Frontiers in health services最新文献

{"title":"Healing through faith: spirituality and shrine visitation as coping mechanisms among haemophilia patients in Kashmir-an interpretative phenomenological study.","authors":"Shabnam Mushtaq, Wakar Amin Zargar, Fayaz Ahmad Paul","doi":"10.3389/frhs.2026.1802955","DOIUrl":"10.3389/frhs.2026.1802955","url":null,"abstract":"<p><strong>Background: </strong>In Kashmir, Sufi traditions are integral to everyday life. Visits to shrines are a culturally significant expression of faith and may influence how individuals cope with lifelong health conditions such as haemophilia.</p><p><strong>Objective: </strong>This study sought to explore the experiences of adults living with haemophilia in Kashmir with spirituality and shrine visitation as coping methods to deal with the psychological, emotional and social challenges of their condition.</p><p><strong>Methods: </strong>A qualitative study using the Interpretative Phenomenological Analysis (IPA) approach was conducted at the Haemophilia day care centre, Sri Maharaja Hari Singh (SMHS) Hospital, Srinagar, Jammu and Kashmir, India. Twelve adults (aged ≥18 years) diagnosed with Haemophilia A or Haemophilia B were recruited through purposive sampling. Data were collected using semi-structured, in-depth interviews and analysed following the principles of IPA.</p><p><strong>Results: </strong>Analysis revealed one overarching theme, <i>visiting shrines as a spiritual coping mechanism,</i> comprising three interconnected subthemes: <i>(1) changing patterns of shrine visitation across the life course, (2) belief in God and living with haemophilia, and (3) haemophilia as God's will.</i> Participants reported visiting shrines as a source of hope, emotional comfort, inner peace, resilience and spiritual connection. Participants recognized the importance of biomedical treatment but also saw shrine visitation as a complementary coping strategy of meaning, strengthening faith and facilitating acceptance of their illness. Participants also found that religious beliefs allowed them to reinterpret suffering through trust in God, which contributed to their psychological resilience when viewed as a lifelong condition.</p><p><strong>Conclusion: </strong>Spirituality and shrine visits are important culturally embedded coping mechanisms for people living with haemophilia in Kashmir. These practices are not a substitute for medical treatment but are a complement to conventional healthcare in addressing the emotional, existential and psychosocial needs of patients. Integrating culturally sensitive spiritual care into haemophilia services may contribute to more holistic, person-centred care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1802955"},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083050","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":"Highlighting person-centredness in technology supported care within nursing homes: a multiple case study.","authors":"A C Noordam, C J Nierse, R J E Vugs, V T J Bisschops, J Adriaansen, T J van der Zijpp, S Cardiff","doi":"10.3389/frhs.2026.1830120","DOIUrl":"10.3389/frhs.2026.1830120","url":null,"abstract":"<p><p>Healthcare technologies are increasingly introduced in long-term care to support monitoring, assessment and clinical decision-making. In nursing homes, however, their use becomes intertwined with everyday care practices and relationships between professionals, residents and family members. This study explores how digital health technologies shape care relationships in nursing homes from a person-centred care perspective. Using the Person-Centred (Nursing) Practice Framework as an analytical lens, a secondary interpretive cross-case analysis was conducted based on three previously prepared narrative case reports describing technology use in different nursing homes in the Netherlands. The original case studies were reported in a narrative case format, providing contextualised insights into how technologies were enacted and experienced in everyday practice. The cross-case analysis explored patterns and variations in how technology-supported care was integrated within care relationships and organisational contexts. Across the cases, professionals and relatives described how timely information and monitoring provided reassurance and supported more responsive care. At the same time, working with technology-generated data required ongoing interpretation and contextualisation by professionals. Technology use was associated with changes in care routines and, in some instances, shifts in roles and responsibilities among professionals. Tensions between safety, privacy and autonomy were also identified, particularly where monitoring technologies were used in dementia care. These findings suggest that the value of technology-supported care does not lie in the technologies alone, but also in how they are introduced, interpreted and integrated within care relationships, professional practices and organisational contexts. Understanding technology-supported care as relational and context-dependent may help inform more person-centred integration of digital health technologies in nursing homes.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1830120"},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083149","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":"Methods used to design audit and feedback interventions to change clinical practice: a scoping review.","authors":"Raquel Gallardo-Aviles, Mª Angeles García-Lirola, M C Gonzalez-Lopez, Regina Sandra Benavente Cantalejo, Carlos Barreda Velázquez, Rebeca Isabel-Gómez, Juan Francisco Gutierrez-Gil, M Concepción Pérez Guerrero, Teresa Molina-Lopez","doi":"10.3389/frhs.2026.1907196","DOIUrl":"10.3389/frhs.2026.1907196","url":null,"abstract":"<p><strong>Background: </strong>To optimize interventions that modify clinical practice, developers should use a systematic design process based on established frameworks. Reviewing current design practices in published literature and understanding established methodological guidelines is essential to identify gaps in knowledge, areas for improvement and promote best practices among interested groups.