Conectar
Ensuring equity in medical specialist distribution is essential for achieving universal health coverage (UHC). This study explored the changes in the availability and distribution of medical specialists in Thailand from 2015 to 2024 and assessed the equity impacts on workforce.
A retrospective longitudinal analysis of national administrative workforce data.
Public and private hospitals across Thailand, covering 1471 facilities in 77 provinces.
The primary outcomes were specialist-to-population ratios and geographical equity measured using the Gini coefficient (G), where values closer to 0 indicate greater equity. Explanatory variables included specialty type, geographical region and the timing of major workforce policies, including mandatory service and specialty-specific legislative interventions.
Between 2015 and 2024, the GPs and specialists in Thailand expanded significantly, with improvements in both density and distribution. The Gini coefficient for GPs showed the largest equity improvement (G=0.42 in 2015 and G=0.22 in 2024), reflecting the impact of mandatory service programme and rural recruitment programmes. Among specialists, emergency and family medicine have shown rapid growth and significant reductions in distribution inequity, reflecting the success of legislative policies. Sustainability of workforce policies was challenged by the ‘leaking stock’ phenomenon due to attraction of career opportunities and economic drives.
Workforce targeted interventions have led to improvements in the availability and equitable distribution of GPs and medical specialists over the past decade. Further policy, such as retention incentives and assisted technology, is needed to achieve equitable distribution across all specialties, particularly in low-density fields. Thailand’s experience offers the lessons for other low- and middle-income countries as the evidence-based and equity-focused workforce policies for UHC advancement.
Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.
A cross-sectional study.
This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).
The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.
The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.
HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.
STORBE guidelines.
No patient or public contribution.
To analyse current Glasgow Coma Scale practice among emergency nurses in China and identify factors influencing assessment quality.
A quantitative, multicenter cross-sectional design.
A convenience sample of 1740 emergency nurses from secondary and tertiary hospitals across 21 provinces completed a validated structured questionnaire between March and April 2025. Participants had at least 6 months of emergency nursing experience. Data analysis included descriptive statistics, chi-square tests, and multiple logistic regression to examine factors influencing correct Glasgow Coma Scale application.
Participants had a mean age of 29.8 years (SD = 6.2). Only 52.5% of nurses demonstrated correct Glasgow Coma Scale application despite 97.0% having theoretical knowledge of scoring criteria. While 56.8% had received Glasgow Coma Scale training, significant standardisation deficiencies emerged. Notably, 41.8% of departments lacked operational guidelines, and 53.7% of nurses experienced scoring disagreements with colleagues. Clinical utilisation varied substantially by patient population: traumatic brain injury (97.8%), neurological diseases (96.9%), and systemic critical illness (85.8%). Multivariate analysis identified six significant factors influencing correct application: standardised training (OR = 2.252, 95% CI: 1.789–2.825), manageable workload ≤ 4 patients/shift (OR = 1.652, 95% CI: 1.327–2.057), departmental guidelines (OR = 1.523, 95% CI: 1.233–1.881), extensive work experience ≥ 9 years (OR = 1.534, 95% CI: 1.182–1.992), while multidisciplinary collaboration issues (OR = 0.559, 95% CI: 0.439–0.712) and special patient experience (OR = 0.520, 95% CI: 0.406–0.666) were associated with reduced accuracy.
Substantial standardisation challenges exist in Glasgow Coma Scale practice among Chinese emergency nurses, characterised by significant gaps between theoretical knowledge and clinical application. Major barriers include insufficient standardised guidelines, inconsistent training approaches, and inadequate interdisciplinary collaboration.
Healthcare administrators should develop national standardised guidelines, implement simulation-based training programs, optimise emergency workflows, and integrate alternative assessment tools to enhance consciousness assessment accuracy and improve patient safety.
STROBE statement adherence.
