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Hoy — Abril 4th 2026Tus fuentes RSS

Spirituality Among Older Adults With Depression: An Interpretative Phenomenological Study

ABSTRACT

Introduction

Spirituality is a crucial yet complex element of holistic nursing care, particularly when providing care for older adults with depression. In Thailand, depression poses a significant mental health challenge. Thai cultural values are deeply interwoven with individuals' beliefs, making spirituality a critical factor in addressing the care of older adults with depression. This study aimed to explore how older adults with depression experience spirituality and construct meaning from it in their daily lives.

Design

An interpretative phenomenological study.

Methods

In-depth interviews of 30 older Thai adults living with depression (aged 60–85 years) from an outpatient psychiatric clinic in southern Thailand were conducted using semi-structured interview questionnaires. Interpretive phenomenological analysis was employed. Data were collected from June to August 2024.

Results

Five themes emerged from the phenomenological data analysis: (1) elusiveness of spiritual meaning, (2) holding oneself together through inner power, (3) finding acceptance through faith in a higher power, (4) family ties shaping peace and despair, and (5) being guided and cared for.

Conclusion

This study highlights that older adults with depression perceive spirituality as essential for their well-being. Personal practices, such as meditation and chanting, played a key role in strengthening spirituality and reducing the risk of relapse in depressive symptoms, which are distinct for each older adult. Understanding spirituality's role in mental health guides nurses to develop strategies for providing more empathetic spiritual care.

Clinical Relevance

Nurses must address depression in older adults through individualized practices to effectively empower their inner strength and coping mechanisms. Understanding each individual's spiritual practices is essential to help them harness their inner strength when coping with depression.

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La enfermera como figura clave para la alfabetización en materia de salud a la población

Actualmente el cuidado de la salud (entendida también como bienestar) es uno de los principales valores, no es de extrañar que los ciudadanos quieran informarse sobre cómo mantenerse sanos e incluso, sobre cómo ser felices (aunque esto último pueda ocasionar más malestar y frustración en quienes suponen que la felicidad es algo que se alcanza y no que algo que se construye). En esta búsqueda de información, las redes sociales, apps e internet juegan un papel fundamental. Sin embargo, estas fuentes no siempre aportan información válida o fiables y por ello, es necesario suplir esa necesidad de información garantizando un acceso a un conocimiento válido, sustentado en evidencia científica. Las enfermeras, por nuestra mayor accesibilidad, cercanía a la población y porque seguimos siendo los profesionales de la salud que inspiran más confianza, debemos tomar un rol protagonista en la alfabetización en salud de la población, para que los ciudadanos sean más competentes tanto para cuidar de su salud como para manejar la enfermedad y controlar los síntomas, pues todo ello redunda en un mayor bienestar y autonomía de nuestros pacientes.

ABSTRACT

Nowadays health (understood also as well-being) is a core value, it is no surprise that people want to learn about how to stay healthy and even how to be happy (although the latter can cause more discomfort and frustration for those who believe happiness is something achieved rather than something which is built). Social media, apps, and the internet play a fundamental role in this search for information. However, these sources not always provide valid or reliable information, so it is essential to address this need by ensuring access to valid knowledge based on scientific evidence. Nurses, due to our greater accessibility, our proximity to the population, and because we continue to be the most trusted healthcare professionals, must take a leading role in promoting health literacy. This will empower citizens to be more competent in managing their health, managing illness, and controlling symptoms, ultimately leading to greater well-being and autonomy for our patients.

Social Isolation and Loneliness Among Older Asian Immigrants Through the Lens of Sense of Coherence: Systematic Review of Qualitative Studies

ABSTRACT

Aim

To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.

Design

Systematic review of qualitative studies.

Data Sources

AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.

Methods

Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.

Results

Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.

Conclusion

Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.

Implications for the Profession and Patient Care

This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.

Reporting Method

The review was undertaken and reported using the PRISMA guidelines.

Patient or Public Involvement

None.