</p><p><strong>Objectives: </strong>This scoping review aims to synthesise the evidence on systematic design processes and methodologies for designing healthcare interventions published in articles and grey literature in the last fifteen years.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched MEDLINE, Embase, and PsycINFO databases for peer-reviewed studies (April 2015-October 2025) describing in detail the selected framework and design process used. We also searched selected websites for published grey literature (from 2011 to October 2025) detailing specific intervention frameworks and design processes. Documents were excluded if healthcare professionals were not among the target recipients, intervention stages were poorly described, or the focus was exclusively on lifestyle habit changes. A narrative synthesis of findings was conducted.</p><p><strong>Results: </strong>We analysed 59 source documents (49 scientific studies; 10 grey literature documents). Across the studies, we identified up to 22 distinct theoretical frameworks (used alone or in combination) and between 2 and 10 process stages. In grey literature documents we identified five different theoretical frameworks and outlined between 4 and 11 stages. The inclusion of sustainability and implementation planning represents a new stage compared to models from 15 years ago, with piloting also emerging as a new, albeit less frequently reported, stage.</p><p><strong>Conclusion: </strong>Variability was identified in the theoretical models used to guide intervention design, which may be applied individually or in combination. Up to eleven stages were identified in the intervention design process. Greater methodological rigour and transparency in study reporting would be needed to improve replicability. Future research areas identified include assessing the impact of systematic design on effectiveness and cost-effectiveness, prioritising the development of de-implementation guidelines, and incorporating diverse, multidisciplinary perspectives into intervention design guidance documents, among others.</p><p><strong>Systematic review registration: </strong>https://doi.org/10.17605/OSF.IO/T5ZSX.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1907196"},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083219","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":"More than a free snack: benefits of mobilized resources and socialization for pediatric healthcare workers.","authors":"Thomas B Ayres, Kristin L Ray, Aimee M Hoflander, Angela L Myers","doi":"10.3389/frhs.2026.1958370","DOIUrl":"10.3389/frhs.2026.1958370","url":null,"abstract":"<p><strong>Introduction: </strong>Addressing the burnout epidemic in the healthcare workforce is a primary concern of the modern healthcare organization and recognized across researchers and leaders of nations. This study aims to test whether a mobilized micro-break intervention, the Wellbeing on Wheels (WOW) Cart, improved health care worker (HCW) energy perceived organizational support and work engagement.</p><p><strong>Methodology: </strong>This study was conducted at an independent children's hospital in the midwestern United States. Between August and September 2024. A total of 367 pediatric HCWs completed our survey. IBM's SPSS was used to analyze the data using <i>t</i>-tests, ANOVAs, linear regression, and polynomial regression to test our hypotheses and <i>post-hoc</i> analyses.</p><p><strong>Results: </strong>The results of this study show that energy (<i>t</i> = 32.35, <i>p</i> < .01, Cohen's <i>D</i> = 1.33), perceived organizational support (<i>t</i> = 17.40, <i>p</i> < .01, Cohen's <i>D</i> = .92), and work engagement (<i>t</i> = 20.56, <i>p</i> < .01, Cohen's <i>D</i> = 1.08) significantly increased following a visit by the WOW Cart. Further, we found that both changes in energy (<i>β</i> = .44, <i>p</i> < .01) and perceived organizational support (<i>β</i> = .32, <i>p</i> < .01) predicted increases in work engagement (<i>R</i> ² = .35, <i>p</i> < .01). Our <i>post-hoc</i> analyses revealed nurses had a greater energy benefit [(<i>F</i> _{(2, 276)} = 2.96, <i>p</i> < .05] compared to nurse practitioners (<i>M</i> _diff = .82, <i>p</i> < .05) and physicians (<i>M</i> _diff = .55, <i>p</i> < .05), but no difference between job roles for perceived organizational support [(<i>F</i> _{(3, 281)} = .47, <i>p</i> = .71] and work engagement [(<i>F</i> _{(2, 283)} = 1.77, <i>p</i> = .15]. Further, we found an exponential increasing benefit from the degree of change in energy for work engagement (coeff. = .53, <i>t</i> = 2.949, <i>p</i> < .05). Additionally, we found a linearly increasing benefit from the degree of changes in perceived organizational support for work engagement (coeff. = -1.88, <i>t</i> = -4.433, <i>p</i> < .01).</p><p><strong>Conclusions: </strong>This study highlights that resource-based micro-breaks may be a viable option for effective HCW well-being intervention. Moreover, interventions can be brought to point-of-care areas. Additional research should determine how long these improvements last.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1958370"},"PeriodicalIF":2.