Journal of evaluation in clinical practice最新文献

{"title":"When Deviation Is Necessary: Balancing Intervention Fidelity and Contextual Adaptation in Haemodialysis Physiotherapy.","authors":"Santosh P Dobhal, Manish Prannath Shukla, Abhishek Mishra, Ira Indurkar","doi":"10.1111/jep.70689","DOIUrl":"https://doi.org/10.1111/jep.70689","url":null,"abstract":"<p><strong>Background: </strong>Exercise-based physiotherapy is recommended as a core component of haemodialysis care; however, its implementation in routine clinical practice remains inconsistent. While intervention fidelity is considered essential for ensuring evidence-based practice, little is known about how physiotherapists adapt rehabilitation protocols in response to the complexities of real-world clinical environments.</p><p><strong>Objective: </strong>To explore how physiotherapists balance intervention fidelity with contextual adaptation during haemodialysis rehabilitation and to examine the cognitive, social, and contextual factors influencing clinical decision-making.</p><p><strong>Methods: </strong>A qualitative interpretive study was conducted across four haemodialysis centres using semi-structured interviews with 16 physiotherapists. Participants were recruited through purposive maximum-variation sampling to capture diverse clinical experiences and practice settings. Data were analyzed using reflexive thematic analysis, with findings subsequently interpreted through the Mindlines model.</p><p><strong>Results: </strong>Four interrelated themes were identified: Safety Overrides Protocol, Experience as the Primary Guide, Context Shapes Practice, and Guidelines as Flexible References, which collectively informed the overarching theme of Adaptation as Skilled Practice. Physiotherapists consistently prioritised patient safety by modifying interventions according to physiological status and individual patient needs. Clinical decisions were informed by experiential knowledge, interprofessional interactions, and organisational constraints, with guidelines serving as flexible reference points rather than prescriptive rules. The findings demonstrate that context-sensitive adaptation represents deliberate clinical reasoning rather than simple protocol non-adherence.</p><p><strong>Conclusion: </strong>Intervention fidelity in haemodialysis physiotherapy should be understood as a dynamic process that accommodates appropriate contextual adaptation while preserving the core intent of rehabilitation. Recognizing adaptive clinical expertise may strengthen the implementation of evidence-based physiotherapy in complex healthcare settings.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70689"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease Experiences of Adolescents With Chronic Kidney Disease: A Phenomenological Study.","authors":"Nagihan Fatma Harmancı, Gökçe Demir","doi":"10.1111/jep.70644","DOIUrl":"https://doi.org/10.1111/jep.70644","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the experiences of adolescents aged 15-17 years diagnosed with chronic kidney disease (CKD), their perceptions of the illness process, and its impact on daily life, in order to inform pediatric nursing practice and multidisciplinary supportive care approaches.</p><p><strong>Methods: </strong>This study was conducted using a phenomenological design. Face-to-face semi-structured interviews were conducted with 10 adolescents selected through criterion sampling. Data were collected using a sociodemographic form and an interview guide. The data were analysed using thematic analysis with MAXQDA 2022.</p><p><strong>Results: </strong>Three main themes and eleven sub-themes were identified: \"Pre-illness Experiences,\" \"Illness Experiences,\" and \"Expectations for the Future.\" Participants reported that CKD caused changes not only physiologically but also psychologically and socially. Common challenges included peer relationship disruptions, emotional difficulties, and daily routine limitations.</p><p><strong>Conclusion: </strong>Adolescents with CKD experience multidimensional challenges affecting their physical, psychological, and social lives. Addressing these challenges requires comprehensive and structured support.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70644"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Visibility Outpaces Expertise: Preserving Trustworthy Medical Authority in the Age of AI and Digital Amplification.","authors":"Manuel Ruiz-Bailén, María Del Carmen Ruiz-Iniesta","doi":"10.1111/jep.70673","DOIUrl":"https://doi.org/10.1111/jep.70673","url":null,"abstract":"<p><p>Contemporary medicine has unprecedented capacity to generate and disseminate information through social media, digital platforms and artificial intelligence. Visibility, communicative fluency and engagement-driven amplification may increasingly influence perceived credibility, contributing to an authority-expertise gap. This gap is not new: prestige, public prominence and institutional status have long functioned as imperfect proxies for competence. What is distinctive about generative AI is that it can relocate authority from identifiable people and institutions to interface-mediated outputs: answers are produced at scale, synthesised across sources, personalised to users and presented with fluency even when provenance and accountability are difficult to inspect. We therefore argue that AI changes the architecture rather than the existence of the problem. Drawing on virtue ethics, epistemology, critical care medicine and contemporary literature on digital communication, we propose that trustworthy medical authority requires alignment among epistemic validity, clinical wisdom and moral integrity. Social visibility remains an amplifier rather than a source of authority. Preserving trust in the AI era therefore requires not only accurate content but mechanisms that keep provenance, uncertainty and human accountability visible. Authority is not generated by fluency; it remains a professional and institutional achievement.