Indian immigrants experience significant dietary acculturation post-migration, shifting from traditional diets to more westernised eating patterns influenced by socioeconomic and environmental factors. This transition, often marked by increased processed food consumption and reduced intake of traditional staples, contributes to elevated risks of obesity and type 2 diabetes. Despite the growing Indian diaspora in Australia, Canada, New Zealand and the UK, the evidence on their dietary acculturation remains limited.

This review will adopt the Joanna Briggs Institute (JBI) methodology for scoping reviews. A three-step search strategy will be applied across databases including MEDLINE (via PubMed), CINAHL, Scopus and Web of Science. Google Scholar will be used as a supplementary search tool to identify additional relevant studies. The search will include peer-reviewed studies and grey literature published in English between 1 January 2000 and 22 May 2025. First-generation Indian immigrants of all ages will be included, while second-generation immigrants, refugee populations and studies linked to non-communicable disease interventions will be excluded. Screening will be conducted in Covidence by two independent reviewers, with discrepancies resolved by a third reviewer. Data will be extracted using a standard JBI tool, charted in tabular form, and synthesised narratively and thematically.

As this review will use published and publicly available data, formal ethics approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and community engagement.

This study intended to investigate barriers to implementing evidence-based intrapartum care during vaginal births, from maternity care providers’ point of view.

A descriptive qualitative study was conducted using in-depth interviews, with data analysed through thematic analysis.

The labour room of a major tertiary care hospital in Central Sri Lanka.

Purposively selected 17 maternity care providers including doctors, nurse managers, nurse-midwives and midwives.

Three major themes and twelve sub-themes were generated: (1) barriers related to care providers (lack of human resources, negative attitudes of care providers, poor relationship among care providers, poor relationship between women and care providers, lack of knowledge on evidence-based practice in childbirth care); (2) barriers related to organisational environment (gaps in management, heavy workload, inadequate physical resources, insufficient in-service training and lack of availability/use of updated guidelines) and (3) barriers related to women’s birth preparedness (women’s limited knowledge on childbirth and intrapartum practices and women’s limited engagement during labour and childbirth). Many maternity care providers perceived that prevailing challenges to implement evidence-based childbirth care were one of the major reasons that impacted the quality of current childbirth care in the labour room.

The findings showed that an integrative approach may be essential to address the diverse barriers to the implementation of evidence-based intrapartum care. It is necessary to engage healthcare administrators, healthcare professionals and care recipients to enhance the quality of current childbirth care in the setting through the successful implementation of evidence-based care.

Adults living with chronic conditions may need to access health programmes to mitigate health-related challenges that persist long after discharge from the hospital. Community physical activity programmes represent critical opportunities for health promotion and chronic disease self-management that can extend beyond hospital-based services. However, navigating the healthcare system and connecting to much-needed physical activity programmes can be challenging due to fragmentation of the health and social care system, especially for those who are transitioning between different healthcare providers, settings, stages of recovery and funding sources (eg, public, private). Patient navigation services can assist with this fragmentation by providing tailored support to individuals with chronic conditions. However, our understanding of patient navigation services in Canada is limited. This rapid review seeks to explore the landscape of patient navigation services supporting Canadians with chronic conditions in connecting to physical activity programmes in the community.

The rapid review will follow the recommendations published by Garritty et al in 2024. Integrated Knowledge Translation will be employed to facilitate meaningful engagement of people with lived experience of chronic conditions throughout the entire research process. Studies published in English that examine patient navigation services in physical activity for community-dwelling Canadians with chronic conditions will be included. Ovid MEDLINE, Embase, Emcare, CINAHL and Google Canada will be searched for articles published from 1990 to May 2025 to identify the characteristics, strengths and limitations, and prioritised features of patient navigation services for community physical activity programmes. The Mixed Methods Appraisal Tool will be used to assess the quality of included studies.

This protocol is a rapid review of published literature and does not require ethical approval. Review findings will be disseminated to various key interest groups through publications, presentations, infographics, social media posts and/or videos.

https://osf.io/gd2zm.