Protocol Registration

PROSPERO (CRD42023425752)

Study reveals need for support and common misperceptions about antimicrobial stewardship and disease knowledge among caregivers of patients with paediatric pneumonia

Por: Zhang · N. · Arunachalam · U.

Commentary on:

Implications for practice and research

  • Nursing practice should implement targeted caregiver education and consistent followup to reduce anxiety, prevent burnout, and improve outcomes

  • Future research should investigate the effectiveness of educational interventions and innovative care models in supporting caregivers and preventing burnout.

  • Context

    Huang et al explore knowledge and attitudes of pneumonia and antibiotic use among caregivers of paediatric patients with community-acquired pneumonia (CAP).1 Caregiver support is a core tenet of holistic care. Nurses have played a major role in supporting caregivers to decrease burnout, improve knowledge and overall support psychological well-being.2 One population where caregiver support has an established need is in the paediatric population.3 Educational interventions on antibiotic knowledge of paediatric caregivers have been found to be effective in bridging knowledge gaps.4 Furthermore, some literature has established knowledge deficits in caregivers...

    Mental health status and associated factors among rural adult women: findings of a community-based cross-sectional study in Bangladesh

    Por: Islam · M. Z. · Sharf-Ul-Alam · S. M. · Rahman · M. F. · Mahmood · F. · Farhana · N. · Akter · S. · Parveen · T. · Alam · Z. · Azim · A. · Khan · M. A. S.
    Objectives

    To assess the mental health status and identify associated factors among rural adult women in Bangladesh.

    Design

    Cross-sectional study using face-to-face interviews with a semistructured questionnaire.

    Methods

    Data were collected between January and February 2025 in three rural upazilas (Dhamrai, Nawabganj and Sreepur) using multistage systematic sampling. The semistructured questionnaire included sociodemographic characteristics, household assets and the Depression Anxiety Stress Scale-21 (DASS-21). The wealth index was calculated using principal component analysis. Cases with mild to extreme levels of depression, anxiety and stress were grouped together to indicate the presence of any level of the three mental health problems. Statistical analyses included descriptive statistics, bivariate analyses using ², Fisher’s exact test and Welch two-sample t-test, and multivariable binary logistic regression to identify predictive factors of mental problems. A Venn diagram was generated to display the proportion of patients with anxiety, depression and stress. Data analysis was performed using SPSS (V.26) and R Studio (V.2025.05) with a significance level of p

    Participants

    A total of 1350 women aged 18 years or older who were available at home during the data collection period and gave consent to participate. Women who were unable to participate due to illness were excluded.

    Results

    Participants had a mean (±SD) age of 36.35 (±12.58) years. The prevalence of depression, anxiety and stress was 47.7%, 60.7% and 23.2%, respectively. Moderate severity was most common among patients with depression (20.34%), anxiety (24.20%) and stress (8.03%). 20% of participants experienced all three conditions simultaneously, with 22% having both depression and anxiety. Multivariable analysis revealed that factors associated with an increased odds of depression, anxiety and stress were chronic diseases (ORs (95% CIs): 2.02 (1.50 to 2.73), 1.44 (1.05 to 1.99) and 1.91 (1.35 to 2.71), respectively) and history of abuse (1.84 (1.28 to 2.66); 3.15 (2.06 to 4.93) and 1.91 (1.28 to 2.83), respectively). Family history of mental illness was associated with an increased odds of anxiety (1.71 (95% CI 1.12 to 2.87)) and stress (1.61 (95% CI 1.01 to 2.52)). So was the presence of a caregiving role (1.68 (95% CI 1.18 to 2.42) and 1.50 (95% CI 1.02 to 2.19) for anxiety and stress, respectively). Having a financial problem was associated with an increased odds of anxiety (1.52 (95% CI 1.16 to 2.00)). A happy family relationship was associated with decreased odds of depression (0.28 (95% CI 0.20 to 0.93)), anxiety (0.22 (95% CI 0.06 to 0.60)) and stress (0.50 (95% CI 0.25 to 1.00)). Conjugal satisfaction was protective against anxiety (0.42 (95% CI 0.18 to 0.80) and stress (0.32 (95% CI 0.17 to 0.59)). Unexpectedly, higher wealth status (being rich) increased depression (1.56 (95% CI 1.04 to 2.34) and anxiety (1.57 (95% CI 1.03 to 2.41) risk.

