluster, 18 families with children aged 6-23 months will be recruited. Our intervention aims to implement an enhanced ECD program in primary care facilities. Intervention group participants will receive usual care alongside enhanced ECD services, including improved facilities, capacity building, and improved ECD services (age-adapted clinical consultations on nutrition and stimulation, age-specific parenting group sessions, home visits, and referrals for children in need). Moreover, an electronic data platform will be used. Control group participants will receive usual care. Our primary outcome is children's overall development, as measured by the Global Scale of Early Development combined form at 12 months of follow-up. Evaluation data will be collected in both arms. Additionally, a process evaluation and an incremental cost-effectiveness analysis will be conducted. Primary analysis will follow the intention-to-treat principle, and it will use generalized estimating equations to assess the population average intervention effect, with adjustment for corresponding baseline outcomes, selected individual variables, county, cluster variables, and variables differing at baseline. Qualitative data will be collected through semistructured interviews and focus groups, guided by the Capability, Opportunity, Motivation, and Behavior framework to explore implementation-related factors. Data will be transcribed for analysis using NVivo 14 (Lumivero). Ethical approval has been obtained from the Institutional Review Board of Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine. RESULTS: This study was funded in 2023 and registered in April 2024. The recruitment of 1044 participants was completed on September 14, 2024. Data collection was completed on January 31, 2026. CONCLUSIONS: We aim to design an enhanced ECD service delivery model that can be embedded into the routine primary health care system. The study findings will guide government policies and reforms for strengthening the health system to scale up ECD services. Furthermore, this project may provide policy evidence to support countries in establishing or expanding their ECD services.
29 May 2026
Read appraisal →BMJ open
Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic review
OBJECTIVE: Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. This calls for a concerted effort from different stakeholders involved in issues of teenagers' sexual reproductive health to achieve the SDG target of 2030 on the reduction of maternal mortality. The objective of this systematic review was to estimate the prevalence of teenage pregnancy and its associated factors in Uganda. DESIGNS: We conducted a systematic review and random-effects meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-analysis standards. DATA SOURCES: After prospective registration (PROSPERO CRD42023486460), a literature search was conducted in PubMed, African Journals Online and Google Scholar in December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies that reported the prevalence of teenage pregnancy among teenagers were included. DATA EXTRACTION AND SYNTHESIS: Articles were screened for relevance at the title, abstract and full-text levels by multiple reviewers. The quality of studies was independently appraised using the Joanna Briggs Institute Critical Appraisal Checklist and Newcastle-Ottawa Scale. Any discrepancies were resolved by reaching a consensus. The process of extracting data included study information, geographical categorisation, type of studies, population, sample size, results/outcomes and prevalence of teenage pregnancy. The risk of bias was determined by Egger's test. The results were pooled using random-effects models to calculate the prevalence of teenage pregnancy with a CI of 95% and I² statistic. RESULTS: Of 918 records screened, 10 studies (4143 participants) were included. The pooled prevalence of teenage pregnancy was 25.5% (95% CI 13.7% to 39.5%; I²=98.9%), with individual study estimates ranging widely from 3.0% to 56.4%, reflecting substantial heterogeneity across study settings, populations and periods of data collection. Higher estimates were observed in the Central-Eastern region (31.7%, 95% CI 19.5% to 45.1%). The overall certainty of evidence was rated as very low using the Grading of Recommendations, Assessment, Development and Evaluation framework, primarily due to very serious inconsistency across included studies (I²=98.9%). CONCLUSIONS: Pooling studies of mixed quality revealed a slightly higher prevalence of teenage pregnancy in Uganda. This review provides valuable insight for policymakers and healthcare providers in developing interventions and policies to reduce the burden of teenage pregnancy from disadvantaged backgrounds. PROSPERO REGISTRATION NUMBER: CRD42023486460.
28 May 2026
Read appraisal →International journal of circumpolar health
Artificial intelligence/machine learning in Alaska Native healthcare systems: symposium perspectives.
Artificial intelligence and machine learning (AI/ML) utilisation in Alaska Native and American Indian (AN/AI) healthcare presents an opportunity to address persistent health disparities and improve the well-being of Alaska Native communities. The 2025 Artificial Intelligence in Alaska Native Health Care Systems symposium occurred in Anchorage, Alaska, with 31 individuals participating in facilitated conversations between various stakeholders and specialists at the Alaska Native Tribal Health Consortium, Southcentral Foundation, Maniilaq Association and Stanford University. The overarching goal of the symposium was to bring together partners within the Alaska Tribal Health System (ATHS) to promote: (1) AN/AI peoples' guidance in support of Tribal sovereignty for AI/ML implementation within the ATHS, (2) expanded technical capacity and (3) centralised guidance and expertise to lead future AI/ML research and implementation with community-defined benefits. During the event, small group discussions focused on the following topics: (1) common AI/ML applications, (2) concerns surrounding AI/ML, (3) current or potential policies guiding AI/ML use and (4) how to build trust in AI/ML models. Themes discussed were data democratisation, AI/ML development and use needs to occur under the principles of data sovereignty, and AI/ML quality improvement and research are needed and distinct. The symposium was an important step in considering how to use AI/ML to optimise AN/AI health and well-being through collaborative partnerships and services.