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70673"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reallocating Surgical Activity to Expand Critical Care Capacity During the SARS-CoV-2 Pandemic: A Descriptive and Analytical Study in a French University Hospital Network.","authors":"Thomas Botrel, Nesrine Moukebel, Benjamin Legros, Fabrice Menegaux, Louis Puybasset, Pierre Rufat, Oualid Jouini, Mathieu Raux","doi":"10.1111/jep.70665","DOIUrl":"https://doi.org/10.1111/jep.70665","url":null,"abstract":"<p><strong>Rationale: </strong>The ability to anticipate ICU beds mobilizable through elective surgical postponements during health system shocks remains poorly quantified.</p><p><strong>Aims and objectives: </strong>Using real-world COVID-19 deprogramming data, we combined a classification of acceptable surgical deferral times with predictive models of expected surgical activity to estimate ICU capacity that can be generated in crisis scenarios.</p><p><strong>Method: </strong>We conducted a retrospective time-series analysis of all surgical procedures performed from 2017 to 2021 in three AP-HP university hospitals. Procedures were classified as non-deferrable (red), deferrable < 1 month (orange), or > 1 month (green). Expected weekly surgical volumes for 2020-2021 without pandemic disruption were predicted using models trained on 2017-2018 and validated on 2019 (XGBoost, Holt-Winters). Multivariable linear regression quantified the association between postponed procedures and ICU beds opened, enabling projection of capacity gains under different postponement scenarios.</p><p><strong>Results: </strong>Among 196,469 procedures, 59% were red, 20% orange, and 21% green. Surgical activity declined by 13% in 2020% and 8% in 2021, while ICU capacity increased by up to 85 and 46 beds, respectively. Reductions were mainly driven by postponement of green procedures (IRR 0.78 [0.75-0.80]). Only postponed green procedures were significantly associated with ICU bed expansion (β = 0.75, 95% CI 0.53-0.97; p < 0.001), accounting for 34.6% of ICU bed demand.</p><p><strong>Conclusion: </strong>Clinically acceptable postponement of low-priority elective surgery contributes substantially to ICU surge capacity. Integrating prioritization and predictive modeling into preparedness strategies may support balanced, data-driven responses to future healthcare system shocks.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70665"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinforcement Learning in Healthcare Analytics: Transforming Personalised Medicine and Clinical Decision-Making.","authors":"T Mathankumar, S Vijayarani","doi":"10.1111/jep.70676","DOIUrl":"https://doi.org/10.1111/jep.70676","url":null,"abstract":"<p><strong>Rationale: </strong>Reinforcement Learning (RL) has emerged as a promising artificial intelligence paradigm for adaptive and sequential decision-making in healthcare, enabling personalised treatment optimisation and intelligent clinical resource management beyond the capabilities of conventional static models.</p><p><strong>Aim: </strong>This review aims to examine recent advances in RL for healthcare analytics, focusing on its applications, emerging techniques, challenges, and future research directions.</p><p><strong>Methods: </strong>The review studies model-free, model-based, deep reinforcement learning, and multi-agent reinforcement learning techniques applied to personalised treatment planning, chronic disease management, clinical decision support, healthcare resource optimisation, and robotic-assisted healthcare. It also explores Federated Reinforcement Learning (FRL), Explainable Reinforcement Learning (XRL), and longitudinal outcome prediction. The reviewed studies utilise healthcare datasets, including the Osteoporosis Dataset, UCI Heart Disease Dataset, Pima Indians Diabetes Dataset, SEER Cancer Dataset, and MIMIC-IV Dataset.</p><p><strong>Results: </strong>The reviewed studies demonstrate that RL-based approaches support adaptive clinical decision-making, personalised treatment recommendations, improved operational efficiency, and patient outcome prediction. FRL offers opportunities for privacy-preserving collaborative learning, while XRL enhances the transparency and interpretability of clinical decisions. However, challenges remain concerning data quality, reward function design, model interpretability, computational scalability, ethical considerations, and regulatory compliance.</p><p><strong>Conclusion: </strong>R.L has significant potential to advance intelligent healthcare analytics through personalised, adaptive, and efficient clinical solutions. Future research should prioritise privacy preservation, interpretability, scalability, ethical AI, and regulatory compliance to develop safe, reliable, and trustworthy RL-based healthcare systems.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70676"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biostatistics for Evidence-Based Medicine: A Practical Review for Clinicians.","authors":"Mayura Thilanka Iddagoda","doi":"10.1111/jep.70682","DOIUrl":"10.1111/jep.70682","url":null,"abstract":"<p><strong>Background: </strong>Biostatistics forms the foundation of evidence-based medicine by providing the methods required to design, analyse, interpret, and critically appraise clinical research. Despite its importance, many clinicians find statistical concepts difficult to understand and apply in everyday practice.