    Conclusions

    A major segment of rural adult women of Bangladesh experiences mental health problems. The findings recommend community-based comprehensive mental health screening programmes, interventions and integration of mental healthcare into primary health systems to address this critical public health challenge.

    Nurse Practitioner Students' Perceptions of an Artificial Intelligence Differential Diagnosis Tool: A Pilot Study

    ABSTRACT

    Aim

    The aim of this study is to assess nurse practitioner students' perceptions and engagement with Isabel's artificial intelligence (AI) based differential diagnosis tool to support their decision-making skills during their theoretical and clinical placement training.

    Design

    This pilot study used a cross-sectional design.

    Methods

    Twenty-six nurse practitioner students provided feedback on their use of an AI differential diagnosis tool in both academic and clinical contexts. This survey used the Post-Study System Usability Questionnaire to assess the engagement levels and usability of the AI tool. Additional questions were included to evaluate the usage patterns, adequacy in training and confidence in diagnosis.

    Results

    There were mixed engagement levels: 44.4% (n = 8/18) used Isabel in two subjects—typically one or both clinical placement units—and 27.8% (n = 5/18) in one subject; students most often used the tool to confirm differential diagnoses. Usability was rated positively with the disease ranking, red flag diagnosis and link to national guideline features demonstrating the highest student usage. While most students found the tool beneficial to use during clinical placement and completing university assignments, some reported challenges due to insufficient training, impacting confidence in clinical application.

    Conclusion

    Isabel has potential as a valuable educational tool in Nurse Practitioner programs, but successful implementation depends on adequate training and support. The findings highlight the importance of comprehensive training and support to maximise AI tool utilisation, with direct implications for programme curricula, clinical education strategies and potential improvements in diagnostic reasoning skills for future nurse practitioners.

    Implications for the Profession and/or Patient Care

    This study provides an example of integrating artificial intelligence (AI) guided clinical decision-making training in nurse practitioner (NP) education. The findings can be used by educational institutions to trial similar AI-integrated learning approaches, enhancing diagnostic competence and potentially improving patient care outcomes.

    Reporting Method

    The Study adhered to the STROBE checklist for reporting.

    Patient or Public Contribution

    No patient or public contribution was made to this study.

    Impacts of Financial Stress on Mental Health and Wellbeing of Nursing Students: A Systematic Integrative Review

    ABSTRACT

    Aim

    To explore the direct relationship between financial stress and mental health and wellbeing of nursing students and characterise the effectiveness of available support mechanisms.

    Design

    Systematic integrative review.

    Data Sources

    Academic Search Complete, CINAHL, Education Research Complete, MEDLINE, ProQuest Central, PsycNET, Scopus and Web of Science were searched in January and October 2024.

    Methods

    Studies reporting a direct relationship between financial stress and mental health and wellbeing in nursing students were included. Data related to sources of financial stress, mental health impacts, and support mechanisms were extracted, synthesised narratively, and reported thematically.

    Results

    Findings from nine studies reveal that financial stress significantly affects nursing students' mental health and wellbeing, contributing to emotional distress and reduced quality of life. Financial stress arises from personal, academic and clinical sources, with the intensity varying based on individual demographic profiles and fluctuating throughout their educational journeys. Marginalised and underserved groups experience greater impacts due to pre-existing disadvantages. Current support mechanisms are largely reactive, providing only short-term relief and failing to address root causes. Additionally, students' efforts to alleviate financial stress in one domain often exacerbated it in another.

    Conclusion

    This review highlights the multifaceted and compounding effects of financial stress on nursing students' mental health and wellbeing. Proactive strategies, including structured employment programs, embedded financial literacy education, and transparent pre-enrolment information offer promising solutions.

