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To explore the challenges and facilitators to consumer engagement in care during hospital attendance, integrating the perspectives of patients, informal carers and care providers.
A qualitative descriptive study using semi-structured interviews.
A total of 102 individual interviews were conducted with patients (n = 43), informal carers (n = 31) and hospital care providers (n = 28) recruited from across Australia using purposive, convenience and snowball sampling. Data were collected between March 2023 and January 2024. Interviews were audio-recorded, transcribed and analysed using thematic analysis.
Eight themes illustrating factors that facilitated or hindered consumer engagement were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Patients, carers and care providers identified many overlapping barriers and facilitators, but differed in how they experienced and emphasised them.
Consumer engagement in hospital care is shaped by individual, interpersonal, organisational, cultural, systemic and ethical factors. Improving engagement therefore requires care environments that actively legitimise patient and carer engagement while providing staff with the time, resources and policy clarity needed to support safe and meaningful participation.
Healthcare organisations could strengthen consumer engagement by improving staff communication practices and cultural sensitivity, supporting patient and carer health literacy, creating structured opportunities for engagement, clarifying confidentiality and safety boundaries, and considering locally feasible support roles or technologies. Such strategies require adaptation to workforce and resource constraints and should be evaluated in future research.
What problem did the study address? ○
Consumer engagement is central to high-quality, patient-centred care, yet the factors that shape it remain incompletely understood, with prior research typically focusing on single perspectives or discrete episodes of hospital care.
What were the main findings? ○
Eight themes were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Although themes were broadly consistent across patients, carers, and care providers, the groups differed in how they experienced and emphasised these factors.
Where and on whom will the research have an impact? ○
The findings will inform care providers, healthcare organisations, and policymakers in developing strategies to improve consumer engagement across hospital settings, with relevance to international contexts where patient-centred care is a priority.
This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines.
Patients and members of the public were involved in the study design, participant recruitment, and interpretation and dissemination of findings. A Patient and Carer Advisory Board provided input from inception to dissemination, ensuring the research addressed patient-relevant priorities.
Not registered.
To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables.
Multicenter, cross-sectional.
A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours.
Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours.
Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship.
Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance.
The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours.
Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.
To evaluate the artificial intelligence-assisted lymphedema education material in patients undergoing breast cancer surgery.
A comprehensive, successful methodological design was used to evaluate the portability of the expandable, AI-supported lymphedema education material for breast cancer. The study was reported in accordance with the STROBE statement (see Data S1 for the completed STROBE [Strengthening the Reporting of Observational Studies in Epidemiology] checklist). When preparing the AI-supported lymphedema education material managed with breast cancer treatment, it is first determined in the education of patients. Then, the commands of the Chat GBT-4 program are included in the scope of the transferred education content. For the created education content, readability was first evaluated and expert opinion was taken for the final version of the draft.
While preparing the AI-assisted lymphedema education material in the study, expert opinions were obtained, and the educational needs of the patients were determined by scanning the literature. Then, 12 commands were given in the ChatGPT-4 program to create the educational content. Formulas were used to evaluate the readability of the created educational content in Turkish and the readability of the health literature. The validity of the lymphedema education material was presented to 10 experts. The experts evaluated the understandability and actionability of the educational material using the Patient Education Materials Evaluation Tool and the Global Quality Scale, which evaluates the quality of the educational material.
It was concluded that the readability index of the lymphedema education material for Turkish was 67.3, and the Turkish readability level was ‘easily understandable’. The readability index of health literature was found to be 11.28, 9.68, 10.58, 39.0, and 11.26, respectively. When the internal consistency coefficient between the experts was examined, it was found to be 0.74. It was determined that the Patient Education Materials Evaluation Tool understandability score average was 92.10 ± 9.03, and the actionability score average was 81.60 ± 18.47. The Global Quality Scale score average, which evaluates the suitability and quality of the content of the AI-supported educational material, was found to be 4.10 ± 0.87.
At the end of the study, it was determined that the educational material was reasonable regarding understandability and actionability. The Turkish readability level was also reasonable and easily understandable.
This study is one of the proactive attempts to use AI in preparing educational materials for nurses and healthcare professionals.
No patient or public contribution.
Advanced simulation is a methodology that allows the development of technical skills and transversal skills such as teamwork and leadership. There are tools to measure the development of technical competencies and student satisfaction with the methodology, but not to measure the development and use of transversal competencies in the clinical practice setting.