</p><p><strong>Aim: </strong>This review provides a practical overview of the fundamental principles of biostatistics relevant to clinicians involved in research or the interpretation of medical literature.</p><p><strong>Design: </strong>and content: Key concepts discussed include the hierarchy of evidence, development of research questions and hypotheses, population and sample selection, sample size determination and statistical power, variable classification, and the distinction between descriptive and inferential statistics. The article also introduces the principles of data organisation, univariate, bivariate, and multivariable analyses, and the factors influencing the selection of appropriate statistical models based on study design, variable type, and data characteristics. Throughout, the emphasis is on understanding the rationale behind statistical methods rather than on mathematical derivations, enabling clinicians to critically evaluate published studies and communicate effectively with statisticians.</p><p><strong>Conclusion: </strong>By providing a structured introduction to core biostatistical concepts, this review aims to improve statistical literacy, facilitate evidence-based clinical decision-making, and support clinicians in conducting and interpreting high-quality clinical research.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70682"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Voice Behavior in Online and Hybrid Multidisciplinary Team Meetings: A Qualitative Study.","authors":"Karin Kee, Stephanie M E van der Burgt, Marike L D Broekman, Rob J A Nabuurs","doi":"10.1111/jep.70614","DOIUrl":"https://doi.org/10.1111/jep.70614","url":null,"abstract":"<p><strong>Rationale: </strong>Guidelines for the treatment of a variety of diseases and medical conditions increasingly call for decision-making by a multidisciplinary team, which typically takes place during multidisciplinary team meetings (MDTMs). However, studies examining in-person MDTMs show that the decision-making processes during such meetings often fall short of optimal performance due to participants refraining from exercising voice behavior-denoting the communicative act of sharing one's perspectives, suggestions, and concerns related to the patient's diagnosis and treatment options with fellow participants. The expanding digitalization and the COVID-19 pandemic have led to an increase in online and hybrid meetings, potentially introducing new obstacles to participants' voice behavior.</p><p><strong>Aims and objectives: </strong>The present paper aims to explore the challenges encountered by participants of online and hybrid MDTMs in exercising their voice behavior.</p><p><strong>Methods: </strong>Observations of neuro-oncology MDTMs in two Dutch hospitals and interviews with chairpersons and participants of the observed MDTMs.</p><p><strong>Results: </strong>Respondents encountered difficulties in expressing their perspectives, ideas, and concerns during online and hybrid meetings, which could be attributed to (1) the absence of non-verbal cues, (2) technological deficiencies, (3) a personal lack of focus, (4) suboptimal layout of the meeting room, and (5) challenges in building relationships with other attendees.</p><p><strong>Conclusions: </strong>Obstacles to voice behavior in MDTMs are multifaceted, with specific barriers inherent to online and hybrid meetings that are not present in in-person meetings.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70614"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-Led Triadic Synergy for Active Aging Intervention Among Migrant Older Adults With Children in China: Study Protocol for a Cluster Randomized Controlled Trial.","authors":"Ziying Chen, Yuhan Yang, Qinghua Zhang, Xinuo Yao, Danyan Lu, Xiaoxiao Hu, Chunyan Leng","doi":"10.1111/jep.70646","DOIUrl":"10.1111/jep.70646","url":null,"abstract":"<p><strong>Rationale: </strong>As the global population of older migrants grows, a unique subgroup of Migrant Older Adults with Children (MOAC) faces compounded challenges of migration and aging. Although relocating to join adult children may offer familial support, these individuals often encounter specific barriers to social integration and public health.</p><p><strong>Aims and objectives: </strong>To address these challenges, this study aims to evaluate the effectiveness of a nurse-led Triadic Synergy Intervention on Active Aging (TSAAIP-MOA) to promote healthy aging and further achieve the goal of active aging among the MOAC.</p><p><strong>Methods: </strong>A multicenter cluster randomized controlled trial will be conducted to recruit eligible MOAC. Communities will be randomly assigned to an immediate intervention group or the wait-list control group, which will receive the 22-day TSAAIP-MOA program, while the wait-list control group will receive the same program subsequently. The primary outcome is the level of active aging; secondary outcomes include changes in intrinsic capacity, health literacy, and social participation. Data will be collected at three time points: baseline (T0), post-intervention (T1), and the 1st month from the initial intervention (T2), and analyzed using repeated-measures ANOVA.</p><p><strong>Discussion: </strong>This protocol will be able to validate the effects of concurrently enhancing intrinsic capacity, health literacy, and social participation on the formation of healthy lifestyles and the improvement of health-related quality of life. This community-based TSAAIP-MOA program holds strong potential as a readily scalable model for real-world implementation to improve healthy aging outcomes and foster active aging among MOAC in migrant destinations.