No patient or public contribution.
by Dandan Feng, Yakun Song, Zuqi Wu, Wuruo Liu, Yuting Pu, Yangcan Gao, Yuying Sun, Jiquan Zhang
Trypsin, a canonical serine protease in crustaceans, plays a crucial role in ontogeny and antibacterial defense. Whether these biological functions correlate with its catalytic characteristics remains unresolved in the freshwater shrimp Neocaridina denticulata sinensis. To address this gap, we characterized a trypsin gene from N. denticulata sinensis (NdTryp) and assessed both its biological roles and its prospective utility. NdTryp was predominantly expressed in the hepatopancreas, where it localized to storage cells (R-cells) and tubule-lining epithelial cells (ECTs). Across development, NdTryp transcripts were essentially absent during early embryogenesis but rose sharply at late stages, temporally coincident with hatching and the onset of feeding. After a challenge with Vibrio parahaemolyticus, the expression of NdTryp was induced, with the expression level significantly increased relative to the baseline expression level. RNA interference-mediated knockdown rendered shrimp more susceptible to infection and was accompanied by extensive hepatopancreatic injury, including epithelial detachment and disruption of the basement membrane. Biochemically, recombinant NdTryp (rNdTryp) displayed proteolytic activity over a broad temperature and pH span. Activity was differentially tuned by metal ions, with several divalent cations producing marked enhancement, whereas ferric iron exerted strong inhibition. Overall, our results showed that NdTryp functions as a multifunctional protease involved in both late embryonic development and innate antimicrobial defense. Furthermore, the robust stability of rNdTryp underscores its potential as an aquafeed additive and candidate for enzymatic biotransformation.by Congli Jia, Fu Yang, Yingchun Li
ObjectiveThis study aimed to identify diagnostic biomarkers for keloid and explore potential therapeutic agents from traditional Chinese medicine (TCM) by integrating network pharmacology approaches. Specifically, we sought to uncover key molecular targets for Aloe vera and validate their roles in keloid pathogenesis.
MethodsWe integrated keloid transcriptome datasets (GSE218007 and GSE237752) by merging GEO data, and identifying differentially expressed genes (DEGs). Functional enrichment analysis (GO, GSEA) and machine learning approaches were applied to select diagnostic biomarkers. Candidate genes were validated via Receiver Operating Characteristic (ROC) curves in training and independent cohorts (GSE44270). PPI networks and Cytohubba algorithms identified hub genes, while TCMSP-screened compounds from Aloe vera were docked with targets using molecular docking.
Results91 Identified DEGs enriched in fibrosis-related pathways. Machine learning prioritized two diagnostic biomarkers: AMPH and TNFRSF9 (AUC > 0.85 in training/testing). PPI analysis revealed IL6 as a hub gene. Aloe vera-derived quercetin targeted HAS2 and IL6 (both P Conclusion
AMPH and TNFRSF9 are promising diagnostic biomarkers for keloid, while quercetin from Aloe vera targets HAS2 and IL6, offering therapeutic potential. The dual role of IL6 underscores its centrality in keloid pathogenesis, connecting bioinformatics predictions with TCM pharmacology. This study provides a foundation for clinical prediction and targeted treatment strategies.
The implantable cardioverter defibrillator (ICD) is a cardiac device recommended for use to prevent the occurrence of sudden cardiac death (SCD) in post-myocardial infarction (MI) patients with reduced left ventricular ejection fraction (LVEF). The evidence informing this guidance comes from landmark trials that are now more than 20 years old. The risk-benefit profile of ICD for the contemporary target population may have changed substantially since then, which raises the question of whether there is evidence for sparing patients a procedure associated with potentially severe complications and high healthcare costs. A main part of the PRevention Of sudden cardiac death aFter myocardial Infarction by Defibrillator implantation (PROFID) project is the PROFID EHRA trial, which is supported by the European Heart Rhythm Association. PROFID EHRA is a European Union-funded, prospective, randomised, multi-centre, non-inferiority study designed to compare optimal medical therapy (OMT) alone to ICD with OMT, for post-MI patients with reduced LVEF. The study also describes economic evaluation methods to quantify the cost and health implications of using OMT alone in place of ICD implantation plus OMT in this group of patients.
