Funnel plots are used to identify intensive care units (ICUs) with a higher than expected risk-adjusted mortality. ICUs with a standardised mortality ratio (SMR) within pre-defined control limits (often the 99.8% CL) are regarded as ‘in control’ and not labelled as a potential outlier for a particular calendar year. However, increased mortality rates not due to random fluctuations within and across the calendar years may be overlooked. We examined whether statistically significant and relevant differences in mortality over time between ICUs regarded as ‘in control’ are present.

A longitudinal register-based study.

88 ICUs in the Netherlands registering the admissions of all critically ill patients in the National Intensive Care Evaluation registry in the Netherlands from 2013 to 2023.

Hospital death analysed in a multivariable logistic regression analysis with a random intercept for ICU. The random intercept variance was translated to the median OR (MOR).

877 ICU-calendar year combinations were included, covering 759 498 unique admissions. The MOR increased from 1.12 (95% CI 1.10 to 1.15) for ICU-calendar year combinations with an SMR within the narrowest 95% CL (N=677) to 1.20 (1.17 to 1.24) for combinations with an SMR within the expanded 99.8% CL (including adjustment for overdispersion) (N=194) and to 1.21 (1.17 to 1.25) when including all ICU-calendar year combinations. Similar results were found for separate calendar years and separate diagnostic groups.

These results show differences in mortality between ICUs that were not labelled as outliers. Assessment of mortality performance should integrate cross-sectional funnel plots, the MOR and longitudinal trends in the SMR to better capture persistent patterns of excess risk.

To define subaxial cervical spine vertebral body and canal dimensions in a paediatric cohort and to assess the influence of age and ethnicity.

Retrospective radiological observational study.

Single-centre tertiary level trauma care setting in New Zealand.

CT scans of children under 18 years of age were reviewed. A total of 111 participants were included (63 New Zealand European (NZE) and 48 Māori). Patients with cervical spine pathology or deformity were excluded.

Not applicable.

Primary outcomes were anteroposterior and transverse vertebral body and spinal canal dimensions measured at the mid-pedicle level from C3 to C7. Secondary outcomes included canal-to-vertebral body (canal:VB) ratios. Associations with age and ethnicity were assessed using correlation analysis and analysis of covariance (ANCOVA).

Absolute vertebral body and canal dimensions were larger in NZE children compared with Māori. Canal:VB ratios were smaller in NZE children, reaching statistical significance at C7 (p=0.011). Age demonstrated a strong positive correlation with mean vertebral body anteroposterior diameter and a moderate correlation with canal:VB ratio. ANCOVA showed ethnicity (NZE) to be a significant predictor of vertebral body dimensions, particularly transverse diameter at C4–C6, while age had a lesser effect. Canal:VB ratios decreased with increasing age from C3 to C7, with low coefficients of determination indicating additional influencing factors.

In this paediatric cohort, vertebral body dimensions were more strongly associated with age than spinal canal dimensions. Ethnicity was associated with modest differences in cervical spine morphology, particularly transverse vertebral body diameter. These findings suggest cervical spine development is multifactorial and may have implications for trauma assessment and spinal cord injury risk evaluation in adolescents. Further studies incorporating anthropometric and sex-specific variables are warranted.

Early-stage mycosis fungoides (MF) is diagnostically challenging due to overlap with inflammatory dermatoses. Age-related immunological and cutaneous changes may modify histopathological presentation. We aimed to compare clinical, histopathological and immunophenotypic features of early-stage MF between geriatric and non-geriatric patients.

Multicentre retrospective cross-sectional study.

Dermatology departments of tertiary centres in Türkiye.

A total of 541 patients diagnosed with early-stage MF were included and stratified into geriatric (≥65 years) and non-geriatric (18–64 years) groups.

The primary outcomes were age-related differences in histopathological and immunohistochemical features. Secondary outcomes included clinical characteristics and quality of life measures. Primary endpoints were prespecified a priori (epidermotropism, basilar lymphocytes, epidermal atrophy, dermal lymphocytic infiltration, papillary dermal fibrosis and CD4-dominant versus CD8(+)/CD4(–) phenotypes); all other comparisons were considered exploratory.