There are limited data about how South Asian (SA) patients, their caregivers and their physicians make decisions about treatment, in particular advanced therapies. The study aimed to explore how SA people with inflammatory bowel disease (IBD), their family members and clinicians experience and perceive treatment-related decision-making with the aim of identifying strategies to improve treatment decision-making in Canada.

A descriptive qualitative study with in-depth semi-structured interviews.

Canada.

Adults residing in Canada, who self-identified as SA, had received treatment or cared for someone who received treatment for IBD from a gastroenterologist in Canada, and who spoke and understood English, Hindi and/or Punjabi were eligible to participate in the study. Clinician participants (eg, nurses, gastroenterologists, colorectal surgeons) were eligible if they had experience treating SA patients with IBD.

Data from 1:1, semi-structured interviews were analysed using deductive and inductive thematic analysis.

The length of time spent in Canada played a central role in patient perspectives on decision-making around IBD treatment. First or second-generation SA people, residency status, family and community involvement, universal factors like stigma, medication costs and preferences for non-pharmacological treatments influenced decision-making. Patient and caregiver participants reported high satisfaction with treatment-related decision-making processes, while clinician participants self-reported lesser satisfaction.

Clinicians and researchers working with SA patients in chronic disease specialties can use these findings to meet the healthcare needs and reduce disparities in optimal treatment for this patient population.

N/A.

To date, few studies have investigated the factors associated with musculoskeletal patients’ willingness to donate biological samples and their knowledge regarding the use of such samples. We investigated the associations between these distinct knowledge factors, patients’ willingness to donate and socio-demographic factors.

Cross-sectional survey.

Musculoskeletal outpatient clinics across four sites in England, representing varied demographic populations.

A total of 469 adult patients attending musculoskeletal appointments were recruited through convenience sampling.

Ordinal regression models were employed to identify socio-demographic and clinical predictors of patients’ willingness to donate biological samples. Other outcome measures specifically in two areas of patient knowledge include: (1) knowledge of sample use and (2) knowledge of surgical waste tissue value and management.

Only 37% of participants were aware of the term ‘biobank’. Despite this, participants showed a high level of knowledge regarding both biological sample use and surgical waste tissue management, although their understanding varied considerably by ethnicity and education. Participants with no formal education exhibited a lower level of knowledge in both areas related to sample use and surgical waste tissue management for biomedical research ((OR 0.30, 95% CI 0.14 to 0.61; p=0.001); (OR=0.29, 95% CI 0.16 to 0.52, p

Despite low awareness, musculoskeletal patients showed a high willingness to participate in biobanking. However, significant disparities by ethnicity and education persist. Targeted, inclusive engagement strategies are needed to address under-representation and foster informed, equitable participation of musculoskeletal patients in biomedical research.

Malaria remains a major public health challenge in India, with transmission dynamics varying widely across ecological, epidemiological, sociobehavioural and health system contexts. Achieving the national malaria elimination target by 2030 requires integrated, context-specific evidence to design effective interventions. This study aims to generate a comprehensive understanding of malaria transmission and factors surrounding it across diverse eco-epidemiological settings in India by assessing malaria burden, identifying determinants of transmission, evaluating health system performance and equity, characterising vector bionomics and insecticide resistance, and examining the influence of environmental drivers.

This longitudinal, multicentric study will be conducted in collaboration with the national programme in 12 districts spanning 10 states in India, covering a population of around 25 000 individuals representing varied ecological contexts (urban, periurban, rural, forest-foothill and coastal) and malaria endemicity levels. In each district, two clusters (villages) with a population of 1000 individuals will be included. A baseline mass survey will estimate malaria prevalence using bivalent rapid diagnostic tests (RDTs) and blood smear microscopy, with low-density parasitaemia detected by PCR in a subset of RDT-negative samples. Participants will be followed for 1 year, with monthly screening of symptomatic individuals using RDT and microscopy, and testing a subset of asymptomatic individuals to detect subclinical infections. Sociobehavioural data will be collected through structured interviews and household observations, with purposive inclusion of vulnerable groups, pregnant women, migrants, elderly persons, individuals with disabilities and tribal populations to assess equity dimensions through mixed-methods approaches. Health system performance will be evaluated through key informant interviews with programme officials, health workers, patients, private practitioners and traditional healers. Entomological surveillance will document vector species composition, density, infection rates and assessment of susceptibility status and intensity of insecticide resistance to commonly used public health insecticides. Environmental variables, including temperature, rainfall and humidity, will be linked with entomological and epidemiological data to explore spatiotemporal relationships.

