NHS Health Checks (NHSHCs) provide individuals with cardiovascular disease (CVD) risk scores alongside advice and signposting to behaviour change support. A particular problem is that the support people receive is often poorly delivered, absent or not tailored to the needs of people in deprived communities, which risks exacerbating health inequalities. Improving this support is critical if NHSHCs are to achieve their goals of prevention and equity.

To explore needs and preferences for behaviour change support among adults in deprived areas, using a digital prototype presenting CVD risk information and signposting to services.

A longitudinal qualitative study involving focus groups and semi-structured follow-up interviews.

Adults from minoritised ethnic groups eligible for NHSHCs, recruited online and through a community centre, with both methods targeting high-deprivation areas.

Participants were first shown the digital prototype in focus groups to generate discussion. Follow-up interviews captured more in-depth reflections on needs for behaviour change support. Data were analysed using reflexive thematic analysis.

We conducted four focus groups and 20 follow-up interviews with 23 adults, predominantly of South Asian ethnicity living in areas of high deprivation. We developed three themes: (1) Trusted information to counter confusion and misinformation; (2) Support that makes change feel possible and meaningful, through culturally and personally relevant advice that addresses unhelpful beliefs about risk reduction and behaviour change and (3) Ensuring access to inclusive, socially connected environments that feel supportive and conducive to action.

For minoritised ethnic adults in deprived areas, NHSHC support should build on everyday practices and foster positive perceptions of services. Alongside service-level changes, policy action is needed to remove structural barriers (eg, cost, safety) that limit people’s ability to act on advice. Such changes could enhance the programme’s contribution to reducing inequalities in CVD prevention.

Evidence-based, compassionate practice is a key objective in midwifery care, with particular emphasis on existential aspects of women’s experiences during the transition to motherhood. In 2014, a scoping review was published exploring this phenomenon. The interest in this review exemplified the growing scholarly and clinical interest in this subject. However, the scoping review is outdated and does not meet up-to-date methodological standards. This qualitative systematic review will synthesise qualitative studies that explore the existential aspects of becoming a mother, aiming to identify potential unmet needs and articulate women’s preferences for care during motherhood transition. Findings from this synthesis may contribute valuable insights for developing evidence-informed clinical guidelines that promote person-centred and holistic maternal care.

This qualitative systematic review will use framework synthesis based on Peter la Cour’s model of Existential health. The data will be collected from five databases (MEDLINE, Embase, PsycINFO, CINAHL and Web of Science), which will be searched from 2010 to the present day. Study selection will prioritise the transition to motherhood in contemporary Western countries.

Ethical approval is not required for a review, and findings will be disseminated in peer-reviewed journals, conferences and social media.

CRD420251018563.

Qualitative research addresses ‘how’ and ‘why’ questions in healthcare. It captures the complexity of clinical practice by providing insights into experiences, behaviours and context often missed by quantitative methods. The objective of this review was to explore the volume, trends and adherence to reporting standards in qualitative research across hospital-based medical subspecialties.

Longitudinal bibliometric review.

Ovid Medline, Embase and Emcare were searched for qualitative research published between 2000 and 2024 in 12 medical subspecialties. For each subspecialty, the number and percentage of qualitative publications was identified. Adherence to reporting standards was assessed in a random sample of publications covering all subspecialties.

Between 2000 and 2024, 715 471 qualitative research studies were published across 12 medical subspecialties, representing 1.36% of all studies (52 620 042). Neurology and oncology had the highest number of qualitative studies (116 835 and 106 360). Although infectious diseases contributed a lower absolute number of qualitative studies (59 947), they had the highest proportion relative to all studies (4.07%). Conversely, nephrology and haematology exhibited the lowest number of qualitative studies (14 510 and 29 198) and smallest proportions (0.90% and 0.81%). Overall, the annual proportion of qualitative research increased from 0.64% (6052/945 008) in 2000 to 1.95% (56 909/2 919 825) in 2024. However, the relative positions remained largely stable over time.

Adherence to reporting standards was generally good, particularly in relation to methodological coherence. However, there was under-reporting of positionality (where researchers consider how their identity and standpoint may influence the research process) and reflexivity (where researchers critically reflect on how their assumptions and decisions shape the study).