The geriatric group had a higher proportion of males (59.5% vs 47.1%; p=0.004), while lesion type, duration, surface involvement and Dermatology Life Quality Index scores did not differ between groups. Histopathologically, epidermotropism (81.3% vs 63.3%), basilar lymphocytes (57.1% vs 45.7%), epidermal atrophy (26.6% vs 13.8%), dermal lymphocytic infiltration (75.8% vs 58.5%) and papillary dermal fibrosis (55.2% vs 38.4%) were more frequent in geriatric patients (all p

Although clinical characteristics were comparable across age groups, geriatric patients showed differences in reported histopathological and immunophenotypic features; these observations may facilitate clinicopathological recognition of early-stage MF in older individuals. However, some features (particularly epidermal atrophy and superficial/papillary fibrosis) are not MF-specific and may partly reflect background age- and site-related changes.

Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M).

To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template.

Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis.

Primary care (general practices) in three English regions.

Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).

Qualitative: Staff at implementation practices.

A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training.

Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices.

Measures of reach, fidelity, acceptability and sustainability.

Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual.

In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation.

Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training.

https://doi.org/10.1186/ISRCTN40295449 (2022–08-03, retrospectively registered.)

Ethnic communities provide an appropriate setting for examining patterns of pregnancy and childbirth. Policy-making aimed at improving maternal health will be rendered ineffective in the absence of knowledge and comprehension of the traditions and beliefs associated with childbirth. The objective of this study was to cross-ethnically compare childbirth experiences.

This research used a cross-sectional methodology and was conducted in 2023. The sampling in the cities of Tabriz (Azeri), Sanandaj (Kurdish), Babol (Mazani), Khorramabad (Lur), Ahvaz (Arab) and Tehran (Fars) was conducted using the cluster random approach. The data collection instruments included questionnaires of sociodemographic and obstetric characteristics and childbirth experience (Childbirth Experience Questionnaire 2.0). In bivariate analysis, a one-way analysis of variance test was employed. In contrast, a general linear model (GLM) was used in multivariate analysis to adjust for the influence of sociodemographic and obstetric characteristics. The data were analysed using SPSS V.24 software. The p value less than 0.05 was considered significant.

Health centres in cities with different ethnic groups all over Iran.

For this purpose, 1331 women from six ethnic groups who were referred to health centres were selected 4 to 6 weeks after giving vaginal birth.

The following are the mean (SD) scores (scoring range: 1–4) for the childbirth experiences of the participating women: Azeri 2.31 (0.32), Kurdish 2.14 (0.31), Fars 2.26 (0.42), Mazani 1.93 (0.38), Lur 2.14 (0.4) and Arab 2.06 (0.18). Results from GLM multivariate analysis showed that while Azeri (B: 0.25; 95% CI 0.16 to 0.35; p

Women of different Iranian ethnicities have varying childbirth experiences. Women of Azeri and Fars ethnic groups report higher satisfaction with childbirth than those of others. Mazeni women had the lowest mean scores for having a positive birth experience. To offer compassionate and effective treatment for their patients, healthcare providers must have a deep understanding of cultural diversity.

Medication errors pose a significant threat to public health. Despite efforts by health agencies and the implementation of various interventions, such as staff training, medication reconciliation and automation, the persistence of these incidents highlights the need for more effective, scalable solutions. In recent years, machine learning (ML) has emerged as a promising approach in healthcare, offering potential to detect and predict medication errors through data-driven insights. This scoping review aims to systematically map the existing literature on ML-based approaches to predict or detect medication errors across all stages of the medication use process. The review seeks to identify the range of ML applications in this domain, characterise methodological trends and highlight current knowledge gaps. The findings will provide a structured and accessible overview for both clinicians and researchers, supporting the development of safer, more data-informed medication practices.

The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. Structured searches will be performed in PubMed, Embase and Web of Science, covering publications from 1 January 2015 to 28 April 2025. Predefined inclusion and exclusion criteria will be used to identify eligible studies. Key information—including ML models, data sources and type, evaluation methods and clinical contexts—will be extracted and analysed using descriptive statistics, visualisations, thematic analysis and narrative synthesis.

This study involves a review of existing literature and does not involve human participants, personal data or unpublished secondary data. As such, ethical approval was not required. All data analysed were obtained from publicly available sources. Findings of the scoping review will be disseminated through professional networks, conference presentations and publications in scientific journals.

This protocol has been registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/38SFY).

Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors.

