Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 28 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 →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 →BMJ open
Implementation determinants of a planned machine learning-enabled surgical scheduling system in a high-volume orthopaedic centre in Canada: qualitative findings.
OBJECTIVES: Elective non-emergent surgical wait times have increased across countries such as Canada, straining operating room (OR) resources and affecting patient outcomes and healthcare spending. Manual scheduling systems in Ontario orthopaedic centres create wide variations in wait times, with recent declines in meeting benchmark targets despite increased procedure volumes. Challenges stem from fragmented referral processes, outdated scheduling methods and resource constraints. Artificial intelligence and machine learning (ML) offer potential solutions for optimising scheduling; however, their implementation remains inconsistent. This study aims to identify determinants affecting the rollout of a new ML-driven automated scheduling system at a high-volume elective orthopaedic surgery centre. DESIGN: A qualitative description approach supported by implementation science frameworks. SETTING: A high-volume elective orthopaedic surgery unit at a Canadian tertiary care centre. PARTICIPANTS: 17 individuals from clinical, administrative and leadership roles who were directly involved in surgical scheduling. INTERVENTIONS: A new ML-driven automated surgical scheduling system. OUTCOMES: Perceptions of the proposed new surgical scheduling system (barriers and enablers of implementation, recommendations for improvement). RESULTS: Three main themes were identified, capturing challenges and enablers in the existing scheduling system: system functionality, process-related factors and resource constraints.Participants described substantial inefficiencies in the existing manual scheduling system, including outdated software, fragmented information systems, inconsistent communication and resource constraints. Across interest-holder groups, there was broad but variable perceived support for a planned ML-enabled scheduling system, particularly for improving duration prediction, access to scheduling data and reporting, alongside concerns about system complexity, workflow fit, training and resource implications. Interest-holders emphasised the importance of user-friendly design, interoperability, responsive training, phased implementation and ongoing feedback. CONCLUSIONS: This pre-implementation qualitative study identified significant process and resource limitations in manual orthopaedic surgical scheduling, but interest-holder support for a well-designed ML-driven system is strong. While participants anticipated potential benefits for scheduling accuracy, throughput and resource allocation, these perceived advantages will require meaningful user engagement, robust training, phased rollout and evaluation in subsequent implementation and outcome studies.
8 July 2026
Read appraisal →Journal of medical Internet research
You Can't Launch This: Trust as Infrastructure in Digital Behavioral Health
Digital behavioral health interventions frequently fail to scale, even when evidence-based and technically and operationally sound. In this News and Perspectives article, researcher, digital behavioral health platform founder, and JMIR Correspondent Trevor van Mierlo concludes a four-part series examining why this occurs, reporting on the foundational role of trust.
25 June 2026
Read appraisal →Croatian medical journal
Artificial intelligence in pathology: a framework for preserving brain capital in the diagnostic apex
AIM: To present a five-criterion calibration framework for evaluating artificial intelligence (AI) tools in pathology centered on preserving "brain capital" - the finite cognitive resources available to clinicians - and stabilizing the "diagnostic apex," the point where histological evidence meets clinical judgment. METHODS: Using cognitive load theory (CLT) and implementation science, we developed the Pathology AI Diagnostic Balance - a conceptual model mapping the physician-specimen interaction within working memory and IT infrastructure constraints - and examined it in the context of peer-reviewed case studies of implemented pathology AI tools. RESULTS: The framework identifies five criteria: Contextual Literacy (integration of clinical history), Responsibility (preservation of signing authority), Evidence Gap Analysis (closure of diagnostic uncertainty), Verification (feasibility of quality control), and Opportunity Cost (return on cognitive investment). Successful tools, such as Ki-67 quantification and breast cancer screening, reduce cognitive burden by automating routine tasks or enabling rapid verification. Conversely, tools requiring an exhaustive re-review or producing opaque recommendations deplete cognitive bandwidth, causing decision fatigue and diagnostic errors. CONCLUSION: Pathologists are positioned to exercise evaluative authority over tools that increase extraneous cognitive load. Clinical expertise represents pathologists' most distinctive contribution to AI development: defining which failure modes matter clinically, what context an AI must integrate, and whether a tool serves patient care. By prioritizing cognitive sustainability over purely technical metrics, the profession can ensure AI functions as a genuine enhancement of diagnostic capability rather than an additional burden on diagnostic workflows.
15 June 2026
Read appraisal →BMC health services research
Anticipated barriers and facilitators of implementing a digital behavioral treatment for chronic pain: a qualitative interview study
BACKGROUND: In digital health innovations, sustainable implementation should be considered from the initiation of the development to ensure that the solution fits into the existing healthcare system. This study aims at identifying barriers and facilitators for the prospective implementation of a digital behavioral intervention for chronic pain in the Swedish healthcare system, as perceived by key stakeholders. METHODS: Eight semi-structured individual interviews were conducted with stakeholders (n = 2 IT developers, n = 4 healthcare managers, n = 2 healthcare professionals). Qualitative data were analyzed using a framework analysis following the Consolidated Framework for Implementation Research (CFIR). RESULTS: A total of 86 facilitators and 38 barriers to prospective implementation were identified across stakeholder interviews. Facilitators included perceived relevance of the digital intervention and organizational readiness. Identified barriers primarily related to insufficient training and supervision, unclear decision-making processes (e.g., specific actions, responsibilities of stakeholders), and the lack of systematic needs assessment to guide implementation planning. CONCLUSION: Overall, findings indicate a high level of openness toward digital interventions within the implementation context. While implementation context largely demonstrates readiness, successful integration will depend on proactively addressing identified barriers. Awareness of these factors enhances the likelihood of successful and sustainable implementation.