The protocol was approved by the Institute Human Ethics Committee of ICMR-Vector Control Research Centre (IHEC 03-0125/N/F). All standard ethical practices will be adhered to. The findings will be shared with stakeholders and published in reputed open-access journals.

The objective of this study is to co-produce a care bundle for women with multiple long-term health conditions (MLTC) that could be pilot tested and implemented in UK maternity services.

Online co-production workshops each attended by 20–30 key interest holders.

United Kingdom, October 2023-February 2024.

Women with experience of pregnancy with MLTC, healthcare professionals and other interest holders involved in commissioning, planning and delivering care for pregnant women with MLTC.

This study followed a three-step process: (1) a consolidated list of key components of care for pregnant women with MLTC was created through secondary analysis of prior collected qualitative data; (2) the list of care components was explored during four co-production workshops; and (3) findings from (1) and (2) were synthesised to develop a maternity care bundle of 4–5 key care components for pregnant women with MLTC.

A maternity care bundle of five key care components for pregnant women with MLTC.

A list of 25 care components was refined to develop a proposed care bundle of five components. These were provisions of early and reliable medication advice and decision support; creation of a ‘goals of care summary’ accessible to women and the care team; provision of continuity of midwifery care throughout pregnancy and postnatal care; provision of a named care coordinator; and a formal postnatal handover of care from the multidisciplinary care team to the General Practitioner (GP) and secondary care team involving the woman.

This study coproduced an evidence-based care bundle for pregnant women with MLTC to enhance communication and ensure individualised care and support. Further collaborative work with women and professionals is required to refine, implement and evaluate its impact on outcomes.

Suboptimal feeding practices in children under five remain a critical concern, particularly in low- and middle-income countries. Integrated Supplementary Feeding programmes (SFPs) combined with Social and Behaviour Change Communication (SBCC) interventions have shown potential, yet global evidence on their design and effectiveness remains scattered across diverse settings and varies widely in scope and quality. This review aims to map global evidence on integrated SFP and SBCC interventions for children aged 6–59 months, assessing their impact on anthropometric, biochemical, nutritional, health, developmental, functional, microbiological and infant and young child feeding (IYCF) outcomes, and to identify contextual factors, evidence gaps and successful strategies. The review will also aim to document cost effectiveness and economic outcomes of this integrated intervention.

The review will follow Joanna Briggs Institute (JBI) methodology, applying the Population–Concept–Context framework and the review title has been registered in Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/ZJ5BG). Eligible studies published between 2000 and 2025 will include community-based interventions for children under five that combine SFP and SBCC. The review will focus on SFP interventions delivered through community-based or public health platforms, including but not limited to take home ration, hot cooked meal, micronutrient powders, coupled with SBCC modalities such as home visits, mobile health and mass media campaigns. Comprehensive searches will be conducted in MEDLINE (PubMed), Cochrane CENTRAL, Google Scholar and organisational websites. Two independent reviewers will screen, extract and appraise studies using Covidence and JBI tools. Data will be analysed using descriptive statistics to summarise study characteristics, intervention types and reported outcomes, helping understand patterns across time and settings. Qualitative findings will be synthesised through descriptive content analysis involving coding and theme development. Expected outcomes include a range of study designs from different settings across the globe, covering diverse delivery models of integrated SFP and SBCC with reported outcomes including dietary indicators, anthropometry, nutritional biomarkers, caregiver practices and cost-effectiveness.

This review is part of a larger cluster randomised controlled trial (NECCTAR) which has received ethical approval from the independent institutional ethics committee of all the participating institutes. The current review will involve only publicly available literature and does not have a separate institutional ethics committee approval. Findings will be disseminated through academic conferences and publications in peer-reviewed journals.

