Frontiers in health services最新文献

{"title":"The theory behind the strategies: interpreting the expert recommendations for implementing change taxonomy through four behavioural lenses.","authors":"Per Nilsen, Kristin Thomas, Hanna Augustsson Öfverström, Maria Fagerström, Kathrine Hald, Jeanette Wassar Kirk","doi":"10.3389/frhs.2026.1800608","DOIUrl":"10.3389/frhs.2026.1800608","url":null,"abstract":"<p><strong>Background: </strong>Implementation strategies are essential for promoting the uptake of evidence-based practices, yet they are often applied without explicit attention to their theoretical foundations. The Expert Recommendations for Implementing Change (ERIC) taxonomy identifies nine strategy categories, but work on exploring the assumptions underlying how these strategies bring about behaviour change is limited. This study aimed to clarify the theoretical bases of ERIC strategies to strengthen conceptual understanding and guide strategy selection.</p><p><strong>Methods: </strong>We conducted a conceptual analysis of the nine ERIC strategy categories and examined how each aligns with four major perspectives on behaviour change: behaviourism, social cognitivism, dual-process models, and culture. We identified the implicit assumptions about change processes for each category and interpreted these through the four lenses to compare convergences and divergences in their explanatory mechanisms.</p><p><strong>Results: </strong>Each theoretical perspective highlighted distinct yet complementary pathways through which implementation strategies operate. Behaviourism emphasized reinforcement and environmental cues; social cognitivism focused on self-efficacy, motivation, and social learning; dual-process models distinguished between automatic and reflective cognitive systems; and cultural perspectives underscored the influence of shared norms and values. Mapping ERIC categories through these perspectives revealed overlaps and tensions, such as between extrinsic reinforcement and intrinsic motivation, or between individual-level processes and collective cultural alignment.</p><p><strong>Conclusions: </strong>Implementation strategies are not theory-neutral but rest on implicit assumptions about how behaviour changes. Clarifying these assumptions reveals why strategies vary in effectiveness across contexts and provides a foundation for more deliberate, theory-informed strategy selection and evaluation. Integrating behavioural, cognitive, and cultural perspectives offers a multidimensional understanding of change processes, enabling researchers and practitioners to design strategies that are contextually aligned, theoretically coherent, and more likely to produce sustainable outcomes.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1800608"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experience of professional identity formation by palliative care practitioners: an exploratory qualitative study by the Singapore Hospice Council.","authors":"Eng Koon Ong, Candice Tan, Andy Sim, Min Chiam, April Thant Aung, Arista Tan, Vanessa Ho, Bee Hia Sim","doi":"10.3389/frhs.2026.1771460","DOIUrl":"https://doi.org/10.3389/frhs.2026.1771460","url":null,"abstract":"<p><strong>Background: </strong>Professional identity formation (PIF), the process through which professionals internalise and reconcile new experiences with a pre-existing identity can lead to better patient care outcomes and staff fulfilment. However, how palliative care practitioners (PCPs) experience PIF is currently unclear. To support services as they expand capacity to cope with increasing needs, this study addresses the question, How is professional identity formation experienced by palliative care providers in Singapore?\"</p><p><strong>Methods: </strong>This exploratory qualitative study investigates how PIF is experienced by PCPs through a Relativist ontological position and a Constructivist epistemological lens. A total of seven focus group discussions involving 35 representatives from 19 member organisations of the Singapore Hospice Council (SHC) were conducted between August and September 2024. Each session lasted approximately 1-1.5 h. The data was audio-recorded, anonymised, transcribed, and analysed thematically.</p><p><strong>Results: </strong>Three themes and 7 subthemes are identified. The three themes are: prevailing professional identity of PCPs, dilemma between professional self-sufficiency and interprofessional collaboration, and expectations of leadership.</p><p><strong>Conclusion: </strong>This study elicited a self-reported, multi-faceted description of professional identity by local PCPs. PCPs' expectations of their professional competence, together with insights about how interprofessional collaboration is practiced and expectations of organisational leadership reinforce the need to adopt a multi-pronged approach towards staff support. Such an approach should include developing PCPs' competence across both biomedical and psychosocial domains, foster IPC practices that translate to staff support, and alignment of organisational goals with service realities. Future research should evaluate the implementation and effectiveness of such approaches.