25 May 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Acceptability of Using Large Language Models to Support Smoking Cessation Attempts: a Qualitative Study Among African Americans Who Smoke
INTRODUCTION: African Americans face significant disparities in tobacco-related diseases and access to smoking cessation resources. Digital health interventions using large language models (LLMs) show promise in increasing engagement and successful quit attempts. However, impressions regarding acceptability of LLM-based interventions among African Americans are unknown and evidence suggests such interventions require tailoring for underserved communities. Our goal was to evaluate perceptions of LLM-based interventions among African Americans to inform development of an LLM-based chatbot to support quit attempts. METHODS: We conducted remote focus groups with adult African Americans residing in Minnesota who smoke cigarettes to determine acceptability of LLM-based health interventions and inform the functionality of an LLM-based chatbot supporting quit attempts. Discussions followed a structured guide and were recorded to facilitate analysis. Transcripts were coded independently by two analysts with a shared codebook. RESULTS: 21 adults participated in focus group discussions. 57.1% of participants were female and the mean age was 45.6 (SD, 10.5). Three themes united participants' feedback: (1) participants limited familiarity with LLM and related AI technology, (2) willingness to use an LLM-based app to support quit attempts, and (3) perceptions of features that impact the acceptability of an LLM-based chatbot to support quit attempts. CONCLUSION: African Americans have complex perceptions and expectations regarding the use of LLMs to deliver health interventions. While many recognize the potential benefits, significant concerns and knowledge gaps remain. To build trust and acceptability, intervention developers should prioritize community engagement and ethical guidelines to ensure that LLM-driven solutions are inclusive and effective for multiple communities. IMPLICATIONS: Large language models and related AI technologies have shown promise for improving access and engagement when deployed through digital health interventions. Focus groups with African Americans who smoke combustible cigarettes revealed factors impacting the acceptability in using LLM-based interventions to support quit attempts. Efforts to build digital health interventions should prioritize community engagement to reduce apprehensions and improve alignment with community needs and values.
23 May 2026
Read appraisal →BMJ open
Patient preferences and willingness-to-pay for AI-enabled blended type 2 diabetes care by digital experience and socioeconomic status: a discrete-choice experiment in China
OBJECTIVES: To elicit stated preferences and willingness-to-pay (WTP) for artificial intelligence (AI)-enabled blended care in type 2 diabetes mellitus (T2DM), and to examine preference heterogeneity by digital experience and socioeconomic status (SES). DESIGN: Cross-sectional discrete choice experiment (DCE). SETTING: 12 community health centres in Jiaozuo and Puyang, Henan Province, China. Data were collected between June and August 2025. PARTICIPANTS: 423 adults diagnosed with T2DM for at least 6 months, recruited using consecutive convenience sampling from routine follow-up appointments. Of 769 participants who completed the survey, 346 were excluded following prespecified data quality criteria (retention rate: 55.0%). OUTCOME MEASURES: Outcome measures included preference weights and WTP (in Chinese Yuan, ¥) for five DCE attributes: monthly subscription fee, recommendation source, feedback modality, in-person follow-up frequency and expert oversight, estimated using mixed logit models. Simulated uptake probabilities for tailored service packages across four user profiles were computed. RESULTS: Among 423 participants, 80.6% had never used AI tools. Price was the dominant driver of choice (62.7% relative attribute importance). Profound preference heterogeneity emerged across subgroups: rural residents (n=78) were highly price-sensitive but preferred physician endorsement (WTP ¥17.58 (US$2.55), 95% CI ¥5.98 to ¥29.17); female participants (n=224) valued guideline recommendations (WTP ¥18.45 (US$2.67), 95% CI ¥7.81 to ¥29.40); and diabetes app users (n=34) were the least price-sensitive but showed a negative preference for AI instant feedback, instead preferring human dietitian feedback. Expert oversight carried a consistent negative WTP across all profiles. Targeting tailored service bundles to intended subgroups increased uptake by 8-16 percentage points compared with non-targeted bundles. CONCLUSIONS: A 'digital experience paradox' exists whereby digitally experienced users view human interaction as a premium service, while underserved groups rely on specific trust markers such as physician endorsement. To avoid widening the digital divide, AI-enabled blended diabetes care must move beyond standardised models towards configurable, equity-driven service pathways.
22 May 2026
Read appraisal →Philosophical transactions of the Royal Society of London. Series B, Biological sciences
Is iron supplementation likely to impair linear growth and gut microbiota composition of Myanmar young children when complementary feeding is not optimized? A randomized controlled trial.
Iron deficiency, with or without anemia, remains a major public health concern among young children in Myanmar. While iron supplementation is widely recommended, its potential adverse effects on growth and gut microbiota warrant investigation, particularly in contexts of poor complementary feeding. To assess the effects of iron supplementation, with or without complementary feeding recommendations (CFRs), on micronutrient status, linear growth and gut microbiota composition among Myanmar children aged 12-23 months, a 24-week randomized controlled trial was conducted in Ayeyarwady Region of Myanmar. Fourteen clusters (villages/wards) were randomized to receive CFRs or not, and children within the clusters were randomized to receive daily aqueous iron or placebo, creating four arms: Placebo (n = 104), CFR (n = 112), Fe (n = 105) and CFRFe (n = 112) totalling 433 children. All intervention groups (CFR, Fe, CFRFe) improved haemoglobin and reduced anaemia risk compared with Placebo (AOR = 0.31 (0.15-0.62), 0.15 (0.07-0.32), 0.14 (0.07-0.31), respectively). CFR and CFRFe also improved zinc status. However, iron-alone (Fe) increased the stunting risk (AOR= 2.74 (1.04-7.23)), while CFRFe did not. No significant effects were observed on gut microbiota composition. Aqueous iron supplementation may impair linear growth when diets are not optimized; combining supplements with optimized complementary feeding may support healthier outcomes. This article is part of the theme issue 'Biological, biomedical and environmental drivers of stunting'.
