Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 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 →PloS one
Transformation of artistic style and innovative design of oriental folk patterns based on AIGC Technology-A case study of Zhuxian town new year paintings from China
In response to the limited cross-domain innovation in the digitalization of traditional oriental folk art, this study takes the New Year pictures of China's Zhuxian Town as a case. It develops a collaborative technical framework of combining the Liblib platform and a LoRA model to explore AI-generated digital re-creation of traditional art. A high-quality dataset was built through a three-stage process of image acquisition, multidimensional screening, and expert review. A three-layer keywords thesaurus was constructed through literature analysis, questionnaire surveys, and semantic clustering. Using a two-stage training strategy combining pre-training and fine-tuning, along with dynamic optimization, the model accurately captures the stylistic features of Zhuxian New Year pictures. The generated outputs integrate traditional aesthetics with modern design and are applied to cultural and graphic creative products. The results demonstrate the effectiveness of the proposed framework for preserving artistic style while enabling cross-domain innovation and offer a practical technical reference for the digital inheritance and modernization of related folk arts.
30 May 2026
Read appraisal →BMJ open
Role of community pharmacy in the prevention of cardiovascular disease in minority ethnic groups in the UK including barriers and facilitators: a mixed-methods systematic review
OBJECTIVES: To evaluate the role of community pharmacy in the prevention of cardiovascular disease (CVD) among minority ethnic groups and to identify key barriers and facilitators influencing engagement with pharmacy-based CVD prevention services. DESIGN: Systematic review using thematic synthesis to analyse both qualitative data and narratively synthesised quantitative data taking a convergent data synthesis approach. Searches were conducted from inception to 16 October 2024 across CINAHL Ultimate (EBSCOhost), EMBASE (Ovid), PubMed (NLM), Scopus (Elsevier) and Web of Science (Clarivate), supplemented by Google Scholar for grey literature and backward and forward citation tracking to identify additional studies. SETTING: Community pharmacy settings across multiple countries, including the UK and international contexts. PARTICIPANTS: Minority ethnic groups accessing community pharmacy services and community pharmacy professionals involved in delivering CVD prevention interventions. INTERVENTIONS: Community pharmacy-based CVD prevention interventions, specifically services addressing CVD risk factors. OUTCOME MEASURES: Outcomes comprised qualitative insights, including barriers and facilitators to engagement with community pharmacy-led CVD prevention services. RESULTS: Twenty-three studies met the eligibility criteria. Five overarching themes were identified: trust, systemic barriers, culturally tailored language, cultural and religious influences and family and social networks. Community pharmacies undertook varied CVD-related roles, most commonly CVD screening and diabetes management with additional contributions to smoking cessation, weight and lipid management, health promotion and medication adherence. Community pharmacies showed potential to support CVD prevention among minority ethnic groups. However, engagement was limited by language barriers, cultural beliefs, lack of trust in healthcare providers and organisational constraints such as time pressures and limited training. Facilitators included culturally tailored interventions, language concordance and strong pharmacist-patient relationships. CONCLUSIONS: Evidence from the UK remains limited, highlighting a need for further research into the role of community pharmacy in reducing CVD disparities among minority ethnic groups. International evidence suggests significant potential for pharmacy-based interventions, but improved cultural competence, targeted service design and greater awareness of determinants of equitable healthcare are essential. Future research should focus on optimising culturally responsive pharmacy-led CVD prevention strategies. PROSPERO REGISTRATION NUMBER: CRD42024579766.