Qualitative research is under-represented in medical subspecialties but has increased steadily over time, with notable variation in adoption between subspecialties. While overall adherence to reporting standards is good, greater attention to positionality and reflexivity is needed to enhance transparency and rigour.

Social prescribing is an approach to addressing non-medical issues affecting people’s health and well-being (eg, loneliness, housing or financial problems). It has gained international traction over recent years as complementary to medical care. A larger research project, comparing social prescribing across European countries, is considering how to tailor provision for the following groups: (a) LGBTIQ+persons, (b) refugees and first-generation immigrants and (c) older adults living alone. As part of this research, a qualitative study will address the question: What are the enabling and limiting factors associated with implementing social prescribing, across different European countries, from the perspective of key stakeholders?

Five European countries (Austria, England, Germany, Poland, Portugal) will be involved. Researchers from each country will conduct approximately 20 semi-structured interviews (total number will be 100). Interviewees will be people receiving, delivering, managing and funding/commissioning social prescribing. Interviews will be audio-recorded and transcribed. A cross-country analysis will be undertaken; framework analysis will support this process, with a chart developed in Excel in which data from across the five countries is summarised by the researchers involved. Summaries will be based on a thematic framework that researchers from the five countries develop together after initially analysing their own data.

Ethical approval was initially secured through the University of Oxford’s Medical Sciences Interdivisional Research Ethics Committee (IDREC 1806086) for data collection in England. This approved application was then used to secure ethics approval in Austria (through Ludwig Boltzmann Gesellschaft), Germany (through Bergische Universität Wuppertal), Poland (through Wroclaw Medical University) and Portugal (through NOVA University of Lisbon). Dissemination will include an academic journal article and presentation at relevant conferences. It will also include short videos, written summaries/policy briefs and an infographic.

This project has received funding from the European Union’s Horizon Europe Research and Innovation Programme under grant agreement No 101155873. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them.

Leprosy remains a significant public health challenge in many low and middle-income countries, including India. People affected by leprosy face multifaceted challenges: physical, psychological, social and economic. In response, donors support self-help groups (SHGs) to improve health, social integration and economic circumstances for marginalised people, including those with leprosy. This study aims to assess the sustainability of SHGs in India after the withdrawal of donor support by examining whether they remain functional and exploring the key factors, barriers and facilitators that influence their long-term social and economic viability.

To examine the functionality of SHGs after withdrawal of donor support, and to explore the factors, barriers and facilitators influencing their long-term social and economic sustainability.

Using qualitative methods, we conducted semistructured interviews with 40 key informants associated with five SHGs formed under the Self-Help Community Development Project implemented in an endemic state of India and funded by The Leprosy Mission Trust India.

It was an exploratory qualitative study using interviews with SHG members and key informants, situated within the self-help community-based project.

While some SHGs demonstrated resilience and adaptability, others faced challenges such as internal discord, loss of members to migration and lack of access to government schemes. Thematic analysis revealed key drivers and barriers to sustainability and realising the benefits of SHGs, highlighting variations in leadership, governance, economic performance and social engagement across groups.

SHGs are often sustained after the funding and managerial donor support have been withdrawn. The findings emphasise the importance of strong leadership, community support and external facilitation in sustaining SHGs and enhancing their impact on marginalised populations. This study contributes to understanding the role of SHGs in addressing the socioeconomic challenges faced by individuals affected by leprosy and offers insights for improving their long-term viability.

Perioperative randomised controlled trials (RCTs) in liver transplantation are relatively infrequent. RCTs performed in this complex patient population need to be robustly conducted to maximise patient benefit and graft utility given the scarcity of donor organs. Recruitment challenges can compromise RCTs and studies in this population face unique challenges due to recipient illness severity, their comorbidities, demographics and the geographical constraints of specialist transplant centres. Emergency presentation and after-hours admission may further limit patients’ capacity or readiness to consider trial participation. This Study Within a Trial (SWAT) specifically explored motivators and barriers to recruitment in patients awaiting liver transplantation.

An observational mixed-methods ‘Study within a Trial’, nested within a feasibility RCT.

This study was dual centred at two Tertiary National Health Service Hospitals; The Royal Free Hospital, a liver transplant centre in North London and University Hospital Birmingham, a liver transplant centre in Birmingham.