17 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Are non-injectable anticipatory medications a viable end-of-life intervention in the community? A systematic review and narrative synthesis.
BACKGROUND: The anticipatory prescribing of injectable medications for symptom management at the end-of-life is an established practice in the UK. Transmucosal and inhaled routes of administration offer alternatives to injections, when patients are no longer able to take medications orally. Their evidence base in the community setting has not been established. AIM: To systematically review and synthesise the published, peer-reviewed evidence regarding the clinical practice and effectiveness, including patients', family caregivers' and healthcare professionals' views, of transmucosal and inhaled anticipatory medications for symptom management at the end-of-life in the community. METHOD: Ten literature databases were searched from inception to February 2025, using terms for non-injectable anticipatory medications, or kits, combined with end-of-life terms. Two journals were hand-searched from 2015 to 2025. References and citations of included papers were searched. Gough's Weight of Evidence Framework was used to appraise the included studies and inform the narrative synthesis. RESULTS: Fifteen papers were included, reporting the use of transmucosal routes, of which nine used a standardised medication kit. The limited evidence of clinical effectiveness, and the views of patients, family caregivers, and healthcare professionals, suggested that transmucosal medications were effective at relieving patients' symptoms and enabling patients to die at home. CONCLUSION: The evidence regarding transmucosal anticipatory medications in the community suggests that they are acceptable, clinically effective, and contribute to reducing unplanned hospital attendances, but is limited and should be treated with caution. Further research is needed to assess whether they offer viable alternatives to injectable anticipatory medications in the community.
16 May 2026
Read appraisal →Environmental research
Mental health benefits of specific blue space types and characteristics: A systematic evidence map.
Natural environments support mental health and wellbeing, yet limited evidence exists about which types or characteristics are most beneficial. This is particularly true for blue spaces (natural or manmade outdoor environments featuring water). This evidence map investigates the mental health and wellbeing benefits associated with specific blue space types (e.g. coast, river) and characteristics (e.g. sounds). Following PRISMA guidelines, specific keywords were used to search for articles published from inception to March 2025. A total of 139 papers were included, examining the relationships between specific blue space types or characteristics and mental health. Coastal environments were the most frequently studied blue space (94 studies). Affect was the most assessed mental health outcome (74 studies). Most studies were conducted in European and Asian countries. Most studies compared blue spaces to urban or a green space environments, rather than other blue spaces. Only six studies directly compared different blue space types within the same study. Overall, the current evidence base does not allow for comparisons between different blue space types or characteristics, due to the limited number of direct comparisons and substantial heterogeneity across study designs, outcome measures, geographical contexts, blue space descriptions, and study populations. Future research should prioritize direct comparisons between different blue spaces, preferably including the detailed descriptions and analyses of specific characteristics, and examine the role of amount and type of exposure to better inform evidence-based recommendations for blue spaces and mental health.
16 May 2026
Read appraisal →PloS one
Health related quality of life among hypertensive adults living in rural Vietnam: Results from a cluster-randomised controlled trial
BACKGROUND: There is a growing burden of hypertension (HTN) among adults living in rural Vietnam, which is associated with reduced health related quality of life (HRQoL). Few community-based interventions have, however, attempted to improve the quality of life in patients with uncontrolled HTN. This study aimed to examine the impact of a multi-component intervention on HRQoL in adults with uncontrolled HTN. METHODS: This cluster-randomized controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) living in a rural setting in Vietnam (2017-2022). Consenting adults with uncontrolled HTN were enrolled. The comparison arm received training sessions about HTN prevention and management and patient education materials. The intervention arm received information similar to the comparison group and three enhancement components, namely a storytelling intervention, home blood pressure (BP) self-monitoring, and expanded community health worker services. The primary outcome was the differential change in HRQoL over 12-month follow-up period, measured using the 12-Item Short Form Health Survey (SF-12), which generates a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12). The total HRQoL score was calculated as the sum of PCS-12 and MCS-12, with higher scores indicating better HRQoL. RESULTS: A total of 671 patients were studied; their mean age was 66 years and 55% were women. At the 12-month follow-up, the intervention group showed a significant increase in their PCS-12 with a multivariable-adjusted difference of 4.2 points (95% CI: 2.0-6.4) compared with the control group. While the MCS-12 scores increased for both groups, their differential change over 12 months was not statistically significant (multivariable-adjusted difference: 1.4 points; 95% CI: -0.6; 3.5). CONCLUSION: Our results demonstrate that a multicomponent intervention effectively improved overall HRQoL with a significant impact on physical health-related HRQoL in individuals with uncontrolled HTN. TRIAL REGISTRATION: ClinicalTrials.gov, Registration number: https://clinicaltrials.gov/study/NCT03590691, (registration date July 17, 2018).
