Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 11 appraisals
AIDS care
"It's a lifeline": perspectives and experiences of health technology use among HIV care providers in rural Florida
The use of health technology, such as telehealth and mobile health used to support or deliver health care, is a promising strategy to improve HIV outcomes among people with HIV (PWH) in the rural South. In-depth interviews were conducted with 21 HIV care providers in rural Florida to understand the perspectives and experiences of using health technology to deliver care for PWH. Thematic analysis was applied. Emerging themes were organized under four domains: current and prior health technology practices, drawbacks to health technology, benefits of health technology, and potential facilitators of health technology. Providers revealed that health technology use has expanded rapidly since onset of the COVID-19 pandemic, especially use of video calls, but they preferred multiple communication methods. Drawbacks to health technology included lack of human connection, increased burden to providers and patients, confidentiality concerns, technology malfunctioning, discomfort with technology, and financing constraints. Benefits included improved communication and access to care, social connection and community support, and reduced HIV-related stigma. Potential facilitators included health technology that is user-friendly, and economic incentives to increase technology use. Health technology holds promise for addressing barriers to HIV care, however, its drawbacks must be addressed to ensure effective implementation in the rural South.
3 Aug 2026
Read appraisal →Journal of medical Internet research
Barriers and Facilitators to Implementing Digital Health Technologies for Remote Management of NCDs in Rural Areas: Mixed Methods Systematic Review
BACKGROUND: Digital health technologies (DHTs) have the potential to improve care delivery and outcomes for patients with noncommunicable diseases. Yet their implementation in rural settings remains uneven, and the factors influencing uptake are not well understood. OBJECTIVE: This mixed methods systematic review aimed to identify barriers and facilitators influencing the implementation and use of DHTs for remote management of noncommunicable diseases in rural areas. METHODS: We searched Medline, Embase, and CINAHL from inception to February 12, 2026, using terms related to digital health, noncommunicable diseases, and rural settings. Following the Joanna Briggs Institute methodology for mixed-method systematic review, we synthesized quantitative and qualitative studies. Barriers and facilitators were categorized using the Consolidated Framework for Implementation Research, and study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: From the initial 1491 records, 14 studies met the inclusion criteria, with most conducted in high-income countries (n=11). Key barriers included technical challenges (software instability and hardware issues), poor internet connectivity, financial constraints, and workforce constraints, such as staff shortages and heavy workloads. Key facilitators included user-friendly technology design, strong leadership, effective teamwork, and ongoing communication. Evidence was predominantly qualitative, with only limited quantitative data available. CONCLUSIONS: DHTs show promise for improving access and continuity of care for cardiovascular disease, hypertension, and diabetes in rural settings; however, their impact is constrained by structural inequities, including limited broadband access, workforce shortages, and financial fragility. These findings highlight important implications for research, policy, and practice, including the need for rigorous mixed methods evaluations sensitive to rural contexts, long-term equity-oriented financing mechanisms, and strengthened organizational readiness to support effective DHT uptake.