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1771460"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of patient safety into educational curricula and continuing professional training - comparison of patient safety competency models.","authors":"Sini Eloranta, Saara Ketola, Tuija Ikonen","doi":"10.3389/frhs.2026.1757601","DOIUrl":"https://doi.org/10.3389/frhs.2026.1757601","url":null,"abstract":"<p><strong>Introduction: </strong>Patient safety is a fundamental component of high-quality healthcare, and integrating its principles into health professional education and continuing professional development is essential for ensuring safe care. This article describes and compares four international patient safety competency models from high-income regions (Australia, Canada, the United Kingdom, the Nordic countries), and the WHO Multi-professional Patient Safety Curriculum Guide and analyzes their similarities and differences. In this descriptive comparative review, the objective is to identify which competency domains each model emphasises, and which competencies are critical for advancing patient safety across healthcare systems.</p><p><strong>Methods: </strong>A thematic analysis of the patient safety competency models was conducted, focusing on their core competency domains and identifying the competencies most critical for advancing patient safety across healthcare systems in high-income regions.</p><p><strong>Findings: </strong>Common competency domains include safety culture, systems thinking, teamwork, communication, risk management, human factors, and continuous learning. However, there are notable differences: for example, the Nordic framework for knowledge and skills emphasizes technology and preparedness, Australia highlights ethics, and Canada focuses on resourcing.</p><p><strong>Discussion: </strong>The comparison of four patient safety competency models in high-income countries, and the WHO Multi-professional Patient Safety Curriculum Guide shows that they share a common set of core domains, providing a strong basis for aligning patient safety education in high-income countries. At the same time, country specific emphases highlight the need for contextual adaptation.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1757601"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organization and resource utilization of specialized neurosurgical care for chiasmatic-sellar tumors in a metropolitan health system: a hospital-based study from Kazakhstan.","authors":"Yerlan Ayaganov, Gani Akhanov, Zhulduz Sadykova, Berik Isatayev, Alibek Zhanisbayev, Yerdos Algazyev, Beknur Umraliyev, Sarafaddin Mansharipov, Ray Omirzak, Ermek Dyussembekov","doi":"10.3389/frhs.2026.1807744","DOIUrl":"https://doi.org/10.3389/frhs.2026.1807744","url":null,"abstract":"<p><strong>Background/objectives: </strong>Chiasmatic-sellar region tumors represent a significant burden for specialized healthcare services due to the need for complex diagnostics, multidisciplinary management, and prolonged inpatient treatment. In the absence of population-based registries, hospital-based analyses provide important insights into the organization of care and resource utilization. This study aimed to assess the organization and key characteristics of specialized neurosurgical care for patients with chiasmatic-sellar tumors in a large metropolitan center in Kazakhstan.</p><p><strong>Methods: </strong>A retrospective hospital-based study was conducted using medical records of adult patients treated for chiasmatic-sellar region tumors in a tertiary neurosurgical center in Almaty between 2019 and 2024. Demographic characteristics, tumor structure, surgical activity dynamics, length of hospital stay, intensive care unit (ICU) utilization, perioperative complications, reoperations, and in-hospital mortality were analyzed using descriptive statistical methods.</p><p><strong>Results: </strong>A total of 342 patients were included (mean age 49.6 ± 14.2 years; 59.9% women). Pituitary adenomas accounted for 82.2% of cases. Surgical activity varied over time, with a temporary decline followed by a compensatory increase in subsequent years. Median length of hospital stay was 16 days (IQR 14-20), and routine short-term ICU monitoring was required for the majority of patients. Postoperative complications occurred in 5.8% of cases, reoperations in 4.1%, and in-hospital mortality was 2.6%.</p><p><strong>Conclusions: </strong>This hospital-based study highlights key organizational features and resource utilization patterns of specialized neurosurgical care for chiasmatic-sellar tumors in a metropolitan setting. These findings provide real-world evidence to support planning and optimization of centralized neurosurgical services in metropolitan health systems of middle-income countries, particularly with regard to inpatient capacity, intensive care utilization, and standardized postoperative pathways.