Adults who were eligible for liver transplantation and recruitment into the associated RCT were eligible for inclusion into the SWAT.

Completion of an 18-question validated written questionnaire which explored motivation for accepting or declining participation in the RCT.

Through completion of the questionnaire, participants shared their perspectives on the RCT and their rationale for consenting or declining participation. Responses were analysed, providing feedback to the Trial Management Group (TMG) to refine recruitment strategies for future trials. An additional component, comprising interviews and audio recordings of recruitment consultations, was planned if the RCT recruitment rates fell below prespecified thresholds or concerns were raised by the RCT TMG, neither of which occurred.

84 completed questionnaires were received. Motivators included patients believing that the trial will benefit others, interest in helping with research, perception that benefits outweigh risks and belief that it offered the best treatment. Barriers included concerns about randomisation, feeling overburdened and a perception of lack of support from family or friends.

This is the first study exploring recruitment to a perioperative RCT involving patients undergoing liver transplantation. Key motivators were altruism and perceived safety, while barriers included concerns about randomisation and lack of family support. Future focus during recruitment should be on neutral patient-centred consultations, adequate information sharing, fostering of patient trust, improved explanation of randomisation and engagement of the patient’s support network.

NCT04941911 (Health Research Authority) and SWAT 152 (the Study With A Trial Database).

Older adults can have difficulties understanding and recalling information prior to hospitalisation for elective treatment. Limited research exists regarding how older adults perceive the accessibility and comprehensibility of the information provided by the hospital prior to elective hospitalisation. This study aims to explore how older adults undergoing elective hospitalisation for transcatheter aortic valve implantation (TAVI) experience the information received from the hospital and their preferences for modes of information delivery.

A qualitative design was used. Data were collected through individual semistructured interviews with older adults prior to hospital discharge following elective TAVI. The data were analysed using reflective thematic analysis.

All patients scheduled for elective hospitalisation for TAVI at a public university hospital in Norway were screened for eligibility.

18 older adults participated in the study. Their median age was 82 years (range 67–91), and two thirds were males.

The data were categorised into four main themes: ‘The paper brochure is worth its weight in gold’, ‘Combination of different modes of information delivery increased understanding and recall’, ‘Trust reduced the need to access and understand information’ and ‘Family played a crucial role in accessing and interpreting health information’.

Older adults undergoing elective hospitalisation found the traditional brochure valuable, alone or in combination with the digital material, which included an animated film. The participants emphasised that support from family members was required to access the digital information.

Strengthening research capacity in Africa is vital for tackling pressing health, educational and socioeconomic challenges facing the continent. At the core of this effort is the cultivation of innovative research leaders through postgraduate training programmes that incorporate mentorship-infused supervision. Such models have demonstrated potential in improving research skills, boosting academic productivity and fostering leadership development among emerging scholars. This systematic review and meta-synthesis protocol aims to examine existing mentorship-infused supervision practices across African higher education institutions. The review seeks to identify effective models, uncover common challenges and barriers, and generate evidence-based recommendations to develop sustainable, contextually relevant strategies. Insights from this work will inform policies and practices to enhance postgraduate research training, advance research leadership and contribute to the broader goal of strengthening research ecosystems across Africa.

A systematic review and thematic meta-synthesis will be undertaken, focusing on qualitative research studies as well as the qualitative components of mixed-methods studies. Relevant studies published in English will be identified through a comprehensive search strategy. The electronic databases, including Medline/PubMed, Scopus, Web of Science, African Journals Online, EMBASE and CINAHL, will be searched to capture a wide range of peer-reviewed articles and grey literature. Databases will be searched from March 2026. Two reviewers will independently perform study selection, data extraction, quality assessment and evaluation of risk of bias, using the Critical Appraisal Skills Programme checklist.

This systematic review and meta-synthesis will analyse publicly available literature and does not require ethical approval, as it involves no primary data collection. It will adhere to established ethical and methodological standards, including proper citation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings will be widely disseminated through open-access journal publication, conference presentations and targeted reports for universities, research institutions and policymakers to inform and support mentorship-based postgraduate research supervision across Africa.

CDR420251049878. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049878.