2 Aug 2026
Read appraisal →Journal of medical Internet research
Digital Peer Support Intervention for Family Caregivers of Individuals With Neuromuscular Disease: Randomized Controlled Trial
BACKGROUND: Neuromuscular diseases (NMD) affect nerves and muscles, resulting in weakness and often profound disability. Family caregivers of individuals with NMD experience significant psychological burden, stress, and reduced well-being. Digital peer support interventions may help to ameliorate these negative impacts. OBJECTIVE: This study evaluated the effect of a 12-week digital peer support intervention compared to usual care on caregiver mastery, competence, stress, burden, anxiety, and depression among family caregivers of individuals with NMD. METHODS: We conducted a parallel-group multicenter randomized controlled superiority trial in Ontario, Canada. Family caregivers of children or adults with NMD were recruited between August 2022 and September 2023 through 7 sites, social media, and national organizations. Participants were randomized 1:1 to a 12-week digital peer support intervention or usual care. The 12-week intervention comprised access to a trained peer mentor, private app-based communication via aTouchAway (Aetonix, Canada), and weekly moderated digital group discussion forums. The primary outcome was caregiver mastery measured using the Pearlin Mastery Scale, adjusted for baseline score. Secondary outcomes included caregiver stress, competence, burden, anxiety, and depression. We calculated adjusted (for baseline score) mean differences using analysis of covariance and generated multivariable linear regression models exploring associations with the intervention and caregiver age, years of caregiving, care recipient medical diagnosis, care recipient ventilation type, adjusting for baseline outcome scores. Intervention fidelity was evaluated through participant engagement metrics. RESULTS: A total of 100 participants were randomized (n=50 intervention and n=50 control). Participants had a mean age of 46.8 (SD 11.6) years, 70% (n=70) were mothers, with a mean length of caregiving of 11.8 (SD 7.6) years. We found no difference in 12-week Pearlin Mastery Scale scores (adjusted mean difference 0.67, 95% CI -1.7 to 3.1). We also found no difference in any of our secondary outcomes. Mentors and participants sent a mean of 21.3 (SD 33.3) and 17.7 (SD 33.0) messages, respectively. Overall, 62% (n=31) of participants and 92% (n=11) of mentors engaged in at least 1 program element for ≥8 of the 12 weeks. CONCLUSIONS: Our 12-week digital peer support program had no effect on caregiver mastery or other caregiving or psychological outcomes among family caregivers of individuals with NMD. This might be partly due to moderate fidelity and variability in participant engagement. Unlike prior caregiver interventions that incorporated structured psychoeducation or self-management training, this intervention evaluated primarily peer support delivered through a digital platform. This study contributes important evidence regarding the feasibility and limitations of scalable digital peer support programs for caregivers of individuals with NMD. These findings highlight the importance of intervention tailoring, participant matching, and sustained engagement. Future research should evaluate longer-duration and more individualized peer support models targeting caregivers earlier in the caregiving trajectory to improve intervention fidelity and ultimately caregiver well-being.
24 July 2026
Read appraisal →JMIR cancer
AI-Enhanced Predictive Analytics to Optimize Tele-Oncology Implementation in Rural Settings: Scoping Review
BACKGROUND: Tele-oncology addresses geographic barriers to cancer care, but implementation challenges persist in rural settings. AI-enhanced predictive analytics offer opportunities for optimizing deployment through personalized, data-driven strategies; however, evidence in rural tele-oncology contexts remains limited, and critical equity considerations remain underexamined. OBJECTIVE: This scoping review aimed to map evidence on AI-enhanced predictive analytics in tele-oncology implementation, with particular attention to rural and underserved populations, to identify research gaps and inform implementation science priorities. METHODS: We searched 5 databases (PubMed, Embase, CINAHL, Web of Science, and IEEE Xplore) using 4 concept domains (tele-oncology, rural implementation barriers, AI or predictive analytics, implementation science) from January 2015 through November 2025. Two independent reviewers screened 330 unique records (title or abstract; Cohen κ=0.78), with the principal investigator resolving conflicts. Of 138 full-text reviews (κ=0.82), 4 studies met inclusion criteria. Data extraction captured study characteristics, AI applications, implementation factors, and outcomes. We used narrative thematic analysis to map findings into three themes: (1) the current tele-oncology implementation landscape in rural and underserved settings, (2) potential AI applications addressing implementation challenges, and (3) implementation considerations for AI systems themselves. RESULTS: Four included studies (1 pilot feasibility study, 1 proof-of-concept validation study, 1 cross-sectional predictive study, and 1 platform development study; published 2019-2025) demonstrated limited evidence at the intersection of AI, tele-oncology, and rural health equity. Patient characteristics predicted telehealth modality preferences with 86.2% accuracy, revealing that male patients exhibited 66% increased odds of video selection versus female patients (P=.004), and urban residents showed 101% increased odds compared to rural counterparts (P<.001). Liu et al demonstrated that disadvantaged populations engaged with AI-generated health literacy content 2.52-fold more frequently than nondisadvantaged counterparts. However, all 4 studies documented substantial implementation barriers (patient, provider, organizational, and system levels) persisting despite technological sophistication. Organizational threshold effects, where remote monitoring interventions succeeded with adequate provider capacity but failed under resource constraints-suggest that algorithmic innovations cannot overcome structural limitations in rural facilities. No studies explicitly examined algorithmic bias, cross-population validation, or potential harms in rural contexts. Geographic concentration in high-resource countries (United States n=2, Greece n=1, and Singapore n=1) and limited oncology-specific focus underscore structural gaps in knowledge generation for underserved populations. CONCLUSIONS: Current evidence remains insufficient to support definitive practice recommendations. The observed evidence gap may reflect broader structural inequities in knowledge generation: populations with the greatest implementation challenges appear to remain substantially underrepresented in AI and digital health literature. Future research should prioritize comparative effectiveness studies in authentic rural contexts with implementation science outcomes, equity-centered cross-population validation, specification of translation mechanisms linking AI predictions to implementation strategies, health economic analyses, and mechanistic research on sociotechnical integration factors, ensuring technological innovation reduces rather than perpetuates disparities in cancer care.