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076961","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":"A scalable outpatient framework for BI-RADS 2-4B breast nodule management: an iodine-DMSO transdermal protocol.","authors":"João Francisco Pollo Gaspary, Luis Felipe Dias Lopes, Fernanda Peron Gaspary, Carmen Brum Rosa, Antonio Geraldo Camara","doi":"10.3389/frhs.2026.1883180","DOIUrl":"https://doi.org/10.3389/frhs.2026.1883180","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low- to intermediate-suspicion breast nodules (BI-RADS 2-4B) generate diagnostic uncertainty, prolonged surveillance, and emotional and operational burden, often without established low-risk interventions designed to support short-interval physiological modulation. Given the redox, endocrine, vascular, and microenvironmental dependencies of benign breast lesions, physiology-guided outpatient modulation may contribute to response-oriented decision-making before conventional oncologic escalation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A structured translational outpatient protocol was developed through mechanistic evidence synthesis, multicriteria translational prioritization, protocol structuring, and exploratory clinical implementation. The workflow integrated Evidence-Informed Design, Work Breakdown Structure, multicriteria decision analysis (MCDA), and DesignThinking/Open Innovation. Systematic reviews of molecular iodine and dimethyl sulfoxide (DMSO) identified translational response domains and mechanistic convergence pathways associated with tissue accessibility, redox modulation, and outpatient feasibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The translational synthesis identified redox modulation, vascular responsiveness, microenvironmental stabilization, tissue accessibility, and immune-related physiological modulation as principal mechanistic domains associated with iodine-responsive breast-tissue modulation. Comparative prioritization identified the transdermal route as the most operationally feasible outpatient configuration. The finalized protocol-2.5 mL of Lugol's solution (5% iodine) combined with 2.5 mL of pharmaceutical-grade DMSO (99.9%), applied transdermally twice weekly for five weeks-was implemented in three exploratory BI-RADS 4B cases using short-interval MRI and ultrasound reassessment. Two cases demonstrated complete radiologic resolution accompanied by vascular-signal normalization and stromal remodeling, including simultaneous remodeling of contralateral BI-RADS 2 nodules; one remained lesion-free during 12-month follow-up. A third case demonstrated a partial imaging-response pattern and was referred for fine-needle aspiration according to predefined reassessment criteria. No major adverse effects or tolerability-related discontinuations occurred; the intervention was discontinued after six sessions in the third case according to the predefined imaging-based stopping rule.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The framework integrates physiological modulation with response-oriented imaging reassessment while preserving compatibility with conventional oncologic workflows. Its low-complexity and reproducible outpatient architecture may possess translational relevance within resource-sensitive and Value-Based Healthcare-oriented breast-care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The exploratory implementation of the iodine-DMSO transdermal protocol yielded biologically coherent, imaging-detectable,","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1883180"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066514","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":"Women's perceptions of changes following the intervention on the prevention of mistreatment in gynecology and obstetrics in Guinea.","authors":"Alpha Oumar Sall, Mamadou Dioulde Balde, Sadan Camara, Kaba Saran Keita, Moussa Camara, Boubacar Alpha Diallo, Madeleine Toure, Aissatou Diallo, Fanta Barry, Tiany Sidibe","doi":"10.3389/frhs.2026.1860891","DOIUrl":"10.3389/frhs.2026.1860891","url":null,"abstract":"<p><strong>Context: </strong>The mistreatment of women in gynecology and obstetrics is practiced in all regions of the world. Studies conducted in Guinea have reported compelling evidence of this practice in gynecology and obstetrics services within health facilities. A prevention and response programme against this mistreatment was initiated and implemented in different regions of the country. The intervention for the prevention and struggle against this mistreatment in gynecology and obstetrics focused on raising awareness among women in the community through community health workers and community relays who received training for this purpose.</p><p><strong>Purpose: </strong>This study aims to determine the changes adopted after the implementation of the intervention by comparing the perceptions of women in the community before and after the intervention.</p><p><strong>Methods: </strong>This was a qualitative study conducted before and after the intervention to assess the changes perceived by women in the community. A purposive sample of 30 women before and 30 after the intervention was used. Community health workers and community relays, who also live and work within the community, identified and selected participants who met the criteria. Data were collected through in-depth individual interviews (IDIs) with 60 women of reproductive age in the community and analyzed using a thematic approach. Community awareness-raising for the prevention of mistreatment was carried out by community health workers and community relays.