Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
Journal of nursing measurement
Measurement of Human Milk Feeding Knowledge, Attitudes, Beliefs, and Self-Efficacy Among Women From Underrepresented Racial and Ethnic Populations: A Systematic Review
Background and Purpose: Human milk feeding inequities persist among women from underrepresented racial and ethnic populations in the United States. Knowledge, attitudes, beliefs, and self-efficacy influence human milk feeding practices. This review evaluates the measurement properties of instruments assessing these variables among underrepresented populations. Methods: A systematic review from CINAHL, MEDLINE, and PsycINFO databases evaluated instruments assessing breastfeeding variables among women from underrepresented racial and ethnic populations. Results: Fifteen instruments were assessed. The Iowa Infant Feeding Attitude Scale (IIFAS) and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) had moderate to strong psychometric scores (α = .67-.86; .79-.96). Conclusions: While several instruments assess human milk feeding variables in underrepresented populations, IIFAS and BSES-SF show the strongest evidence. More culturally appropriate instruments are needed.
13 July 2026
Read appraisal →JMIR aging
Smart Speaker-Based Applications to Support Social Connectedness in Older Adult Residents in Affordable Housing: User-Centered Design Study
BACKGROUND: Older adults in affordable housing face heightened risks of social isolation and loneliness due to limited social networks, transportation barriers, chronic conditions, and inadequate technology access. Smart speakers offer potential for enhancing social connectedness in this underserved population, yet technology interventions are rarely designed with meaningful input from older adults themselves. User-centered design (UCD) approaches can address this gap by engaging end users throughout the development process to ensure technology solutions align with their needs and living contexts. OBJECTIVE: This study aimed to engage older adults in affordable housing in an iterative UCD process to develop prototype scenarios for smart speaker-based applications that promote social connectedness while addressing safety, community-building, and wellness needs. METHODS: We conducted a 3-stage UCD study with 29 older adults (mean age 70, SD 6.8 years; 23/29, 79% African American; 20/29, 69% high school education or less) living alone in affordable housing between April 2021 and April 2022. Stage 1 included 5 focus groups (n=25) combining needs assessment discussions with rapid brainstorming activities. Stage 2 involved research team synthesis of focus group transcripts and brainstorming data to create a Design Strategies Map, development of initial prototype scenarios, 5 evaluation focus groups (n=18) to gather feedback, and iterative scenario refinement. Stage 3 comprised 4 validation focus groups (n=17) to assess refined scenarios and identify implementation recommendations. Participants included both smart speaker users (n=13) and nonusers (n=16). Data were analyzed using thematic analysis for needs assessment, content analysis for brainstorming ideas and feedback, and matrix analysis for systematic comparison across scenarios. RESULTS: Participants generated 153 ideas for smart speaker use, with Health and Safety and Daily Assistance being the most frequent categories. Analysis revealed that social connection needs were inseparable from safety concerns related to living alone. Through iterative co-design, we developed 7 prototype scenarios across 4 functional categories: Checking-In (peer and management safety verification with privacy controls), Social Companion (conversational artificial intelligence-based companionship and emotional support), Community Involvement (virtual bulletin boards and activity coordination), and Wellness Check (system-initiated monitoring of activity and behavioral patterns as health indicators with user-controlled interventions). Participants emphasized requirements for personalization, opt-in/opt-out controls, "Do-Not-Disturb" functionality, and safeguards preventing replacement of human connection. CONCLUSIONS: Older adults in affordable housing engaged in technology design and provided valuable insights that challenge assumptions about their needs and preferences. The prototype scenarios addressed the dual imperatives of social connection and safety while living alone, offering a foundation for developing technology-based applications tailored to underserved populations. Implementation should prioritize user control, privacy protection, and human-in-the-loop design ensuring that technology facilitates rather than replaces human connection and community programming, alongside consideration of user characteristics to build trust and ensure effective, sustained use of the intended technology platform.
9 July 2026
Read appraisal →Journal of medical Internet research
Operationalizing Digital Health Equity in Artificial Intelligence-Enabled Patient Decision Aids for Older Adults: Mixed Methods Study
BACKGROUND: Artificial intelligence-enabled patient decision aids (AI-PDAs) hold promise for supporting older adults with chronic diseases in accessing personalized health information, clarifying preferences, and engaging in shared decision-making. Achieving equity in their design requires attention to the complex health care and digital contexts in which these tools are used. While the Digital Health Equity Framework (DHEF) provides a conceptual foundation, practical strategies for its application remain limited. OBJECTIVE: This study aimed to identify equity-related determinants and generate actionable design strategies for applying the DHEF to AI-PDAs for older adults. METHODS: A mixed methods study was conducted. Semistructured interviews were conducted with older adults living with hypertension and/or diabetes, health care providers, and medical students to explore equity determinants relevant to AI-PDAs. In parallel, a review of reviews synthesized existing evidence on approaches to addressing these determinants. Interview findings and review findings were integrated through an iterative mapping process conducted by the research team and refined through multidisciplinary expert consultation involving medicine, public health, social services, and computer science. RESULTS: A total of 33 stakeholders were interviewed, including 15 older adults, 8 health care providers, and 10 medical students. Thirteen reviews were included in the umbrella review. The integrated synthesis identified equity determinants spanning individual, interpersonal, community, and societal levels across both the health care and digital environments, together with cross-level concerns related to algorithmic fairness. These findings informed 5 recommendations for equitable AI-PDA development: (1) co-design with end users to address their needs, (2) embrace relationship-centered design, (3) leverage community resources to improve support, (4) promote accessible and equitable artificial intelligence (AI) governance in society, and (5) enhance equitable AI through algorithmic fairness. Together, these recommendations provide practical guidance for design, pilot testing, implementation, and evaluation. CONCLUSIONS: By integrating stakeholder perspectives with synthesized review evidence, this study extends the DHEF from a primarily conceptual framework toward a more practice-oriented approach for AI-PDAs for older adults with chronic disease. Health care settings serve as a mediating sociotechnical context where AI tools may either support or constrain equitable care participation. The findings underscore the need for interdisciplinary collaboration to align technological innovation with equity-oriented design. Future work should focus on co-designed prototypes, real-world testing, and measurable equity outcomes.