The aim of this study was to explore current safety practices and improvement strategies for safety measures.

A qualitative descriptive method was utilised from January to February 2025, employing both convenience and purposive sampling techniques. A total of 51 direct observations, 8 focus group discussions and 19 key informant interviews were conducted as part of the data collection.

This study was conducted in health institutions, Woreda health offices and Zonal health offices within the Awi Zone of Ethiopia.

Comprising frontline health professionals, case team leaders, facility administrators and health officials at both the woreda and zonal levels.

The data analysis identified two principal themes: ‘safety measures practice’ and ‘improvement strategies’. Safety practices varied from low to moderate. Five areas were found to have ways to improve safety measures: infrastructure and supply chain management, training and capacity-building, community engagement, policy strengthening and enforcement and human resources management with behavioural change interventions.

The implementation of safety measures was inconsistent. To enhance safety measures, addressing individual behaviours and issues that are structural, cultural and systemic is essential. Encouraging participation, fostering teamwork and implementing regular monitoring can help make safety practices a routine part of the organisation. This would make the workplace safer, improve healthcare and enhance the overall effectiveness of the healthcare system. This study provides valuable insights that can inform the development of effective implementation strategies in other resource-limited settings.

To understand how key relational factors lead to observed outcomes in mental health peer support.

This realist-informed qualitative review synthesised findings from 18 studies to develop programme theory relating to interpersonal contexts, linked outcomes and underlying mechanisms of change of mental health peer support.

Four databases were searched: PsycINFO, Embase, Medline, CINAHL.

All studies were evaluated for relevance and rigour for development of programme theory.

Qualitative data were extracted from 20 studies. A realist-informed synthesis identified repeating themes with context-mechanism-outcome configurations.

This identified five key contextual factors that together form the APPEAR framework (Accepting, Personalised Practice, Empowering, Available and Reciprocal). These contextual factors were found to interact to create the conditions for improved personal recovery outcomes in the domains of (1) self-acceptance, (2) confidence, (3) hopefulness, (4) self-expression, (5) relationships and (6) knowledge and skills.

The APPEAR framework offers an operational foundation for understanding interpersonal mental health peer support interventions.

The study aims to present recommendations for a revised Doctor of Pharmacy (Pharm-D) curriculum that aligns with regional needs and international standards of pharmacy education.

An exploratory qualitative study involving individual semistructured interviews. Data were collected and reported in accordance with Consolidated Criteria for Reporting of Qualitative Studies.

Face-to-face interviews were conducted in the respective offices of the experts and online interviews were conducted on Zoom and Google Meet.

Purposive and snowball sampling was used to recruit experts due to the eligibility criteria of including associate professors with a PhD, and snowball sampling facilitated the recruitment of experts from all provinces and internationally. Interviews were transcribed verbatim and data were analysed using an inductive thematic approach using NVivo V.15. All interviews were conducted in English.

The study engaged 49 experts from national and international settings with an age range of 25–60 years (median=43 years). The researchers came out with six themes and their subthemes from the data including: (a) understanding current Pharm-D curriculum in Pakistan, (b) inevitable changes required in the Pharm-D curriculum, (c) specific-subject based changes, (d) foundational steps to achieve the required changes, (e) barriers to the implementation of these changes and (f) impact of Pharm-D curriculum change.

The findings highlighted a clear need to revise the curriculum by incorporating enhanced clinical pharmacy content, integrated learning approaches, elective courses, interprofessional education, mandatory hospital and clinical placements, experiential learning through simulation-based methods and research components through a collaborative approach from policy makers and academic stakeholders.

The risk of acquiring chronic kidney disease (CKD) is rising in Middle East countries, particularly due to the high prevalence of diabetes and hypertension. Healthcare professionals (HCPs) play a vital role in patient education, risk management and early detection of CKD, thereby impacting health outcomes across countries with varying resource levels. This study aimed to identify the obstacles to primary and secondary prevention of CKD among HCPs in Syria.

We conducted a descriptive qualitative study design underpinned by semistructured interviews. Data were analysed using thematic analysis.

Participants were recruited across the Syrian Arab Republic, encompassing diverse geographical areas, hospital types and community centres.