15 May 2026
Read appraisal →Journal of medical Internet research
Plain Language Summarization of Environmental Health Research Using Generative AI: Community-Engaged Qualitative Study
BACKGROUND: Plain language summaries (PLSs) are increasingly required in environmental health publications to improve public accessibility. Generative artificial intelligence (AI) systems such as large language models can automatically produce such summaries; however, automated summaries often overlook local context and cultural relevance-limitations that are critical in environmental health research, where affected communities face disproportionate exposure and health risks. OBJECTIVE: This study aimed to develop and refine community-informed prompts for generating PLSs of environmental health research using generative AI. METHODS: We conducted a community-engaged qualitative study in Louisville, Kentucky, involving workshops with 97 participants from 4 stakeholder groups: summer interns at a local social justice nonprofit organization, participants in a youth development program, participants in a faith-based community organization, and members of a community advisory board focused on environmental justice. Participants reviewed PLSs generated using 3 different prompt styles in GPT-4o (ChatGPT, OpenAI). Feedback was collected through structured discussions and facilitator notes. Data were analyzed using thematic analysis informed by knowledge translation frameworks to identify preferred structural, linguistic, and contextual features of the summaries. RESULTS: Participants consistently preferred summaries between 300 and 400 words, written at a sixth- to eighth-grade reading level. Key priorities included presenting definitions before findings, using headings and bullet points to improve readability, and clearly explaining real-world and environmental justice implications. Narrative summaries without structure were viewed as overly long and difficult to interpret, while purely bullet-based formats were considered too simplified. Feedback from youth participants emphasized clarity and practical relevance, while faith-based participants highlighted the importance of trust and contextual framing. These insights informed the development of a community-refined prompt that included definitions, key findings, an introduction, and a concluding section on community implications. CONCLUSIONS: Community-engaged prompt development may improve the relevance and interpretability of AI-generated PLSs of environmental health research. Incorporating stakeholder perspectives into prompt design offers a replicable strategy for improving research translation and ensuring AI-generated summaries reflect the informational needs of affected communities.
15 May 2026
Read appraisal →Journal of medical Internet research
Efficacy of Technology-Based Interventions on the Reduction of Loneliness: Systematic Review and Meta-Analysis
BACKGROUND: Loneliness is a widespread public health concern linked to increased risks of health problems. As populations age, the demand for effective interventions to mitigate loneliness continues to grow. OBJECTIVE: This meta-analysis aimed to examine the effectiveness of technology-based interventions in reducing loneliness. METHODS: A systematic literature search was conducted in Web of Science, PsycInfo, PubMed, Scopus, Google Scholar, Embase, and the Cochrane Library in August 2024. We included randomized controlled trials that examined the effectiveness of technology-based interventions compared with any control group in reducing loneliness across all age groups. Nonrandomized studies, qualitative research, and studies lacking sufficient statistical data for effect size calculation were excluded. After screening 1089 records, 7 studies involving 580 participants met the inclusion criteria. Data were extracted by 3 independent reviewers, with discrepancies resolved by a fourth reviewer. The risk of bias was assessed using the Cochrane risk-of-bias tool. A random-effects model was used to synthesize effect estimates, with standardized mean differences as the primary effect size metric. Heterogeneity was assessed using the Q statistic and I² index, and a prediction interval was calculated to estimate the expected range of true effects. RESULTS: We found a small and statistically nonsignificant overall effect of technology-based interventions on loneliness (pooled standardized mean difference=-0.21, 95% CI -0.59 to 0.17; 95% prediction interval -1.14 to 0.63). Substantial between-study variability was present (I²=57%; τ²=0.08; τ=0.28), and the prediction interval indicated that true effects in future studies may range from substantial reductions to moderate increases in loneliness. Differences between intervention types could not be examined due to the limited number of eligible studies. The Egger test showed significant funnel plot asymmetry (t5=-5.47; P=.003). However, since the trim-and-fill method identified no missing studies, the asymmetry is unlikely to be fully explained by publication bias. CONCLUSIONS: Unlike previous reviews, which focused primarily on older populations or included nonrandomized studies, this meta-analysis provides a rigorous synthesis of only randomized controlled trials across the lifespan. Our findings do not provide evidence for a reliable reduction in loneliness following technology-based interventions. Moderate heterogeneity indicates that effects differ across studies, and the limited number of eligible trials prevented the analysis of potential moderators. By incorporating robust prediction intervals and a broader age demographic, this study offers a more comprehensive view of the variability of intervention outcomes compared with existing literature. The wide prediction interval suggests that intervention effects may vary across settings. In practice, technology-based approaches should be viewed as supportive tools that require careful tailoring rather than universal solutions to loneliness.
12 May 2026
Read appraisal →Journal of global health
The effectiveness and cost-effectiveness of cash plus interventions to prevent acute malnutrition in Somalia: evidence from an adaptive cluster randomised control trial
BACKGROUND: Acute malnutrition affects millions of children aged <5 years, as well as pregnant and lactating women globally, especially in humanitarian settings. Although cash plus interventions - cash or food transfers combined with complementary components - are widely implemented, evidence remains limited on which combinations and durations are most effective at preventing acute malnutrition. METHODS: We conducted a three-arm cluster-randomised trial within the 'Save the Children's Cash Plus for Nutrition' programme in Somalia. Monthly support was provided as cash alone (arm 1), cash plus social and behaviour change communication (arm 2), or cash plus an additional cash top-up (arm 3). Further, we randomised 33 villages across arms, targeting approximately 1500 households. Primary outcomes included the prevalence and incidence of acute malnutrition in children aged 6-59 months and in mothers, assessed at baseline, midline (three months), and endline (six months). We also conducted market monitoring, qualitative data collection, and analysis. RESULTS: Child acute malnutrition prevalence was approximately 15.0% in each arm at baseline. After three months, prevalence declined by 2.0 percentage points in arm 1 to 13.0% (95% confidence interval (CI) = 10.3, 16.1), representing a relative reduction of 13.3%. In arm 2, prevalence declined by 5.9 percentage points to 9.1% (95% CI = 6.8, 11.8), a relative reduction of 39.3%. In contrast, prevalence in arm 3 remained essentially unchanged, increasing to 15.1% (95% CI = 12.1, 18.6). By endline, there was little change from midline in all arms. Maternal malnutrition improved most in arm 2, but differences were not statistically significant. All arms showed improvements in dietary diversity and food security, but only arm 2 achieved sustained nutrition gains. Household livelihood conditions appeared to improve overall, though monthly expenditures nearly doubled. Arm 2 was the most effective and cost-effective. CONCLUSIONS: Adding social and behaviour change communication to cash transfers significantly improved child nutrition compared to cash alone, highlighting that integrated approaches can enhance nutritional outcomes and at minimal additional cost in humanitarian settings. REGISTRATION: ClinicalTrials.gov: NCT06642012.