The review title has been registered in OSF (https://doi.org/10.17605/OSF.IO/ZJ5BG).

Medication non-adherence in older adults with long-term conditions contributes to significant morbidity, mortality and healthcare costs. While adherence support tools exist, many interventions fail to reach those most at risk. Automated medication dispensers (AMDs) show promise in improving adherence and health outcomes, but their integration into routine community pharmacy practice remains underexplored. This study aims to assess the effectiveness of an AMD intervention with SMS reminders in enhancing medication adherence among older adults and to evaluate how this technology can be integrated into community pharmacy workflows.

This randomised controlled trial involves 144 participants recruited from eight community pharmacies who will be randomised to receive either the AMD intervention or usual care. Primary outcomes include medication adherence, measured through pharmacy records and self-report at baseline, 3 and 6 months. Secondary outcomes include Morisky Medication Adherence Scale, health-related quality of life (SF-12), and healthcare resource use. A nested mixed methods process evaluation will explore uptake, acceptability and implementation.

The study protocol has been approved by the University of Bedfordshire Institute for Health Research Ethics Committee (IHREC1039), the NHS and the local authority Research Governance and Research Ethics Committee (NHS REC reference: 25/EE/0026). The findings will be disseminated via a final report, peer-reviewed journal publications and presentations at relevant conferences.

ISRCTN18849739.

To evaluate the impact of digital supportive supervision (DiSS) for maternal and child healthcare on utilisation of services in Rajasthan state of India, as well as exploring the perceived enablers and barriers to the implementation of DiSS.

We employed a sequential mixed-method study design. Routine monthly service data from April 2016 to March 2023 were analysed using an interrupted time-series (ITS) analysis with a control group, followed by qualitative in-depth key-informant interviews.

The study is set at the primary healthcare level in Rajasthan state in India, where maternal health, child health and nutrition (MCHN) sessions are conducted at village level to deliver essential maternal and child health services.

Based on the proportion of MCHN sessions supervised digitally, two districts demonstrating high DiSS uptake were selected as intervention districts, and two matched districts were identified as comparator districts, creating a quasi-experimental design. Using routine data extracted from the pregnancy, child tracking and health services database, a segmented regression analysis using ITS was undertaken to assess temporal changes in service utilisation. For the qualitative component, we purposively sampled supervisors in intervention districts (ranked by DiSS supervisory volume) and conducted interviews until thematic saturation (n=18).

The intervention involved digitising the traditional paper-based supportive supervision of MCHN sessions in Rajasthan through a DiSS tool. Supervisors across state, district, block and sector levels used smartphones or tablets to record MCHN session data offline, which was automatically analysed and reported on dashboards on submission.

The study aims to measure the change in the monthly rate of MCHN service uptake following the rollout of DiSS in Rajasthan state.

Pentavalent and inactivated-polio vaccine uptake significantly improved in the intervention group, while no change was observed in the comparator group. Both groups showed significant improvement in the iron and folic acid supplementation among pregnant women and uptake of BCG, Hepatitis B birth dose and Measles vaccines among children, with greater increase in the intervention group. Notably, pneumococcal-conjugate-vaccine uptake declined significantly in the comparator group, whereas no significant change occurred in the intervention group. Limited digital literacy during the initial rollout and compatibility restriction of the digital application to Android devices were chief barriers. Among the enablers, its user-friendly interface, offline functionality, GIS-based monitoring and automated report generation were reported to enhance the timeliness, accountability and efficiency of supportive supervision. This, in turn, strengthened the feedback loop, empowering programme managers to promptly identify and address any shortcomings.

DiSS has the potential to strengthen the healthcare system and significantly improve the utilisation of MCHN services.

Enteric fever, primarily caused by Salmonella enterica Typhi and Salmonella enterica Paratyphi A (SPA), is endemic mainly in South Asia, disproportionately affecting school-age children. Although typhoid conjugate vaccines (TCVs) are effective and implemented in many countries, no licensed vaccine exists against paratyphoid A. Bivalent vaccines targeting both S. Typhi and SPA may address this gap. Although field efficacy trials are not considered feasible, controlled human infection models (CHIMs) offer an alternative pathway for evaluating vaccine efficacy. This will be the first efficacy study of a bivalent vaccine against typhoid and paratyphoid A using a paratyphoid CHIM.