19 July 2026
Read appraisal →Journal of medical Internet research
Addressing the Key Challenges of Decentralized Clinical Trials in Europe: Multistakeholder Perspective Delphi Study
BACKGROUND: Decentralized clinical trials (DCTs) represent an emerging model in clinical research, accelerated by the restrictions imposed during the COVID-19 pandemic. By leveraging digital technologies and local health care resources, DCTs aim to increase accessibility and reduce participant burden compared to traditional site-based models, which often face recruitment failures and high attrition rates. While various regulatory initiatives in Europe, such as the Accelerating Clinical Trials in the European Union program and the European Medicines Regulatory Network recommendation paper (updated in October 2025), have sought to facilitate their implementation, the widespread adoption of DCTs remains limited due to significant operational, regulatory, and technological challenges, including platform fragmentation and gaps in digital literacy. OBJECTIVE: This study aimed to identify and prioritize actionable solutions to the main challenges of DCT implementation in Europe from a multistakeholder perspective, gathering insights to address specific ethical, legal, and operational barriers. METHODS: Building on a preceding strengths, weaknesses, opportunities, and threats analysis, a 2-round Delphi study was conducted, involving 26 experts in clinical trials, ethics, law, regulation, and patient engagement between March and May 2023. In the first round, 309 open-ended responses were collected via REDCap (Research Electronic Data Capture; Vanderbilt University) surveys and underwent systematic inductive content analysis using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) with independent double coding. This process resulted in 244 unique proposals that were categorized according to 6 key challenges. In the second round, 39 synthesized proposals were evaluated using a 4-point Likert scale. Consensus was defined as ≥80% agreement on the appropriateness of each proposal. RESULTS: High levels of consensus were achieved, with 32 out of the 39 proposals reaching the threshold and 14 achieving 100% unanimity. Overall, 82% of the proposals were rated as "appropriate" or "very appropriate." Key recommendations included providing support and training for health care professionals, enhancing investigational medicinal product and biological sample logistics through validated technologies, improving collaboration with local health care providers, fostering regulatory harmonization while respecting national specificities, strengthening capacity-building initiatives, and promoting accessible, user-friendly digital tools supported by hybrid trial models. Conversely, proposals such as peer-to-peer participant support and the centralization of ethics reviews at the European Union level failed to reach consensus. CONCLUSIONS: The study offers a prioritized compilation of expert-driven recommendations for overcoming current barriers to DCT implementation in Europe. The adoption of these recommendations could support the development of more inclusive, efficient, and sustainable decentralized research frameworks across diverse health care systems.