</p><p><strong>Results: </strong>The women in the community mostly reported a reduction in the frequency of mistreatment in gynecology and obstetrics, especially physical violence. However, according to some women, verbal violence and other forms of mistreatment persist.</p><p><strong>Conclusion: </strong>This intervention has shown signs of improvement in preventing and combating physical violence, but structural and relational forms of violence persist.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1860891"},"PeriodicalIF":2.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032070","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 a digital audit-and-feedback surveillance system for diabetic ketoacidosis: study protocol for the DEKODE programme.","authors":"Amanda Ling Jie Yee, Kalyaani Persad, Aspasia Manta, Amy Grove, Punith Kempegowda","doi":"10.3389/frhs.2026.1836949","DOIUrl":"10.3389/frhs.2026.1836949","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic ketoacidosis is one of the leading causes of unplanned hospital admission among people with diabetes, yet adherence to treatment guidelines remains inconsistent, contributing to variation in care and suboptimal outcomes. Conventional audit approaches are limited by non-standardised data collection, restricting benchmarking and shared learning. The Digital Evaluation of Ketosis and Other Diabetic Emergencies (DEKODE) platform was developed as a cloud-based audit-and-feedback system to support near real-time performance monitoring and continuous quality improvement, but its implementation requires theory-informed evaluation.</p><p><strong>Methods: </strong>This multi-site, mixed-methods study involves six National Health Service hospitals, including early adopters and sites new to DEKODE. Guided by an implementation research logic model, the study links contextual determinants to tailored strategies. Quantitative outcomes, including episode duration, guideline adherence, complications, and clinical outcomes, will be analysed using interrupted time series methods. Qualitative stakeholder interviews will be analysed thematically, and findings integrated using triangulation.</p><p><strong>Results: </strong>The study will assess the impact of DEKODE on clinical and process outcomes and identify determinants influencing adoption, fidelity, and sustainability.</p><p><strong>Discussion: </strong>Findings will inform scalable implementation of digital audit-and-feedback systems to reduce variation in acute diabetes care and improve patient outcomes.</p><p><strong>Clinical trial registration: </strong>https://www.isrctn.com/ISRCTN17096714, identifier ISRCTN17096714.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1836949"},"PeriodicalIF":2.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042182","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":"From cognitive overload to institutional escalation: formalizing the supply-demand production condition in patient-safety failure.","authors":"Yngve Mikkelsen","doi":"10.3389/frhs.2026.1846144","DOIUrl":"10.3389/frhs.2026.1846144","url":null,"abstract":"<p><p>Physician exit, unit closures, and regulatory interventions are conventionally treated as separate workforce and governance problems. The workload-patient safety literature documents the empirical relationship between system strain and deterioration in outcomes; the agency literature describes the information asymmetry governing physician behavior; the organizational safety science literature describes how systems drift toward failure under production pressure. What remains insufficiently specified is a formal account of the production conditions that may connect these literatures, and a candidate mechanism through which institutionally determined cognitive demands may translate, via physician decision-making, into outcome deterioration, recursive self-amplification, and observable institutional escalation. This paper offers a formal conceptual specification of that proposed mechanism. We represent clinical outcome quality as a function of the ratio of effective cognitive supply to cognitive demand: O = f(S/D), where S = I · f(WM, e, <i>λ</i>) and D = f(v, c, a). The notation is intended to make hypothesized relationships explicit and generate testable predictions; it is not an empirically estimated or validated cognitive production function. When effective supply becomes insufficient relative to demand, the effort-accuracy trade-off is expected to favor resource-conserving reasoning, increasing the risk of outcome deterioration. Institutions may observe indirect proxies of strain but not the proposed latent S/D condition directly or reliably in real time, creating an information asymmetry that can impede correction. A recursive feedback loop with asymmetric updating is proposed to account for nonlinear degradation and recovery. Drawing on Currie and colleagues' (2012) analysis of institutional work in healthcare and Hirschman's exit-voice-loyalty framework, we propose a four-tier escalation model (T1-T4) culminating in the agent's veto. T1-T4 is intended as a typical cost-increasing pathway rather than an invariant sequence; tiers may overlap or be skipped. A 31-case illustrative inventory across 16 jurisdictions (1999-2026) illustrates that phenomena classified as T4 are documented across diverse contexts but does not validate the causal framework or estimate prevalence. Six testable propositions are derived.