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1807744"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equitable access to the COVID-19 vaccines in Africa (ECOVA) findings from a qualitative enquiry in Zimbabwe.","authors":"Tatenda Dorcas Kujeke, Gracious Madimutsa, Nyasha Masuka","doi":"10.3389/frhs.2026.1549192","DOIUrl":"https://doi.org/10.3389/frhs.2026.1549192","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic exposed significant global disparities in vaccine distribution and access, prompting urgent calls to strengthen national delivery systems. In Zimbabwe and across the African continent, reliance on imports highlighted the need for both robust local distribution mechanisms and enhanced vaccine manufacturing capabilities. Africa's potential to produce vaccines, raw materials, and medical supplies exists, but its realization demands strategic investment and the promotion of public-private partnerships (PPPs). This study aims to analyze Zimbabwe's current COVID-19 vaccine distribution and delivery mechanisms, and explore the potential of PPPs to establish the necessary structures and processes to guarantee prompt access and administration of vaccines, particularly among vulnerable populations.</p><p><strong>Methods: </strong>We conducted qualitative in-depth interviews with twenty purposively sampled Key Informants, all possessing specialized knowledge of Zimbabwe's Expanded Programme on Immunization (EPI) and the COVID-19 vaccination program. A standardized template, shared across the study consortium, guided the participant selection process.</p><p><strong>Results: </strong>Our qualitative investigation reveals that equitable vaccine access was hindered by the lack of routine adult vaccination compared to the well-established immunization of children through the EPI program. While utilizing the EPI infrastructure for COVID-19 vaccine rollout was deemed successful and commendable by key informants, it also faced criticism for perceived disparities in rural outreach, favouring urban areas. The stationary vaccination sites posed challenges for vulnerable groups like the elderly and those living with disabilities in rural regions who faced difficulties traveling long distances, underscoring the urgent need for greater efforts to ensure equitable vaccine access across all population segments.</p><p><strong>Discussion: </strong>Participant perspectives on local vaccine production in Zimbabwe reflect a blend of optimism and apprehension. Many expressed a strong desire for domestic vaccine development, recognizing its potential public health benefits and self-sufficiency. However, a sizeable number doubted Zimbabwe's current capacity to produce vaccines, citing economic challenges. Instead, they suggested forging partnerships with other African nations to collectively establish a regional or continental hub of excellence, sharing costs and reaping mutual benefits. An essential takeaway from this pandemic is the stark revelation of systemic gaps within the healthcare infrastructure. It is crucial to seize this opportunity to fortify the health system, ensuring its resilience in preparation for future pandemics.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1549192"},"PeriodicalIF":2.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers, processes, and outcomes related to burnout and moral injury in the public safety workforce: a scoping review.","authors":"Samantha A Meeker, Margaret Ziemann, Alys Barton","doi":"10.3389/frhs.2026.1778314","DOIUrl":"https://doi.org/10.3389/frhs.2026.1778314","url":null,"abstract":"<p><strong>Introduction: </strong>Despite growing awareness of mental health, stress, and trauma among public safety workers (EMTs, firefighters, and emergency dispatchers), gaps remain in programs and research addressing burnout and moral injury -especially when compared to the attention given to healthcare professionals and, to some extent, police officers. The objective of this study is to systematically review the literature on the environmental, relational, and operational drivers, processes, and outcomes associated with burnout and moral injury among public safety personnel according to a national framework.</p><p><strong>Methods: </strong>A systematic search following PRISMA extension for Scoping Reviews guidelines was conducted across six databases for peer-reviewed publications from 2004 to 2024. Search terms focused on burnout, moral injury, and public safety professions. Reference lists from included studies and key journals were also hand-searched. Identified studies were uploaded to Covidence and screened by three reviewers using defined criteria.</p><p><strong>Results: </strong>Of nearly 13,000 articles identified, 43 were included. Only three studies examined moral injury. Most studies examined individual burnout factors (e.g., age, gender), with less attention to organizational drivers. Key drivers included operational factors (e.g., occupational stress, organizational support) and non-organizational factors (e.g., traumatic events, work-family conflict). Burnout outcomes, discussed in fewer studies, primarily related to individual-level physical and mental health or job satisfaction and turnover.</p><p><strong>Discussion: </strong>Understanding burnout and moral injury from the perspective of public safety workers is critical to public health, given their frontline role during crises. While they safeguard the well-being of others, their own health has significant implications for downstream providers and patient outcomes. Although systems-level contributors to burnout and moral injury are increasingly acknowledged in broader healthcare, this lens is less often applied to public safety workers-especially in relation to moral injury. Addressing these issues requires a deeper understanding of their origins, particularly the organizational factors that shape how burnout and moral injury manifest in this workforce. Future research must address multi-level drivers to inform more effective and targeted interventions.