12 May 2026
Read appraisal →BMJ open
Potential harms of social prescribing: a global umbrella review and dark logic model
OBJECTIVES: Social prescribing has provided a lifeline to people, capturing the importance of quality support offered via community connections. It has not been exempt from difficulties, resulting in low-quality evidence on effectiveness in part due to high drop-out rates and lack of controls. While these have been the focus of recent research, less attention has been paid to the safety implications of social prescribing. This review aims to understand safety implications of social prescribing interventions and to build a dark logic model of how harms are produced. DESIGN: Using review of review (umbrella) methodology, we searched nine databases to June 2024. DATA SOURCES: Medline/Ovid, Embase, PsycINFO, Cochrane Library/Wiley, Web of Science and Scopus) were searched from 1 January 2010 to 3 June 2024. ELIGIBILITY CRITERIA: Included reviews were systematic/scoping/narrative reviews or meta-analyses, which synthesised primary data collected from any person in receipt, involved in delivery or the commissioning of social prescribing interventions. The context of the review was social prescribing interventions/services based in primary healthcare (statutory) or third sector (non-statutory) in any country. Only reviews that were published in English and in peer-reviewed journals were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data from included reviews using the Typology of Harms Framework (which includes five categories of harms associated with interventions: physical, psychological, group/social, equity and opportunity harms) and to build a dark logic model to understand what contributes to these harms. RESULTS: Sixteen reviews were included, reporting on social prescribing research including a link worker. Of the identified harms, we found that opportunity harms (harm related to the cost, inappropriate or ineffective interventions) were most reported. There was also evidence extracted to suggest plausible psychological, equity (impact caused by inequity in provision, delivery or access) and group/social harms (impact that overly or inadvertently excludes a person). No physical harms were identified. CONCLUSIONS: Social prescribing, as with any delivery of care, has the potential to cause harm. We identified a range of potential harms (psychological, group/social, equity or opportunity harm) from social prescribing; however, it is unlikely to be an exhaustive list. We provide two clear outcomes: (1) the need for robust design of social prescribing research, including collection of data on the incidence and prevalence of harms, (2) recognition of the potential for harm from social prescribing and to address these where practicable.
11 May 2026
Read appraisal →Journal of medical Internet research
Online Community Support for Stroke Survivors and Caregivers: Scoping Review
BACKGROUND: Previous studies found that online communities are critical in supporting stroke survivors and caregivers for stroke recovery. However, it is unclear how such online communities are designed, or could be designed. OBJECTIVE: This review aims to identify the key design elements of an online community to support stroke survivors and caregivers, that is, the actors, types of community support, and supporting technologies. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We included journal articles related to online community support for stroke. Editorials, registers, opinion pieces, letters, and conference papers were excluded. Online databases PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and ProQuest were searched for articles published from January 2015 to June 2025. Articles were screened based on the title, abstract, and full text using Covidence software. After screening and full-text review, we read the selected articles in detail to analyze and synthesize information on key actors, types of support, and technologies used to support stroke survivors and caregivers. RESULTS: A total of 77 articles were included. These articles discussed digital support technologies (52 articles), community functions and roles (18 articles), online stroke community systems (6 articles), and the stroke ecosystem (1 article). Our review found that the online community of support for stroke survivors and caregivers includes the caregivers themselves (46 articles), health workers (24 articles), and the local community/society (14 articles). Online communities mainly provide informational support, including giving advice (28 articles) and tangible aids (29 articles), followed by social support to create a sense of belonging (26 articles). Technologies discussed included mobile health (25 articles), web-based systems (12 articles), virtual/augmented reality (8 articles), sensors/wearable technology (8 articles), video-guided exercise apps (4 articles), and telehealth/telerehabilitation/teleconsultation/telestroke (4 articles). Only one examined how cultural differences influence technology. CONCLUSIONS: Although technologies are essential in online communities of support for stroke survivors and caregivers, this review shows a lack of studies that analyze the use and role of technologies in such online communities. This could be because the key actors of the online communities are the caregivers, who mainly seek social support and therefore do not require sophisticated technology. Nevertheless, technologies such as telerehabilitation and video-guided exercise apps could be important for other actors, including the local community and health workers, to enable them to support stroke survivors and their caregivers.
3 May 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Cumulative access to print books improves literacy achievement: Evidence from a five-year randomized trial in high-poverty schools
For more than a century, studies have shown that children who grow up in homes with more books achieve higher levels of academic success, yet it remains unclear whether books themselves improve learning or simply reflect broader socioeconomic advantages. Skill-development theory holds that greater access to books directly improves literacy through increased print exposure and reading practice, whereas the cultural capital account suggests books are indicators of broader family resources, including parental education, academic norms, and enrichment opportunities, that promote achievement independently of the books themselves. To provide causal evidence, we conducted a school-level randomized controlled trial of a program that builds children's home libraries. In 2018, we randomly assigned 60 high-poverty public elementary schools to treatment or control groups. Students in 30 treatment schools received four book distributions over 5 y, averaging about seven books per distribution, and prominently including high-interest and culturally relevant titles; students in 30 control schools received none. Tracking students from 2018-19 through 2022-23, we find a statistically significant intention-to-treat impact on reading achievement of d = 0.100 and a larger d = 0.207 advantage for those completing the full 5-y program. These impacts correspond to approximately 25 to 32% and 52 to 65% of a typical year's learning, respectively. The largest benefits are concentrated among students who received books across all distributions, indicating that cumulative exposure drives the strongest impacts. These findings provide evidence supporting skill-development theory and highlight a scalable strategy for improving literacy outcomes in high-poverty urban schools.