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1846144"},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026773","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":"Building meaningful relationships through co-design: reflections from a participatory multi-year research partnership to create MedManageSCI.","authors":"Lauren Cadel, Angela Chow, Sander L Hitzig, Lisa M McCarthy, Shoshana Hahn-Goldberg, Carolen Carvalho, Emily Ching, Shannon Fiedorec, Michael Gateman, Anita Kaiser, Aaron Kowalchuk, Shveta Makim, Kiesha Mastrodimos, Holly Mo, Phillip Raney, Rasha El-Kotob, Sara J T Guilcher","doi":"10.3389/frhs.2026.1876265","DOIUrl":"10.3389/frhs.2026.1876265","url":null,"abstract":"<p><strong>Background: </strong>Participatory approaches to research, including co-design, are essential to enhancing healthcare quality and safety and for minimizing the research-to-practice gap. Our team co-designed a medication self-management toolkit, MedManageSCI, to empower adults with spinal cord injury/dysfunction (SCI/D) to better integrate medications into their daily lives.</p><p><strong>Objective: </strong>We reflect on the lessons learned through the co-development of MedManageSCI and provide practical considerations for future co-design and implementation research.</p><p><strong>Methods: </strong>A participatory multi-methods study was conducted to co-develop, implement, and evaluate MedManageSCI. A working group comprised of adults with SCI/D, caregivers, and healthcare providers guided all aspects of this research, participating in a total of 10 meetings over the three-year project. In the final meeting, a reflective discussion was facilitated to identify key insights, practical strategies, and future considerations for engaging a diverse group of individuals in a multi-year, participatory research process. The audio-recording and notes from this session were analyzed independently and with the working group.</p><p><strong>Results: </strong>The working group consisted of nine adults with SCI/D, nine healthcare providers (e.g., physicians, nurses, pharmacists, physical therapists, occupational therapists), and one caregiver from across Canada. We identified an overarching theme, development of meaningful relationships, which was enabled through the following three key insights: co-creating a vision and having a collaborative culture, ensuring structured and intentional engagement, and closing the loop through authentic transparency. Across the overarching theme and insights, we discuss practical strategies and future considerations to support meaningful and sustained engagement in participatory research.</p><p><strong>Conclusions: </strong>By sharing our processes and key learnings, our goal is to inform and strengthen future co-design and implementation research by promoting shared and inclusive leadership, ensuring meaningful engagement, and fostering psychologically safe environments.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1876265"},"PeriodicalIF":2.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018762","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":"Barriers and enablers for health system reform.","authors":"Danitza Chavez-Montoya, Caitlin Main, Kavyashree Satish, Borna Müller, Jennifer Gill, Panos Kanavos","doi":"10.3389/frhs.2026.1887541","DOIUrl":"10.3389/frhs.2026.1887541","url":null,"abstract":"<p><strong>Introduction: </strong>Health systems worldwide face escalating pressure from the growing burden of non-communicable diseases and population ageing, as well as chronic workforce shortages, infrastructure limitations, and structural misalignment between care models designed for acute illness and the long-term needs of complex patients. Many countries are pursuing comprehensive transformation efforts including shifting care closer to home, enhancing early disease detection and addressing workforce challenges. This study aims to identify examples of transformation across these domains, including specifically service delivery decentralisation, workforce transformation and enhancement of screening and diagnostic services for early detection and treatment - and determine common barriers and enablers in order to make recommendations for improvement.</p><p><strong>Methods: </strong>A mixed-methods approach, combining a scoping literature review and semi-structured one-on-one interviews was utilised. Searches of peer-reviewed literature were performed in EMBASE, Global Health, and Ovid MEDLINE databases. The Rayyan platform was used for systematic management of references, deduplication, and screening. Titles and abstracts were independently reviewed by two members of the research team before full-text review and data extraction. 153 peer-reviewed papers and 35 grey literature reports were analysed, whilst 17 expert stakeholders, including policy experts, academics, health policy experts and clinicians from six countries were interviewed.</p><p><strong>Results: </strong>67 transformation case studies were included. Of these, 36 were focused on service delivery decentralisation, 16 on screening and 12 were related to workforce adaptation. A final set of 34 barriers and 27 enablers was identified and grouped empirically into six areas including: political, governance and policy; funding, incentives & resource allocation; workforce capacity, capability & culture; system integration, structure and care coordination; digital infrastructure, technology and data; communication, engagement, and change management.</p><p><strong>Discussion: </strong>Finally, a set of 25 recommendations, across seven groups, are made for policy makers and other relevant stakeholders. These findings provide practical, evidence-based insights to guide policymakers in designing scalable, context-sensitive health system transformation strategies.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1887541"},"PeriodicalIF":2.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042169","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}