12 July 2026
Read appraisal →BMC public health
Motivating factors and possible barriers to participation in digital prevention courses of two statutory health insurance funds in Germany: a qualitative interview study
BACKGROUND: Digital prevention courses offered by statutory health insurance funds in Germany represent a low-threshold opportunity to support health-promoting behaviors through pre-recorded, video-based programs focusing on exercise, nutrition, or stress management. However, little is known about insured individuals' motivations and barriers to participation. This study aimed to identify relevant motivating and obstructive factors for participation in digital prevention courses and to explore differences compared to on-site formats. METHODS: We conducted semi-structured telephone interviews with 20 insured members of two large regional statutory health insurance funds in Germany (AOK North-East and AOK North-West) who had recently completed digital prevention courses. Participants were recruited via e-mail invitations sent by the health insurance funds following course participation. Five additional interviews were conducted with participants of on-site courses for contextual comparison. Interviews were conducted between February and December 2023, transcribed verbatim, and analyzed using qualitative content analysis with a deductive-inductive coding approach based on the study objectives and interview guide. RESULTS: The sample included 20 participants (mean age 41 years, range 25-72; 19 women and 1 man) who had completed digital prevention courses. Participants emphasized temporal flexibility, home-based access, and low preparation effort as key facilitators of participation. Additional motivators included health-related goals, free access, practical content, reminders, and the possibility to repeat sessions. Reported barriers included a lack of discipline, reduced social interaction and commitment compared to on-site formats, and work- and family-related demands. The availability of recorded sessions was perceived as a major advantage that facilitated course completion. Participants also valued competent instructors, but called for clearer differentiation of difficulty levels, broader course options, continued access to materials, and follow-up opportunities. The contextual comparison showed that on-site course participants particularly valued the sense of community and the possibility of individual corrections by instructors. CONCLUSIONS: Digital prevention courses are well accepted and can promote participation due to their flexibility and accessibility. However, challenges such as reduced social interaction and the need for self-discipline limit their full potential. To enhance their effectiveness and reach, digital prevention programs should integrate more tailored content, structured follow-up offers, and interactive or hybrid elements that foster engagement and social connectedness. TRIAL REGISTRATION: German Clinical Trial Register DRKS00029761; Registration date 27.07.2022; https://drks.de/search/de/trial/DRKS00029761 .
9 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Patients' expectations and barriers towards postoperative telehealth follow-up after oncologic breast surgery in France
BACKGROUND: Surgery is the most frequent treatment for breast cancer and requires postoperative follow-up to detect complications and monitor patient recovery. Postoperative telemonitoring has demonstrated benefits in improving rehabilitation and psychological well-being. However, patient expectations of and barriers to telehealth follow-up after oncologic breast surgery remain insufficiently explored. METHODS: A prospective survey was conducted among adult patients attending pre- or postoperative follow-up appointments for breast cancer in the Department of Breast and Reconstructive Surgery at the Civil Hospitals of Colmar between March and August 2025. The questionnaire comprised four sections: demographic data, treatments received, telemedicine accessibility and acceptability, and patient expectations of and barriers to telemonitoring. RESULTS: A total of 124 questionnaires were analyzed. Results demonstrated high accessibility to digital tools among participants. Although patients recognized several advantages of telemonitoring, most expressed a strong preference for in-person follow-up visits. The most expected features included the ability to report postoperative complications and to monitor recovery and pain. The main barrier was the fear of reduced human contact. Retired status was associated with lower acceptance of postoperative telemonitoring. CONCLUSION: These findings support the implementation of a hybrid follow-up model combining early postoperative telemonitoring with later in-person consultations, which could help reassure patients and shorten hospital stays while maintaining personalized care. The monocentric design may limit the external validity of the findings. Future studies should explore patients' perceptions following repeated use of telemonitoring tools and incorporate healthcare professionals' perspectives on their integration into clinical practice.