We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI.

A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway.

The two hospitals serving the population of Akershus county, Norway.

Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study.

Cardiovascular risk assessment was performed at study inclusion (2012–2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016–2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection.

MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI.

In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF.

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01555411.

A neglected area of patient safety research is how the characteristics of mental health staff and teams may influence incidents, specifically, through unintended and harmful consequences of clinical care. While the research literature into patient safety has increased, there is still a need to further consider safety on mental health wards, for example, the role of the staff team in containment and conflict. This review aims to explore the question, ‘How do staff and team characteristics relate to safety incidents in adult inpatient mental health settings?’.

The review will follow Whittemore and Knafl’s integrative review framework. CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, Web of Science will be searched. Literature published after 1999, that includes extractable quantitative, qualitative and mixed methods data exploring the relationship between staff and team characteristics on incidents in adult inpatient mental health settings, will be suitable for inclusion. The Mixed Methods Appraisal Tool will be used for quality appraisal and data analysis and will comprise data reduction, display and comparison.

No new data or access to participants will be involved in this review. As such, ethical review will not be required. Dissemination will include publication in peer-reviewed journals and presentations at national and international conferences.

This review has been registered on PROSPERO (ref. CRD420251119981; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251119981).

Emotional difficulties, such as low mood and worry, are more prevalent among female forces veterans compared to their male peers. However, female veterans are more reluctant to access mental health services available for armed force veterans. To enhance help seeking, the Iona female forces veterans (IonaFFV) research app has been developed and adapted for low mood and worry management among female veterans. This feasibility randomised controlled trial primarily seeks to explore the methodological uncertainties of conducting a definitive randomised controlled trial using IonaFFV. Secondary aims seek to explore acceptability and engagement with IonaFFV. Additionally, progression criteria will be assessed to determine feasibility of moving to a definitive trial.

Participants were recruited online and asked to complete two screening assessments to assess eligibility. Eligible participants were randomised using block randomisation to use either the IonaFFV or Iona sham app for 6 weeks. Recruitment and randomisation are complete, and data collection is currently ongoing. At the end of the 6-week intervention period, participants will complete the Patient Health Questionnaire-9, the Generalised Anxiety Disorder-7 and Work and Social Adjustment Scale outcome measures. At 4 weeks postintervention (10 weeks postrandomisation), participants will complete the same outcome measures in addition to the mHealth App Usability Questionnaire (MAUQ) to assess acceptability of both IonaFFV and Iona sham. At the end of the study, the participants who were in the Iona sham group will be given an option to use the IonaFFV app for 6 weeks. Proportions will be reported for feasibility and demographic data with descriptive analysis conducted for the outcome measures. Median values with IQRs will be conducted for each subscale of MAUQ.

This study received ethical approval from the University of Exeter Psychology Ethics Committee with consent obtained from all participants. Study findings will be published in peer-reviewed journals, presented at conferences, with a final report presented to the funders of the project.

ISRCTN50744553.

Antimicrobial resistance (AMR) is one of the most urgent global health threats, responsible for an estimated 4.95 million deaths annually, including 1.27 million directly linked to drug-resistant infections. Nigeria is particularly affected, ranking 19th globally in AMR-related mortality, with an estimated 64 500 attributable and 263 400 associated deaths in 2019. These estimates are likely conservative due to limited surveillance. Economically, AMR could cost Nigeria 5%–7% of its GDP by 2050.

Despite this burden, antibiotic misuse remains widespread, with 42% of adults and over 46% of children under 5 receiving antibiotics without prescriptions. At the primary healthcare (PHC) level, where most antibiotics are prescribed, challenges such as limited diagnostics, inconsistent prescription and poor access to digital tools hinder effective antimicrobial stewardship (AMS).

The primary objective of this study is to assess the knowledge, attitudes and practices regarding antimicrobial resistance (AMR) among PHC prescribers in Imo State, Nigeria. A secondary objective is to explore preliminary indicators of their digital readiness to inform future technological interventions for AMS.

A cross-sectional study using an online questionnaire.

PHC facilities across all 27 local government areas of Imo State, Nigeria.

A purposive sample of 547 facility-based public PHC prescribers included 84% of all facility Officers-in-Charge of health facilities in the state and 16% of other PHC workers who were involved in prescription.

