Hypertension is the leading global risk factor for mortality, causing over 10 million deaths annually. In sub-Saharan Africa, hypertension prevalence is high, particularly in rural areas, where it is less likely to be diagnosed, treated or controlled effectively. This results in a high burden of complications, including heart failure, stroke and kidney disease. Community-centred approaches using community health workers (CHWs), risk-based approaches and simplified treatment regimens have shown promise in improving hypertension management. However, there is limited evidence on the effectiveness of such approaches in rural sub-Saharan Africa.

The primary aim of this study is to assess the feasibility of a community-centred intervention for hypertension management in rural Kenya and The Gambia. The objectives are to evaluate the intervention’s adoption, fidelity, reach and dose; understand the mechanisms of action and contextual factors affecting its implementation; assess acceptability from the perspectives of patients, healthcare providers and policymakers; estimate the costs associated with the intervention; and evaluate study procedures to inform the design of a future full-scale trial.

We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30–80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation.

Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters.

This study is registered with the ISRCTN- The UK’s Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).

The growing advancement of innovative stem cell technologies requires careful evaluation of their economic, clinical and societal impacts. Early economic evaluations are essential for developing new medical technologies and supporting key decisions about commercialisation and market access. This scoping review explores Early Health Technology Assessment (eHTA) approaches specifically related to human stem cell technologies. By examining how eHTA can support the commercialisation of these therapies, we aim to clarify its role in optimising resource allocation and enhancing both the clinical and societal benefits of stem cell technologies.

To explore the use of eHTA in the development of stem cell-related technologies, a scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review Extension guidelines. Systematic searches were conducted across scientific databases (MEDLINE, International HTA database, EconLit, PAIS Index and EconPapers), grey literature sources (Overton) and through hand-searching to identify eligible articles published from inception to 14 April 2026. No limits were imposed on language. Reviewers will independently record data from eligible studies using a standard data abstraction form. The gathered information will be synthesised both quantitatively and narratively.

Formal ethical approval is not required, as this study does not involve the collection of primary data. The findings will be shared through professional stem cell networks, published in national and international health technology assessment conference proceedings and submitted for open-access, peer-reviewed publication.

Miscarriage, defined in the UK as loss of pregnancy prior to 24 weeks gestation, can have long-term psychological implications. Clinical guidelines for perinatal bereavement care do not provide guidance on how best to support the mental health of women, and their partners, after miscarriage. Peer support (support from those who share common characteristics) is often sought, but there is little understanding of its access and use. We conducted a systematic review to understand the barriers to and facilitators of the implementation of peer support to improve mental health outcomes for parents after miscarriage.

Systematic review and thematic synthesis.

A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national Call for Evidence.

Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included.

Two independent reviewers used standardised methods to search, screen, extract and code included studies. Suitable studies were evaluated using the Critical Appraisal Skills Programme Qualitative Research Checklist. Findings were extracted and subjected to a thematic synthesis.

Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. ‘Engaging in relational recognition’ reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. ‘Mechanisms of Communality’ describe how communality is enacted through dynamic peer interactions, including modelling and facilitating grief, benchmarking physical change and mattering through reciprocity, highlighting mutual support and shared coping. ‘Dynamics of Access’ consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects.

These findings form the first synthesis of peer support after miscarriage and bring a nuanced service user perspective of barriers and facilitators by examining evidence from diverse studies. Peer support after miscarriage was seen to be a dynamic, relational process shaped by shared experience, mutual exchange and context-specific factors. Findings underscore key policy and practice considerations, including the use of trauma-informed, loss-sensitive approaches and consideration of intersectionality, that should be reflected when offering peer support services, with and for, those who have experienced miscarriage.

CRD42024518248.

Obsessive-compulsive disorder (OCD) is characterised by obsessive thoughts and compulsive actions. These obsessive-compulsive symptoms (OCS) are subclinical manifestations that do not meet the full diagnostic criteria for OCD and are associated with anxiety, depression and lower quality of life (QoL). Medical students are vulnerable to developing OCS due to stress in medical school. This study assessed OCS prevalence and its association with the mental well-being and QoL of medical students in Egypt.