To develop and validate a scale to measure the impact of clinical simulation on the development and application of teamwork and leadership competencies.
A multicentre study was carried out in two Spanish universities in which the Clinical Simulation Learning Teamwork and Leadership Scale was developed and validated.
The study was carried out in several phases: development of the questionnaire using a Delphi method, pilot test and validation of the construct with a sample of 207 nursing students. Reporting of this research adheres to STROBE guidelines.
Content validity was checked according to Aiken's V for the three attributes of the questionnaire. Reliability or internal consistency was assessed with Cronbach's α and the sensitivity analysis showed no significant variation when any item was eliminated. On the other hand, McDonald's Omega statistic was used. Intraobserver reliability was taken from a sample of 47 students, in which it was observed that the intraclass correlation was positive.
The Clinical Simulation Learning teamwork and leadership scale is a valid instrument for measuring the development of transversal competencies.
This scale will provide information to evaluate the weight of the clinical simulation in the students' knowledge.
It is a tool for evaluating transversal skills that is proven valid and will improve the training of students.
The instructions of the STROBE checklist have been followed.
The students have participated in the knowledge transfer self-assessment.
To assess perceived patient safety competencies among nursing students and to examine their associations with their perceptions regarding clinical learning environment and unfinished nursing care.
An international comparative cross-sectional study.
A total of 1442 nursing students from the Czech Republic, Italy, Slovakia, and Türkiye participated between February and December 2025. Data were collected using the Health Professional Education in Patient Safety Survey, the Clinical Learning Environment, Supervision and Nurse Teacher scale, and the Unfinished Nursing Care Survey for Students. Descriptive statistics, non-parametric tests, Spearman correlations, and multivariate general linear modelling were applied.
Students reported significantly higher patient safety competencies in clinical compared with academic settings (p ≤ 0.001). Significant cross-country differences were observed across all competency domains (p ≤ 0.001). Perceived patient safety competencies were positively correlated with the overall quality of the clinical learning environment (r = 0.356–0.420; p < 0.001) and negatively correlated with unfinished nursing care (r = −0.107 to −0.171; p < 0.001). Multivariate analysis demonstrated that pedagogical atmosphere, premises of nursing care, supervisory relationship, and particularly the role of the nurse teacher were significant predictors of patient safety competencies.
The development of nursing students' patient safety competencies is closely linked to the quality of clinical learning environments. Strengthening educational and organisational conditions within clinical placements may play an important role in preparing future nurses for safe clinical practice.
Improving the quality of clinical learning environments, strengthening supervision, and addressing unfinished nursing care may support the development of nursing students' patient safety competencies and contribute to safer patient care.
The study was carried out according to the STROBE checklist.
No Patient or Public Contribution.
by Dandan Liu, Huixia Ji, Ye Chen, Tongzhou Zhou
BackgroundMetabolic dysfunction‑associated steatotic liver disease (MASLD) is a multisystem metabolic disorder. The impact of occupational noise exposure on metabolic processes through non-auditory pathways is also closely associated with hepatic steatosis in addition to obesity. Most studies examine noise exposure or Body Mass Index (BMI) alone on ultrasound-detected hepatic steatosis(UDHS), while few examine BMI’s interaction with occupational noise duration. The underlying mechanisms of these combined effects remain unclear. The correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers is examined, as well as the interactive role of BMI
ObjectiveThis study investigates the correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers, as well as the interactive moderating effect of BMI on this association.
MethodsA retrospective study involved 769 male workers exposed to occupational noise. Ultrasound was used to diagnose hepatic steatosis. Modified Poisson regression with robust variance estimation was used to analyze variable associations. A slope analysis and Johnson-Neyman test were used to validate BMI and variable interactions. A sensitivity analysis was performed to ensure robustness.
ResultsOverall, 53.2% of workers had UDHS. Noise exposure duration showed a significant independent association with UDHS,with a negative interaction effect on BMI (P = 0.006) after adjusting for confounding factors. In normal-weight workers, each additional year of noise exposure was associated with an 8.2% higher UDHS likelihood (P < 0.001), but not statistically significant in overweight/obese individuals; BMI = 27.7 kg/m² represented the critical threshold where the magnitude of this association approached zero. Alcohol consumption and overweight/obesity were independent risk factors.