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70646"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Natural Language Processing and Traditional Qualitative Analyses of Caregiver Feedback From a Community-Based Intervention for Children With Autism.","authors":"Carmen Caruthers, Samantha Hochheimer, Melanie Pellecchia, Amanda Gulsrud, Elizabeth McGhee Hassrick, David Mandell, Aubyn Stahmer, Connie Kasari, Suzannah Iadarola","doi":"10.1111/jep.70667","DOIUrl":"https://doi.org/10.1111/jep.70667","url":null,"abstract":"<p><strong>Background: </strong>Satisfaction data is a commonly used construct to evaluate programs, products, and experiences. This data is collected through forced choice (scales, surveys) and/or open-ended measures. While open-ended questions have the greatest potential for more useful and candid feedback, analysis of this data can be time-consuming.</p><p><strong>Objective: </strong>This paper compares two evaluation methods, traditional qualitative analysis (TQA) and Natural Language Processing (NLP), to analyze themes from open-ended satisfaction data of a caregiver-mediated intervention for families of autistic children, called 'Mind the Gap (MTG)'.</p><p><strong>Methods: </strong>This secondary analysis utilized existing survey data from 73 caregivers that participated in the MTG trial. To identify themes, TQA was performed using latent coding, and R statistical software was used for NLP, with strategies including term frequency and sentiment analysis. Methods were evaluated independently and in combination.</p><p><strong>Results and conclusion: </strong>Both methods are comparable in thoroughly analysing this type of data, with each method contributing both unique and overlapping themes. TQA and NLP showed parent satisfaction with materials and organization, as well as peer coach support. NLP may provide more thorough results while also reducing the time burden associated with TQA, although this strategy may also overlook important nuance in data. This clinical trial is registered as 'Mind the Gap (AIRB-3) (MTG)' at clinicaltrials.gov, registration number NCT03711799.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70667"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Knowledge and Vaccine Hesitancy Following Immunization Training Among Family Health Workers: The Role of Experience and Cognitive Flexibility.","authors":"Yusuf Emre Bostan","doi":"10.1111/jep.70680","DOIUrl":"https://doi.org/10.1111/jep.70680","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Vaccine hesitancy is one of the principal barriers to immunization programs, and health workers are central to this process both in countering hesitancy and through their own attitudes. Although educational interventions targeting health workers are widespread, how the effect of such training differs according to individual characteristics-and which factors determine this variation-remains insufficiently understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims and objectives: &lt;/strong&gt;This study aimed to evaluate the effect of a 4 h immunization training program delivered to family health workers on vaccine knowledge and vaccine hesitancy, and to determine whether professional experience and cognitive flexibility predict knowledge gain and attitude change.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-group pre-test-post-test design was used in Trabzon in February 2026. Vaccine knowledge was measured with a 10-item test, vaccine hesitancy with the short form of the Vaccine Hesitancy Scale, and cognitive flexibility with the Cognitive Flexibility Inventory. Change scores were examined with baseline-adjusted multiple linear regression, and the experience × cognitive flexibility interaction with an exploratory moderated regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 272 participants, representing 95% of the source population, were analyzed. Immediate post-training knowledge recall increased substantially (from 6.77 to 8.76 out of 10; dz = 1.34; p &lt; 0.001); 84.9% of participants improved their score, and the proportion answering at least 8 of the 10 items correctly rose from 32.4% to 87.9%. The reduction in vaccine hesitancy was statistically significant but negligible in magnitude (Δ = -0.90; p = 0.033; dz = -0.13); this corresponds to 1.9% of the 48-point usable range of the scale, with 51.4% of participants scoring lower, 12.4% unchanged and 36.3% higher after the training. The only individual characteristic that predicted attitude change was the Control dimension of cognitive flexibility (β = -0.116; p = 0.026), whereas professional experience predicted neither knowledge gain nor attitude change. The exploratory experience × cognitive flexibility interaction did not survive heteroscedasticity-consistent estimation and is reported as hypothesis-generating only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A brief, lecture-based training program substantially increased knowledge but produced no meaningful change in vaccine hesitancy in practice. This dissociation suggests that attitude change may require more than the transfer of information, and that cognitive flexibility-given the small and only partly robust associations observed here-is an individual factor whose role should be tested directly. Because of the uncontrolled design and the administration of the post-test immediately after the training, the findings describe short-term recall and immediate attitude reporting; any claim about causality or durability would require a controlled design w","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 7","pages":"e70680"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}