Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 7 appraisals
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Telehealth Competency Evaluation Tools: A Scoping Review
INTRODUCTION: Telehealth is an integral part of healthcare. Exposure to telehealth education is essential for both students and health care professionals to support its effective adoption and appropriate utilization. This scoping review aims to explore whether and which telehealth competencies are being assessed and the methods used to evaluate them among health care professionals and students. METHODS: An electronic literature search was performed using six electronic databases between January 2024 and February 2025. We included studies where telehealth competencies or their components were evaluated by some type of tool (validated or researcher created). Strict inclusion and exclusion criteria were used, and each article was evaluated by at least two reviewers. RESULTS: Out of 1,217 articles screened by title and abstract, 75 met inclusion criteria, with 36 of those selected for inclusion in this review. Participants were evaluated mostly by researcher-created tools that lacked psychometric properties or adapted nontelehealth evaluation tools. Few validated/reliable tools directly measured telehealth competencies. DISCUSSION: The results of this review illustrate there exists a lack of available validated/reliable evaluation tools to appraise telehealth competencies. Few studies included an evaluation of all telehealth competencies but rather focused only on communication and technology proficiency; none evaluated the appropriate use of telehealth or digital disparities. CONCLUSIONS: More research is needed to develop validated telehealth evaluation tools that can be used across disciplines and encompass all telehealth competencies. Additionally, true research methods are needed to adequately assess the impact of telehealth education on the performance and confidence of learners.
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 →Vaccine
Interventions to improve pre-school vaccination timeliness: a systematic review.
BACKGROUND: Improving the timeliness of pre-school vaccinations (children aged 0 to 5 years) is an important public health goal to prevent outbreaks and maximise protection during early childhood. Multiple studies have highlighted the need for effective public health interventions to improve timely vaccination, and consequently the overall effectiveness of vaccination programmes. We aim to synthesise evidence on vaccination timeliness interventions and subsequently provide recommendations to improve pre-school vaccination timeliness in England. METHODS: We conducted a systematic review of randomised controlled trials (RCTs) and non-randomised studies. Studies were eligible if they were conducted in high-income countries and evaluated an intervention to improve timeliness of any pre-school vaccination on the United Kingdom (UK) national childhood vaccination schedule. Five databases and grey literature were searched to February 2025. Risk of bias was assessed using Cochrane risk of bias tools. Data were analysed using random-effects meta-analyses and synthesis without meta-analysis (using effect direction plots). RESULTS: Of the 10,385 records from database searches and 1490 records from citation searches, 33 studies were eligible (15 RCTs, 18 non-randomised studies). Most studies were conducted in the USA (n = 24) and reported on the timeliness of multiple pre-school vaccines (n = 23). Twelve studies (36%) were judged as serious or critical risk of bias, eleven at moderate and ten at low risk. Various intervention groups were identified: call-recall (n = 10), quality improvement (n = 9), education (n = 5), multicomponent (n = 5), combination vaccines (n = 2), communication (n = 1) and vaccination schedule change (n = 1). We found limited evidence from a small number of studies of a potential beneficial effect of combination vaccines, communication, quality improvement, education and schedule change interventions. CONCLUSION: We identified several possible interventions to improve pre-school vaccination timeliness. However, we found limited quantity and quality of evidence on this topic. We recommend further high-quality studies evaluating interventions to improve vaccination timeliness in England, and application of consistent vaccination timeliness definitions.