The primary outcome measures were composite scores for knowledge (adequate/inadequate), attitude (positive/negative) and prescribing practice (good/poor), derived from a validated questionnaire. Secondary measures included sources of AMR information and indicators of digital readiness.

While 77.1% demonstrated adequate knowledge, only 32.7% exhibited positive attitudes and 88.5% reported poor prescribing practices. Attitude was the strongest predictor of good practice (OR=17.585, p

These findings underscore a critical gap between knowledge and practice, driven in part by limited access to digital decision-support tools. To address the documented gaps in tool access and training, strengthening digital inclusion through context-adapted e-learning, offline-compatible AMS tools and simplified digital antibiograms is a necessary implication for improving antibiotic stewardship and clinical outcomes at the PHC level.

People with serious mental illness (SMI) can experience significant physical health challenges. The Health Champions intervention was developed to support their physical health through using trained volunteers. However, volunteer and patient perspectives on the impact and implementation of this intervention have yet to be understood.

To compare the views of patients and volunteers on the Health Champions intervention.

A qualitative thematic analysis was conducted on interviews with 29 study participants. Interviews were carried out either face-to-face, via Microsoft Teams, or by telephone and included 12 patients (6 men and 6 women) and 17 volunteers (the Health Champions) (5 men and 12 women).

Four overarching themes were identified, highlighting both similarities and differences between stakeholders’ perspectives: (1) supporting goal setting; (2) impact on positive lifestyle; (3) experiences and perception of the programme and (4) navigating challenges during the programme. Both groups found the programme to be largely successful, by motivating patients to work towards their physical health goals and facilitating successful matching of patients with volunteers. Volunteers and patients valued good communication with the research team. Though both groups shared some views on the challenges with scheduling and a lack of face-to-face contact during the COVID-19 pandemic, their perceptions on how patients incorporated their health changes during and after the programme, as well as other administrative concerns such as views on the efficacy of journaling and breakdown of roles, differed.

The Health Champions intervention was perceived as useful to improve the physical health of patients with SMI. Differences in the views between the two stakeholders may result from their distinct experiences and expectations. Future volunteering programmes should further support the diverse physical health needs of patients with SMI.

Group A Streptococcus (Strep A) causes a wide spectrum of diseases, ranging from pharyngitis and impetigo to severe invasive infections and immune-mediated conditions such as acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. Contemporary data on the global burden of Strep A diseases are lacking. The proposed study aims to use administrative data from numerous jurisdictions to estimate age-specific incidence or prevalence of Strep A diseases, with an emphasis on severe clinical endpoints. Depending on the availability of data, a secondary objective will be to estimate the economic burden of Strep A diseases.

This population-based descriptive study will use routine health data obtained from different low-income and middle-income and high-income countries through international research collaborations to estimate the country-level and global burden of Strep A diseases. Data will be primarily obtained and collated from hospital or national health laboratory databases for individuals across all age groups, along with emergency department, primary care and microbiological datasets where available. Strep A disease endpoints will be identified using International Classification of Diseases 10th Revision or other relevant coding systems and microbiological diagnosis. Age-specific incidence and prevalence rates will be computed using population denominators, and country-level age-adjusted rates will be applied to standard global reference populations to estimate the number of cases globally.

Ethical approval to conduct this study was obtained from the Human Research Ethics Committee at the University of Western Australia (reference: #2024/ET000401) and governance approval was obtained from The Kids Research Institute Australia. The findings from this study will be published in peer-reviewed journals and presented at Strep A Vaccine Global Consortium collaborative meetings.

To assess nutrition-related knowledge, attitudes and practices among pregnant women, and identify socioeconomic and healthcare determinants.

A cross-sectional study on maternal nutrition during pregnancy.

Pregnant women attending primary healthcare centres in the south of Tehran from December 2022 to March 2024.

1535 pregnant women of all ages living in the south of Tehran (both Iranian and non-Iranian).

Pregnant women were systematically selected from primary healthcare centres. Data were collected via validated questionnaires and electronic health records. Statistical analyses included multivariate logistic regression (adjusted ORs (aORs) with 95% CIs) and generalised linear mixed models.