A nationwide cross-sectional study was conducted across 15 Egyptian medical schools. Using convenience sampling, 1850 students participated by completing a self-administered questionnaire that used validated scales. We assessed OCS with the Obsessive-Compulsive Inventory-Revised (OCI-R) using a screening cut-off of ≥21, QoL with the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-QSF), and anxiety and depression with the 4-item Patient Health Questionnaire (PHQ-4). Descriptive statistics and logistic regression were employed.

Clinically significant OCS prevalence among medical students was 51.1%. Significant predictors for OCS included being female (adjusted OR (AOR)=1.25), attending a private university (AOR=1.64), and having personal (AOR=2.05) or combined personal and family history of mental illness (AOR=2.69). OCS presence was associated with a lower QoL score (Q-LES-QSF: 41.00 vs 43.97) and higher psychological distress score (PHQ-4: 5.93 vs 3.57) compared with students without OCS (p

OCS are prevalent among Egyptian medical students, especially females, private university attendees and those with a personal or family history of mental illness. These symptoms are associated with higher psychological distress and a lower QoL. As OCS were identified using a screening cut-off, and given the cross-sectional design, findings should be interpreted cautiously, warranting further longitudinal investigation. Universities should consider implementing mental health support, screening and awareness programmes to address these issues.

Anomia is a primary feature of aphasia that negatively impacts quality of life. Although current anomia treatments improve word retrieval, long-term retention and generalisation of trained words to discourse-level communication are rarely measured. Treatment that produces lasting naming gains and generalises to real-world use is one of the top priorities of people living with aphasia. Here, we report the protocol for a randomised clinical trial that investigates individualised anomia treatment through adaptive naming deadlines to achieve ‘desirable difficulty’ to promote learning retention and generalisation.

We implement a within-subject sequential, crossover design in which 30 participants with chronic post-stroke aphasia will complete three anomia treatment conditions in randomised order: (1) an adaptive condition where the naming deadline (ie, amount of time the participant is given to name the item) dynamically adjusts between 1.5 and 10 s based on ongoing participant performance and (2) a static Effort-Maximised condition where there is a fixed 10-second naming deadline for all treatment sessions and (3) a static Accuracy-Maximised condition where items are presented immediately in auditory and orthographic form and are repeated by the participant. In each condition, participants are treated on 40 unique non-overlapping words across eight treatment sessions. Before and after each condition, participants complete naming probes and discourse probes. Treatment outcomes from the adaptive treatment will be tested against the two static conditions using linear mixed-effects modelling. Our primary outcome is performance on noun picture naming at 3 months post-treatment. We evaluate production of treated words in discourse probes as a secondary analysis. We predict that our novel, adaptive naming treatment will produce more successful outcomes compared with the static treatment conditions.

The Institutional Review Board of the University of Pittsburgh approved the trial protocol (Study 21120130). Following study completion, results will be disseminated in peer-reviewed journals. If hypothesised results are observed, the adaptive treatment will be a novel, empirically based intervention for long-term retention of anomia treatment gains, positively impacting the lives and recovery of individuals living with aphasia.

NCT05653440.

To describe the epidemiology, ecological determinants and public-health response to a yellow-fever (YF) outbreak in Wa East District (WED), Ghana, and to identify operational gaps to strengthen surveillance and immunisation in high-risk rural settings.

A cross-sectional descriptive outbreak investigation integrating epidemiological, entomological, vaccination-coverage and community knowledge assessments, conducted under Ghana’s Integrated Disease Surveillance and Response framework.

WED, located in the Upper West Region of Ghana, is an agrarian, forest-fringe area bordering the Mole National Park, characterised by limited access to health services and seasonal nomadic movements.

All suspected YF cases (N=57) reported between epidemiological weeks 41–46 of 2021; 50 community respondents interviewed for knowledge and awareness and 52 households inspected for entomological indices.

Demographic and clinical characteristics of cases, spatial–temporal distribution, vaccination coverage, Aedes vector indices, community knowledge and awareness levels and response interventions.