A purposive sample of 12 HCPs was interviewed using online semistructured interviews. The interviews were audio-recorded, transcribed verbatim and thematically analysed from November 2023 to May 2024.

Several factors hindered CKD primary prevention and early detection among HCPs in Syria. These include individual factors such as a lack of knowledge, awareness and training. Interpersonal factors include unclear role delineation and poor communication among HCPs. Community/societal factors include a lack of government financial support, lower clinical priority for CKD, inadequate supplies for CKD primary prevention and diagnosis, a lack of patient education resources, limited access to nephrology services and a fragmented healthcare system.

The primary and secondary prevention of CKD in Syria is still nascent. Comprehensive strategies addressing individual, interpersonal and community/societal barriers are necessary to advance CKD primary prevention and early detection efforts. The study contributes to advancing the primary and secondary prevention of CKD and guiding targeted interventions and collaborative efforts to improve early detection of CKD in Syria. Analysing the local context of Syria and the availability of international resources for CKD primary prevention and early detection provides a decision-making framework that outlines actionable strategies for both domestic capacity-building and international organisational support.

To elicit the benefits of shared decision-making to doctors who are champions of this approach.

A qualitative interview study that used practical thematic analysis.

We identified a purposive international sample of doctors in active clinical practice who were recognised champions of shared decision-making, working in various clinical disciplines.

24 doctors in active clinical practice were interviewed; 14 were male and 10 were female; 20 had been in clinical practice for over 10 years (range 1–30). 12 practised in North America, 10 in Europe, 1 in South America and 1 in Asia; 4 doctors worked in internal medicine, 4 in primary care, 5 in surgery, 3 in paediatrics, 3 in oncology and 1 in each of the following disciplines: emergency medicine, palliative care, geriatrics, physical medicine and rehabilitation, anaesthesiology, and cardiology.

This selected sample of doctors consistently reported that shared decision-making provided benefits to themselves, their patients and their teams. Shared decision-making reinforced and enhanced their self-identity as ethical professionals, supporting patient autonomy, increasing their professional fulfilment and reducing their risk of burnout. These intrinsic benefits accompanied reports of other consequential benefits, namely, patients’ achieving better-informed, preference-sensitive decisions, a higher likelihood of improved patient outcomes, improved efficiency and team function. The doctors viewed the approach as providing connectedness, shared responsibility resulting in a lighter burden, acting as a buttress against moral injury and the emotional strain of clinical work and, where relevant, mitigation against becoming the second victim of a bad or unexpected outcome.

Doctors who champion shared decision-making report significant benefits to themselves and their patients. These benefits have not been widely reported, which has implications for motivating doctors to adopt shared decision-making. Instead of addressing presumed gaps in communication skills, it might be better to highlight the positive impact on professional fulfilment and the protective effect of shared decision-making.

We conducted a pilot randomised controlled trial (the PHaCT study), including a process evaluation to assess the acceptability of a housing-led Critical Time Intervention (CTI) for prison leavers and the use of a trial design. This paper presents the process evaluation findings.

To explore the acceptability of both the intervention and the trial design to participants and those delivering the intervention, and to assess whether the intervention was delivered with fidelity.

A process evaluation following Medical Research Council guidelines. Data collection included semi-structured interviews with participants and CTI caseworkers and observations of intervention delivery. A thematic analysis of interviews and observations was conducted to understand the intervention’s implementation and contextual factors as well as the trial process acceptability.

Participants for the pilot trial were recruited from three prisons in England and Wales where the intervention was being delivered.

While 28 out of 34 trial participants consented to interviews, only one was completed. Seven caseworkers were interviewed.

A housing-led CTI to support people leaving prison at risk of homelessness, involving phased, time-limited support from caseworkers, starting prerelease and continuing postrelease, to help secure stable housing and build independence, without directly providing housing.

The intervention’s acceptability was primarily reflected through the positive feedback and success stories shared by CTI caseworkers, as well as observational data indicating high acceptance among service users. The trial design’s acceptability was challenged by concerns about randomisation and equipoise, with staff viewing randomisation as unethical due to limited support for vulnerable populations. The fidelity to the CTI intervention housing-led approach was adhered to as best as possible; stable housing was prioritised for service users before addressing other needs. Despite these efforts, both sites encountered significant challenges due to limited housing availability and complex systems for securing social housing, particularly for single men leaving prison.