ConclusionNoise exposure is associated with UDHS risk among male workers, yet BMI modifies this association, whereby the magnitude of this association weakens as BMI increases. These findings are specific to male factory workers and cannot be generalized to female populations. Accordingly, tailored occupational health protection strategies can be developed for noise-exposed populations.
by Michael E. J. Stouthandel, Danial Forouhar, Charlotte Debbaut, Jurgen Deviche, Liesl De Graeve, Bernard Depypere, Maarten Meire, Dominique Adriaens, Tom Van Hoof
IntroductionA better 3D visualisation of the lymphatic system could provide more accurate cancer treatment approaches, but this requires contrast agent injections. Since lymphatic vessels are very small, cannulations to administer contrast agent are very difficult to perform manually. As such, a dedicated set up for lymphatic vessel micro cannulations is required.
Materials and methodsA micromanipulator rig for full body micro cannulations was constructed. The rig consists of an aluminium frame that can be positioned over a dissection table. It combines the micromanipulator with a sliding gantry plate and a double jointed positioning system to provide as many possible angles of approach as possible. Fluid pressure control devices and a surgical microscope can also be included in the set up.
ResultsMicro cannulations on a full body could successfully be performed using the micromanipulator rig. After only a short learning curve to explore the movement possibilities/range of the device, the micromanipulator rig quickly outperformed manual micro cannulations.
ConclusionsGiven the short learning curve and the success rate of the micro cannulations with the micromanipulator rig, we would strongly recommend other microvascular researchers to use the micromanipulator rig for future experiments involving micro cannulations.
The Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded eligibility for community-based care particularly for Veterans facing geographic or capacity-related barriers. Patients with diabetic foot ulcers (DFU) require timely specialty management and are vulnerable to fragmented care, yet little is known about how the MISSION Act reshaped patterns of DFU-related specialty care within and outside the VA. We conducted a retrospective cohort study of Veterans aged 65 or older with a new DFU diagnosis in VA between 2016 and 2022. We identified DFU-related specialty encounters (podiatry, vascular surgery, infectious diseases and endocrinology) and categorised community encounters as VA-paid or Medicare-paid. We assessed annual trends in community specialty care and changes in the proportion and payer type of care before and after the MISSION Act. Among 76 398 patients, VA-paid community specialty care increased substantially following the MISSION Act, with larger relative growth among rural Veterans (rural: +119%; urban: +96%). In contrast, Medicare-paid DFU specialty care declined during the same period (rural: −12%; urban: −13%). Following the MISSION Act, reliance on VA-paid community specialty care increased markedly for Veterans with DFU, particularly in rural areas, while reliance on Medicare-paid care decreased.
Missed nursing care threatens quality and safety, but patient counts may not capture shift-level demands. We examined associations of patient-count and perceived workload indicators with missed care, separating within- and between-nurse effects.
A multicenter observational study using repeated shift-level measurements.
The study included 502 shift records from 213 nurses in 16 medical–surgical units across six Italian hospitals; the primary analysis included 480 records from 196 nurses. Patient-count indicators were nurse-reported numbers of assigned, isolated, and specialist-care patients; perceived workload included work rhythm/quantity, mental workload, emotional workload, and work organization. Grouped-binomial generalized estimating equations modeled the proportion of applicable activities missed, with nurse clustering, robust standard errors, exchangeable correlation, and hospital fixed effects. Workloads were decomposed into within- and between-nurse components, and four missed-care domains were examined.
Nurses reported a mean of 6.5 missed activities per shift; 29.9% of shifts had no missed care. The seven workload indicators were jointly associated with missed care (robust Wald χ 2[7] = 22.95, p = 0.002). Work rhythm/quantity was the only individual indicator with a nominal p-value below 0.05 (OR 1.24 per SD, 95% CI 1.03–1.49; p = 0.023), but it did not remain significant after Benjamini–Hochberg correction (q = 0.159). Assigned patient count was not clearly associated (OR 1.14, 95% CI 0.94–1.40; p = 0.192). In exploratory within–between analyses, the between-nurse work rhythm/quantity component was associated with missed care (OR 1.42, 95% CI 1.11–1.82; p = 0.005), whereas the within-nurse component was not (OR 1.03, 95% CI 0.90–1.17; p = 0.649). Domain-specific associations did not remain significant after multiplicity adjustment.
The workload indicators were jointly associated with missed nursing care, with secondary analyses indicating that the global signal was evident in the perceived-workload block. However, no individual workload indicator remained statistically significant after multiplicity adjustment. Work rhythm/quantity and its between-nurse component should therefore be regarded as exploratory signals requiring confirmation in studies with denser repeated measurements.