A total of 57 suspected cases (33 males 24 females) were identified, of which 12 (21.1%) were laboratory-confirmed. The case-fatality ratio among confirmed cases was 33.3% (95% CI 9.7% to 65.1%). Most cases occurred in individuals aged 6–30 years and were clustered in the Ducie community. The epidemic curve, based on confirmed cases, showed a single focal wave between epidemiological weeks 41 and 46 of 2021, peaking in week 45 and declining thereafter following intensified outbreak response activities, particularly surveillance and risk communication. Routine YF vaccination coverage was 25% before the outbreak, increasing to 95% after the mass campaign. The district’s composite risk score was 83%, indicating very high transmission risk. Entomological indices (House Index=48.5%, CI=36.1%, Breteau Index=159.6) exceeded WHO thresholds, confirming intense Aedes proliferation. Community awareness was low, with only 22% recognising the viral cause, 16% identifying mosquitoes as vectors and 10% knowing that vaccination prevents YF.

The outbreak reflected the convergence of ecological vulnerability, low baseline immunity and poor community awareness. Sustained high routine immunisation, structured Aedes surveillance and continuous risk communication are essential to prevent recurrence and advance Ghana’s commitment to the WHO Eliminate Yellow Fever Epidemics strategy.

Video-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small cell lung cancer (NSCLC). This procedure, however, is dependent on the patient’s ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomised controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.

Data on NSCLC patients will be collected from routinely collected university hospital records linked with German cancer registry data. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicentre open-label two-parallel arm superiority randomised trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within 3 months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted non-parametric Kaplan-Meier curves.

The Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg with an approved addendum with Dnr 2023–112 has approved this study. The study uses anonymised routinely collected hospital and cancer registry data in accordance with applicable data protection regulations. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

Non-communicable diseases (NCDs) have become the leading cause of mortality globally, with a sharp rise in Iran due to lifestyle changes and urbanisation. Although many NCD risk factors are modifiable, limited understanding of their determinants hinders effective prevention. To address this, the Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort was established in 2014 to study NCDs nationwide. The Sabzevar PERSIAN Cohort Study (SPECS) is the first in northeastern Iran, aiming to investigate environmental and social factors influencing NCDs in a unique regional context.

SPECS enrolled 5174 adults (aged 35–70 years) in northeastern Iran between January 2018 and January 2019 through a census and an online registration process. The baseline data collection included demographic verification, informed consent, health questionnaires, anthropometric measurements and biological samples (blood, urine, hair, nails). The annual follow-up began in April 2019, with full reassessments every 5 years over a 15-year period. The data is gathered via an active and passive follow-up, supported by trained staff and registry linkages.

Of the 5174 participants, 4241 (81%) remained in the study. Among the cohort, 54.5% were female, with a mean age of 50.5 years. The majority were married (93.5%), and nearly half had at least high-school education (46.5%) and moderate socioeconomic status (49.4%). Drug abuse history (smoking/drugs) was reported by about 15% of the sample. The mean body mass index was 26.9 kg/m², and the average blood pressure was higher in males (118.1/74.0 mm Hg) than in females (111.5/70.2 mm Hg). The common conditions included hypertension (22.8%), kidney stones (22.4%), fatty liver (15.4%) and diabetes (13.8%). Cancer had the highest treatment rate (100%), while fatty liver had the lowest (70.1%). Stroke had the highest mean age of onset (51.2 years), and epilepsy the lowest (23.7 years). All health data were self-reported.

SPECS, part of the national PERSIAN cohort initiative, is the only adult NCD-focused study in Khorasan Razavi. Its 15-year follow-up aims to generate region-specific insights into the incidence of NCDs and their risk factors. The ethnically homogeneous sample enhances statistical power, and the findings may inform culturally tailored health policies. While self-reported data have limitations due to bias, high initial participation and access to free healthcare support long-term engagement, especially among lower-income groups.

Enhancing maternal and infant health is a cornerstone of global health advancement. This can be achieved by building sustainable health monitoring systems that can accurately and reliably generate high-quality data and produce evidence-based recommendations for policymakers. By identifying gaps and strengths in current systems, this review aims to highlight current practices in monitoring maternal and infant health outcomes, including low birth weight.