    Implications for the Profession

    While financial stress cannot be fully eradicated, targeted support for at-risk students can mitigate its impacts, improving their mental health and educational outcomes.

    Impact

    This review addresses the critical issue of financial stress among nursing students, highlighting its disproportionate impact on marginalised and underserved groups. It underscores the need for proactive interventions and systemic reform to improve educational experiences globally.

    Reporting Method

    Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement.

    Patient or Public Contribution

    No patient or public contribution.

    Trial Registration: PROSPERO: CRD42024514262

    Doctoral Education: The Need for Radical Reform

    ABSTRACT

    In this final editorial of our group of four, we take up the challenge of thinking about radical reform of doctoral education. We contend that without decisive action, nursing risks losing its capacity to shape the future of healthcare. Therefore we suggest there is a need for radical reform of doctoral education, focusing on three key areas.

    Mapping the direct and indirect costs of patient and public involvement (PPI) in stroke and aphasia research: a scoping review protocol

    Por: Charalambous · M. · Kountouri · A. · Kola · E. · Claudia De Souza · A.
    Introduction

    Patient and public involvement (PPI) is increasingly embedded in stroke and aphasia participatory research, enhancing relevance and inclusivity. While the benefits of PPI are well-documented, the costs, both direct (eg, honoraria, travel, accessibility materials) and indirect (eg, time, administrative burden, emotional labour), remain poorly reported. This scoping review aims to (1) identify and categorise direct and indirect costs of PPI in stroke research, (2) examine how these costs are defined, reported or implied, (3) map cost-related barriers and facilitators and (4) expose evidence gaps to inform the Mapping the Economic and Social Tangible and Emotional Resources of Patient and Public Involvement (MASTER-PPI) framework.

    Methods and analysis

    Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we will search Medline, PUBMED, Embase, CINAHL, APA PsycINFO, Scopus and Web of Science, as well as grey literature (NIHR INVOLVE, Horizon Europe, non-governmental organisation (NGO) reports). Eligible studies include those reporting or implying direct or indirect costs of PPI in stroke research. Two reviewers will independently screen and extract data, which will be synthesised descriptively and thematically. Findings will be aligned with the MASTER-PPI framework.

    Ethics and dissemination

    Ethical approval is not required. The findings will be disseminated through peer-reviewed journal publications, conference presentations, social media posts in lay language and policy briefs tailored for NGOs and funders.

    Registration

    This protocol is registered with the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/VM9ZU).

    Doctoral Education in Nursing Is a ‘Special Issue’

    ABSTRACT

    The extent to which the analysis of the state of play of doctoral education and suggested ways forward are seen as being radical is of course dependent on the context within which nursing research programs currently exist. We are aware that no one size fits all contexts, but we are also aware of a critical need to challenge dominant perspectives and practices and work toward a radical repositioning of the nursing PhD. At a time when the narrative of nursing shortages is pervasive, we need to be positioning nursing research and researchers at the heart of the solution. Without a radical reconsideration of how we build sustainable research teams, the opportunity will bypass us. The special issue on doctoral education deliberately set out to be disruptive, to surface critical questions and trigger a conversation that needs to be had. We are open to continuing this conversation.

    Nursing Students' Perceptions of Acceptable Use of Smartphones During Clinical Placement: A Cross‐Sectional Study

    ABSTRACT

    Background

    The rise in smartphone use presents opportunities and challenges in clinical settings. Despite guidelines restricting mobile phone use, nurses frequently rely on them for various purposes. While beneficial, smartphone use poses risks to information security, patient safety, and care quality, prompting the need for monitoring.

    Objective

    This study examined smartphone usage among nursing students and their perspectives on acceptable and unacceptable use during clinical placements.