Workload surveillance research should evaluate patient-count and multidimensional perceived-workload indicators together. The present coefficient-specific findings are insufficient to support the operational use of work rhythm/quantity as a stand-alone workload indicator.
by Isabella DeStefano, Adanna Ibeku, Krystal Hunter, Melissa Micallef, Alla Kushnir
“Late preterm” or “LPT” neonates are generally defined as infants born between 34 0/7 and 36 6/7 weeks gestation and constitute approximately 74% of all preterm births. While much effort has been put into evaluating the nutritional needs of early preterm or low birthweight infants, there is a shortage of research on the nutritional needs of LPT infants. This work examined how adherence to current nutrition guidelines and how the use of fortification of feeds affected the growth of LPT neonates in the first year of life. A retrospective chart review was conducted of 898 neonates born between 34 0/7 and 36 6/7 weeks gestation, as identified from electronic medical records. The study site where the data was obtained was an urban hospital in New Jersey. Head circumference, weight, and length at birth, documented as measurements, percent, and z-scores, at discharge, at two months, at six months, and at twelve months post birth, were collected and evaluated. Data regarding the neonate’s feeding regimen, caloric fortification, and type of nutrition at the point of discharge were assessed. Data were analyzed using independent t-tests and Mann-Whittney U tests to assess the relationship between adherence and growth parameters. Of these participants, 50.1% were male, the mean gestational age was 34.91 (±1.19), and the mean birth weight was 2317 (±489) grams. Infants with lower birth weight (BW) were more likely to receive fortification (BW p < 0.001, BW percentile p < 0.001). Participants who followed fortification guidelines had lower birth weight, discharge weight, and weight percentile (p < 0.001), as well as lower z-scores for BW, length, and head circumference (HC) at birth and at discharge. At six and twelve months, weight, weight percentile, length, length percentile, head circumference, and head circumference percentiles were not statistically significant. The results show that adherence to nutritional guidelines recommending fortified feeding is associated with growth within the first year of life of LPT infants. By two, six, and twelve months, there were no differences in z scores in participants with fortification.Psychosocial interventions are essential to support people living with dementia and their carers. A consensus on what is most important for research on psychosocial intervention in dementia and how intervention studies should best be conducted is currently lacking. This protocol describes the research plan aimed at achieving consensus on (i) the relevance of core elements (CEs) for the development, feasibility testing/piloting, evaluation and/or implementation phases of psychosocial interventions in dementia and (ii) methodologies (eg, design) and methods most suitable to address CEs per phase.
This study was co-designed with a multi-stakeholder advisory group and a multi-disciplinary INTERDEM (psychosocial INTERventions in DEMentia) Methodology Taskforce steering committee. It will involve a multi-phase modified Delphi design, including surveys and group discussions with stakeholders, namely people living with dementia, (informal/unpaid/family) carers, health and social care professionals, policy makers, representatives from insurance companies and psychosocial researchers. A series of iterative ‘rounds’ will be conducted. In round 1 (Phase 1: ‘identification’), stakeholders will be asked to complete an online survey rating the importance of CEs from the UK Medical Research Council (MRC) Framework, namely (i) consider context; (ii) develop, refine and (retest) programme theory; (iii) engage stakeholders; (iv) identify key uncertainties; (v) refine interventions and (vi) economic considerations per phase; propose relevant additional CEs and list methodologies/methods that most suitably address CEs. These ratings will be further explored through online discussion rounds (Phase 2: ‘elaboration’). In round 2 (Phase 3: ‘consensus’), participants will be asked to rate the importance of CEs again (ie, new CEs and where no consensus was reached in Phase 1) and the usefulness of methodologies/methods to address CEs. Outcomes will be discussed with the advisory group and steering committee (Phase 4: ‘validation’). This process (Phases 3 and 4) will be repeated until a consensus on CEs and methodologies/methods is achieved.
Ethical approval was received at Maastricht University (FHML-REC/2025/078) and the University of West London (UWL/REC/SBS-01195). Participants will sign informed consent prior to study participation. Results will be disseminated through a peer-reviewed publication, seminars, webinars, conferences, postgraduate dementia programmes, blogs, commissioner briefings and social media.
Open Science Framework (https://doi.org/10.17605/OSF.IO/DQRFA).