The review will adopt the Arksey and O’Malley framework and the Joanna Briggs Institute’s Scoping Review Methods Manual. Three databases, including PubMed, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature), as well as relevant grey literature sources, will be searched for articles describing active global population-based maternal and infant health monitoring systems published in English from the year of database inception till 30 September 2025. Two reviewers will independently screen titles and abstracts, followed by independent full-text screenings against predefined eligibility criteria, with data extracted using a data extraction form. After data extraction, a narrative synthesis will be performed. The findings will adhere to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.

This review is based on publicly available data; no ethical approval is required. The findings of this scoping review will be published in journals and presented at relevant conferences.

This study aimed to quantify how patient risk factors relate to COVID-19 severity across categories 1–5 in a prospective, hospital-based cohort. We hypothesised that greater severity would be associated with higher odds of intensive care unit (ICU) admission and in-hospital mortality. Secondary aims were to assess associations with age, viral variants, symptom clusters, lymphocyte count, fasting blood glucose and cytokine profiles.

Prospective cohort study.

A secondary-care/tertiary-care hospital and linked community settings in Cheras, Kuala Lumpur, Malaysia.

This study was nested within the COVGEN project, a prospective COVID-19 cohort conducted at Hospital Canselor Tuanku Muhriz UKM (HCTM), Cheras Health Clinic and the Bandar Tun Razak COVID-19 Assessment Centre in Cheras, Kuala Lumpur, Malaysia, from 1 August 2021 to 31 October 2022. 2532 participants were enrolled at baseline. Eligible participants were Malaysian citizens aged 12–18 years (paediatric/adolescent) or ≥18 years who had reverse transcription-polymerase chain reaction–confirmed COVID-19 at recruitment and resided in Kuala Lumpur or Selangor. Patients who had a clinically unstable condition and those who declined participation (personally or via a next-of-kin or legal representative) were excluded. This analysis included 559 patients hospitalised at HCTM; after excluding five with incomplete questionnaires, 554 remained for analysis (413 admitted to general wards and 141 to ICUs). Categories 3–5 comprised hospitalised patients, whereas categories 1–2 included hospitalised individuals and a subset recruited from community settings.

Primary outcomes included disease severity (categories 4–5 vs 1–3), ICU admission and in-hospital mortality. Secondary outcomes included associations with age strata, viral variant (delta vs omicron), symptom clusters, lymphocyte count, fasting blood glucose and cytokines: interferon gamma-inducible protein 10, interferon gamma, interleukins 8, 10, 2, 6 and 7 and tumour necrosis factor alpha.

141 of 554 (25.5%) patients required ICU care. Compared with milder categories, category 5 was associated with markedly higher odds of ICU admission (OR 204.50; 95% CI 37.54 to 1114.18; p55 versus

An increasing clinical severity category was strongly associated with ICU admission and mortality. Age, delta infection, specific symptom clusters, lymphopenia, hyperglycaemia and pro-inflammatory cytokines identified higher-risk patients, supporting risk-stratified management and prioritisation for enhanced monitoring.

To compare clinical radiography training experiences (structure, resources, participation, feedback) and self-perceived competence/practice readiness between public and private radiography centres in Lagos State, Nigeria.

Comparative cross-sectional survey design from August to October 2025 using a validated self-administered questionnaire distributed in person during departmental seminars and clinical debriefings at University of Lagos-affiliated centres.

Centre-based settings at public and private radiodiagnostic centres.

A total of 260 final-year students and recent graduates, 130 each from public and private radiodiagnostic centres. Inclusion criteria included: age ≥18 years, with ≥6 months clinical exposure, from centres affiliated to the University of Lagos. All participants completed the self-administered questionnaire. There were no interventions.

The primary outcome was the self-perceived competence/practice readiness, and the secondary was participation, extent and feedback mechanisms, measured as planned without protocol deviations. All variables were measured using validated items in the questionnaire.

Private centres significantly outperformed public centres in hands-on practice and feedback, with higher self-perceived competence (mean 35.6±5.7 vs 32.8±6.4; p=0.001). There were no significant differences in training structure (p=0.78). Public centres reported higher patient loads (86.2% vs 68.5%; p=0.001) but lower equipment availability (47.7% vs 72.3%; p

Private centres were associated with higher self-perceived competence and readiness, better resources and feedback, while public centres offered greater patient volumes. Hybrid placements and targeted infrastructure investment are recommended to help address disparities in perceived readiness.