1 June 2026
Read appraisal →JMIR research protocols
Implementation of Mobile-Based Programs for Alcohol Cessation in the Treatment of Alcohol-associated Liver Disease: Protocol for a Type 1 Hybrid Implementation-Effectiveness Trial
BACKGROUND: The rising burden of alcohol-associated liver disease (ALD) calls for effective interventions. Alcohol cessation remains the only intervention known to reduce long-term ALD morbidity and mortality. Integrating treatment for alcohol use disorder with medical and hepatology care shows significant promise. OBJECTIVE: This study aims to conduct a randomized, controlled, type 1 hybrid implementation-effectiveness trial in patients with ALD to evaluate an evidence-based smartphone app for alcohol use disorder (Connections). The primary aim is to (1) compare the effectiveness of the Connections app plus usual care to the effectiveness of usual care alone on days of alcohol abstinence for patients with ALD and (2) assess the implementation of the Connections app in the ALD population using a multilevel model of system change to determine facilitators and barriers to the successful adoption of the app at the patient, provider, and clinic levels. METHODS: Study procedures were approved by the Institutional Review Board on March 13, 2024. Patients are recruited from General Hepatology and Multidisciplinary Clinics in Wisconsin and Michigan. Participants are randomized to an intervention (Connections + treatment as usual) or no intervention (treatment as usual). During the 6-month enrollment period, participants complete monthly e-surveys measuring alcohol consumption and quarterly e-surveys measuring patient health indicators and behaviors. Patients earn up to US $240 for participation. RESULTS: This study was funded in September 2023. Recruitment began in June 2024 and is ongoing. As of February 26, 2026, 144 participants have been enrolled in the study. Of these, 65 (45.1%) have completed all the study activities. We aim to recruit 298 participants through 2027, with analysis and results publication estimated in 2028. CONCLUSIONS: Implementation insights highlight the importance of flexibility and strong provider relationships. Challenges include reliance on technology, which limits access for patients with low digital literacy, and the risk of loss to follow-up. This trial is the first fully powered implementation-effectiveness study of a mobile health app for alcohol cessation in ALD, testing a new care model that integrates multidisciplinary expertise. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/94231.
1 June 2026
Read appraisal →JMIR medical informatics
The Regional Implementation of an Electronic Health Record-Integrated Ambient Scribe in Primary and Secondary Care in England: Real-Time Qualitative Evaluation
BACKGROUND: There is significant potential for ambient scribe technology to enhance health care productivity, with a growing range of applications being developed and implemented internationally. Strong organizational drivers to improve efficiency, coupled with the technology's potential to help address clinician burnout, are accelerating interest and adoption. However, limited attention has been paid to the integration of such systems within electronic health records and unintended consequences, as stakeholders navigate their implementation and integration into clinical practice. OBJECTIVE: This study therefore aimed to explore the processes involved in implementing and adopting ambient scribe technology across diverse health care settings. METHODS: We conducted a real-time, longitudinal qualitative evaluation of a pilot implementation of an integrated ambient scribe system across National Health Service primary care and secondary hospital settings within a care system in the Midlands region of England. Data collection involved in-depth one-to-one interviews conducted in several phases: an initial scoping study to identify key interests and stakeholders for inclusion, followed by an implementation study with participants involved in the pilot. We also conducted 16 hours of nonparticipant observations of consultations. The implementation study gathered data at 2 time points, before implementation and 3 to 4 weeks after, to capture experiences, changes, and emerging impacts over time. RESULTS: We collected data from 45 individuals. Use cases varied across settings and shaped how ambient scribe systems were deployed. Differences between general practice and secondary care in documentation purpose, format, and workflow created challenges for developing and validating templates, though the technology showed flexibility across contexts. Automated note-taking often improved patient interaction but required clinicians to adjust how they spoke to ensure the technology captured their reasoning. Outputs were sometimes generic, reinforcing defensive documentation and reducing personal tone or contextual recall. Integration pathways carried distinct trade-offs: stand-alone systems (which were used by many stakeholders in our study) were easier to adopt but offered limited long-term benefits, while integrated systems required greater effort and standardization, yet promised improved efficiency and safety. CONCLUSIONS: The ambient scribe market remains immature and volatile, creating strategic uncertainty for health systems. Careful procurement approaches are needed to balance the risks and benefits of integrated versus stand-alone systems, while aligning user demand with organizational needs for integration.