26 Apr 2026
Read appraisal →PloS one
An AI-based chatbot to support health-related social needs among pediatric primary care population: Protocol for a pilot randomized controlled trial
Unmet health-related social needs (HRSNs) are major drivers of poor health outcomes in early childhood. Children with unmet HRSNs are at greater risk for developmental delays, caregiver stress, and increased healthcare utilization, yet current screening approaches in pediatric primary care are resource-intensive and inconsistently implemented. AI-powered chatbots (conversational agents or virtual assistants) may offer a private, secure, scalable, and cost-effective alternative for identifying unmet needs and connecting families to services. This protocol describes a pilot randomized controlled trial designed to evaluate the feasibility, acceptability, and usability of DAPHNE, an AI-driven chatbot developed to facilitate the identification of unmet HRSNs and provide personalized community resource referrals. One hundred caregivers of children under two years of age will be recruited from Nationwide Children's Hospital pediatric primary care clinics and randomized to either the standard care (control) group or DAPHNE+ Standard care (intervention) group (n = 50 each arm). Caregivers will complete surveys at baseline, 1 month, 3 months, and 6 months post-intervention (depending on the measure). For the intervention group, participants will receive weekly chatbot prompts and on-demand access throughout the 6-month study period. Primary outcomes include study feasibility (recruitment, retention, and survey completion across both arms), acceptability (caregiver-reported ratings in both arms and intervention-specific ratings), and usability of the DAPHNE chatbot (System Usability Scale among intervention participants). Secondary outcomes includes caregiver-reported outcome measures (caregiver stress, self-efficacy, satisfaction with resource access, quality of life), and electronic health record-derived measures (including documentation of HRSN screening and referrals, adherence to well-child visits, missed appointments, emergency department utilization, and estimated healthcare costs). In addition, ten primary care providers will also participate to assess workflow integration and report on current HRSN practices. Mixed-methods analyses will integrate survey data, chatbot engagement metrics, and qualitative interviews to refine both the intervention and the study protocol. The results of this study will inform the design of a future multi-site trial to evaluate the efficacy and implementation of DAPHNE for addressing HRSNs in pediatric primary care. Trial registration: NCT07168382.
23 Apr 2026
Read appraisal →Journal of epidemiology and community health
Utilisation of in-person and telehealth care among US adults with loneliness and social isolation
BACKGROUND: Telehealth has become a critical tool for improving access to care among populations facing physical barriers to in-person care. However, its potential role in delivering care to adults with social barriers remains underexplored. We examined whether adults with loneliness or social isolation are more likely to use telehealth care versus in-person care compared to adults without loneliness or social isolation. METHODS: This cross-sectional study analysed data for US adults in the 2021 Medical Expenditure Panel Survey. Loneliness and social isolation were measured using the UCLA Loneliness Scale and the Berkman-Syme Social Network Index. Three indicators of healthcare utilisation were used as outcomes: in-person care only, telehealth care only and a combination of both. RESULTS: Among adults experiencing loneliness and social isolation, the likelihood of using only in-person care was lower by 4.1 (95% CI -6.1 to -2.1) and 2.8 (95% CI -5 to -0.6) percentage points. In contrast, the likelihood of using only telehealth care was higher by 2.6 (1.1-4.2) and 5.4 (3.9-6.9). The likelihood of using both in-person and telehealth care was also higher by 2.3 (0.7-3.9) and 5.2 (3.7-6.7), but telehealth was used more frequently than in-person care. Furthermore, telehealth utilisation for mental health services was higher among adults experiencing loneliness or social isolation. CONCLUSION: Compared with adults who are not lonely or socially isolated, adults experiencing loneliness and social isolation are more likely to use telehealth and less likely to use in-person care. Telehealth may serve as a viable alternative for individuals facing social challenges in accessing in-person services.
11 Apr 2026
Read appraisal →International journal for equity in health
Community participation in responding to health misinformation
Responses to health misinformation increasingly emphasize the importance of community engagement, yet the role of participation and power sharing remains under-theorized and inconsistently described in the peer-reviewed literature. Drawing on findings from the systematic review Overcoming Health Misinformation in Marginalized Groups, which examined 32 studies evaluating approaches to tackling health misinformation, we reflect on how the depth and quality of community participation shape trust, engagement, and intervention success. We argue that sustained partnership, shared decision-making, and local ownership enhance message credibility and reach by embedding health information within trusted social contexts. We propose strengthening equity-focused responses through structured reporting tools that center power, trust, and co-production as practical design principles rather than implementation add-ons. Making participation visible is critical if community engagement is to move beyond rhetoric and contribute meaningfully to addressing health misinformation in contexts of low institutional trust.
