To identify behavioural and household factors associated with poor oral hygiene among Japanese kindergarten children in a population with high health awareness, using the Debris Index-Simplified (DI-S) as a clinical proxy for early oral hygiene deterioration.

Cross-sectional study.

Seven kindergartens in Sapporo city, Japan.

Of the 1229 kindergarten children invited, 871 provided parental consent (consent rate: 70.9%). Among them, 675 children aged 1–6 years who completed both the questionnaire and oral examination (completion rate: 54.9%). Most post-consent losses were due to logistical and staffing constraints. Children were stratified into ≤3 year and ≥4 year academic classes.

The primary outcome was oral hygiene status based on the DI-S scores (categorised as good (DI-S=0) or poor (DI-S>0). The secondary outcome was the presence of dental caries, defined as decayed, missing and filled primary teeth: dmft≥1. Multivariable logistic regression was used to estimate associations between poor oral hygiene and behavioural and household factors.

Among the 675 children, 168 children (24.9%) exhibited poor oral hygiene (DI-S>0) and 89 children (13.2%) had dental caries (dmft≥1). In multivariable analysis adjusted for demographic, dental and dietary variables, poor oral hygiene was significantly associated with being from a multiple-child household (OR 1.67, 95% CI 1.16 to 2.42) and irregular juice consumption (OR 1.60, 95% CI 1.07 to 2.38). Age-stratified analysis revealed that these associations persisted among those in the ≥4 year class, with additional significance for infrequent tooth brushing (

In a high health awareness Japanese preschool population, poor oral hygiene was independently associated with household composition and juice consumption, rather than traditional dental behaviours. These findings suggest the need to broaden preventive strategies beyond routine dental guidance to include family structure and dietary patterns, particularly in low-prevalence settings. Differential associations between DI-S and caries experience emphasise the utility of early clinical indices in oral health promotion.

The term ‘culture of care’ began to be used following the Francis Report in the UK in 2013. This concept involves three dimensions: personal care, leadership care and co-worker care. Personal care focuses on employees’ attitudes and behaviours. Co-worker care relates to a sense of community, and leadership care relates to how employees perceive leaders and managers as caring individuals dedicated to ensuring the well-being of others. Previous studies investigating culture assessment tools used in the healthcare system reported that although organisations are increasingly using culture assessment instruments, there is a focus on assessing safety and quality cultures rather than on caring perspectives. This scoping review aims to map existing studies related to the assessment of culture of care.

This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The search strategy will include four indexed databases (PubMed, EMBASE, Cochrane Library and Latin American and Caribbean Literature in Health Sciences) and additional sources not retrieved with the adopted search strategy. The search strategy will be constructed using the controlled vocabulary in Health Sciences Descriptors, Medical Subject Headings and Emtree. Relevant articles in all languages, without restrictions related to date of publication, will be considered eligible for inclusion. Two independent researchers will select articles based on the inclusion criteria, and a third author will be consulted to establish consensus, if necessary. Data extraction will involve a form with information on the study characteristics, methodological issues and main results from the evidence sources. The extracted data will be analysed using descriptive and content analysis.

Ethics approval is not required, as this review will use data from publicly available bibliographic sources. The results will be disseminated through publications in scientific journals and presentation of the evidence to interested parties.

The protocol was registered in the Open Science Framework (DOI: 10.17605/OSF.IO/U9Q53).

To develop and validate a concise, physician-specific quality-of-life scale (Afya MedQol) Index, and to examine sociodemographic and occupational correlates of physician well-being in Brazil.

Nation-wide, cross-sectional, web-based survey employing split-sample psychometric validation: exploratory factor analysis, confirmatory factor analysis (CFA), multidimensional graded-response item-response theory calibration and post-stratification weighting to the 2025 Brazilian medical demographic census.

Physicians practising in all five Brazilian macro-regions and 27 state medical councils (2 July 2024–6 August 2024).

A total of 2005 fully responding physicians (56% women; mean age 38.5±12.6 years).

Domain scores—F1: Quality of Life, F2: Institutional Support, F3: Perceived Stress—and a Fisher-information-weighted global score. Convergent validity with WHOQOL-Bref; subgroup differences (Cohen’s d, partial ²).