This is a phase II multicentre, double-blind, randomised controlled trial assessing the efficacy and immunogenicity of a bivalent conjugate vaccine candidate, Serum Institute of India Typhoid Conjugate Vaccine (Bivalent) (SII-TCV(B)), against SPA using a CHIM in healthy UK adults aged 18–55 years. A total of 192 participants will be randomised 1:1 to receive either SII-TCV(B) or a licensed Vi-polysaccharide typhoid vaccine (Vi-PS). All participants will be orally challenged with S. Paratyphi A (strain NVGH308) 28 days postvaccination. Participants will be monitored closely for 14 days and treated at 14 days postchallenge or promptly on diagnosis, according to prespecified criteria. The primary objective is to evaluate vaccine efficacy of SII-TCV(B) against paratyphoid infection using a CHIM. The coprimary immunogenicity objective is to assess non-inferiority of the typhoid IgG response compared with a licensed Vi-PS control.

The study has received ethical approval from the Berkshire Research Ethics Committee (24/SC/0309) and regulatory approval from the UK Medicines and Healthcare products Regulatory Agency. Results will be disseminated via peer-reviewed publications and scientific meetings.

ISRCTN65855590.

Leptospirosis is a significant public health concern worldwide, as it imposes a substantial economic burden on the global economy. Despite a comprehensive search of the relevant literature, few studies evaluating the economic burden experienced by leptospirosis patients were identified. In particular, very few studies thoroughly examined the cost components, including direct, indirect and intangible costs. This paucity of evidence further motivates the need to conduct a more focused search using a systematic review approach. Thus, this study aims to systematically review the global literature on the magnitude and aspects of the direct, indirect and intangible costs incurred by leptospirosis patients and the methods available for assessing these costs.

This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines. The Population, Intervention, Comparison, Outcomes, Study Design framework was used to develop the review questions. The search strategy will comprise two key term blocks: ‘Leptospirosis’ and ‘Economic cost’. A comprehensive literature search will be conducted in PubMed, Web of Science, Scopus, MEDLINE, CINAHL, the Cochrane Library, EconStor and IDEAS to collect publications from inception to July 2025. The search will be limited only to English-language and peer-reviewed publications. The Mixed Methods Appraisal Tool will be used to assess the quality of eligible studies. Extracted cost data will be categorised into direct, indirect and intangible costs. A meta-analysis will be conducted to quantify the magnitude of these costs if sufficient methodological and contextual homogeneity exists. Moreover, a narrative synthesis will be performed to analyse the qualitative data related to intangible costs.

As this study will use secondary data, ethical approval is not required. The systematic review’s findings will be published in a scientific journal and presented at relevant conferences to address the knowledge gap regarding the economic burden (including direct, indirect and intangible costs) faced by leptospirosis patients. The results of this systematic review will guide policies for prioritising prevention, improving surveillance and efficiently allocating resources to control leptospirosis.

PROSPERO CRD 42024585056.

To examine how patients and family members decide whether to accept a highly invasive intervention (aortic valve replacement (AVR)) when their condition (aortic stenosis (AS)) is asymptomatic and its course uncertain.

Nested, longitudinal, qualitative substudy of an ongoing randomised controlled trial (RCT) (NCT04204915) testing early intervention (EI) versus watchful waiting (WW) in patients with asymptomatic severe AS.

Six select UK sites of the RCT.

Select participants of the RCT, their next-of-kin and some who declined RCT participation.

73 interviews were conducted, with 41 participants.

Few knew much about AS before diagnosis. Uncertainty and the need for reliable information regarding symptoms and progress was a significant problem.

While some expressed unease at a major intervention for an asymptomatic condition, there were no outright objections to the idea.

Those who declined participation in the RCT did so for personal reasons, for example, their home circumstances did not permit the required period of recovery or they felt too old to risk intervention.