11 Apr 2026
Read appraisal →The New England journal of medicine
Multifaceted Strategies for Hypertension Control in Low-Income Patients
BACKGROUND: Uncontrolled hypertension disproportionately affects populations that have substantial health disparities. Data regarding the effectiveness and implementation of multifaceted, team-based strategies for hypertension control among low-income patients are lacking. METHODS: We randomly assigned federally qualified health center clinics in Louisiana and Mississippi to use either a multifaceted implementation strategy (intervention group) or enhanced usual care (control group) for hypertension control. The intervention included team-based care, protocol-based intensive blood-pressure management, blood-pressure audit and feedback, health coaching on lifestyle changes and medication adherence, and home blood-pressure monitoring. Enhanced usual care involved educating physicians about clinical guidelines for hypertension. The primary effectiveness outcome was the mean change in systolic blood pressure from baseline to 18 months. The primary implementation outcome was the adherence summary score (on a scale of 0 to 4, with higher scores indicating better adherence to blood-pressure management). RESULTS: A total of 36 clinics underwent randomization. Among these clinics, we enrolled 1272 patients with uncontrolled hypertension who were 40 years of age or older; 642 were in the intervention group and 630 were in the control group. The mean age of the patients was 58.8 years, 56.7% were women, 63.4% were Black, 75.9% were unemployed, and 73.4% had a family income of less than $25,000 per year. At 18 months, the mean change from baseline in the systolic blood pressure was -15.5 mm Hg (95% confidence interval [CI], -17.4 to -13.6) in the intervention group and -9.1 mm Hg (95% CI, -11.0 to -7.2) in the control group (between-group difference, -6.4 mm Hg; 95% CI, -9.0 to -3.8; P<0.001). The mean adherence summary score over the 18-month follow-up period was 2.8 (95% CI, 2.7 to 2.9) in the intervention group and 2.1 (95% CI, 2.0 to 2.2) in the control group (between-group difference, 0.7 points; 95% CI, 0.6 to 0.8; P<0.001). Serious adverse events occurred in 20.9% of the patients in the intervention group and in 21.7% of those in the control group. CONCLUSIONS: Among low-income patients with hypertension, a multifaceted, team-based implementation strategy resulted in a significantly greater reduction in systolic blood pressure than enhanced usual care. (Funded by the National Heart, Lung, and Blood Institute and others; IMPACTS-BP ClinicalTrials.gov number, NCT03483662.).
9 Apr 2026
Read appraisal →BMJ open
Process evaluation of a basic life support educational intervention (FirstCPR cluster randomised study) delivered at community organisations in New South Wales, Australia.
BACKGROUND: The FirstCPR cluster randomised trial delivered multimodal basic life support (BLS) learning opportunities to community organisations. An a priori process evaluation examined intervention implementation, including participation, reach, uptake and member engagement. METHODS: The study used a multimethod process evaluation. Data were collected via semistructured interviews, focus group discussions, participant surveys, study records, web analytics and in-field observations. These sources captured participation patterns and implementation measures (delivery, reach, uptake and engagement: opt-in to digital messages and attendance at training sessions), as well as reasons for refusals and withdrawals. Qualitative data were analysed thematically and organised using the UK Medical Research Council process-evaluation framework. Qualitative and quantitative data were analysed separately and subsequently interpreted collectively to contextualise implementation patterns and identify barriers and enablers that influenced trial successes and failures. RESULTS: Intervention uptake and engagement varied significantly across organisations, with greater success observed in social and faith-based groups. Of the 82 intervention clusters, 78 (95%) received intervention materials; 74 (90%) engaged in at least one activity and 15 (18%) engaged in all activities. Participation was primarily driven by the organisation's leadership interest and support in providing BLS training to members, and by the time available to facilitate intervention activities. The presence of a dedicated liaison/champion emerged as the most critical enabler of member engagement and implementation. Feedback recommended concise, simple and culturally tailored modules, with practical components delivered in shorter, convenient sessions. Intervention delivery was affected by contextual challenges, including COVID-19 disruptions that limited in-field recruitment and group activities. CONCLUSIONS: Process evaluation can strengthen community-based interventions by identifying mechanisms and contextual factors that shape implementation and engagement. Partnering with social and faith-based organisations may be an effective approach to disseminating educational programmes such as life-saving skills to lay communities. Minimising research burden and ensuring organisational leadership support may improve participation while brief, practical and culturally tailored training may enhance engagement. TRIAL REGISTRATION NUMBER: ACTRN12621000367842.
9 Apr 2026
Read appraisal →Global public health
Link between housing and community factors and mental health and psychological well-being of refugee parents and children in high-income countries: A systematic review
Whilst forced migration is known to significantly increase the risk of mental health problems, the influence of post-migration factors for refugee children and parents in high-income countries remains understudied. However, systemic post-migration factors have the potential to be modified by policy and practice to improve outcomes. This systematic review identifies the housing and community factors examined in research and their link to the mental health and psychological well-being of refugee parents and children in high-income countries. Adhering to the PRISMA guidelines, we searched the databases of PubMed, PsycINFO and Embase for studies published in peer-reviewed journals until the 17th of October 2025. Of the 11,588 studies identified, 30 were eligible for inclusion in this review. Our findings particularly suggest favourable mental health outcomes among those living with their families/relatives or foster care as opposed to reception centres, as well as those with social support. Perceived discrimination consistently showed an association with negative mental health outcomes. The findings suggest a gap in the evidence base focusing on parents, education and school-related factors. We recommend that policy makers provide family-based living arrangements and improve access to spaces for social support. Future research in this field will benefit from further sub-group analyses.
8 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A community based participatory research approach to evaluate barriers and facilitators for behavioral weight loss intervention implementation in a predominantly black community.