31 May 2026
Read appraisal →Journal of medical Internet research
Using the NASSS-Complexity Assessment Tool to Evaluate the Implementation of "Cadê O Kauê?": Chat-Story Intervention for Youth Participation in Mental Health Promotion in Brazil
BACKGROUND: The global public health challenge of young people's mental health is particularly evident in Brazil, which is considered the most anxious and the fifth most depressed country globally. In response to this, a digital intervention, that takes the form of a storytelling chatbot named "Cadê o Kauê?" (translation: "Where is Kauê?"), was coproduced by an interdisciplinary team of researchers, young people, and narrative designers as part of a project titled Engajadamente. The intervention was designed to strengthen Brazilian adolescents' skills in promoting their peers' mental health through direct support and collective action for mental health. The intervention was rolled out in select schools in Brazil and online via social media, but it encountered challenges during the initial implementation phase in school settings. OBJECTIVE: This project's primary objective is to evaluate the implementation of "Cadê o Kauê" in school settings in Brazil, assess current and potential complexities, and formulate recommendations to reduce or manage these complexities. The secondary objective of this project is to understand the current and potential sociotechnical change resulting from the implementation of the "Cadê o Kauê" in a real-world setting. METHODS: The Non-adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS) framework was selected as the theoretical framework to identify different areas of complexity across domains and further thinking of ways to reduce or manage these complexities. Data were gathered by conducting semistructured online interviews with the Engajadamente team members based in the United Kingdom and Brazil. The NASSS-Complexity Assessment Tool was used as a sensemaking device to facilitate a collective understanding of the implementation, and narratives were mapped onto specific NASSS domains. Key themes were identified across overarching domains using thematic analysis to meet the objectives of this evaluation. RESULTS: The results mapped onto the NASSS domains generated a narrative about the initial implementation of "Cadê o Kauê?" in schools. Existing and potential complexities across technology, organization, and wider system domains were characterized by interdependencies, unintended consequences, and uncertainties. The implementation of "Cadê o Kauê?" highlighted challenges related to internet dependency, infrastructure limitations, and varying levels of organizational readiness, teacher preparedness, and school culture. Addressing these through offline solutions, additional teacher training, whole-school engagement strategies, and a value-informed complexity approach can enhance accessibility, alignment with school priorities, and adaptability within Brazil's dynamic sociopolitical context. CONCLUSIONS: Using the NASSS framework, the evaluation captured both current and emerging complexities in implementing "Cadê o Kauê?" in schools. By engaging with theory-informed approaches to technology implementation projects and deep-diving into discursive dynamic interactions between technology and its "context" of implementation, we have explored ways to manage these complexities and developed suitable recommendations to guide the Engadajamente team and support similar projects in the future.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence
BACKGROUND: Long-term noninvasive positive airway pressure (PAP) therapy is an effective, albeit complex, intervention for obstructive sleep apnoea (OSA) and/or chronic hypercapnic respiratory failure (CHRF) in patients with chronic obstructive pulmonary disease (COPD). PAP uptake and use is often reported in studies designed for other purposes. Systematic review methods were used to summarise acceptance of and adherence with PAP therapy. METHODS: A systematic search for studies that reported the proportion of patients that either declined or accepted PAP therapy and/or objective use of newly prescribed PAP therapy in patients with COPD was conducted according to a predefined protocol (PROSPERO CRD42021259262). Meta-analysis and meta-regression techniques were used to establish summary effect estimates and explore heterogeneity. RESULTS: On average, PAP therapy was declined or discontinued by 14% (95% CI 10-19) of participants, often within 6 weeks of initiation among studies reporting repeated measures. The pooled median adherence was 6.3 h·day-1 (95% CI 5.9-6.6). While meta-regression found higher acceptance (p=0.03) and shorter use per day (p<0.01) for the indication of OSA versus CHRF, this explained only some heterogeneity in the summary effect estimates. Summary of study-level variables associated with acceptance or adherence highlighted limitations in the available literature. CONCLUSIONS: An anticipated six out of seven patients with COPD newly prescribed PAP therapy will be successful using therapy; however, heterogeneity was substantial among studies, and only partly explained by indication for use. Prospective studies to explore barriers to use and detailed reporting of acceptance and adherence in studies on PAP therapy in patients with COPD are needed.
29 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Facilitators and barriers to the implementation of traditional Chinese exercises in cancer patients: a mixed-methods systematic review
PURPOSE: To identify barriers and facilitators to the implementation of traditional Chinese exercises in cancer patients. METHODS: This was a mixed-methods systematic review. It searched for published studies from nine different sources. Data synthesis followed a convergent integrated approach according to the Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were qualitized using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS: Twenty-one studies were included. Forty-three implementation determinants were identified across five domains of the Consolidated Framework for Implementation Research (CFIR), including 25 facilitators and 18 barriers. Key facilitators included perceived benefits, simplicity, social support, and flexible delivery, whereas major barriers involved symptom burden, resource constraints, competing life demands, and limited organizational support. CONCLUSIONS: The implementation of traditional Chinese exercises in cancer patients is shaped by multilevel determinants across CFIR domains. Implementation outcomes depend on the alignment between intervention characteristics, patient capacity, and contextual conditions. Context-sensitive and tailored strategies are required to improve uptake and long-term sustainability.
25 May 2026
Read appraisal →Studies in health technology and informatics
Frameworks for Digital Health Engagement: A Scoping Review Protocol
Digital health technologies (DHTs) are increasingly integral to healthcare delivery, yet sustained engagement remains inconsistent across users and settings. This scoping review aims to map frameworks and instruments that conceptualise digital health engagement across adoption and sustained use. Searches were conducted in Scopus, Web of Science, ACM Digital Library, and PsycINFO. The review will clarify conceptual coverage and identify gaps in digital engagement.