CFA supported a three-factor, 13-item solution (Comparative Fit Index=0.987; Root Mean Square Error of Approximation=0.050) with strict invariance across sex and graduation-year quartiles. Item-response modelling showed marginal reliability =0.82. Convergent validity with WHOQOL-Bref domains was strong (r=0.55–0.73). Weighted mean (95% CI) scores were: Global 67.2 (66.5–67.9), F1 69.5 (68.9–70.2), F2 64.1 (63.4–64.8) and F3 62.5 (61.8–63.2).Women scored higher on Perceived Stress (F3) than men by 5.6 points (weighted mean difference 5.6, 95% CI 4.0 to 7.2; Cohen’s d 0.28). Physicians working ≥60 hours/week scored higher on Perceived Stress than those working ≤44 hours/week by 8.8 points (weighted mean difference 8.8, 95% CI 6.7 to 10.9; Cohen’s d 0.40). Well-being increased with income up to ~BRL 25 000 per month and plateaued thereafter.

Afya MedQoL Index is a psychometrically robust, 13-item instrument capturing personal, organisational and stress dimensions of physician well-being. Perceived Stress—shaped by workload, institutional climate and gender—was the most discriminative domain, while additional income beyond an upper-middle-class threshold conferred negligible benefit. Findings support policies aimed at capping duty hours, fostering ‘just-culture’ environments and expanding flexible work models.

Cancer-related cognitive impairment is frequently reported by patients with breast cancer after chemotherapy. These difficulties can hinder return to work. It is therefore particularly important to assess and manage these impairments, especially to facilitate employment. We propose the Cog-VR pilot study to assess patient adherence to a virtual reality (VR)-based cognitive rehabilitation programme to support employment.

This prospective interventional pilot study aims to assess adherence to a VR-based cognitive rehabilitation programme in patients with breast cancer (n=23) treated by chemotherapy reporting cognitive complaints following cancer and its treatments. The programme consists of six weekly individual sessions (1 hour/week), including cognitive training, psychoeducation and VR immersion (10–15 min). VR tasks train executive functions, attention, memory and processing speed. The primary endpoint is the programme adherence, defined as completing at least five out of six VR sessions, each lasting a minimum of 5 min. The main secondary endpoints are objective cognitive tests and patient-reported outcomes (subjective cognitive functioning (Functional Assessment of Cancer Therapy—Cognitive Scale), anxiety/depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy—Fatigue)) assessed before and after the programme. Furthermore, cyber sickness (Simulator Sickness Questionnaire) at each session, VR usability (System Usability Scale—third session) and patient satisfaction to the programme will also be assessed.

The study was approved by the local ethics committee (French Ouest II personal protection committee no. ID RCB: 2023-A02163-42) on January 2024. It was validated by the review board of the participating center. An individual participant data-sharing statement is not planned. Written informed consent will be obtained from all patients before any study procedure. The results of this pilot study will be disseminated through peer-reviewed journals and conference presentations.

NCT06267014.

Racial disparities in critical illness outcomes are well-described, with social determinants of health as likely contributors. We sought to identify inequalities in readmissions and mortality between black and white patients among survivors of critical illness with sepsis and assess whether these disparities were explained by neighbourhood characteristics, health insurance and hospital quality.

Retrospective cohort study examining 90-day and 9-month readmissions and survival as coprimary outcomes. Models included age, sex, race and area deprivation index (ADI), Medicaid status or hospital Centers for Medicare & Medicaid Star rating. Accelerated failure time and Cox proportional hazards models with subgroup analyses by age and surgical status were employed.

14 community and tertiary hospitals in Western Pennsylvania.

48 027 survivors of sepsis with critical illness; 20 952 (50.4%) male; 6489 (13.5%) identified as black.

Black patients were younger (mean age 59.0 years vs 65.8 years), more likely to have higher ADI, Medicaid insurance and receive care at lower-quality hospitals. Black patients had higher readmission risk: (90-day subdistribution HR (SDHR) 1.13 (95% CI 1.04 to 1.23); p=0.003); 9-month SDHR: 1.11 (95% CI 1.03 to 1.20); p=0.005). Adjusting for age and sex, we found no difference in 90-day and 9-month mortality (90-day acceleration factor (AF): 1.04 (95% CI 0.91 to 1.19); p=0.556; 9-month: 1.08 (95% CI 0.96 to 1.22); p=0.196), which remained consistent when including ADI, Medicaid status or hospital quality. Mortality among black patients was increased relative to white patients among patients ≥60 years (9-month AF 1.23 (95% CI 1.07 to 1.42; p=0.004)) and among surgical patients (90-day AF: 1.23 (95% CI 1.01 to 1.50; p=0.04); 9-month AF: 1.28 (95% CI 1.07 to 1.53; p=0.006)). Medicaid status, but not ADI or hospital quality, attenuated racial differences in subgroup mortality.

