Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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African journal of reproductive health
Artificial intelligence-enabled digital reproductive health education: corpus-based strategies for strengthening Spanish health communication capacity
This study examines how corpus-grounded artificial intelligence (AI) can strengthen Spanish reproductive health communication capacity within China's digital health ecosystem. A mixed-methods design was employed, combining corpus linguistics, AI-assisted message generation, expert-informed evaluation, and quantitative user assessment. A domain-specific Spanish reproductive health corpus was constructed from 3,052 documents, including clinical guidelines, patient education materials, and FAQs/user queries, yielding 1,065,110 tokens for linguistic analysis and AI grounding. Corpus-derived readability benchmarks, lexical simplification rules, and discourse patterns were integrated into an AI content generation pipeline to produce reproductive health messages, which were then compared with non-corpus-grounded AI outputs. The user evaluation phase was conducted among 240 Spanish-speaking or Spanish-proficient adults in selected Chinese metropolitan cities. Data were collected through a structured questionnaire measuring Corpus-Grounded AI Generation, Spanish Communication Quality, and Health Communication Capacity, and were analyzed using reliability testing, correlation analysis, and structural equation modeling. The findings showed that corpus-grounded AI significantly improved Spanish communication quality, while communication quality had the strongest effect on users' comprehension, confidence, and help-seeking intention. Mediation analysis further demonstrated that Spanish communication quality significantly mediated the relationship between corpus-grounded AI generation and health communication capacity. The study concludes that linguistically informed AI design can enhance the clarity, accessibility, and effectiveness of reproductive health education and offers a practical framework for multilingual digital health communication in sensitive healthcare contexts. Cette étude visait à examiner le rôle de l'IA guidée par la linguistique de corpus dans l'amélioration de la qualité de la communication en espagnol sur la santé reproductive au sein de l'écosystème numérique chinois. En utilisant une approche à méthodes mixtes, la recherche a combiné l'analyse de corpus de textes espagnols sur la santé reproductive, la génération de contenu basée sur l'IA et l'évaluation par les utilisateurs. Un corpus espagnol spécifique au domaine de la santé reproductive a été construit et intégré dans un pipeline de génération d'IA ancré dans le corpus pour optimiser la lisibilité, l'exactitude et la sensibilité culturelle. La qualité de la communication et la capacité de communication en santé ont été mesurées à l'aide d'une analyse de fiabilité, de tests de corrélation et de modélisation par équations structurelles. Les résultats ont révélé que l'IA ancrée dans le corpus améliore significativement la qualité de la communication en espagnol, ce qui améliore à son tour la compréhension des utilisateurs, l'auto-efficacité et les intentions de recherche d'aide. La qualité de la communication est apparue comme un mécanisme médiateur clé entre la conception de l'IA et les résultats en matière de communication santé. Sur le plan théorique, l'étude établit une base pour intégrer la linguistique de corpus dans les systèmes d'éducation à la santé pilotés par l'IA, tandis que sur le plan pratique, elle propose un cadre évolutif pour les plateformes multilingues d'éducation à la santé reproductive. Ces résultats ont des implications importantes pour les politiques mondiales de santé numérique, la gouvernance de l'IA et les stratégies de communication en santé reproductive.
30 May 2026
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Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic review
OBJECTIVE: Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. This calls for a concerted effort from different stakeholders involved in issues of teenagers' sexual reproductive health to achieve the SDG target of 2030 on the reduction of maternal mortality. The objective of this systematic review was to estimate the prevalence of teenage pregnancy and its associated factors in Uganda. DESIGNS: We conducted a systematic review and random-effects meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-analysis standards. DATA SOURCES: After prospective registration (PROSPERO CRD42023486460), a literature search was conducted in PubMed, African Journals Online and Google Scholar in December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies that reported the prevalence of teenage pregnancy among teenagers were included. DATA EXTRACTION AND SYNTHESIS: Articles were screened for relevance at the title, abstract and full-text levels by multiple reviewers. The quality of studies was independently appraised using the Joanna Briggs Institute Critical Appraisal Checklist and Newcastle-Ottawa Scale. Any discrepancies were resolved by reaching a consensus. The process of extracting data included study information, geographical categorisation, type of studies, population, sample size, results/outcomes and prevalence of teenage pregnancy. The risk of bias was determined by Egger's test. The results were pooled using random-effects models to calculate the prevalence of teenage pregnancy with a CI of 95% and I² statistic. RESULTS: Of 918 records screened, 10 studies (4143 participants) were included. The pooled prevalence of teenage pregnancy was 25.5% (95% CI 13.7% to 39.5%; I²=98.9%), with individual study estimates ranging widely from 3.0% to 56.4%, reflecting substantial heterogeneity across study settings, populations and periods of data collection. Higher estimates were observed in the Central-Eastern region (31.7%, 95% CI 19.5% to 45.1%). The overall certainty of evidence was rated as very low using the Grading of Recommendations, Assessment, Development and Evaluation framework, primarily due to very serious inconsistency across included studies (I²=98.9%). CONCLUSIONS: Pooling studies of mixed quality revealed a slightly higher prevalence of teenage pregnancy in Uganda. This review provides valuable insight for policymakers and healthcare providers in developing interventions and policies to reduce the burden of teenage pregnancy from disadvantaged backgrounds. PROSPERO REGISTRATION NUMBER: CRD42023486460.
28 May 2026
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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 →BMJ sexual & reproductive health
Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review
OBJECTIVES: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. STUDY DESIGN: We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare. RESULTS: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. CONCLUSIONS: Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.
15 Apr 2026
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