Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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AIDS care
"It's a lifeline": perspectives and experiences of health technology use among HIV care providers in rural Florida
The use of health technology, such as telehealth and mobile health used to support or deliver health care, is a promising strategy to improve HIV outcomes among people with HIV (PWH) in the rural South. In-depth interviews were conducted with 21 HIV care providers in rural Florida to understand the perspectives and experiences of using health technology to deliver care for PWH. Thematic analysis was applied. Emerging themes were organized under four domains: current and prior health technology practices, drawbacks to health technology, benefits of health technology, and potential facilitators of health technology. Providers revealed that health technology use has expanded rapidly since onset of the COVID-19 pandemic, especially use of video calls, but they preferred multiple communication methods. Drawbacks to health technology included lack of human connection, increased burden to providers and patients, confidentiality concerns, technology malfunctioning, discomfort with technology, and financing constraints. Benefits included improved communication and access to care, social connection and community support, and reduced HIV-related stigma. Potential facilitators included health technology that is user-friendly, and economic incentives to increase technology use. Health technology holds promise for addressing barriers to HIV care, however, its drawbacks must be addressed to ensure effective implementation in the rural South.
3 Aug 2026
Read appraisal →Journal of the American College of Surgeons
Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination
The rapid adoption of telemedicine has transformed healthcare delivery in the US, enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared with in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: preoperative, intraoperative, and postoperative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. A comparative analysis with existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.
18 July 2026
Read appraisal →BMC medical research methodology
Digital focus groups in healthcare interventions: A reflexive methodological analysis of how socio-technical and relational factors co-produce qualitative data.
BACKGROUND: Digital focus groups are increasingly used in health research, yet their methodological implications within complex interventions remain insufficiently examined. When conducted with pre-existing cohorts, digital focus groups may function not only as evaluative tools but also as relational and socio-technical encounters that shape the generation of qualitative data. The goal of the present study was to examine how digital focus groups operate within this context. METHODS: This study presents a methodological re-analysis of focus group material originally collected for the evaluation of a hybrid psychosocial prevention intervention, examining how digital focus groups operate within this context following the perspective of Situational Analysis. Digital focus groups were conducted with participants who had completed the hybrid intervention together in fixed cohort groups, meaning participants were already acquainted with one another prior to the focus group sessions. For the analysis, the transcripts were examined using descriptive, inductive coding. Verbatim quotations were used as methodological markers to illustrate how relational, emotional and technological factors shaped the data. RESULTS: Pre-existing cohort cohesion strongly influenced how participants engaged in the digital setting, fostering emotional safety, peer-supported learning, motivational reinforcement and opportunities for self-regulation. Digital platforms structured visibility, turn-taking and synchronization, while differences in devices, connectivity and digital literacy affected participation and the stability of group interaction. The researcher role expanded to include facilitation, technical troubleshooting and emotional anchoring, making the research team part of the socio-technical infrastructure. At times, the focus groups elicited supportive or motivational effects that echoed elements of the intervention itself, blurring the line between evaluation and unintended interventional effects. CONCLUSIONS: Focus groups in intervention research operate as relational encounters rather than neutral data-collection tools. This applies particularly to Digital Focus Groups. Recognizing how pre-existing relationships, technological environments and researcher involvement shape interaction is essential for methodological transparency and rigorous interpretation. The findings highlight the importance of reflexivity, attention to digital differences, and awareness of unintended interventional dynamics when designing and interpreting digitally mediated qualitative methods in healthcare contexts. Furthermore, the findings indicate that the choice between digital and in-person FGs should not be guided by pragmatic considerations alone, but by the relational, technological and institutional conditions of the research situation. TRIAL REGISTRATION: DRKS-ID: DRKS00033080 (registration date: December 7, 2023).
13 July 2026
Read appraisal →JMIR formative research
Clinician Decision-Making Around Offering Home Video Telehealth Visits: Qualitative Study
BACKGROUND: Use of in-home video telehealth rapidly expanded in response to the COVID-19 pandemic, including at Veterans Affairs (VA), a forerunner in telehealth. Despite this uptick, differences in use by patient age and rurality created a digital divide that persists to this day. While clinicians frequently cite patients' older age and lack of technical skills as barriers to in-home video telehealth, it remains unclear how clinicians decide whether to offer video visits to patients and to what extent these beliefs may hinder offering video visits to older adults. Gathering perspectives from clinician users of in-home video telehealth may illuminate opportunities to ensure continued access to care through solutions such as telehealth. OBJECTIVE: This study aimed to examine clinician decision-making around the offer of in-home video telehealth to understand how interprofessional clinicians determine to whom they offer in-home video telehealth and what factors (organizational, personal, or attitudinal) influence their decision. METHODS: We conducted a qualitative study by using semistructured interviews. Participants were interprofessional clinicians (N=16) employed by 11 different VA hospitals and included 1 clinical pharmacist, 6 medical doctors, 2 nurse practitioners, 1 occupational therapist, 3 psychologists, 1 physical therapist, 1 speech-language pathologist, and 1 social worker. All the participants had at least some experience using in-home video telehealth from locations across VA (the largest integrated health care system in the United States) and were interviewed over a 6-month period. Interviews focused on clinicians' use of video telehealth and the decision-making process involved in offering in-home video telehealth. We used directed content analysis with a rapid analytic approach, given the time-pressured nature of our project. RESULTS: This study revealed that clinician decision-making around offering in-home video visits is complex and influenced by several domains, namely, (1) clinician factors, including experience with video and perceived benefits of video; (2) appointment factors, including the visit's clinical goal; (3) clinician-reported patient factors, including age and willingness to try video; (4) patient social context, including caregiver availability; (5) geographical factors, such as availability of reliable high-speed internet and patient distance from the medical center; and (6) health system factors, including technical support and clinician ability to work from home. Access to in-home video telehealth may be facilitated by clinician familiarity and confidence with telehealth technology, strategies to improve patients' technical skills, and support for caregivers. Infrastructure also plays an important role, including device availability, broadband reliability, and clear protocols for matching services to video visits. CONCLUSIONS: Findings highlight the importance of clinician competency in telehealth, patient and caregiver digital readiness, and a supportive technology infrastructure to equitable in-home video care. In addition, improved guidance for specific clinical services and awareness of potential biases may enable consistent, accessible telehealth delivery for older adults and medically complex populations.
20 June 2026
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