The findings revealed that a majority of pregnant women (83.3%; 95% CI 81.2% to 85.3%) exhibited low levels of nutritional knowledge (scores below 12), whereas 14% demonstrated moderate knowledge (scores between 12 and 17), and only 2.7% (95% CI 1.9% to 3.8%) possessed high nutritional knowledge (scores above 18). In terms of attitudes, 36.9% of respondents expressed positive views toward nutrition, with higher education significantly associated with positive attitudes (aOR=1.8; 95% CI 1.3 to 2.5, comparing higher vs lower education levels). Dietary variety was consistently reported by 65.4% of participants, while 8.5% lacked dietary variety. Statistically significant associations were observed between educational attainment, socioeconomic status and nutrition-related practices (p

As a cross-sectional study, these findings highlight substantial gaps in nutrition knowledge among pregnant women in Tehran, with socioeconomic status and education playing crucial roles in shaping dietary behaviours. Improving nutritional education through healthcare interventions is essential for enhancing maternal and fetal health outcomes.

Early screening for autism spectrum disorder (ASD) can enhance educational and health outcomes for affected children. This narrative systematic review explores school-based screening tools used around the world to identify children with ASD and explore the differences across socio-demographic groups.

Systematic review of electronic databases (EMBASE, MEDLINE, PsycINFO, Cochrane and Scopus) in October 2024 of papers published between 2011 and 2024.

Mainstream school-based settings globally.

Children aged 4–16 years old attending mainstream school.

School-based screening tools for ASD, including all types of informant and format of tools reported in eligible studies.

Primary outcomes included prevalence of screen positives, sensitivity and specificity of the screening tools. Secondary outcomes included participants’ sex, socioeconomic status and ethnicity, and the relation of this to the primary outcomes.

Of 7765 eligible articles, 14 studies were included in this review. We identified eight different school-based ASD screening tools. Study populations ranged from 103 to 16 556 children, with sensitivity and specificity varying by screening tool used, age group, setting and ASD prevalence. The percentage of children screening positive for ASD ranged from 0.7% to 8.5%. Studies were conducted in Europe (n=6), Western Pacific (n=4), the Americas (n=3) and Eastern Mediterranean (n=1) regions. No studies explicitly explored accuracy or validity outcomes based on ethnicity or socioeconomic status. Half of the 14 studies (n=7) reported the sensitivity and specificity of the screening tools; sensitivity ranged from 58% to 94% and specificity from 61% to 100%. There was insufficient evidence to recommend any single ASD screening tool.

ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations.

Many researchers conduct a process evaluation alongside an effectiveness trial of a public health intervention to better understand mechanisms behind observed effects. Yet, there is no standardised, scientifically accepted guideline for reporting such process evaluations, which impedes interpretation and comparison of study results. The aim of this project was to develop a consensus-based and expert-based guideline for reporting process evaluations of public health interventions conducted alongside an effectiveness trial.

We conducted an e-Delphi study with a large panel of international experts.

Based on purposive sampling, we invited 137 international experts that had been involved in the design of process evaluations, researchers who published high-profile process evaluations or frameworks, editors of journals that publish process evaluations, and authors of other reporting guidelines.

Based on a literature search, a first draft of the reporting guideline included 32 items, which was proposed to panel members during the first round. Of the invited 137 invited international experts, 73 (53%) participated in at least one round of the e-Delphi study. Participants rated the inclusion and comprehensibility of the proposed items on a 5-point Likert scale and provided comments and suggestions for relevance and definitions of the items. Adjustments to the items and descriptions were proposed to the e-Delphi panel until consensus of ≥67% for each individual item was reached. In total, 64 (88% of 73) completed round 2, and 55 (76% of 73) completed round 3. This resulted in 19 items that are included in the consensus-based process evaluation reporting guideline for public health intervention studies (CONPHES) guideline. The items cover a detailed description of the intervention that is evaluated, the implementation strategies applied, and underlying causal pathways, and the role of the delivery and support team. The guideline also requires describing the evaluation framework and how evaluation outcomes were assessed. Lastly, the guideline includes items on providing a detailed description of applied analyses (both quantitative and qualitative) and measures for assuring quality. The guideline is accompanied by an Explanation and Elaboration document, with a more detailed explanation of each item.

We expect that the CONPHES reporting guideline for process evaluations of public health interventions can improve the reporting of process evaluations of interventions aimed at promoting public health. This can potentially facilitate more effective translation of public health research into practice and contribute to improving both individual and population health outcomes.