30 June 2026
Read appraisal →The Cochrane database of systematic reviews
Views and experiences of weight management for people living with mobility-limiting conditions, intellectual disabilities or severe mental illness: a qualitative evidence synthesis
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This qualitative evidence synthesis (QES) aims to address the question: What is known from qualitative evidence about behavioural weight management for people living with mobility-limiting conditions, intellectual disabilities, or severe mental illness? The five review objectives are as follows. To explore individuals' experiences with weight and behavioural weight-management programmes. This includes understanding how individuals living with mobility-limiting conditions, intellectual disabilities, severe mental illness and their carers experience managing their weight and how they perceive and engage with behavioural weight-management programmes, including how accessible, supportive, and relevant they find the programme elements. To identify barriers to and facilitators of managing a healthy weight and accessing behavioural weight-management programmes. Focusing on the unique obstacles encountered by each population group, we will examine issues such as physical accessibility, communication challenges, financial constraints, and gaps in tailored support that may prevent equitable participation. We will also include people's perspectives on structural and system-level barriers, as well as the influence of intersectional factors (e.g. gender and ethnicity), on the challenges of maintaining weight and accessing and benefiting from support. To understand the impact of stigma and discrimination on programme engagement and outcomes. This objective seeks to uncover how stigma related to weight, disability, or mental health influences individuals' willingness to participate, their inclusion and sense of belonging with others within the programmes, and overall programme satisfaction. It also examines the role of stigma as a potential barrier to success. To capture the perspectives of programme providers and healthcare practitioners. Gathering insights from healthcare providers and programme facilitators, this objective assesses which programme elements are considered successful and which present ongoing challenges. This includes evaluating aspects like accessibility, engagement strategies, and support mechanisms that may require improvement. To produce an inclusive piece of research through incorporating the insight of people with lived experience and professional expertise in interpreting and considering the implications of the evidence. By synthesising this qualitative evidence, the review aims to provide a comprehensive understanding of how to design and implement behavioural weight-management programmes that are more inclusive, effective, and responsive to the needs of these populations.
29 June 2026
Read appraisal →Journal of medical Internet research
Accessibility of Digital Financial Applications for People With Visual Impairment: Scoping Review
BACKGROUND: Routine financial activities are now conducted primarily through digital channels. Many such systems remain inaccessible to more than 2.2 billion people globally living with vision impairment, limiting independent financial management. Constrained access can create financial strain and social disadvantage, reducing access to health-enabling resources, and contributing to avoidable health inequities. OBJECTIVE: This scoping review maps evidence on the accessibility of digital financial services for individuals with visual impairment (VI) as a digital determinant of health. We synthesized barriers and facilitators, characterized study designs, settings, and populations, and identified evidence gaps to inform inclusive design, digital health research priorities, and policy. METHODS: A scoping review was conducted using the Joanna Briggs Institute framework and reported in line with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eight databases (PubMed, MEDLINE, CINAHL, Scopus, Web of Science, Business Source Complete, ProQuest, and IEEE Xplore) were searched for peer-reviewed papers in English published between 1995 and 2026. Searches featured controlled vocabulary and free-text terms structured in 3 conceptual blocks (VI, digital financial services, and accessibility or usability). A random sample of 20% of titles, abstracts, full texts, and included studies was independently screened or charted by 2 reviewers to calibrate decisions; the remainder were screened and charted by a single reviewer. Data were charted using a standardized extraction form, and results were synthesized descriptively and thematically. RESULTS: Twenty-three studies met the inclusion criteria. Studies were conducted across 12 countries, with the largest number from India (n=7), Indonesia (n=2), Thailand (n=2), and the United States (n=2). Study designs included qualitative studies (n=6), mixed methods studies (n=1), cross-sectional studies (n=4), nonrandomized experimental studies (n=2), and technical or design-focused evaluations (n=6). One study was a large population survey (n=19,136), and the remaining studies with human participants had sample sizes ranging from 4 to 36 participants. Accessibility barriers were reported across all platform types, with authentication-related barriers described in 18 studies and screen reader incompatibility in 17 studies. Reported barriers included reliance on sighted assistance for tasks such as login, verification, and payments, compromising privacy and independence. Facilitators included assistive technology support, logical navigation order, nonvisual feedback mechanisms, and accessible authentication alternatives. Evidence mapping revealed recurrent barrier patterns across Android, iOS, and web platforms. No longitudinal or intervention-based evaluations were identified. CONCLUSIONS: This review provides a focused synthesis of accessibility evidence at the intersection of digital financial services and VI, a domain addressed by neither prior digital accessibility reviews nor financial inclusion for people with disabilities. Authentication methods, interface labeling, and navigation were identified as persistent cross-platform accessibility barriers. The findings carry implications for financial technology developers, accessibility auditors, and policymakers implementing accessibility legislation and extend the digital determinants of health framework by demonstrating how inaccessible financial technology may compound health inequities.
25 June 2026
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