The economic evaluation has been designed to conduct a pre-trial cost-effectiveness analysis (CEA) prior to the availability of trial data, followed by a within-trial cost-consequences analysis (CCA) and a long-term post-trial CEA, conducted from the National Health Service and Personal Social Service perspective in England. The pre-trial CEA uses simulation modelling informed by available evidence to assess the lifetime costs and quality-adjusted life years of OMT alone and ICD+OMT in post-MI patients with reduced LVEF at risk of SCD, as defined in the PROFID EHRA trial. The within-trial CCA is intended to summarise the health-related quality of life (HRQoL), healthcare resource use and associated costs observed during the PROFID EHRA trial follow-up period. The post-trial CEA updates the pre-trial model by incorporating contemporary evidence about the HRQoL and costs observed during the trial and the occurrence of those events and outcomes accruing during the trial follow-up period and projecting them into the expected lifetime of the patients. Sensitivity analyses are performed to assess the robustness of the CEA results with respect to both model assumptions and uncertainty in the value of the model input parameters. Finally, a value of information analysis will identify the key drivers of uncertainty surrounding the model conclusions regarding the optimal treatment strategy, establishing if further research may be required.
The PROFID EHRA trial, under legal sponsorship of Charité—Universitätsmedizin Berlin, Germany, received its first ethics approval by the Medicine Research Ethics Committee of the La Paz University Hospital in Madrid, Spain (reference number LHS-2019-0209). Before including patients, for all participating study centres, the required local, central and/or national ethical approval has to be obtained. As of the date 13 November 2025, at least one participating study centre in the following countries has received ethical approvals from relevant ethics committees: Austria, Belgium, Czech Republic, Denmark, France, Germany, Great Britain, Hungary, Israel, the Netherlands, Poland and Spain. Results will be shared with the general public through various media channels and additionally with healthcare professionals and the scientific community through scientific meetings, conferences and publications.
Investigate the epidemiological characteristics of outpatients initially diagnosed with skin ulcers who were ultimately confirmed to have cutaneous malignant tumours, and provide a diagnostic and therapeutic basis for the occurrence of secondary diseases in chronic wounds. We conducted a retrospective study analysing clinical data from patients initially diagnosed with skin ulcers at our hospital between July 2021 and February 2025, and analysed the epidemiological characteristics of malignant transformation in these ulcer cases. Among 128 patients initially diagnosed with skin ulcers, 16 cases (12.5%) were confirmed with cutaneous malignancies. The malignant group had a significantly higher mean age (69.44 ± 11.30 years) compared to the non-malignant group (58.39 ± 17.88 years; t = 5.752, p = 0.01). The distribution of lesion sites differed significantly between the malignant and non-malignant groups (χ2 = 30.498, p < 0.01). In the malignant group, the head and neck (41.2%) and trunk & extremities (41.2%) were the predominant sites. The most common malignancy was squamous cell carcinoma (SCC). The trunk & extremities was the most frequent site (62.5%). The second was basal cell carcinoma, which mainly occurs in the head and neck (80.0%). The mean duration of ulceration was 4.5 years. The primary treatment modality was surgical excision (11 cases, 68.8%). Approximately one-seventh of skin ulcer cases were confirmed as cutaneous malignancies. This finding underscores the significance of skin ulcers as potential malignant lesions, highlighting the need for clinicians to maintain a high index of suspicion and promptly perform histopathological examinations to improve early detection rates of skin cancers.
Nurses' health status significantly impacts their well-being and patient safety. Workflow interruptions, perceived workload, and missed nursing may potentially affect their physical and mental health. However, there is currently a lack of systematic studies on the relationships between these factors.
This study aims to explore how workflow interruptions influence nurses' health status through perceived workload and missed nursing, and provide strategies to promote nurses' health.
In October 2024, an online survey was conducted among 646 clinical nurses from three healthcare facilities in Henan Province. The survey covered nurses' demographic information, workflow interruptions, health status, perceived workload and missed nursing. Statistical analysis and model construction and validation were performed using SPSS 25.0 and AMOS 26.0 software.