24 May 2026
Read appraisal →Studies in health technology and informatics
Logic Models on Health Information Technology: First Insights from a Cross-Disciplinary Scoping Review
BACKGROUND: Health information technology (HIT) interventions are complex, yet theory-based approaches such as logic models or Theory of Change (ToC) remain rarely applied in medical informatics, although they could clarify assumptions, link activities to outcomes, and support design and evaluation. OBJECTIVES: This scoping review examined how logic models and ToC have been used in HIT research across disciplines. METHODS: Following the PRISMA-ScR guidelines, databases were searched up to August 2025. Eligible studies explicitly applied logic models or ToC to HIT. Data were extracted on HIT type, purpose of using logic models, and reported benefits and challenges. RESULTS: Sixty-nine studies met inclusion criteria, most published after 2020. A majority of studies developed logic models for patient-facing HIT such as mHealth or telehealth. Logic models were mainly used to support HIT design or evaluation and were mostly newly developed. Reported benefits of using logic models included conceptual clarity and better stakeholder communication; challenges involved resource demands and limited generalisability. CONCLUSIONS: Logic models and ToC are increasingly used for HIT but remain inconsistently applied and seldom reused. Standardised reporting and repositories could strengthen theory-informed evaluation in medical informatics.
24 May 2026
Read appraisal →BMJ open
Toolkit to prompt and support stopping antidepressants in general practice: an interview study exploring patient participants' experiences in the RELEASE trial.
OBJECTIVE: To explore patient experiences with the RELEASE (Redressing long-term antidepressant use) toolkit resources, including antidepressant hyperbolic tapering plans designed to minimise withdrawal symptoms as part of the RELEASE trial's implementation evaluation to understand what aspects of the toolkit work well and identify areas where refinement could enhance future implementation. The RELEASE intervention, a multistrategy intervention codesigned with general practitioners (GPs) and patients to prompt and support stopping long-term (>12 months) antidepressants, is being evaluated in an effectiveness-implementation hybrid type-1 cluster randomised controlled trial in general practice. STUDY DESIGN: One-to-one semistructured qualitative interviews using reflexive thematic analysis to identify patterns of shared meaning. SETTING: General practice, south-east Queensland, Australia. PARTICIPANTS: Adult participants (aged 18 years or older) taking an antidepressant long-term allocated to the intervention arm of the RELEASE trial. RESULTS: 31 participants with an average duration of antidepressant use of 16.5 years (range 1-30 years) were interviewed. Seven themes were identified. Across seven themes, participants described how the RELEASE toolkit resources prompted reflection on their antidepressant use, supported informed conversations with GPs, and offered tapering plans that were both structured enough to instil confidence and flexible enough to help participants feel in control of their tapering journey. They also identified barriers, including beliefs that very small tapering doses were unnecessary, difficulty accessing the mini-doses required for hyperbolic tapering and the challenge of managing withdrawal symptoms. For those who successfully stopped, the transition was associated with a renewed sense of autonomy. Participants also offered practical suggestions to strengthen the toolkit and its broader implementation. CONCLUSIONS: The RELEASE toolkit resources played a meaningful role in prompting and supporting informed shared decision-making and guiding attempts to stop antidepressants. Clearer messaging about the potential for withdrawal symptoms and access to mini-doses for tapering are needed to support patients to safely stop antidepressants. TRIAL REGISTRATION NUMBER: ACTRN12622001379707p; Pre-results.
23 May 2026
Read appraisal →Journal of the American Heart Association
Determinants of Successful Implementation: A Mixed-Methods Evaluation of a Team-Based Telehealth Hypertension Management Program for Underserved Patients
BACKGROUND: Hypertension management using home blood pressure monitoring-guided pharmacotherapy is more effective than clinic-based care, but the benefit is attenuated in underserved patients. We evaluated implementation determinants of a team-based telehealth hypertension management program providing home blood pressure monitoring-guided pharmacotherapy and self-management and social support. METHODS: We used Exploration, Preparation, Implementation and Sustainment, and Health Equity Implementation Frameworks for semistructured interviews and inductive/deductive coding using thematic analysis of qualitative data and quantitative analysis to evaluate team-based telehealth hypertension management program implementation facilitators, barriers, acceptability, appropriateness, and feasibility. We purposefully sampled 20 patients with hypertension and 16 clinic key players from 2 safety-net clinics in North Carolina. Quantitative measures were Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, Patient Assessment of Chronic Illness Care, Organizational Readiness for Implementing Change (all measures' score ranged 1-5; higher score is better). We used concurrent embedded mixed methods (qualitative + quantitative) for convergence and complementarity. RESULTS: Five qualitative themes emerged around (1) staffing barriers, coordinated teamwork, and friendly study tools; (2) the program's patient and provider centeredness; (3) ease of home blood pressure monitoring; (4) personalized, comprehensive self-management calls; and (5) social support. Patients and clinic key players found the program acceptable (mean±SD, 4.42±0.84 and 4.56±0.59), appropriate (4.42±0.86 and 4.61±0.50), and feasible (4.40±0.89 and 4.44±0.53), respectively. Patient Assessment of Chronic Illness Care and Organizational Readiness for Implementing Change scores were 4.22±1.01 and 4.11±0.78, respectively. CONCLUSIONS: Implementing a team-based telehealth hypertension management program depends on its tailoring to patients and providers and having their endorsement; a user-friendly and trust-promoting model; and having a viable financial plan. Future studies should assess clinical and cost effectiveness of the program. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05424744.