This wider study faced significant challenges which impacted the process evaluation. Despite these issues, the evaluation provides important insights into the challenges of conducting trials on interventions for people leaving prison. The challenges experienced should inform future study designs with similar populations and in similar settings.

ISRCTN46969988.

There is substantial literature on opioid pharmacotherapies from a service user perspective, mostly focused on methadone and buprenorphine. However, as a relatively new formulation, much less is known about user experiences and views of Long-Acting Injectable Buprenorphine (LAIB). To date, no published reviews have qualitatively described LAIB service user experience. The objective of this scoping review is to identify and describe the peer-reviewed qualitative studies examining the service user experience of LAIB.

This scoping review will follow the methodology described by Arksey and O’Malley, further adapted by Levac et al and others. The search strategy will be developed in collaboration with an expert librarian and will include searches of Medline, Embase, PsycINFO, CINAHL, Scopus and Web of Science as well as citation chaining. The search dates will range from 2016, when LAIB was first approved, to the date of the final search. Included studies will investigate the perspectives and experiences of LAIB treatment participants with opioid dependence, within an Opioid Treatment Programme (OTP). For service users, the pharmacological formulation of LAIB significantly reshapes both the clinical practice and the social dynamics within OTPs. To effectively capture the depth and nuance of service users’ experiences, this review will be limited to qualitative, mixed-method, case series or case study designs, with a further restriction to peer-reviewed articles published in English. Identified references, with duplicates removed, will be imported into Covidence for title/abstract screening, full-text review and data extraction by two independent reviewers. All decisions on data inclusion or exclusion will be by consensus agreement, using a third reviewer if necessary. A living experience researcher will lead analysis of manuscript content in NVivo using inductive coding to produce a descriptive thematic analysis. The narrative summary will present key study characteristics, quality appraisal and synthesised findings that describe service user experiences and perspectives of LAIB, guided by the Systematic Reviews and Meta-Analysis for Scoping Reviews checklist.

This scoping review undertakes secondary analysis of data in the public domains only and thus does not require ethics approval given no participants are directly involved. The results of the review will be published in a peer-reviewed journal, presented at relevant academic and community conferences, and discussed and disseminated to/with community organisations, service users and policy-makers.

Prepublication history and additional supplemental material for this paper are available online. To view these files, visit: Open Science Framework https://doi.org/10.17605/OSF.IO/XMHKN.

To explore the experience and impact of physical chronic illnesses in the lives of young people.

Qualitative study using semi-structured interviews.

Interviews were conducted between March 2023 and February 2024 either via video call (14) or face-to-face (19). Recruitment was done primarily through flyers in public spaces, specialists’ waiting rooms and research pages of chronic disease websites and supplemented through snowballing.

Young adults aged 19–29 years (n=33, mean age 23 years) who had lived with a physical chronic illness for 6 months or more. All participants lived in Australia.

Three key findings were identified: (i) chronic illness impacts the lives of young people in a particular way, as participants reported that their young age, and the youth of their peers, influenced their interactions with healthcare professionals, their access to support and their sense of isolation; (ii) participants struggled to come to terms with, and describe, the influence of their chronic illness on their overall life and lifestyle, particularly when outside of the ‘expected’ symptoms of disease; (iii) the lack of education and guidance about the wide range of impacts that chronic illness can have seemed to compound participants’ reported sense of guilt, self-blame and exhaustion.

This study illustrates how youth is a critical contextual element when considering different population groups’ challenges in managing chronic illnesses. It finds that young people may internalise blame for these challenges despite the fact they are structural issues. Understanding this context will aid the provision of better healthcare experiences and support programmes. Further research could help establish better expert and peer support models to help adults and young people better anticipate, understand and manage the wide-reaching impacts of chronic illness.

To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.

A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.

Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.

Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).

Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.

The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).

Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.

Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.