29 May 2026
Read appraisal →Journal of medical Internet research
Effect of Integrated Internet-Based Acceptance and Commitment Therapy and Behavioral Activation Among Ethnic Minority Young Adults With Alcohol Use Disorder in Hong Kong: Pilot Randomized Controlled Trial
BACKGROUND: Alcohol use disorder (AUD) profoundly affected ethnic minority young adults due to unique stressors, such as acculturation challenges and discrimination. Our prior studies found that experiential avoidance behavior and discrimination significantly contributed to AUD. These findings warranted third-wave interventions, such as acceptance and commitment therapy (ACT). Nonetheless, barriers to engagement with value-based activities may affect ACT efficacy. Behavioral activation (BA) may be an alternative for this shortcoming. Integrating these interventions has shown promise. However, no studies evaluated its effectiveness in this group. Therefore, evaluating the preliminary effectiveness and feasibility of this intervention was needed. OBJECTIVE: This study aimed to evaluate the feasibility measures. The secondary objective aimed to examine its effectiveness on cumulative abstinence duration, drinking days, drinks per drinking day, heavy drinking days, alcohol abstinence self-efficacy, readiness to change, psychological flexibility (Acceptance and Action Questionnaire-version II), and everyday discrimination score. METHODS: A pilot parallel randomized controlled trial was conducted. Forty young ethnic minorities who can speak English and have AUD based on DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria were recruited and randomly assigned to either Acceptance and Commitment Therapy with Behavioral Activation (ACT-BA; n=20) or Treatment-as-Usual (TAU; n=20) using a computer-generated random number; assessors were blinded to group assignment. Outcomes were collected at baseline (T0) and postintervention (T1). The analysis included descriptive statistics, independent samples t test, chi-square test, and generalized estimating equations with multiple imputations. To further supplement findings, a qualitative interview was conducted. RESULTS: A total of 148 ethnic minority young adults were screened, with an eligibility rate of 38.5% (57/148). Of these, 85.9% (49/57) consented, and among them, 81.6% (40/49) were randomized to either the ACT-BA or TAU. The retention rate was 82.5% (33/40), of which 75% (30/40) completed the postintervention assessment (ACT-BA: 16/20, 80%; TAU: 14/20, 70%). The adherence rate was 81.7% (4.9/6 sessions), and participants reported no adverse effects. Finally, 40 participants (20 for each group) were analyzed. The intervention group showed a promising improvement in drinking days (B=-4.12, 95% CI -8.10 to -0.13; P=.04, d=-0.57), drinks per drinking day (B=-1.56, 95% CI -3.06 to -0.07; P=.04, d=-1.89), alcohol abstinence self-efficacy (B=11.95, 95% CI 0.10-23.81; P=.048, d=0.81), and Acceptance and Action Questionnaire-version II (B=-6.41, 95% CI -12.77 to -0.06; P=.04, d=-0.65). CONCLUSIONS: This study, unlike existing evidence, presents an innovative integration of ACT and BA delivered via an internet-based self-help format. The findings contribute to the field by providing preliminary evidence that this integrated intervention is feasible and promising for AUD. The main implication in the real world is to conduct a fully powered randomized controlled trial to further examine its effectiveness with longer follow-up to serve as a stand-alone treatment option for ethnic minorities.
22 May 2026
Read appraisal →The New Zealand medical journal
The impact of cultural concordance between health professionals and patients: a narrative review
AIM: The aim of this article is to summarise international evidence on the impacts of cultural/ethnic concordance between patients and health professionals and to discuss the implications for New Zealand. METHOD: Database searches were conducted from August to September 2025 using Scopus, Embase and PubMed, using key terms related to health outcomes and cultural/ethnic concordance. RESULTS: A total of 25 relevant systematic reviews, meta-analyses and research studies were included for analysis. Overall, evidence is predominately from the United States of America and findings are variable. Cultural concordance is associated with improved communication quality, trust, satisfaction and perceived respect. Concordance is also associated with improved healthcare utilisation, medication adherence and uptake of preventative interventions. Some studies found concordance was associated with differences in clinical decision-making. Impact on clinical outcomes is mixed, with some studies finding concordance has a positive impact on caesarean section rates, diabetes management, surgical outcomes and addiction treatment, while others found no impact. CONCLUSION: Cultural concordance between patients and their health professionals matters, with evidence of impact on patient experience, communication quality, engagement and adherence, clinical decision-making and some clinical outcomes. Findings are inconsistent: the strength of association and groups which see the greatest benefit vary between studies. To reduce health inequities, we need to increase the diversity of the workforce and train all health professionals to provide non-racist, equitable care.