In 2024, 30.4% of the German population had a migration background. People with migration-related language barriers face numerous challenges within the healthcare system, which can negatively impact their health outcomes. While language barriers affect healthcare in general, oncology represents a complex field in which effective communication is crucial. For people with cancer in particular, difficulties in understanding information, treatment options, and the healthcare system itself may hinder access to services. This increases the risk of complications, prolonged hospitalisations and readmissions. At the same time, there is little information about this group, and evaluations of structured services are lacking. This study assesses a nurse-led complex intervention focusing on structured information and ongoing support for people with cancer and migration-related language barriers.
The intervention is designed for people with cancer and migration-related language barriers and comprises three key elements: (a) continuous guidance provided by already existing roles of oncology nurse specialists, (b) a telephone interpreting service and (c) multilingual informational materials. We will assess the intervention’s effectiveness with a controlled before-and-after study. Assuming an effect size of d=0.5 and using a 2:1 allocation ratio with 80% power, we aim to recruit 126 people with cancer and migration-related language barriers (84 intervention; 42 control) for participation. We will assess the primary outcome psychosocial support needs assessed with the Psychosocial Risk Questionnaire (PSR) at admission, discharge, and 3-month post-discharge using paper-based or digital questionnaires. The secondary outcomes, such as knowledge, quality of life, anxiety and satisfaction, are measured alongside the primary outcomes and compare the distribution of items and scores using Student’s t-test (total scores) or the Wilcoxon rank sum test (individual items) at a one-sided significance level of 5%. We will use an embedded process and economic evaluation to examine the feasibility, acceptability and implementation of the intervention in line with the Medical Research Council guidance for process evaluations of complex interventions.
The Ethics Committee of the Faculty of Medicine, University of Cologne (No. 23–1303 and 24–1266), approved the protocol, and the study was registered in the German Clinical Trials Register. We will disseminate the results of the study through peer-reviewed publications and at academic conferences.
German Clinical Trials Register (DRKS00034749).
To evaluate resilience, burnout, intent to leave and use of resiliency skills among new graduate nurses following the introduction of resiliency skills during a nurse residency programme.
This programme evaluation used a quasi-experimental, repeated-measures design, with assessments conducted at baseline, 2 weeks and 3 months following the intervention.
Nurse residents participated in a 1-h, in-person introduction to the evidence-based Community Resiliency Model (CRM) as part of a didactic day away from bedside care. The CRM is a sensory-focused self-care approach to regulating the nervous system and is associated with improved healthcare worker well-being and work team engagement. Changes in resilience and burnout were evaluated over time, and relationships among resiliency skill use, resilience, burnout and intent to leave were examined.
The training was well received based on post-intervention surveys. A total of 135 nurse residents were trained, and 68 provided evaluation data at baseline and 3 months. No significant changes in resilience, burnout or intent to leave scores were observed. However, 73% of new graduate nurse participants reported using the resiliency skills at least once during the 3 months following training.
This evaluation suggests that the CRM training is feasible and acceptable as an addition to new graduate nurse professional development strategies. Although no significant changes in resilience, burnout or intent to leave were observed, the majority of participants reported using resiliency skills following training. Introducing sensory-based resiliency skills during the residency period may provide nurses with practical strategies for managing role transition and work-related stress that can be reinforced and further developed throughout their careers.