7 July 2026
Read appraisal →Journal of medical Internet research
Patients' Experiences of Nurse-Led eHealth Interventions for Chronic Heart Failure: Qualitative Systematic Review and Meta-Synthesis
BACKGROUND: Chronic heart failure (CHF) is a major chronic condition in the context of global population aging and is associated with high prevalence, frequent rehospitalization, and high mortality. Self-management is widely recognized as an important factor influencing prognosis and quality of life among patients with CHF. Nurse-led eHealth interventions have been increasingly used in postdischarge CHF management and have shown potential for improving adherence and health-related behaviors. However, existing studies have predominantly focused on objective outcomes, and limited systematic synthesis has examined patients' subjective experiences, which may restrict the patient-centered optimization and sustainable implementation of these interventions. OBJECTIVE: This study aimed to systematically synthesize patients' experiences of nurse-led eHealth interventions for CHF, identify facilitators and barriers to engagement and implementation, and inform the patient-centered optimization of intervention design through a qualitative systematic review and meta-synthesis. METHODS: This qualitative systematic review and meta-synthesis was conducted in accordance with the Joanna Briggs Institute methodology for qualitative systematic reviews. A comprehensive search was performed in PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, CNKI, WanFang, and VIP from database inception to April 30, 2026, supplemented by manual searches of the reference lists of the included studies. Following methodological quality appraisal, the findings of the included studies were extracted and synthesized using thematic synthesis. RESULTS: A total of 23 studies involving 424 patients with CHF were included, comprising 17 qualitative studies and 6 mixed methods studies. Four synthesized themes and 12 subthemes were generated: (1) patient empowerment and enhanced self-management, (2) sense of security and continuity of care under professional support, (3) variations in acceptance and emotional responses, and (4) barriers and challenges in implementing eHealth interventions. CONCLUSIONS: Nurse-led eHealth interventions may provide important support for CHF management from the patient perspective by promoting empowerment and extending care support beyond hospital settings. The findings suggest that future intervention design should better address patient heterogeneity, technological usability, and long-term sustainability. Further efforts are needed to strengthen individualized adaptation and technological optimization to enhance the accessibility, acceptability, and patient-centered implementation of these interventions.
7 July 2026
Read appraisal →Child and adolescent psychiatric clinics of North America
Technology-Enabled Crisis Care for Youth: Bridging the Gap
The article discusses technological advancements in mental health care for youth in crisis, addressing workforce shortages and enhancing care delivery. Technologies like remote patient monitoring, telehealth, mobile health applications, virtual reality therapy, and artificial intelligence improve symptom tracking, communication, and treatment accessibility. Clinical decision support systems and therapy chatbots enhance crisis assessment and management. Various settings employ telepsychiatry and extend reach, while digital therapeutics and monitoring ensure ongoing support. Challenges include regulatory compliance, data privacy, and technological limitations. Future directions emphasize interoperability, safeguards for new and adapting technologies, patient-centered care, and integrated digital health systems.
3 July 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Training humans to detect AI-generated faces
As AI-generated faces become indistinguishable from real ones, deepfake technology poses escalating threats to information integrity and security. While algorithms can detect deepfakes, they suffer from opacity and critical vulnerabilities-and training humans to identify specific visual artifacts has proven largely ineffective. Here, we introduce a fundamentally different approach that harnesses people's global impressions of faces. Building on findings that AI and human faces evoke systematically different perceptual impressions (Miller et al., 2023), we trained participants to attend to these distinguishing qualities without explicit instruction on how to use them. Using a rigorous pre-post design with untrained test faces, we demonstrate that all participants (N = 45) improved, with mean accuracy nearly doubling. High performers achieved near-perfect detection, and participants developed metacognitive insight, showing appropriate confidence calibration only after training. A test-retest control study ruled out practice effects as an explanation for training gains, and an online replication demonstrates the scalability of our approach. As the technology advances, targeting systematic biases that are inherent to generative AI, and which manifest in global features, may offer a more durable defense than approaches reliant on image artifacts alone.
30 June 2026
Read appraisal →JMIR nursing
Digital Health Literacy and Attitudes Toward Telehealth Use in Practice Among Nursing Students in Saudi Arabia: Cross-Sectional Study
BACKGROUND: Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students' attitudes toward using telehealth in clinical settings. OBJECTIVE: This study aimed to determine the relationship between nursing students' digital health literacy and their attitudes toward telehealth use in practice. METHODS: A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses' Attitudes Toward Use of a Telehealth Scale. RESULTS: A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice. CONCLUSIONS: Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.
24 June 2026
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