    Design

    This cross-sectional study used convenience sampling to recruit undergraduate nursing students from five universities in Australia and New Zealand. Participants completed the Attitude Towards Digital Device Use during Clinical Placement (Adduct) Scale online between September 2021 and August 2022. The survey included closed and open-ended questions. Descriptive and inferential analyses were conducted using SPSS. Exploratory factor analysis identified attitudinal dimensions, while group comparisons assessed demographic variations. Qualitative responses were thematically analysed. Reporting followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

    Results

    Among 279 respondents, drawn from an eligible population of 2682 students, the response rate was 10.4%. Age significantly influenced perceptions of unacceptable smartphone use. Younger students (mean age = 25.0, SD = 9.8) were more likely to view such use as acceptable, with those up to 21 years reporting higher scores on the Unacceptable Use sub-scale compared to older peers (p = 0.024). Most respondents found smartphone use beneficial for accessing information and learning, though concerns included distractions and confidentiality breaches. Younger students were at greater risk of non-adherence to guidelines.

    Conclusion

    Smartphones can enhance learning and efficiency, but clear guidelines and education are needed to balance benefits with risks, particularly for younger students.

    Relevance to Clinical Practice

    This study highlights the need for clear guidelines and structured training to balance educational benefits of smartphone use with the risks of distraction and breaches of patient confidentiality in clinical practice.

    Patient or Public Contribution

    No patient or public pontribution.

    Prevalence of texting thumb among medical students and its association with behavioural patterns during digital device usage: a cross-sectional study

    Por: Salameh · M. A. · Odeh · H. · Boyajian · S. D. · Amaireh · E. A. · Jaradat · E. · Bawardi · S. S. · AlTaamreh · B. · Al Haj Ali · N. S. · Madi · A.
    Background

    Teenagers widely use digital devices for information sharing and other daily activities. Their heavy reliance on smartphones and tablets may contribute to repetitive-use injuries of the thumb.

    Objectives

    This study aimed to investigate the prevalence of texting thumb (TT) among medical students and to identify the potential associations between TT and behavioural patterns during digital device use.

    Design, setting and participants

    This cross-sectional study employed an online, self-developed questionnaire to assess demographic and behavioural patterns associated with smartphone use. Data on thumb pain and its features were evaluated for diagnostic purposes. This study comprised medical students from six medical schools in Jordan. Data were collected from 482 medical students, excluding those who did not meet the inclusion criteria.

    Results

    The prevalence of TT was 34%, predominantly on the right side (53%) and at the thumb base (69%). The findings suggest that TT was significantly associated with specific behavioural patterns, including supporting the forearm (p=0.026, adjusted OR: 1.611; 95% CI 1.059 to 2.449), number of texting per day (p=0.005, adjusted OR: 1.319; 95% CI 1.086 to 1.603) and studying hours per day using a digital device (p=0.002, adjusted OR: 1.586; 95% CI 1.193 to 2.109). Also, students’ attitudes toward thumb pain were significantly associated with the TT (p=0.005, adjusted OR: 1.351; 95% CI 1.094 to 1.668).

    Conclusion

    Students’ attention to behavioural patterns is crucial when using digital devices. Supporting the forearm, limiting text message use, avoiding prolonged use of digital devices, never ignoring hand pain and resting the hand significantly reduce the risk of thumb overuse injury.

    Prevalence and determinants of unintended pregnancy among female sex workers (FSW) in Jashore, Bangladesh

    by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan

    Background

    Unintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.

    Methods

    A cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.

    Result

    The lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.

    Conclusion

    This study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.

    Invisible pero científica: la Enfermería en el Día de la Mujer y la Niña en la Ciencia

    La Organización de las Naciones Unidas (ONU) proclamó el 11 de febrero como el Día Internacional de la Mujer y la Niña en la Ciencia, con el objeto de promover el acceso y la participación plena y en condiciones de igualdad a mujeres y niñas en la ciencia, la tecnología y la innovación puesto que, lógicamente, la ciencia no tiene género. Sin embargo, las barreras y prejuicios sistémicos que apunta la ONU como justificación de la necesidad de este día, seguramente sí impactan en nuestra disciplina, altamente feminizada, y puede ser uno de los motivos por los que esta sea entendida más como una carrera vocacional que como una carrera científica, pese a que eso no sea realmente así.