20 May 2026
Read appraisal →Systematic reviews
Barriers and facilitators to the implementation and adoption of computerised clinical decision support systems: an overview of reviews
BACKGROUND: The use of computerised clinical decision support systems (CDSSs) holds considerable potential in enhancing healthcare delivery by improving patient safety, practitioner performance, and patient outcomes. However, despite the numerous reported advantages of CDSSs, their adoption remains restricted, thereby compromising the full realisation of their potential. To enable a profound evaluation and successful implementation of these systems, it is imperative to identify the reasons for their limited uptake. The objective of this study is to provide a comprehensive overview of the barriers and facilitators to the implementation and adoption of decision support systems across healthcare settings. METHODS: This study was reported in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement. A systematic search was conducted in the databases PubMed, IEEE Xplore, Scopus, and Web of Science from inception to 15 October 2024, targeting at review articles of primary studies focusing on the identification and reporting of barriers and facilitators to the implementation and adoption of CDSSs across healthcare settings. The risk of bias of the included reviews was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool, and the primary study overlap was calculated using the corrected covered area method. All data on barriers and facilitators to the implementation and adoption of CDSSs were extracted from the included reviews, synthesised through a mapping of identical factors, and ranked according to their frequency of occurrence. RESULTS: Of the 1640 records retrieved through database searches, 30 reviews were included in this overview, which summarised the findings of 721 unique primary studies. A total of 101 distinct factors influencing the implementation and adoption of CDSSs were identified and could be categorised into the overarching categories of human, technology-related, and contextual factors. The following six factors were reported most frequently: usability, usefulness/perceived benefits, organisational readiness, training, trust, and workflow integration. CONCLUSIONS: The findings of this study highlight the diversity of factors that influence a successful implementation of CDSSs and emphasise the need for their comprehensive evaluation that goes beyond the assessment of general performance aspects but takes into account human and contextual factors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024507614.
15 May 2026
Read appraisal →BMJ open
Cluster-randomised-controlled trial evaluating the impact of implementing the Canadian C-Spine Rule in prehospital cervical spine trauma care by the French Emergency Medical Call Center: IPSTRAUC study - a protocol
INTRODUCTION: In France, cervical spine trauma frequently results in systematic prehospital immobilisation with a cervical collar, despite a low incidence of clinically significant injuries. This practice may lead to unnecessary discomfort, delayed care and emergency department (ED) overcrowding. The Canadian C-Spine Rule (CCR) is a validated tool for identifying patients at low risk of cervical injury but its use is currently limited to ED settings. An adapted version (CCRa) has been validated in Canada for prehospital use, demonstrating safe reduction in immobilisation rates. This study aims to evaluate the feasibility, safety and clinical impact of CCRa implementation in the French prehospital emergency setting. The objectives are to assess whether the implementation of the CCRa by French prehospital emergency teams can safely reduce unnecessary cervical spine immobilisation in stable trauma patient, optimise imaging use and decrease ED overcrowding while maintaining patient safety. METHODS AND ANALYSIS: This is multicentre, cluster-randomised-controlled trial involving 16 Emergency Medical Call Center and their affiliated prehospital emergency services in France. Each centre will be randomised to either implement the CCRa or usual care with standard immobilisation practices. Alert adult patients (18-65 years) with suspected closed cervical spine trauma and Glasgow Coma Scale score of 15 will be included. The primary outcome is the proportion of patients with suspected cervical spine trauma who are transported to the ED. Secondary outcomes include the appropriateness of cervical spine immobilisation, use of cervical imaging, ED visits for neck pain, immobilisation-related complications, healthcare costs at 30 days, and feasibility and acceptability of CCRa implementation among prehospital professionals (effectiveness-implementation hybrid type 1 design). Quantitative data will be collected during prehospital care, ED admission and follow-up at days 14 and 30, while implementation outcomes will be assessed at the end of the intervention period using questionnaires and qualitative interviews. ETHICS AND DISSEMINATION: The study has been approved by a national ethics committee (CPP), the French competent authority and registered to the French National Authorities (ID-RCB 2024-A00636-41). It is funded by the French Ministry of Health via the 2023 PREPS programme (DGOS). Results will be published in a peer-reviewed journal and presented at relevant scientific meeting. The sponsor of the study is Rennes University Hospital. The findings may support broader CCRa implementation in European EMS systems. TRIAL REGISTRATION NUMBER: NCT06983873.
14 May 2026
Read appraisal →JMIR nursing
From Concept to Practice: Lessons From the Balanced Nursing Teams Decision-Support System
The global nursing workforce crisis demands a shift from reactive staffing to strategic workforce optimization through data-driven decision-support systems. This viewpoint paper reflects on the development and attempted implementation of the balanced nursing teams system, a decision-support tool integrating approximately 250 data points-of which roughly 150 are extracted from existing organizational systems (human resources, scheduling, electronic health records, quality registries) through flexible import mechanisms, and the remainder collected through a built-in 360-degree staff survey with automated analysis-across 10 domains to evaluate nursing team balance between capacity, performance, and outcomes. Following crowdfunding by 18 Belgian health care organizations, balanced nursing teams were implemented across 8 diverse settings (home health care, general hospitals, academic centers) between 2019 and 2023. Using the Human-Organization-Technology fit framework, we analyze why evidence-informed, organization-endorsed digital innovations struggle to achieve adoption. Our analysis reveals 3 interdependent barrier categories: technological fragmentation (vendor lock-in, legacy systems, prohibitive integration costs), organizational siloing (Chief Nursing Officers [CNOs] lacking budgetary authority, nursing framed as peripheral to strategic priorities), and managerial hesitance (fear of punitive data use, cognitive overload from staffing crises). These barriers were worsened by the substantial data-integration burden that the system's breadth imposed on organizations with limited digital maturity. Critically, only one site (ie, a nurse-led home health care organization where leadership held both strategic authority and resource control) achieved sustained implementation. This contrast demonstrates that workforce optimization through data depends not on software maturity alone, but on achieving simultaneous fit across human, organizational, and technological domains. We argue that the persistent marginalization of nursing leadership within hospital governance structures represents the fundamental barrier to digital transformation in nursing workforce management. The urgency paradox is striking: while nursing represents health care organizations' highest operational cost and most direct patient interface, workforce optimization tools are consistently deprioritized in favor of regulatory compliance systems and billing infrastructure. Bridging this gap requires systemic investment in nursing leadership authority, data interoperability standards, and recognition that data-driven workforce decisions are strategic imperatives rather than operational luxuries.