Reasons for accepting early intervention included the belief that the condition was serious and likely to deteriorate, and so better to have the intervention before such deterioration, as well as avoiding long waiting lists. Trusting clinicians’ judgement played a part in some decisions. Patients also wanted choice in the type of intervention received.

The longitudinal interviews (n=32) showed satisfaction in the early intervention group despite some problems in the the early recovery phase, especially for those undergoing surgical AVR.

Where evidence supports major intervention for an asymptomatic condition, patients are likely to accept the offer, although personal circumstances play an important role in decision-making. Where a condition is not well known to the public, such as AS, patients rely on clinicians and other resources to help decide. Liaison with patient groups in developing shared decision-making resources may help with complex decisions.

NCT04204915

To assess the impact of the non-reimbursement policy on vitamin D therapy discontinuation in patients from the general and rheumatic populations.

A cross-sectional study.

Research institute specialised in health research and two outpatient pharmacies in the Netherlands.

Patients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.

Data were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value

The primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.

Of the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p

The implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged

Living labs represent a user-centric approach to solving real-world challenges by encouraging active participation of external stakeholders in co-designing the research and innovation process. Highlighted by contextual research and user co-creation, living labs are ideal for addressing the challenges of providing optimal healthcare to patients living in rural and remote regions. Our objective was to synthesise the existing research on the living lab approach in co-designing, developing or implementing a rural healthcare service, clinical intervention or health-related technology.

Scoping review.

A search was conducted on 10 May 2025, to identify articles from three electronic databases (MEDLINE, EMBASE and CINAHL).

We included published literature that presented a living lab approach to improve the provision of healthcare services in a rural environment. We excluded articles examining social determinants of health (eg, physical activity and general health promotion) without a direct link to clinical service innovation or healthcare delivery.

We collected data on study methodologies, settings, stakeholders and innovation types. Data extraction was performed by two independent reviewers using a standardised form. We used frequencies and a narrative synthesis to map characteristics, methods and contexts of living lab applications in rural healthcare.

The search identified a total of 1080 articles and ultimately included 11 articles. Studies were published between 2016 and 2025 and conducted in Canada (n=3), the USA (n=3), Australia (n=2), Guatemala (n=1), Uganda (n=1) and France/Portugal (n=1). Study settings included rural hospitals, regional health networks, Indigenous communities, farming and fishing communities and underserved rural regions. Health issues targeted included cardiovascular disease, diabetes, musculoskeletal conditions, perinatal care, palliative care and infectious disease management. Study methodologies included formalised, theory-driven frameworks (n=4), community-based participatory research (n=4), user- or human-centred design (n=3) and co-design workshops and interviews (n=3). Only one study explicitly used the term ‘living lab’ to describe their innovation.

Relatively few living lab approaches have been meaningfully applied in rural health. There is a need for greater global diversification, expanded domains of focus and more robust evaluation to fully understand the potential and impact of living labs in rural healthcare.

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).

Paediatric palliative care (PPC) improves the quality of life of children with life-limiting and life-threatening conditions, with caregivers playing an important role. Providing PPC in low-income and lower-middle-income countries (LMICs) is challenging due to limited resources, inadequate access to specialised care, financial constraints, and cultural or religious beliefs. This study aims to synthesise qualitative research on the experiences of primary care givers caring for children with cancer receiving palliative care in LMICs.

A systematic search will be conducted using electronic databases: MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, CINAHL (Cumulative Index to Nursing and Health Literature), Web of Science, and PsycINFO. Additional articles will be searched in the reference list of the selected articles. Review questions will be framed into different components according to the Population, phenomena of Interest, Context, and Outcome (PICO) framework. Primary caregivers of children with cancer will be the population of interest. Both title and abstract screening and full-text screening will be done by two independent reviewers. The quality of included studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. The thematic synthesis approach will be followed as it will allow a transparent summarising of the qualitative data.

This study is not subject to ethics approval, as the work is carried out on published documents. The findings of this review will be disseminated among a broader audience through scientific channels, including publication in open-access journals and presentations at both national and international forums.

CRD420251065491.