    ABSTRACT
    The United Nations (UN) proclaimed February 11 as the International Day of Women and Girls in Science, in order to promote full and equal access to and participation by women and girls in science, technology, and innovation, since science, logically, has no gender. However, the systemic barriers and prejudices cited by the UN as justification for the need for this day do have a gender. These prejudices surely do impact in our discipline, highly feminized, and may be one of the reasons why it is often understood as a vocational career rather than a scientific one, despite this not being entirely the case.

    A systematic review of the scope and impact of rural primary healthcare innovations using digital health technology

    Por: MacAskill · W. · Gill · P. · Woloszczuk · C. · Alam · K. · Wallis · K. · McGrail · M. R. · Kondalsamy-Chennakesavan · S. · Nasir · B. F.
    Objectives

    Digital technology in primary healthcare service delivery can enhance accessibility, service delivery and health outcomes in rural populations. The objective of this systematic review is to review and synthesise the scope and impact of digital health technology innovations within rural primary healthcare settings.

    Design

    Systematic review.

    Data sources

    Articles published on PubMed, PsycINFO, Cochrane Central, SCOPUS, Web of Science, EMBASE and CINAHL between January 2013 and October 2025 were searched using key search terms.

    Eligibility criteria

    Patient, intervention, context, outcome model criteria guided article eligibility. Included articles were undertaken in rural populations, used digital health technology for treatment or management, explored the impact of digital health technology on rural primary healthcare and reported on healthcare outcomes. Included articles were in the English language and presented peer-reviewed primary research.

    Data extraction and synthesis

    Extraction was performed using a bespoke standardised template by multiple reviewers. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. Descriptive analysis and conventional inductive content analysis were applied to quantitative and qualitative data, respectively. The review is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement guidelines.

    Results

    66 studies were included in the review. Most studies were conducted in the USA (n=26). Most studies focused on adult patient populations, with limited representation of Indigenous (In=3) and paediatric populations (n=2). Telemedicine/telehealth interventions using audio, video or both were the most common (n=36). Remote patient monitoring or point-of-care testing was integrated into 21 studies. Physical health conditions, particularly diabetes (n=17), cardiovascular diseases (n=11) and general primary healthcare concerns (n=13) were commonly reported. Others reported on areas including mental health, hypertension, obesity and pregnancy care.

    Conventional inductive content analysis identified key themes: cost and time effectiveness, quality healthcare provision, consumer acceptance from both patients and practitioners, and healthcare service provider perspectives. Uptake barriers included staff workload and patient non-compliance, while facilitators encompassed process standardisation and practitioner acceptance and endorsement. Consumer acceptance was linked to satisfaction, willingness to engage and improved health outcomes and well-being.

    Conclusions

    Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including the integration of artificial intelligence. Overall, digital health interventions offer a promising avenue to improve healthcare outcomes in rural areas and should be prioritised for government funding and investment.

    PROSPERO registration number

    CRD42023477233.

    Understanding the acceptance of medical marijuana among Malaysian adults: a cross-sectional online survey

    Por: Rahman · A. B. · Naserrudin · N. A. · Seman · Z. · Zin · Z. M. · Dapari · R. · Hassan · M. R. · Rashid · A. A. · Dahaban · M. U. M. · Jahaya · N. H. · Balamurugan · H. · Krishnan · M.
    Background

    Global discussions surrounding the medical use of marijuana have gained momentum; yet in Malaysia, cannabis remains strictly prohibited under the Dangerous Drugs Act 1952. Despite its legal status, there is growing public discourse on its potential therapeutic benefits. Understanding public acceptance is critical for informing future health policies and public education efforts.

    Methods

    This study used a cross-sectional design, web-based survey among Malaysians aged 18 years and above using convenience and snowball sampling methods. The survey collected data on sociodemographic characteristics, lifestyle factors (eg, smoking and drug use), awareness of medical marijuana and perceived risk. Multivariable logistic regression analysis was performed to identify factors associated with acceptance of medical marijuana decriminalisation.