by Jasmine S. Turner, Victo Kyobutungi, Hellen Ayozu, Nikhit D’Sa, Mark J. D. Jordans
This study aimed to develop an intervention to improve consistent school attendance in participation with caregivers, teachers, and other stakeholders, in refugee settings in Uganda. In Phase 1, we organized four group model building workshops with caregivers and teachers in four refugee settlements to identify factors influencing attendance and caregiver engagement in education, and generate proposed actions to address them. We synthesized the outputs into a causal map and set of intervention strategies. These were reviewed through four respondent validation workshops with caregivers, teachers, school management, and representatives from refugee settlement authorities, international organisations, and local government. The resultant intervention – SchoolLinks – was field tested in one school with students and teachers of Primary 3 and Accelerated Education Programme 1 (government-run non-formal education supporting refugee and out-of-school children to complete primary school). Feedback was systematically collected from school staff, caregivers, children and community members to inform adaptations to improve the SchoolLinks design. Group model building revealed that attendance and retention were influenced by caregivers’ attitudes toward education and encouragement towards their children, which affected children’s motivation to attend school. Relationships between caregivers and teachers, mediated by their communication, mutual knowledge, and constrained by language barriers, influenced caregivers’ attitudes and levels of encouragement. Broader contextual factors, including poverty and lack of safety, undermined attendance and retention. SchoolLinks comprises six complementary strategies: (1) caregiver–teacher meetings, (2) meeting translation, (3) enrolment week with digital data capture, (4) attendance monitoring and incentives, (5) homework clubs, and (6) children walking in groups to school. Field testing supported the intervention’s acceptability, appropriateness, and feasibility. This multi-phase participatory approach provides insights into intervention development in refugee contexts. Future research should aim to identify the intervention’s mechanism(s) of action, analyse cost-effectiveness and cost-efficiency, engage children in further development, and assess the transferability of SchoolLinks to other settings.Children discharged after in-hospital treatment for severe anaemia or severe malaria in sub-Saharan Africa remain at high risk of readmission and death, particularly in malaria-endemic settings where recurrent infections are common. Post-discharge malaria chemoprevention (PDMC) has demonstrated substantial reductions in mortality and hospital readmissions and is now recommended by the WHO. However, optimal PDMC delivery strategies, via existing health systems, that optimise adherence remain unclear, particularly in West Africa where implementation and evidence of impact on clinical outcomes are limited. This trial aims to determine the effectiveness of different PDMC delivery strategies and adherence support mechanisms in optimising completion of PDMC courses. Secondary objectives include assessing clinical outcomes (readmissions, outpatient visits, mortality), evaluating health system linkage mechanisms and examining the acceptability and feasibility of the different delivery approaches.
A cluster-randomised implementation trial will be conducted in central and southern Benin across urban and rural settings. Clusters, defined as villages within the catchment areas of two referral hospitals, will be randomly allocated (1:1:1) to one of three arms: (A) facility-based drug distribution (all courses) at discharge with community health worker (CHW) home visit reminders; (B) monthly community-based drug delivery by CHWs combined with phone reminders; and (C) dispensing all courses to caregivers at discharge without adherence support (control). Eligible participants are children under 10 years hospitalised with severe anaemia or severe malaria and clinically stable at discharge. All participants should receive three courses of dihydroartemisinin–piperaquine at weeks 2, 6 and 10 post-discharge and will be followed for 14 weeks. The primary endpoint is incomplete adherence to the full PDMC regimen (3 courses/9 doses). Secondary endpoints include all-cause and malaria-specific readmissions, outpatient visits and mortality. Quantitative outcomes will be analysed using mixed-effects regression models under an intention-to-treat approach. Qualitative methods will assess acceptability and feasibility among caregivers, providers and policymakers.
Ethical approval was received from the institutional review boards of the Benin Institute of Applied Biomedical Sciences and Liverpool School of Tropical Medicine. Trial findings will be disseminated to national and international stakeholders through meetings, peer-reviewed publications and major conferences to inform PDMC policy, implementation guidelines and global malaria scale-up efforts, particularly through engagement with the World Health Organization and major malaria funding partners
Middle Nurse Managers (MNMs) play a pivotal role in translating organizational strategy into operational practice, ensuring care quality, and fostering team performance. Despite their importance, limited research has examined the factors influencing MNMs' competencies, particularly the interplay between individual and organizational determinants.
To examine the direct and moderating effects of self-efficacy and other organizational and individual factors on MNMs' competence knowledge and competence application across Italy.
A cross-sectional, multicenter study was conducted between September 2022 and December 2023 with the participation of 382 MNMs from public and private healthcare organizations. Data were collected using validated instruments, including the Chase Nurse Manager Competencies Scale, the Questionnaire on Experience and Work Evaluation (QEEW 2.0), and the Leadership Self-Efficacy Scale. Structural equation modeling (SEM) tested direct effects of educational appropriateness, leadership training intentions, autonomy, role clarity, and work complexity, and the moderating role of self-efficacy.
Educational appropriateness, autonomy, and role clarity were significantly associated with competence knowledge, while educational appropriateness and autonomy were associated with competence application. Self-efficacy was directly associated with both competence outcomes and significantly moderated the relationship between educational appropriateness and autonomy with each competence dimension, with positive associations observed among individuals with higher self-efficacy (β = −0.456 for knowledge; β = −0.459 for application, p < 0.001).
Self-efficacy was associated with competence outcomes and moderated the associations between organizational factors and competence. High self-efficacy may reduce reliance on perceived educational appropriateness, whereas lower self-efficacy increases its importance.
FreshRSS 