In a retrospective analysis of intensive care unit (ICU) survivors with sepsis, black patients had higher readmission rates but comparable mortality to white patients, except among older and surgical subgroups. Medicaid status influenced racial inequalities in mortality, highlighting a need for targeted post-ICU interventions.

Osteoporosis represents a growing public health concern in the Middle East and North Africa (MENA) region, where ageing populations and limited healthcare access contribute to high fracture rates and poor treatment adherence. Despite the existence of clinical practice guidelines, these often lack integration of stakeholder perspectives such as those of patients, healthcare providers, insurers and systems. Understanding knowledge, attitudes and practices (KAP) related to osteoporosis is essential to inform inclusive, culturally relevant strategies for prevention and management. This systematic review aims to evaluate the knowledge, attitudes (preferences) and practices (behaviours) of key stakeholders, including adults aged 50 years and older and healthcare providers, regarding the prevention, diagnosis and treatment of osteoporosis in the MENA region.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines, we conducted comprehensive searches of MEDLINE and Embase for studies published from January 1994 to January 2025. Two reviewers independently screened titles, abstracts and full texts in duplicate. Title/abstract and full-text screening were completed by September 2025. Data extraction will begin in October 2025 and will be performed in duplicate using piloted standardised forms. Risk of bias assessment and data synthesis will follow, using validated design-specific tools and a narrative approach guided by the Synthesis Without Meta-analysis framework. The review was initiated in June 2025, and completion of analysis and manuscript preparation is anticipated in June 2026.

This review synthesises data from publicly available literature and does not involve primary data collection with human participants; therefore, ethics approval is not required. Findings will be disseminated through peer-reviewed publications, conference presentations and deposition of study materials on the Open Science Framework.

This protocol is registered on the Open Science Framework.

Health systems must guarantee access to quality, safe and effective medicines. Essential medicine lists (EMLs) are crucial prioritisation tools to inform coverage decisions and steward limited health resources under the context of universal healthcare. This study aims to develop a consolidated framework for prioritising the assessment of health technologies to review and update EML for treating diseases or health problems managed in primary healthcare (PHC).

A mixed-methods approach was designed to validate the framework. An initial scoping systematic review will be conducted to search for studies that describe criteria used to prioritise the assessment of health technologies for PHC. The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping review studies. A comprehensive search was conducted in the following sources: PubMed, Embase, Cochrane Library, Virtual Health Library (LILACS, WHO IRIS, IBECS, PAHO-IRIS, PAHO, LIS, BRISA), Health System Evidence, Global Healths, Health Evidence and Epistemonikos from the inception until February 2025. Two review authors will screen and extract data independently. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews reporting guidelines. An iterative process online using the Delphi hybrid with stakeholders through predetermined consensus thresholds, a combination of a four-point Likert scale and open-ended questions will be conducted to select and validate the criteria identified in the scoping review.

We will provide a consolidated framework to inform decision-makers for prioritising the assessment of health technologies for the national EML for PHC. This is an important step in using evidence to inform public health policies. We plan to share findings through a variety of means, including publications in peer-reviewed journals, presentations at national conferences, invited workshops and webinars, email discussion lists affiliated with our institutions and professional associations, and academic social media.

The aim of this study is to identify and analyse research priorities across the osteopathic profession internationally, to determine how different interested parties conceptualise research importance and to examine how contextual factors influence research prioritisation.

A mixed methods sequential exploratory design combining an umbrella review, a thematic analysis, an expert consensus agreement and an international cross-sectional survey was used to define, validate and evaluate research priorities.

An international online survey, available in nine languages, was distributed through professional osteopathic organisations and network worldwide, a patient representative organisation and social media.

2229 respondents including patients (7.4%), practitioners (42.1%), students (17.4%), educators (13.5%), researchers (5.0%) and policy makers (4.3%) from across 42 countries.

Primary outcomes were interested party’s conceptualisation of research importance and validation of the priorities in Research for Osteopathic Care (PROCare) framework. Secondary outcomes included current research priorities across interested parties groups and influence of contextual factors on prioritisation.