Selective dorsal rhizotomy (SDR) is one of the treatment options available for spasticity management in ambulatory children and young people with cerebral palsy (CYPwCP). Although improvements in gross motor function one to two years after surgery have been established, evidence of longer-term benefit requires further investigation. Given the irreversible nature of SDR and the increased rehabilitation commitments required from families and clinicians, providing evidence of longer-term benefits is essential to support their decision-making. This study aims to investigate medium (3–5 years) and long-term (6–10 years) SDR outcomes in ambulatory children with CP and how SDR affects families’ lives over time.

This is a convergent parallel mixed-methods study using the International Classification of Functioning, Disability and Health as a theoretical framework. The study aims to recruit 90 CYPwCP participants, who had SDR at a tertiary hospital in the UK when aged between 3 and 14 years. Participants (parents and CYPwCP) will be invited to complete an online survey and attend the hospital for one follow-up visit 3 or more years after SDR. Comparisons will be made with existing data on objective measures and parent-reported outcomes collected in clinical practice at baseline, 6, 12 and 24 months to understand the trajectory of changes. Semistructured interviews will be conducted with 18–20 parents/carers and 25–30 CYPwCP to understand their perspectives on the outcomes of SDR compared with their prior expectations. The Framework Method will be used to analyse qualitative data both inductively and deductively. Qualitative and quantitative study data will be integrated using joint displays.

Ethical approval has been obtained through the Coventry and Warwick Research and Ethics Committee (24/WM/0078). Findings will be shared through international conferences, peer-reviewed journals, social media and dissemination events for families and CYP.

NCT06518889.

This study aimed to understand the knowledge possessed by informal medicine vendors regarding antibiotics and antibiotic resistance, identify the perceptions held by informal medicine vendors about antibiotics and their uses and examine the practices employed by informal medicine vendors in the sale and distribution of antibiotics.

Exploratory qualitative study using semi-structured interviews and direct observations.

Markets and shops across 11 villages in the Nanoro health district, Burkina Faso.

23 informal medicine vendors, aged between 25 and 55 years and with 8–30 years of experience, were recruited through snowball sampling in the Nanoro health district of Burkina Faso.

Informal medicine vendors exhibited a limited understanding of antibiotics, often confusing them with other treatments and referring to them using local terminologies based on perceived use and effectiveness. Antibiotics were perceived as universal remedies, supported by therapeutic belief, empirical reasoning and community solidarity, with empirical diagnosis, approximate dosing and informal preparation techniques passed on through imitation. These findings emerged across themes including perceptions, symbolic attributes and sales practices.

Informal medicine vendors in rural Burkina Faso demonstrated limited understanding of antibiotics and antimicrobial resistance, with practices shaped by local beliefs and empirical experience. These findings underscore the need for context-sensitive interventions that include tailored education and regulatory engagement to improve antibiotic stewardship and mitigate the spread of resistance.

The objective of this study was to explore medical practitioners’ understanding of antimicrobial resistance (AMR) and its aspects, such as its causes, possible outcomes and how doctors can contribute to its prevention.

This qualitative study was conducted in Sri Lankan healthcare settings.

Using convenience sampling, the study included allopathic medical practitioners aged 18–60 years, excluding intern-medical officers, until data saturation.

One-on-one interviews were conducted online or in person, depending on each participant’s preference. A structured questionnaire was used to triangulate the information.

Data were categorised into four: (1) understanding, awareness and identifying AMR as an issue among medical practitioners, (2) knowledge and understanding of factors that contribute to AMR development among medical practitioners, (3) knowledge and understanding of the outcome of AMR and (4) knowledge and understanding of preventive measures against AMR among medical officers. Interviewees showed an awareness of AMR; however, their knowledge was not up to date. Key reasons for inappropriate antibiotic use included unavailability and poor quality of antibiotics and unawareness of updated guidelines, especially in the government sector. In the private sector, patient pressure, the need to attract patients and the high cost of investigations contributed to misuse. Additionally, low patient literacy about AMR was a significant factor.

This study revealed that although medical practitioners in Sri Lanka are aware of AMR, their knowledge remains limited in certain areas. Several challenges contributed to inappropriate antibiotic use, including the availability and quality of antibiotics, external pressures from patients and financial constraints. The findings of this study highlight the urgent need for continuous medical education and public awareness campaigns to improve both practitioner and patient understanding of AMR. Addressing these issues is essential for effectively preventing and managing AMR in healthcare settings in Sri Lanka.