Workflow interruptions were significantly negatively correlated with both physical component summary and mental component summary. Perceived workload and missed nursing served as mediators between workflow interruptions and physical and mental component summaries.
Workflow interruptions directly affect nurses' health status and indirectly influence it through perceived workload and missed nursing. Therefore, strategies should be implemented to optimise workflows, reduce workflow interruptions, lower perceived workload and take measures to minimise missed nursing. Future research could explore how to implement workflow optimization to improve nurses' health status effectively.
This study provides important guidance for improving nurses' health. The results reveal that optimising workflow and reducing work interruptions can effectively reduce nurses' perceived workload, thereby decreasing the occurrence of nursing omissions, and ultimately contributing to the overall improvement of nurses' health.
This study adhered to the cross-sectional Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
by Bo Zou, Fengchan Xi, Tao Gao, Wenkui Yu
BackgroundThe role of early enteral nutrition (EEN) in septic shock remains unclear. This study aimed to evaluate the association between EEN and clinical outcomes in septic patients requiring vasopressor therapy and invasive mechanical ventilation.
MethodsThis retrospective cohort study used the MIMIC-IV database and included adult septic patients receiving vasopressors and mechanical ventilation at ICU admission. EEN was defined as enteral nutrition initiated within 48 hours. The primary outcome was 28-day mortality. Secondary outcomes included ICU and hospital length of stay, and duration of mechanical ventilation. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders. Vasopressor dose was stratified based on the maximum norepinephrine-equivalent dose in the first 48 hours: low (0.5). Multivariable regression models were used to assess associations.
ResultsA total of 4,673 patients were included, of whom 997 (21.3%) received EEN. Before weighting, EEN was associated with higher 28-day mortality (21.9% vs. 15.3%). After IPTW adjustment, early feeding remained significantly associated with increased mortality (adjusted odds ratio 1.80; 95% confidence interval, 1.42 to 2.27). In stratified analyses, EEN was associated with increased mortality in the medium-dose (odds ratio 1.66; 95% confidence interval, 1.26 to 2.19, p Conclusions
In critically ill septic patients receiving vasopressors and mechanical ventilation, EEN was associated with increased 28-day mortality, particularly among those receiving medium- or high-dose vasopressor therapy.
Colonoscopy is an essential procedure for the early diagnosis of colorectal conditions; however, over 60% of patients undergoing non-sedated colonoscopy report moderate to severe pain. This study aims to investigate the central analgesic mechanisms of transcutaneous electrical nerve stimulation based on wrist-ankle acupuncture theory (TENS-WAA). A multimodal approach combining electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) will be employed to assess pain-related brain activity, with artificial intelligence applied to model the relationship between objective neurophysiological signals and subjective pain experience.
This is a single-centre, randomised, double-blind, controlled trial involving 60 patients undergoing colonoscopy without anaesthesia. Participants will be randomly allocated (1:1) to either an electrical stimulation group receiving TENS-WAA or a sham stimulation group. EEG and fNIRS data will be acquired before, during and after the procedure. The primary outcome is the analysis of EEG-fNIRS signals to characterise cerebral responses associated with pain modulation. Secondary outcomes include patient-reported pain using the Visual Analogue Scale (VAS), total colonoscopy duration and the correlation between EEG-fNIRS indicators and VAS scores. A deep learning framework will be used to enhance pain prediction accuracy.
This study has received ethical approval from the Ethics Committee of Changhai Hospital, Shanghai (approval reference CHEC2025-006), and has been registered at ClinicalTrials.gov. Written informed consent will be obtained from all participants. Findings will be disseminated in peer-reviewed academic journals and at relevant scientific conferences, regardless of outcome, contributing to evidence-based, non-pharmacological pain management strategies.
ClinicalTrials.gov, NCT06813703.