Three distinct approaches to priority-setting emerged: conservative (42.9%), sceptic (20.2%) and enthusiast (36.9%). Organising research priorities as a construct built from domains and subdomains was shown to be internally valid (Cronbach’s α=0.911). ‘Patient safety’ (nominated by 82% of relevant countries) and ‘physical activities and mobility’ (51.0%) were the most prioritised subdomains. ‘Digital health’ ranked lowest (28th of 28 subdomains). Significant geographic variations were observed mainly for the overall importance to most research domains. Strong consensus emerged around core priorities including patient safety, physical activity promotion and understanding treatment mechanisms.

The PROCare framework provides a validated structure for evaluating osteopathic research priorities across diverse interested parties. While geographic variations exist in priority emphasis, fundamental agreement on key research domains suggests potential for internationally coordinated research strategies. Future work should focus on developing mechanisms to ensure balanced representation of conservative, sceptic and enthusiast perspectives in research planning.

Multiple sclerosis (MS) is a chronic neurological condition that affects approximately 150 000 people in the UK and presents a significant healthcare burden, including the high costs of disease-modifying treatments (DMTs). DMTs have substantially reduced the risk of relapse and moderately reduced disability progression. Patients exhibit a wide range of responses to available DMTs. The Predicting Optimal INdividualised Treatment response in MS (POINT-MS) cohort was established to predict the individual treatment response by integrating comprehensive clinical phenotyping with imaging, serum and genetic biomarkers of disease activity and progression. Here, we present the baseline characteristics of the cohort and provide an overview of the study design, laying the groundwork for future analyses.

POINT-MS is a prospective, observational research cohort and biobank of 781 adult participants with a diagnosis of MS who consented to study enrolment on initiation of a DMT at the Queen Square MS Centre (National Hospital of Neurology and Neurosurgery, University College London Hospital NHS Trust, London) between 01/07/2019 and 31/07/2024. All patients were invited for clinical assessments, including the expanded disability status scale (EDSS) score, brief international cognitive assessment for MS and various patient-reported outcome measures (PROMs). They additionally underwent MRI at 3T, optical coherence tomography and blood tests (for genotyping and serum biomarkers quantification), at baseline (i.e., within 3 months from commencing a DMT), and between 6–12 (re-baseline), 18–24, 30–36, 42–48 and 54–60 months after DMT initiation.

748 participants provided baseline data. They were mostly female (68%) and White (75%) participants, with relapsing–remitting MS (94.3%), and with an average age of 40.8 (±10.9) years and a mean disease duration of 7.9 (±7.4) years since symptom onset. Despite low disability (median EDSS 2.0), cognitive impairment was observed in 40% of participants. Most patients (98.4%) had at least one comorbidity. At study entry, 59.2% were treatment naïve, and 83.2% initiated a high-efficacy DMT. Most patients (76.4%) were in either full- or part-time employment. PROMs indicated heterogeneous impairments in physical and mental health, with a greater psychological than physical impact and with low levels of fatigue. When baseline MRI scans were compared with previous scans (available in 668 (89%) patients; mean time since last scan 9±8 months), 26% and 8.5% of patients had at least one new brain or spinal cord lesion at study entry, respectively. Patients showed a median volume of brain lesions of 6.14 cm³, with significant variability among patients (CI 1.1 to 34.1). When brain tissue volumes z-scores were obtained using healthy subjects (N=113, (mean age 42.3 (± 11.8) years, 61.9% female)) from a local MRI database, patients showed a slight reduction in the volumes of the whole grey matter (–0.16 (–0.22 to –0.09)), driven by the deep grey matter (–0.47 (–0.55 to –0.40)), and of the whole white matter (–0.18 (–0.28 to –0.09)), but normal cortical grey matter volumes (0.10 (0.05 to 0.15)). The mean upper cervical spinal cord cross-sectional area (CSA), as measured from volumetric brain scans, was 62.3 (SD 7.5) mm². When CSA z-scores were obtained from the same healthy subjects used for brain measures, patients showed a slight reduction in CSA (–0.15 (–0.24 to –0.10)).