14 May 2026
Read appraisal →JMIR research protocols
Investigating the Implementation and Impact of AI-Assisted Fall Prevention in Hospitals: Protocol for a Multicenter, Multimethod Observational Study in Sweden (SAFE)
BACKGROUND: Artificial intelligence (AI) has the potential to enhance patient safety, particularly in the prevention of in-hospital falls. Recent advances in sensor-based AI systems allow for the analysis of complex, multimodal data to generate real-time alerts, enabling health care professionals to intervene before a fall occurs. By shifting from reactive responses to proactive risk management, these technologies may enable reductions in fall incidence and improvements in care outcomes. As a result, hospitals across Europe are increasingly adopting such systems. Nevertheless, empirical evidence concerning their routine implementation remains limited, particularly concerning their impact on patient safety, clinical workflows, and the usage of health care resources. Addressing these gaps is essential for effective and sustainable integration into hospital care. OBJECTIVE: This paper outlines the protocol for the multicenter, multimethod project SAFE (Safe AI-Assisted Fall Prevention Through Evidence), which investigates the implementation and impact of AI-assisted fall prevention in Swedish hospitals. METHODS: The research project is a collaboration between Halmstad University and hospitals in the Västra Götaland Region (VGR) and will, during 2026-2028, investigate an ongoing large-scale AI system implementation in VGR hospitals, covering up to 2400 patient beds. Using surveys, interviews, observations, and a retrospective study, it will track the implementation and impact over time. Two learning laboratories involving patients, their relatives, and health care professionals will be conducted to codevelop strategies for the implementation of AI-assisted fall prevention. RESULTS: The project will provide evidence-based insights and practical guidance on AI-assisted fall prevention. The findings will be relevant not only to patients, health care professionals, and hospital organizations, but also to policymakers and stakeholders involved in the digital transformation of health care. CONCLUSIONS: Although VGR serves as the primary research setting, the project's results will inform future similar initiatives in Sweden and offer transferable lessons for other health care systems internationally. This study will contribute to the evidence base on AI-assisted fall prevention in health care, supporting the responsible and scalable integration of such systems across diverse health care environments.
11 May 2026
Read appraisal →JMIR formative research
Older Adults' Experiences Navigating Setup of Digital Health Technology: Implementation Report
BACKGROUND: Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. OBJECTIVE: The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup "pain points" that may influence initial impressions and intention to use the technology over time. METHODS: A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. RESULTS: Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app's customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. CONCLUSIONS: First impressions of digital health apps play a critical role in influencing older adults' emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.
11 May 2026
Read appraisal →The Veterinary record
FEC Check: Development of a decision support tool to aid interpretation of gastrointestinal nematode faecal egg counts in sheep
BACKGROUND: Gastrointestinal nematode infections are ubiquitous in grazing livestock worldwide impacting animal health and production. Faecal egg count (FEC) is an accessible diagnostic test that can guide the need for treatment. However, interpretation of FECs can be challenging. METHODS: A prototype decision support tool (DST) was developed using a 'traffic light'-style gradient of potential clinical impact on sheep FEC results. Focus groups were conducted with farmers, livestock advisors and veterinary clinicians to examine the barriers to FEC uptake and provide feedback on the prototype tool. RESULTS: Barriers to uptake for FEC testing included timeliness of reporting, lack of perceived need and knowledge gaps. The DST was well received at all focus groups, with simplicity and ease of use identified as key principles to drive uptake. At the 12 months post-launch, the DST had 1916 users. LIMITATIONS: Engagement with stakeholders with less familiarity with FECs may improve usability for a wider audience. CONCLUSION: The final DST developed here represents a practical resource to improve the interpretation of FEC results reported by farmers and other stakeholders. The initial uptake observed within the first year since launch is promising for the wider adoption of evidence-based parasite management.