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 →PloS one
Delayed health-seeking behavior and its associated factors among cancer patients in Ethiopia: A systematic review and meta-analysis, 2025
BACKGROUND: Delayed Health-seeking behavior among cancer patients is a major contributor to late diagnosis, poor prognosis, and high mortality, particularly in low-resource settings like Ethiopia. However, evidence on the magnitude and determinants of delayed care-seeking remains fragmented. OBJECTIVE: This systematic review and meta-analysis aimed to estimate the pooled prevalence of delayed Health-seeking behavior among cancer patients in Ethiopia and to identify associated factors influencing delays. METHODS: This study employed a systematic review and meta-analysis design to assess delayed Health-seeking behavior and its influencing factors among cancer patients in Ethiopia. A systematic search was conducted in PubMed, Scopus, Web of Science, CINAHL, AJOL, Google Scholar, and Ethiopian University repositories until April 27, 2025. The data were extracted from March 10-20 and analyzed from March 21-30, with report generation till April 27, 2025, using R software. Meta-analysis was performed using a random-effects model, with forest plots illustrating pooled prevalence and associated factors. Heterogeneity was assessed using the I² statistic, and study quality was evaluated using a validated tool. RESULTS: Seven studies conducted across multiple regions of Ethiopia were included in the final analysis with a total of 2,641 participants. The pooled prevalence of delayed Health-seeking behavior among cancer patients was 54% (95% CI: 39%-68%). Meta-analysis of associated factors showed that rural residence was significantly associated with delayed Health-seeking behavior, with patients residing in rural areas having more than threefold higher odds of delay (AOR = 3; 95% CI: 1.81-4.19), poor knowledge about cancer was strongly associated with delay, with nearly seven times higher odds among patients with poor knowledge compared to those with adequate knowledge (AOR = 6.63; 95% CI: 2.21-11.05), lack of cancer awareness was also a significant predictor of delayed Health-seeking behavior (AOR = 2.63; 95% CI: 1.75-3.51), and patients without pain were over three times more likely to delay Healthcare(AOR = 3.38; 95% CI: 2.44-4.67) were factors associated with delayed Health-seeking behavior. CONCLUSIONS: Our review showed that half of the cancer patients in Ethiopia experienced delayed health-seeking behavior. Delayed care-seeking was associated with rural residence, poor knowledge, limited awareness of cancer, and absence of pain symptoms. Targeted interventions, including public awareness campaigns, expansion of healthcare services in rural areas, and financial support initiatives, are urgently needed to reduce delays and improve early cancer diagnosis and outcomes. PROSPERO REGISTRATION NUMBER: CRD420251037845.
4 July 2026
Read appraisal →The Keio journal of medicine
Comparison of Clinical Development of Digital Therapeutics among Japan, the United States, and Germany
Digital therapeutics (DTx) have demonstrated promising potential as a novel therapeutic approach, with their clinical development gaining momentum. Comparison of DTx development between Japan, a relative newcomer, and Germany and the U.S., known for favorable circumstances, is a topic of interest. DTx developed in Japan as of November 2023 were identified on the Pharmaceuticals and Medical Devices Agency (PMDA) website and in the literature. Similar DTx available in the U.S. and Germany were identified in the databases maintained by the U.S. Food and Drug Administration (USFDA) and Federal Institute for Drugs and Medical Devices (BfArM). Data on their clinical trials and regulatory status were obtained from these databases and their respective national clinical trial registries. The data obtained were compared and analyzed. By November 2023, Japan had developed DTx, encompassing 11 therapeutic areas. Seven DTx had reached or completed the confirmatory study stage, whereas five DTx were in the exploratory phase. Twenty DTx in the therapeutic areas were selected from the U.S. and Germany. A total of 27 DTx were reviewed regarding the designs of confirmatory studies and regulatory actions taken. Trial designs demonstrated more similarities than differences across the countries and therapeutic areas. Placebo trial design-associated difficulties were conspicuous. Although regulatory actions to place DTx in the market differed across countries, they effectively ensured the efficacy and safety of DTx that were suitable for marketing considering the most current science. The regulatory measures in the three countries seem to have positively impacted DTx development.
27 June 2026
Read appraisal →Vaccine
Impact of standing orders on vaccine uptake: A systematic review.
OBJECTIVE: We sought to evaluate the impact of standing orders on vaccine coverage in clinical settings. METHODS: Two reviewers independently screened and included studies that evaluated use of standing orders either alone or in combination with other interventions and collected data on vaccine coverage. We extracted effect sizes for studies that used only standing orders as an intervention and had a comparison group. RESULTS: The search yielded 56 eligible studies, 22 of which evaluated standing orders-only interventions. Standing orders increased vaccine uptake by a median of 13 percentage points (IQR 2-20 percentage points). Eight of these studies had a comparison group including 1 randomized trial; 5 were at low risk of bias. The overall findings were similar those for seasonal influenza vaccine (median increase of 12 percentage points; IQR, 6-24; 7 studies) and pneumococcal vaccines (14 percentage points; 2-20; 5 studies), the two most studied outcomes. Multi-component studies paired standing orders with interventions for providers frequently (34%-63% of studies), patients often (20%-49%), and systems least often (3%-14%). CONCLUSIONS: Standing orders show one of the largest effects among vaccine uptake interventions. Future research should focus on randomized trials, childhood vaccination, and behavioral aspects of implementation in healthcare systems.
21 June 2026
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