    Results

    Out of 2047 respondents, 88.4% supported medical marijuana decriminalisation based on clinical evidence. Key predictors of acceptance included male gender (adjusted OR (AOR) 1.71; 95% CI 1.29 to 2.26), higher education (Bachelor’s degree AOR 1.56; 95% CI 1.09 to 2.23 and Master’s/PhD AOR 2.04; 95% CI 1.34 to 3.10), self-employment (AOR 1.84; 95% CI 1.22 to 2.77) and private sector employment (AOR 1.40; 95% CI 1.03 to 1.89). Behavioural factors, such as smoking (AOR 1.58; 95% CI 1.10 to 2.27), prior drug use (AOR 1.86; 95% CI 1.30 to 2.67) and low perceived risk (AOR 5.82; 95% CI 3.48 to 9.73), were also significantly associated with acceptance.

    Conclusions

    A large proportion of Malaysian adults supported the clinical use of medical marijuana. Acceptance was strongly associated with demographic and behavioural factors, particularly gender, education and perceived risk. These findings may guide the development of targeted public health education and inform future discussions on regulatory approaches in Malaysia.

    Frailty and disability among older adults residing in Rohingya refugee camp in Bangladesh

    by Afsana Anwar, Mahmood Parvez, Farhan Azim, Uday Narayan Yadav, Saruna Ghimire, Ateeb Ahmad Parray, Shovon Bhattacharjee, ARM Mehrab Ali, Rashidul Alam Mahumud, Md Irteja Islam, Md Nazmul Huda, Mohammad Enamul Hoque, Probal Kumar Mondal, Abu Ansar Md Rizwan, Suvasish Das Shuvo, Sabuj Kanti Mistry

    Background

    Frailty and disability often emerge with ageing and affect quality of life. Older adults residing in Rohingya refugee camp in Bangladesh are particularly susceptible to frailty and disability due to adverse physical and social environment along with limited health and social care services available in the camp. This study aimed to investigate the prevalence and factors associated with frailty and disability among Rohingya older adults living in Bangladesh.

    Methods

    This cross-sectional study was conducted among older adults aged ≥60 years residing in the Rohingya refugee settlement in Bangladesh. The primary outcomes were frailty and disability, explored using the ‘Frail Non-Disabled (FiND) questionnaire. Data were collected face-to-face during November-December 2021, using a semi-structured questionnaire. A multinomial logistic regression model was used to identify the factors associated with frailty and disability.

    Results

    The majority of participants (n = 864) were aged 60–69 years (72.34%), male (56.25%), married (79.05%), and without formal education (89.0%). The study revealed a high prevalence of frailty (36.92%) and disability (55.21%) among the participants. The multinomial regression analysis showed that the likelihood of experiencing disability was significantly higher among participants who were aged 70–79 years (RRR = 2.65, 95% CI: 1.25, 5.66) and ≥80 years (RRR = 8.06, 95% CI: 1.05, 61.80), were female (RRR = 3.93, 95% CI: 1.88, 8.1.9), had no formal education (RRR = 4.34, 95% CI: 2.19, 8.63), were living in a large family (RRR = 1.82, 95% CI: 1.05, 3.18) and were suffering from non-communicable diseases (RRR = 2.36, 95% CI: 1.32, 4.22) compared to their respective counterparts. The regression analysis also revealed that frailty was significantly higher among participants who were female (RRR = 2.82, 95% CI: 1.34, 5.94), were suffering from non-communicable diseases (RRR = 2.28, 95% CI: 1.27, 4.09), and had feeling of loneliness (RRR = 2.16, 95% CI: 1.11, 4.22).

    Conclusions

    The findings underscore the need for long-term care and health promotion activities to alleviate the burden of frailty and disability among older adults in humanitarian settings. Efforts should particularly target the most vulnerable groups- older individuals (≥80 years), women, those without formal education, those living in large families, and those with non-communicable diseases.

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