Children and adolescents in sub-Saharan Africa (SSA) experience exceptionally high levels of trauma, including experiencing multiple forms of abuse and witnessing violence. Exposure to such traumatic events may lead to the development of post-traumatic stress disorder (PTSD), or other health-related or behaviour-related harms. Untreated PTSD in adolescents results in significant impairments in their adaptive, social, emotional and academic functioning. To date, various intervention strategies have been developed internationally to reduce the severity of PTSD symptoms among children and adolescents. However, despite the documented mental health burden, there is limited evidence of culturally and contextually appropriate PTSD interventions in SSA. The objective of this scoping review is to investigate the evidence-based treatments available for adolescents diagnosed with PTSD in SAA. This investigation includes evaluating whether identified treatments were considered culturally and contextually appropriate.
This scoping review will follow the methodological framework proposed by Arksey and O’Malley. This framework outlines six essential stages for conducting scoping reviews: (1) Defining the research question, (2) Locating pertinent studies, (3) Study selection, (4) Charting the data, (5) Collating, summarising and reporting the results and (6) Consulting with stakeholders. Findings will be presented using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Major databases, including PubMed (Medline), Scopus Academic Search Premier, Africa-Wide Information, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Centre, Healthsource: Nursing/Academic, PsycINFO, PsycARTICLES and SocINDEX will be searched.
This review will not involve the collection of primary data from human participants. While formal ethics approval is not required, permission to conduct the study has been obtained from the Human Research Ethics Committee of the Faculty of Health Sciences at the University of Cape Town. The results of the scoping review will be submitted to a relevant academic journal, including presentations at relevant conferences, to contribute to academic literature and inform future research.
Childhood cancer accounts for a significant proportion of global childhood mortality, especially in low-income and middle-income countries (LMICs). Unlike many adult malignancies, primary prevention of childhood cancers is not possible. Improving survival requires a two-pronged strategy: earlier diagnosis and effective treatment. Our study aims to establish the feasibility, clinical and implementation effectiveness of an adapted early warning signs and symptoms (EWSS) intervention in Cameroon and Kenya. It will equip healthcare workers, Ministry of Health (MOH) representatives and National Cancer Institute leaders with evidence-informed guidance on implementing context-adapted interventions to improve the early detection and referral of childhood cancers in these countries.
The study is a quasi-experimental, hybrid type 2 implementation effectiveness study based on a Ghanaian adaptation of the ‘Saint Siluan’ EWSS campaign. Our protocol proposes context-specific adaptation and evidence-based implementation of the EWSS intervention through iterative engagement with country-level implementation teams to train healthcare workers and improve referral pathways for earlier childhood cancer diagnoses in each study country. Training effectiveness will be measured through pretraining and post-training tests of knowledge and application, as well as training satisfaction surveys. Clinical effectiveness will be assessed by using a REDCap database to track the number of newly diagnosed childhood cancer cases in the study regions and counties, healthcare timelines and paths to diagnosis, and the stage and proportion of metastatic disease at diagnosis. Implementation effectiveness will be evaluated through interviews with senior and mid-level health system partners and clinicians, tracking fidelity to the implementation process as laid out in The Implementation Roadmap Workbook, and analysis of meeting minutes from monthly local implementation team meetings.
This study has received ethical approval from The Hospital for Sick Children (REB # 1000080092) and all participating sites. We have received National Ethical Clearance from the Cameroon Ethical Board (#1699) and Regional Administrative Authorizations from our piloting regions (Centre and West). We have also received ethical clearance from Kenyatta National Hospital (KNH) (ERB# KNH-ERC/RR/955) and our National Commission for Science, Technology and Innovation in Kenya licence from the counties we are piloting in Kenya. As clinical data will be collected from existing health registries and patient charts, patient consent will not be required; however, we will obtain consent from all members of the leadership implementation teams and operational implementation teams for their participation in the implementation meetings and from all individuals participating in the semistructured interviews. We will disseminate findings to build awareness and share findings among various target audiences: (1) key county and regional parties (eg, clinical societies, advocacy groups, country MOHs and regional bodies such as the East African Community, Economic Community of West African States); (2) international bodies such as the WHO; and (3) the academic community.