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1778314"},"PeriodicalIF":2.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of the primary care general practitioner cluster model: experiences from Hungary.","authors":"Ferenc Maráczi, Attila Virág, Gergő Túri, Péter Pikó, Csilla Kaposvári, Rita Teller, Csaba László Dózsa, István Vingender","doi":"10.3389/frhs.2026.1769211","DOIUrl":"https://doi.org/10.3389/frhs.2026.1769211","url":null,"abstract":"<p><strong>Background: </strong>In 2021, Hungary introduced general practitioner (GP) clusters to improve access to local healthcare and strengthen cooperation among primary care providers. However, there is limited evidence on how these clusters operate.</p><p><strong>Objective: </strong>The aim of this research is to provide a comprehensive description of how GP practices and clusters function, and to describe variables associated with a GP's participation in a cluster.</p><p><strong>Methods: </strong>We analysed national data on general practices and GP clusters in Hungary for the period 2021-2024. This data was obtained from the National Hospital Directorate and supplemented with information from publicly available sources. After harmonising and integrating the data, we used descriptive statistical methods to characterise the operation of practices and clusters. We also used multivariate regression models to examine factors associated with GPs' decisions to join a cluster.</p><p><strong>Results: </strong>Between 2021 and 2024, the number of GP clusters increased from 365 to 422. Nearly half of all practices had joined by 2024. On average, clusters included seven practices, with one-third collaborating with dentists. Significant regional disparities were observed in cluster participation, while the adoption of digital health technologies and point-of-care tests remained limited. While GP clusters have expanded nationwide, participation appears higher in better-resourced districts.</p><p><strong>Conclusion: </strong>As in many other developed countries, GP clusters have become increasingly widespread in Hungary. One-third of these clusters involve collaboration between GPs and dentists. While these clusters provide a variety of professional services, challenges persist due to vacant practices and regional disparities. To ensure sustainability, future efforts should strengthen digital health integration and promote the widespread adoption of innovative services provided by GP clusters.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1769211"},"PeriodicalIF":2.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining an integrative multidimensional framework for patient complaint management systems.","authors":"Aydin Teymourifar","doi":"10.3389/frhs.2026.1767605","DOIUrl":"https://doi.org/10.3389/frhs.2026.1767605","url":null,"abstract":"<p><p>Patient complaints represent a significant yet sometimes underutilized source of organisational learning in hospitals. While they are sometimes processed as administrative tasks aimed at resolution, emerging research demonstrates their value as indicators of system vulnerability and early warning signals for patient safety. This mini-review contributes to the literature by offering a new integrative framework that synthesizes eight previously fragmented domains of complaint management: System Consistency in Learning from Complaints, standard classification of complaints, leadership commitment for organisational learning, effective individual and interpersonal behaviour for organisational learning, organisational change driven by organisational learning, data analytics for organisational learning, proactive risk detection, ethical and legal considerations. Using an integrative, framework-informed methodology, the paper combines inductive identification of conceptual patterns with deductive synthesis across theoretical and policy literatures. The review's key contribution lies in reconceptualizing patient complaints as a system embedded within hospital operations, rather than an administrative function. By mapping connections across the eight domains, the framework reveals how complaints serve as multidimensional organisational assets that can expose systemic weaknesses, cultural blind spots, and latent safety risks. The review also identifies significant theoretical and measurement gaps, including the lack of validated multidimensional instruments to assess complaint management holistically. It further proposes a new research direction by outlining how performance-based contracting could align incentives among patients, clinicians, and managers to strengthen responsiveness and learning, with implications for health system governance and public health oversight.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1767605"},"PeriodicalIF":2.