Modelling with both standard statistics and machine learning approaches is currently planned to predict individualised treatment response by integrating all the demographic, socioeconomic, clinical data with imaging, genetic and serum biomarkers. The long-term output of this research is a stratification tool that will guide the selection of DMTs in clinical practice on the basis of the individual prognostic profile. We will complete long-term follow-up data in 4 years (January 2029). The biobank and MRI repository will be used for collaborative research on the mechanisms of disability in MS.

The postnatal period is critical for preventing maternal and neonatal morbidity and mortality. Globally, a significant proportion of maternal and neonatal deaths occur within the first 6 weeks after delivery. Timely and adequate postnatal care (PNC) can detect and manage life-threatening complications; however, service utilisation remains alarmingly low in many low- and middle-income countries, including Saudi Arabia. Addressing the behavioural and perceptual factors that influence service use is essential for improving health outcomes.

This study aimed to assess mothers’ utilisation of PNC services and examine how their health beliefs and sociodemographic characteristics influence this behaviour.

A cross-sectional study guided by the Health Belief Model (HBM) was conducted to explore predictors of PNC utilisation.

Eight primary healthcare (PHC) centres were randomly selected from 179 PHC centres distributed in the different governorates of the Jazan region of Saudi Arabia.

A total of 464 mothers were surveyed between October and December 2023 using an interviewer-administered questionnaire.

The primary outcome was PNC utilisation, defined by the number of postnatal visits. The independent variables included sociodemographic characteristics and HBM constructs (perceived susceptibility, benefits, barriers and cues to action).

In terms of PNC utilisation, 80.0% of participants had two or fewer postnatal visits, whereas 20.0% had three or more postnatal visits. Perceived barriers had the strongest influence (mean score 2.51±0.87), followed by cues to action (2.43±0.89), susceptibility (1.92±0.72) and benefits (1.86±0.64). In the multivariate analysis, perceived barriers, cues to action and perceived susceptibility were significantly associated with PNC utilisation, with adjusted ORs of 1.679 (95% CI: 1.007 to 2.799), 0.470 (95% CI: 0.256 to 0.863) and 0.405 (95% CI: 0.197 to 0.832), respectively.

PNC utilisation in the Jazan region remains suboptimal. Perceptual factors, particularly barriers and cues to action, play a central role in service use. Health interventions targeting these beliefs and improving follow-up mechanisms may help increase PNC engagement and improve maternal and infant health outcomes in Saudi Arabia.

The global population is ageing with percentages of older adult individuals aged 65 years and older projected to increase from 17% in 2020 to 22% in 2040. Therefore, comprehensive approaches that integrate health and social care are increasingly vital to address the needs of the older population and promote healthy ageing. The WHO defines healthy ageing as maintaining functional ability and well-being in later life, emphasising holistic health beyond disease absence. Older adults’ health outcomes are influenced by social determinants of health (SDH) encompassing factors across various domains including healthcare access, education access, social and community context, neighbourhood and built environments and economic stability. Research on healthy ageing is mainly focused on healthcare achievements, but designing comprehensive measures requires attention to the full spectrum of SDH. This protocol describes the scoping review that aims to collate and critically appraise published articles on SDH measures in older adults to promote healthy ageing.

The scoping review will follow Arksey-O’Malley five-stage scoping review method and the Joanna Briggs Institute’s Scoping Review Methods Manual. Studies available in English-language published from 1 January 2015, the year the WHO’s first World Report on Ageing and Health was published, and up to 1 February 2025, will be identified from databases including PubMed, Scopus, CINAHL and Cochrane Database for Systematic Reviews. Two reviewers will screen titles and abstracts, followed by independent full-text screenings for inclusion. After data extraction, a narrative synthesis will be performed. Experts in the field will be consulted to ensure the results’ feasibility and relevance.

Ethical approval is not required for this review since it relies on available data. The results of the review will be disseminated through publication in journals and presentations at local, regional and global healthy ageing conferences or any related conferences.

Alliance ruptures constitute a high risk of premature treatment termination and poor psychotherapy outcome. The Alliance-Focused Training (AFT) is a promising transtheoretical approach to enhance therapists’ skills in dealing with alliance ruptures.