10 May 2026
Read appraisal →Journal of medical Internet research
Rapid Deployment of Telemedicine in HIV Care: Mixed Methods Study of Providers' Attitudes and Perceptions
BACKGROUND: The COVID-19 pandemic prompted an abrupt transition to telemedicine for HIV care, necessitating the exploration of provider attitudes and experiences to understand its ongoing viability and impact. OBJECTIVE: This study aimed to assess providers' attitudes toward and experiences with telemedicine at HIV clinics in the Chicago area during the COVID-19 pandemic at 2 time points and at 2 clinical sites. METHODS: We conducted a convergent mixed methods study to evaluate and explore providers' attitudes toward and experiences with telemedicine at HIV clinics in the Chicago area during the COVID-19 pandemic, applying the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the updated Consolidated Framework for Implementation Research. This study assessed HIV providers via surveys at 2 time points, capturing responses on the acceptability, appropriateness, feasibility, and maintenance of telemedicine. Semistructured key informant interviews were conducted on a random selection of 10 participants to explore perceived experiences with telemedicine. RESULTS: Among emailed providers, 43 of 83 (51.8%) and 27 of 82 (32.9%) responded to survey 1 and survey 2, respectively. The first survey recorded telemedicine usage at 75%, which decreased to 58% by the second survey. Overall, the majority of respondents agreed with statements that assessed telemedicine as appropriate, acceptable, and feasible. There were overall few statistical differences in responses between sites, although more providers at the community site indicated at least some potential value in telemedicine when compared to providers at the university hospital (100% agree or strongly agree vs 82.3%; P=.04) in survey 1. In survey 1, providers with more than 10 years of experience were less likely to report telemedicine helped them see more patients (31.6% agree or strongly agree vs 70.6% for providers with ≤10 y of experience; P=.008). Fewer experienced providers felt they could talk about private issues with their patients during telemedicine (57.9% of more experienced vs 88.3% of less experienced providers; P=.03). Key informant interviews provided qualitative insights into telemedicine integration, revealing mixed sentiments; providers appreciated the flexibility and accessibility that telemedicine offered but preferred in-person visits for their thoroughness, especially for physical examinations and laboratory tests. Despite initial barriers such as technical challenges and patient preferences for in-person visits, telemedicine was deemed feasible for maintaining communication and care quality. Providers highlighted the need for better technological support and ongoing training to optimize telemedicine usage. CONCLUSIONS: Our study underscores telemedicine as a sustainable adjunct to traditional HIV care, emphasizing the importance of addressing technological and training barriers to enhance its efficacy.
3 May 2026
Read appraisal →BMJ health & care informatics
Barriers associated with the implementation, adoption, scale-up and sustainability of mHealth in Sub-Saharan Africa: a systematic review guided by the NASSS Framework
OBJECTIVES: The objectives of this study were to highlight and evaluate the factors affecting the non-adoption, abandonment of and challenges to scale-up, spread and sustainability of mHealth in Sub-Saharan Africa (SSA) and to assess the appropriateness of the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) Framework in the SSA context. METHODS: A systematic search of published research was conducted using PubMed and Embase research databases from 2012 to 2025. Peer-reviewed studies from SSA countries, evaluating mHealth interventions, were included in this study. Papers were analysed to identify barriers according to the seven domains of the NASSS Framework, which are (1) condition, (2) technology, (3) value proposition, (4) adopters, (5) organisation(s), (6) wider system, (7) embedding and adaptation over time RESULTS: This study identified 409 barriers across 91 papers. 309 barriers were covered by the seven NASSS Framework domains, while 100 were unaddressed by the framework. The main barriers were associated with domain 2, the technical aspects of the technology (27%). Other prominent barriers related to the wider system (18%), the adopter (11%), the organisation (9%) or condition (8%), with the value proposition (1%) and embedding and adaptation over time (1%), least hindering implementation. Challenges which were unaddressed by the framework (24%) included socioeconomic and infrastructural issues, distinct to lower and middle-income countries (LMIC). DISCUSSION: This paper highlights the importance of evaluating rudimentary aspects of mHealth and preparing infrastructure before addressing more complex issues during mHealth implementation in SSA. CONCLUSION: Although the NASSS Framework is applicable to the SSA region, it would benefit from some further development to improve its applicability in LMICs.
25 Apr 2026
Read appraisal →BMJ open
From legalisation to practice: implementation of newly legalised health interventions in healthcare settings - a systematic review.
OBJECTIVES: Over the last decade, a growing number of health interventions (eg, medical assistance in dying and mitochondrial donation) have become legalised or decriminalised globally. Newly legalised health interventions share characteristics that are distinct from other health interventions, making their implementation more challenging. They are often highly emotive, controversial and associated with strong opinions and ethical dilemmas, with some of them being high-stake and irreversible. This study aimed to identify, systematise and map the factors that affect the implementation of health interventions that have recently been legalised. DESIGN: A systematically conducted review. DATA SOURCES: PubMed, Scopus, EMBASE and CINAHL were searched to identify studies published between 2014 and 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies if they evaluated the implementation of health interventions that were newly legalised or newly decriminalised. DATA EXTRACTION AND SYNTHESIS: Data were extracted and synthesised through descriptive analysis. Both deductive and inductive thematic analyses were applied to map the barriers, facilitators and implementing strategies that influence the implementation of newly legalised health interventions in healthcare settings. RESULTS: The search strategy yielded 1510 publications, of which 78 were included in this review. Findings showed that several newly legalised health interventions, including medical assistance in dying (n=56 studies); medical abortion (n=13); assisted human reproduction (n=3); psychedelic-assisted therapies (n=3); use of medical cannabis (n=2) and use of biosimilars (n=1) were addressed. The analysis identified a total of 880 diverse barriers, facilitators and strategies in five domains across system, organisational and individual levels: (1) patients/service users/consumers; (2) healthcare providers; (3) healthcare organisation; (4) legal processes and (5) system. These were further divided into 27 themes of barriers, 18 themes of facilitators and 17 themes of strategies. CONCLUSIONS: Implementing newly legalised health interventions is complex. Our findings can support the development of an implementation plan for the spread and scaling of future health interventions, maximising the impact of interventions and making them accessible to more people and health organisations.