PURPOSE: Breast cancer survivors with overweight or obesity have worse breast cancer specific survival and outcomes as compared to those with average weight by Yung and Ligibel (Clin Adv Hematol Oncol 14:790-797, 2016) and Druesne-Pecollo et al. (Breast Cancer Res Treat 135:647-654, 2012). Our pilot Group-basEd Telehealth behavioral Weight Los (GET-WEL) Program showed that fewer Black breast cancer survivors (BBCS) enrolled and lost less weight than White breast cancer survivors by Allison et al. (Obesity Science and Practice 10:e70023, 2024). This study is aimed at using a community-based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention among BBCS. METHODS: Eight BBCS from a predominantly Black community were invited to participate in semi-structured interviews that were voice recorded, transcribed, coded, and analyzed via comparative thematic analysis. RESULTS: Thematic analyses revealed multiple barriers within participants. These included lack of affordable healthy food access, safety concerns with regards to outdoor activities, lack of affordable fitness center memberships, time constraints related to competing work/life obligations, and steep learning curves with technology use. Most BBCS preferred an integrated community-based coach to guide their weight loss interventions via a combination of both virtual and in-person sessions. CONCLUSION: Our results indicate that a multimodal approach including nutrition education, reducing physical activity barriers, limiting time constraints by implementing both in-person and virtual platforms, and assisting with technology courses, is necessary to improve the equitable implementation of weight loss interventions. BBCS recommended utilizing established community facilities and leveraging known community members such as nutrition counselors and physical trainers to increase successful implementation.
6 Apr 2026
Read appraisal →PloS one
Perception and acceptance of micronutrient-Fortified Bouillon among Non-Index Household Members: A longitudinal sub-study nested within a randomized trial in Northern Ghana
BACKGROUND: Fortified bouillon cubes offer a scalable strategy to address micronutrient deficiencies in West Africa. However, success depends on household members' perceptions and acceptance. This study assessed changes in perception and acceptance of fortified bouillon cubes over time and explored factors influencing these outcomes among non-index household members (NIHMs) from trial households in Northern Ghana. METHODS: This longitudinal mixed-methods study was nested within a double-masked randomised controlled trial. Households received micronutrient-fortified bouillon cubes (vitamin A, vitamin B12, folic acid, iron, zinc, iodine) or control cubes (iodine only) for nine months. One NIHM (≥15 years) per household (n = 1,047) was enrolled. Structured interviews were conducted during early (months 1-2; n = 731) and late (months 7-9; n = 796) phases. Composite perception (8 items) and acceptance (10 items) scores (range: 1-5; higher scores = more positive perceptions/greater acceptance) were derived from an 18-item validated instrument. Bayesian linear mixed-effects models assessed temporal changes and associated individual and household factors. Twenty-four focus group discussions (months 4-5) explored drivers and barriers. RESULTS: Mean age of NIHMs was 40 ± 14.7 years; 59% were female. Perception scores increased over seven months, from 3.4 to 4.1 (adjusted posterior mean difference [aPMD] = 0.69; 95% credible interval [CrI]: 0.57, 0.81). Acceptance remained high (4.59 to 4.58; aPMD = -0.02; 95% CrI: -0.07, 0.03). No differences were observed between trial arms. At early timepoint, perception scores were lower among household heads compared with other household members, and lower among formal employees compared with farmers. Acceptance was higher among individuals from severely food-insecure households and lower among those from mildly food-insecure households. Focus groups revealed that perceived health benefits, sensory appeal, and cultural fit drove acceptance, while infertility-related myths and food colour changes were barriers. CONCLUSION: Fortified bouillon cubes were accepted, with perceptions improving over time. Public education will be essential to address misconceptions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05178407); Pan-African Clinical Trial Registry (PACTR202206868437931). The authors confirm that all ongoing and related trials for this intervention are registered.
5 Apr 2026
Read appraisal →JMIR aging
Digital Resources and Social Connectedness Among Ethnic Minority Older Adults: Systematic Review and Meta-Analysis
BACKGROUND: Being socially connected is essential for health and well-being. Nonetheless, many older adults face social isolation, especially in ethnically diverse societies. Digital technologies offer a pragmatic approach to addressing problems with social connectedness; however, a consolidated understanding of their association with social connectedness among ethnic minority older adults remains unaddressed. OBJECTIVE: We conducted a systematic review and meta-analysis to investigate the prevalence and utility of digital resources in promoting social connectedness among ethnic minority older adults. METHODS: This systematic review and meta-analysis was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were retrieved from 4 electronic databases. A random-effects meta-analysis was used to estimate the pooled prevalence along with its 95% CI. RESULTS: Twelve studies were included. The research approaches used by the included studies were as follows: quantitative (n=5), qualitative (n=5), and mixed methods (n=2). Overall, the estimated prevalence of internet use, which was defined as engaging in online activities through digital devices, was 81.8%. Commonly used digital devices were computers (66.7%), smartphones (63.2%), and tablets (29.3%). Sociodemographic, economic, and health-related factors influenced the adoption and use of digital resources among ethnic minority older adults. These older adults relied on digital resources to build meaningful social connections through social participation, maintaining cultural and religious ties, promoting transnational social networks, and fostering their potential for social connectedness. However, digital resources were not always useful for social connectedness and adversely affected in-person contact. CONCLUSIONS: Digital resources can promote social connectedness among ethnic minority older adults by enabling them to maintain their cultural and social values. Cities and regions aiming to promote the social connectedness and well-being of ethnic minority older adults should consider intersectional factors that affect access to digital resources and the sustainable adoption of digital resources.
4 Apr 2026
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