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planning for an aging nursing workforce: data-driven implications for health policy and service sustainability in Italy.","authors":"Luca Fimmanò, Marco Damonte Prioli, Fabrizio Figallo, Giovanni Orengo, Antonio Uccelli, Michele Messmer","doi":"10.3389/frhs.2026.1778755","DOIUrl":"https://doi.org/10.3389/frhs.2026.1778755","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses are a vital component of healthcare systems, directly influencing the quality and continuity of patient care. Globally, demographic shifts have led to a rising proportion of older nurses. In Italy, this trend presents challenges, given the rapidly aging population and ongoing workforce shortages. With a retirement age of 67, many older nurses remain in physically demanding roles despite medically documented work limitations, raising concerns about workforce sustainability, safety, and long-term planning.</p><p><strong>Methods: </strong>This study analyzed demographic trends among nurses at a major Italian public hospital. Data were extracted from the hospital's human resources system (IRIS WIN) for the period 2010-2024. A total of 2,184 nurses employed as of 31 December 2024 were stratified into four age groups (24-44, 45-54, 55-58, and 59-67 years) and mapped against clinical settings with varying levels of work intensity. Retirement eligibility was projected through 2033. Health-related absenteeism and medically documented work limitations were analyzed by age group and job intensity level.</p><p><strong>Results: </strong>Between 2010 and 2024, the proportion of nurses aged 24-44 declined by 36.6%, while those aged 55-58 and 59-67 increased by 222.3% and 1,914%, respectively. Projections indicate a further 91% increase in the oldest age group by 2033. In 2024, 66% of nurses aged 55-58 and 61% of those over 59 were working in high- or extremely high-intensity clinical areas. Older nurses (>55 years), representing 40% of the workforce, accounted for 54% of all health-related absenteeism, equivalent to 87 full-time nursing positions. The number of nurses with medically documented work limitations in the oldest age group is expected to double in the coming years.</p><p><strong>Discussion: </strong>This study highlights the urgent challenges of an aging nursing workforce which are not unique to Italy's NHS, but are a global issue. A growing proportion of older nurses, many with medically documented work limitations, are working in demanding clinical environments, trends already testing healthcare systems in many countries worldwide with a potential impact on patient safety, quality of care, and workforce resilience. Urgent investment in workforce planning, age-responsive role adaptation, and transitional pathways is essential to ensure sustainable, high-quality care delivery and to safeguard workforce health.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1778755"},"PeriodicalIF":2.7,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing group metacognitive therapy to improve mental health in NHS cardiac rehabilitation: the PATHWAY beacons study of adoption, adherence and data capture.","authors":"Adrian Wells, Andrew Belcher, David Reeves, Patrick Doherty, Paul Wilson, Lora Capobianco","doi":"10.3389/frhs.2026.1793055","DOIUrl":"https://doi.org/10.3389/frhs.2026.1793055","url":null,"abstract":"<p><strong>Aims: </strong>Anxiety, depression, and post-traumatic stress symptoms are common in cardiac rehabilitation (CR) patients. Group metacognitive therapy (MCT) alongside CR can significantly improve such symptoms compared to usual care. We aimed to conduct the first implementation study of group-MCT in NHS CR services. The objectives were: 1. Establish sites and assess levels of adoption; 2. Revise and pilot data capture via national auditing systems to assess MCT attendance and uptake; 3. Assess site-level MCT-adherence under roll-out conditions.</p><p><strong>Methods: </strong>A mixed-methods study evaluated implementation of group-MCT in routine care in CR services. Services across England were recruited as early adopters and staff were trained. The National Audit of Cardiac Rehabilitation (NACR) database was modified to collect and assess performance of group-MCT data capture. Five implementation outcomes were assessed; uptake and adherence, data-capture and quality, patient characteristics, site-level of adoption, and treatment adherence.</p><p><strong>Results: </strong>Twenty-six courses of group-MCT were delivered across six services, with an average of 4.3 courses per site and 131 patients receiving treatment. 82.4% of patients attended at least four sessions. Five services met all outcomes and were classed as green; one failed on one criterion and was rated amber. Data capture worked but with some minor discrepancies. Levels of intervention adherence were excellent, with high consistency across sites and time.</p><p><strong>Conclusions: </strong>We established six sites meeting our recruitment threshold and demonstrated satisfactory data capture on MCT attendance and uptake via national auditing systems. Five out of six sites met all adoption criteria. Site level adherence and compliance was excellent at 86.7%. Wider-scale adoption could improve access to evidence-based psychological therapy and enhance outcomes across the 188 CR-services in England.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1793055"},"PeriodicalIF":2.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}