24 Apr 2026
Read appraisal →Journal of health organization and management
Implementing telemedicine for cancer care in European healthcare organizations: lessons from the eCAN Joint Action
PURPOSE: Telemedicine represents a promising innovation to complement conventional cancer care in Europe to improve treatment quality and patient outcomes. Funded between September 2022 and December 2024, the Joint Action "Strengthening eHealth including telemedicine and remote monitoring for health care systems for CANcer prevention and care" (eCAN JA) aimed to bring the benefits of telemedicine to cancer patients across the European Union (EU) Member States, with 35 partner organizations from 16 countries and explored its feasibility through multicenter clinical trials. This study sheds light on key factors to implement telemedicine services for cancer care in European healthcare organizations (HCOs) and offers a forward-looking perspective by conducting a foresight exercise as part of the Sustainability Work Package (WP4) of the eCAN JA. DESIGN/METHODOLOGY/APPROACH: Foresight is an umbrella term for innovative strategic planning, policy formulation and solution design methods that empower decision-makers. For our multi-country foresight study, we followed three sequential steps to gain qualitative and quantitative findings on the facilitators of telemedicine services for cancer patients in clinical settings, comprised of (1) literature review; (2) surveys to HCOs in different EU Member States and (3) a foresight workshop with survey respondents. FINDINGS: Telemedicine implementation in HCOs requires equipping healthcare professionals with the necessary skills, ensuring system compatibility and addressing resource constraints for hybrid care models for success. Future policies in the EU should focus on establishing telemedicine training for healthcare professionals and support interoperability as well as user-friendliness of telemedicine services in HCOs. Policies should also address clinical workload challenges, enable harmonized telemedicine protocols across Europe, provide incentives for implementation and invest in digital infrastructure in HCOs for a sustainable telemedicine adoption. ORIGINALITY/VALUE: To the best of our knowledge, this is the first study to conduct a foresight analysis on the feasibility of telemedicine for cancer care across different HCOs in EU Member States.
20 Apr 2026
Read appraisal →BMJ open
'It's not just diabetes': implementation enablers and barriers of an indigenous-focused virtual diabetes care clinic using the Consolidated Framework for Implementation Research (CFIR) - a qualitative assessment.
INTRODUCTION: Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals. OBJECTIVES: We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic's staff and providers. RESEARCH METHODS AND DESIGN: Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers. RESULTS: The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding. CONCLUSION: The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada's Truth and Reconciliation Commission's calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.
19 Apr 2026
Read appraisal →JMIR formative research
Development of iGET Living, a Digital Graded Exposure Intervention for Youth With Chronic Pain: Multiphase User-Centered Design and Pilot Study
BACKGROUND: Pediatric chronic pain affects up to one-third of youth and is associated with significant disruptions in social, emotional, and behavioral functioning. Although behavioral treatments are effective, access remains limited due to geographic, financial, and systemic barriers. Digital behavioral health interventions offer a promising solution, but many lack user-centered design, iterative refinement, and implementation-informed development strategies that support usability and scalability. OBJECTIVE: This study aimed to develop and iteratively refine iGET Living, a digital graded exposure intervention for youth with chronic pain, using a combined user-centered and implementation-informed framework, and to evaluate its preliminary acceptability, feasibility, and user-perceived success. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR) and the mHealth (mobile health) Agile Development and Lifecycle model, intervention development proceeded through 3 phases. Phase 0 translated an evidence-based in-person graded exposure treatment (GET Living) into an initial digital prototype. Phase 1 involved iterative user-centered refinement across 3 cycles of qualitative development sessions with youth with chronic pain (n=15), incorporating think-aloud usability testing, Likert-rated feedback, and rapid qualitative analysis mapped to CFIR constructs to guide real-time modifications to content, design, and functionality. Phase 2 piloted the refined intervention with a new sample of youth (n=38, n=30 completers) recruited from a tertiary pediatric pain clinic to evaluate feasibility, acceptability, treatment credibility and expectancy, and user-perceived functional improvements. Quantitative outcomes were summarized descriptively, and qualitative exit interview data were analyzed using rapid qualitative analysis. RESULTS: Across development cycles, youth feedback informed substantive refinements to the intervention, including reducing text density, incorporating animated educational videos, enhancing interactive features, and improving navigation and layout. These changes resulted in progressive improvements in clarity, satisfaction, and acceptability across prototypes. In the Phase 2 pilot study, participants reported moderate-to-high treatment credibility (mean of 19.71 out of 30) and expectancy (mean of 17.96 out of 30), as well as high satisfaction (mean of 46.12 out of 60). Acceptability ratings across domains of the Theoretical Framework of Acceptability were favorable. Qualitative exit interviews highlighted the interventions' perceived role in helping youth re-engage in valued activities. CONCLUSIONS: Using a combined CFIR and agile development approach, iGET Living emerged as a feasible, acceptable, engaging digital graded exposure intervention for youth with chronic pain. These findings highlight the value of integrating implementation frameworks and participatory design early in digital intervention development and support further evaluation in a preliminary efficacy trial.
18 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 →