Home-based exercise offers a cost-effective way to receive thorough rehabilitation without the requirement of costly supervised treatment.
To investigate the effects of home-based exercise on the balance ability in post-stroke patients.
A thorough search was carried out on various databases, such as Cochrane Library, Web of Science, PubMed, Embase, and China National Knowledge Infrastructure Library, until October 2024. The inclusion criteria were limited to randomized controlled trials that evaluated the impact of home-based exercise interventions.
The meta-analysis indicated that home-based exercise significantly improved static balance ability (Berg Balance Scale [BBS]: MD = 3.45, 95% CI [1.43, 5.47], I 2 = 71%, p = 0.0008, random-effects model). Conversely, the analysis revealed that the home-based exercise group did not exhibit a statistically significant improvement in the Time up and Go Test (TUG) when compared to the control group (TUG: MD = −0.34, 95% CI [−4.30, 3.61], I 2 = 96%, p = 0.86, random effects model). The subgroup analysis revealed that home-based exercise significantly enhanced balance ability in patients with subacute stroke (BBS: p < 0.0001; TUG: Overall effect p = 0.02). However, no significant improvement was observed in patients with chronic stroke (BBS: p = 0.39). Regarding the duration of intervention, both short-term and long-term interventions were effective on the BBS (p < 0.0001 and p = 0.0008, respectively), although no significant difference was found for the TUG. Participants engaging in exercise for more than 90 min per week demonstrated greater improvements in balance ability (BBS: p < 0.0001; TUG: p = 0.02). When considering national economic levels, significant effects on the BBS were observed in both developed and developing countries (p = 0.0001 and p < 0.0001, respectively), while significant effects on the TUG were noted only in developing countries (p = 0.04).
Home-based exercise interventions showed significant results in improving static balance in patients with subacute stroke, especially home-based exercise that lasted longer than 12 weeks and lasted at least 90 min per week. However, more methodologically rigorous randomized controlled trials are needed to validate these results. In addition, the optimal exercise program and type to optimize the balance ability of stroke patients also need further research.
Digital exclusion has been linked to adverse health outcomes among older adults. However, its relationship with health literacy, a midstream determinant of health outcomes in aging populations, remains insufficiently explored.
To investigate the relationship between digital exclusion and health literacy among older adults, and to assess the mediating effects of social support and self-efficacy.
A cross-sectional study.
Data from the 2021 Psychology and Behaviour Investigation of Chinese Residents (PBICR) survey were used. Digital exclusion was assessed through self-reported non-use of computers or smartphones. Health literacy, social support and self-efficacy were measured using the Short-Form Health Literacy Instrument, the 12-item Perceived Social Support Scale and the New General Self-Efficacy Scale. Generalised linear models (GLM) were employed to examine the relationships between digital exclusion and health literacy, while mediation analysis with bootstrapping assessed the mediating roles of social support and self-efficacy.
A total of 1147 older adults participated in the study, with 27.64% identified as digitally excluded and a moderate level of health literacy. GLM analysis identified several significant factors influencing health literacy, including digital exclusion, social support, self-efficacy, higher education levels, household monthly income per capita > 3000 RMB, non-agricultural hukou, chronic conditions and medication use. Mediation analysis revealed that digital exclusion negatively impacted health literacy. Social support and self-efficacy partially mediated the relationship between digital exclusion and health literacy.
Digital exclusion is negatively associated with health literacy among older adults, with social support and self-efficacy partially mediating the relationship.
This study underscores the importance of addressing digital exclusion, as well as promoting social support and self-efficacy to enhance health literacy in ageing populations.
This study provides insights into the relationship between digital exclusion and health literacy among older adults, as well as the mediating effects of social support and self-efficacy, offering potential targets for health literacy improvement.
STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology).
No patient or public contribution was involved.
Background
Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment.
Objectives
This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic.
Methods
Foreign-born Chinese women aged 18–45 years, with a gestational diabetes index pregnancy of 0.5–5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving.
Results
Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants were mainly recruited from social media (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time.
Discussion
We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants. 
FreshRSS 