To evaluate the effectiveness of Modified AFT with doubling (MAFT-D), a randomised, patient and evaluator-blinded, multicentre trial was designed comparing MAFT-D (delivered to trainee therapists and supervisors) and psychotherapy training/treatment as usual (TAU) for therapists (n=120) and their patients with depressive disorders (n=240). A total of 17 cooperating centres, each offering either cognitive-behavioural or psychodynamic psychotherapy training, will contribute to recruitment. Stratification by centre (both for therapists and patients) and hence therapeutic approach (cognitive-behavioural vs psychodynamic psychotherapies), and by comorbid personality disorder (yes vs no, for patients) will be carried out. The two hierarchically ordered primary hypotheses are: In MAFT-D compared with TAU, a stronger reduction of depressive symptoms and a lower rate of patient dropout is expected from baseline to 20 weeks after baseline. Follow-up assessments are planned at 35 weeks, 20 months and 36 months postbaseline to evaluate the persistence of effects. Secondary patient-related and therapist-related outcomes as well as predictors, moderators and mediators of change will be investigated. Mixed models with repeated measures will be used for the primary analyses.

Ethical approvals were obtained by the institutional ethics review board of the main study centre as well as by review boards in each federal state where one or more cooperating centres are located (secondary votes). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

DRKS00014842; https://drks.de/search/de/trial/DRKS00014842.

This study aims to assess the level of mental health literacy (MHL) and identify its associated factors among undergraduate university students in Lebanon. A secondary objective is to evaluate the Global Barriers to Counselling scores, their associated factors, and to examine their relationship with MHL.

Cross-sectional study using an online self-administered questionnaire.

University-level educational settings in Lebanon, including students from both public and private institutions across multiple regions.

This study enrolled undergraduate students of all academic disciplines using a convenience sampling technique. Inclusion criteria included being 18 years and above, currently enrolled at university, able to comprehend the English language and consenting to participate.

Primary outcomes: MHL scores, using the Mental Health Literacy Scale (MHLS); and Global Barriers to Counselling score, using the Revised Fit, Stigma and Value Scale (RFSV). Secondary analysis examined factors associated with MHLS score and Global Barriers to Counselling scores using multivariable linear regression.

A total of 572 participants (65.0% female; mean age 21.1±3.7 years) were included. Most were Lebanese (87.4%). The median MHLS score was 86 (IQR 77–95), indicating generally good MHL. Factors associated with lower MHLS were male gender (β=–4.17, 95% CI –7.18 to –1.16, p=0.007) and being of non-Lebanese nationality (β=–6.26, 95% CI –11.06 to –1.46, p=0.011). Presence of a previous mental health diagnosis was associated with a higher MHLS score (β=5.32, 95% CI 1.43 to 9.22, p=0.008). The Global Barriers to Counselling score had a median of 28.7 (IQR 23.21–36.21). Male gender was significantly associated with a higher barrier score (β=3.44, 95% CI 4.85 to 5.04, p

This study highlights good overall MHL among undergraduate university students in Lebanon, with variations based on gender, nationality and prior mental health exposure. Higher mental health literacy was associated with fewer perceived barriers to seeking counselling. These findings emphasise the need for tailored mental health initiatives in Lebanese universities that promote literacy, reduce stigma and enhance help-seeking behaviour across diverse student populations.

To identify and contextualise evidence-based strategies for implementing deprescribing practices at different levels of healthcare in Brazil, through the development of an evidence brief for policy that includes stakeholder deliberation and considers barriers, facilitators and equity aspects.

This protocol outlines the development of an evidence brief for policy using a mixed-methods design. It involves synthesising evidence for health policies by integrating global research and local evidence through three stages: stakeholder exchange, evidence brief development and external endorsement. The Supporting Policy-Relevant Reviews and Trials tools for evidence-informed health policies will guide both the synthesis of strategies and the facilitation of deliberative dialogues. The synthesis will encompass evidence from systematic reviews and meta-analysis on deprescribing strategies across healthcare levels, focusing on effectiveness, harms, costs, perceptions, barriers, facilitators and equity. Studies proposing strategies not yet implemented will be excluded. Study selection and data extraction will be conducted independently and in duplicate. The methodological quality of included studies will be assessed using the A Measurement Tool for Assessing the Methodological Quality of Systematic Reviews-2 criteria. Synthesised evidence will be used to develop evidence-based strategies, which will then be presented in deliberative dialogues for endorsement by stakeholders and adaptation to the Brazilian context. Endorsement rates will be classified as high, moderate or low based on predefined criteria.

This study was approved by the University of Sorocaba Research Ethics Committee (certificate 82098324.7.0000.5500). Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and conference presentations.

CRD42024548845.