12 May 2026
Read appraisal →JMIR formative research
Comparing Large Language Models and Traditional Machine Translation Tools for Translating Medical Consultation Summaries: Quantitative Pilot Feasibility Study
BACKGROUND: Translation of medical consultation summaries is essential for equitable health care communication in culturally and linguistically diverse populations. While machine translation (MT) tools and large language models (LLMs) are widely accessible, their feasibility and safety for health care contexts remain underexplored. OBJECTIVE: This pilot study investigates the feasibility and limitations of using LLMs and traditional MT tools to translate medical consultation summaries from English into the most common languages other than English spoken in Australia-Arabic, Chinese (simplified written form), and Vietnamese. METHODS: Two simulated summaries-a simple patient-facing summary and a complex clinician-oriented interprofessional letter-were translated using 3 LLMs (GPT-4o, Llama-3.1, and Gemma-2) and 3 MT tools (Google Translate, Microsoft Bing Translator, and DeepL). Translations were benchmarked against professional third-party interpreter translations using Bilingual Evaluation Understudy, Character-level F-score, and Metric for Evaluation of Translation with Explicit Ordering metrics. RESULTS: The translation performance varied across languages, tools, and summary complexity when assessed using automatic evaluation metrics. Traditional MT tools outperformed LLMs on surface-level metrics, while LLMs showed relative strengths in semantic similarity for Vietnamese and Chinese. Arabic translations improved with complex input, suggesting morphological advantages. The metric-based evaluation highlighted feasibility but also risks, particularly in Chinese clinical contexts. CONCLUSIONS: This pilot study provides formative evidence of opportunities and limitations in applying artificial intelligence translation for health care communication. Findings underscore the importance of human oversight; domain-specific evaluation metrics; and further formative and clinical research to guide the safe, equitable use of artificial intelligence translation tools.
14 Apr 2026
Read appraisal →Epidemiology and psychiatric sciences
Cross-cultural validity of the generalized anxiety disorder 7-item scale (GAD-7): a systematic review and standardized assessment
AIMS: The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7. METHODS: We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively. RESULTS: Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible. CONCLUSIONS: The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.
14 Apr 2026
Read appraisal →PloS one
Exploring barriers and enablers to diabetes self-care practice in Ethiopia, 2025: A qualitative systematic review
INTRODUCTION: Diabetes mellitus is a growing public health concern in Ethiopia, with increasing prevalence and a high proportion of undiagnosed cases. Effective self-care is crucial for managing diabetes; however, many patients face challenges ranging from personal beliefs to systemic and sociocultural constraints. Although multiple qualitative studies have explored these challenges, a synthesized, context-specific understanding that incorporates broader social and health system factors remains limited. This review aimed to synthesize qualitative evidence on barriers and facilitators of diabetes self-care practice in Ethiopia. METHODS: A qualitative systematic review was conducted in accordance with PRISMA 2020 and PRISMA-QS guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar was performed using relevant keywords and Medical Subject Headings. Eligible studies included primary qualitative and mixed-methods studies with extractable qualitative findings that explored diabetes self-care barriers and facilitators among patients, caregivers, or healthcare providers in Ethiopia. Purely quantitative studies, reviews, editorials, and studies conducted outside Ethiopia were excluded. Thematic synthesis was employed to integrate findings, and the GRADE-CERQual approach was used to assess confidence in the review findings. RESULTS: Eleven studies were included, comprising qualitative and mixed-methods designs conducted across diverse urban and semi-urban healthcare settings in Ethiopia. Study participants included adults with type 1 and type 2 diabetes, as well as healthcare professionals and caregivers. Six major barriers to diabetes self-care were identified: health system limitations, individual-level challenges, socioeconomic constraints, behavioral and lifestyle factors, cultural and social norms, and lack of social support. Key facilitators included strong family and social support, health education and counseling, patient motivation and skills, culturally aligned practices, and signs of health system readiness. CONCLUSION AND RECOMMENDATION: Diabetes self-care in Ethiopia is shaped by interconnected individual, cultural, and systemic factors. While substantial barriers persist, important enablers, particularly family involvement and supportive healthcare interactions, offer opportunities for improvement. Interventions should be culturally sensitive, community-centered, and supported by strengthened health systems. Policy efforts should prioritize integration of diabetes care into primary healthcare services, capacity building of healthcare providers, and incorporation of patients' lived experiences into care planning. Prospero registration number CRD420251033692.
11 Apr 2026
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