This study aimed to address the spatial distribution and multilevel analysis of healthcare access barriers among women of reproductive age in Somalia.

The study was conducted across Somalia, an East African country facing significant spatial disparities in healthcare access. A cross-sectional study design was employed, using data from the 2020 Somali Demographic and Health Survey (SDHS). The data were analysed using both multilevel logistic regression and spatial analysis. To pinpoint barriers and identify statistically significant spatial clusters, the data were analysed using multilevel logistic regression in Stata V.17 and spatial analysis in R Studio (V.4.4.1), respectively.

The study population consisted of a weighted sample of 5118 women of reproductive age (15–49 years) from the SDHS.

Spatial analysis revealed significant regional heterogeneity, with high-prevalence areas concentrated in the northern region of Togdheer and a south-central cluster encompassing Galguduud, Hiiraan and Bakool. Multilevel analysis presented that women in the Bay region had nearly 10 times (AOR: 9.62) the risk of facing healthcare access barriers. While women in the highest quintile of wealth (AOR 0.21), those in higher education (AOR 0.30), those aged 45–49 (AOR 0.49) and not currently working (AOR 0.46) were significantly less likely to report access barriers.

Healthcare access barriers in Somalia are driven by a complex interplay of socioeconomic factors, specifically maternal age, education, employment and household wealth, and profound geographical disparities. Access barriers are not uniform but are geographically clustered in the south-central regions (Bay, Bakool, Hiiraan) and Togdheer in the northern region. Policy efforts must prioritise infrastructure investment in these identified high-burden hotspots while simultaneously dismantling systemic inequalities through the expansion of female education and financial protection schemes. This data-driven approach offers a definitive roadmap for decision-makers to equitably allocate resources and ensure that the most vulnerable populations are not left behind.

To identify the individual and community-level factors associated with barriers to accessing healthcare services among currently married women in Somalia.

A cross-sectional analysis using data from the 2020 Somalia Demographic and Health Survey.

Somalia.

A nationally representative sample of 30 311 currently married women aged 15–49 years with complete data on outcome and explanatory variables.

The primary outcome was ‘reporting at least one barrier to accessing healthcare’, a composite binary variable based on four specific problems: obtaining permission to go for treatment, getting money for treatment, distance to the health facility and not wanting to go alone.

A substantial majority (77.06%) of married women reported experiencing at least one barrier to accessing healthcare. Financial cost was the most common barrier (69.91%), followed by distance to health facilities (65.95%), reluctance to go alone (49.64%) and the requirement for permission (46.03%). Multilevel analysis confirmed that higher household wealth was strongly protective (richest vs poorest: adjusted OR (aOR)=0.27, 95% CI 0.24 to 0.32). Paradoxically, factors typically considered protective were associated with increased barriers: women with secondary education (aOR=1.19, 95% CI 1.00 to 1.41) and those with educated husbands (aOR=1.23, 95% CI 1.14 to 1.33) reported more obstacles. Similarly, urban residents faced higher odds of barriers than their nomadic counterparts (aOR=1.40, 95% CI 1.27 to 1.55). Significant regional disparities were evident, with community-level context explaining 26.30% of the total variance in reporting barriers.

Access to healthcare for married women in Somalia is predominantly hindered by economic, educational and community-level constraints. Targeted interventions addressing socioeconomic disparities, infrastructural deficits and specific community contexts are essential to alleviate these barriers.

To assess the levels of knowledge, attitudes and practices (KAP) toward skin cancer prevention among Malaysian adults and to examine differences in KAP across socio-demographic groups.

Cross-sectional online survey.

Community-based study conducted in Malaysia using social media recruitment.

A total of 386 adults aged ≥18 years residing in Malaysia. Most participants were young adults (86.3%), female (55.4%) and of Chinese ethnicity (65.5%). Healthcare professionals were excluded.

Primary outcomes were levels of knowledge, attitude and preventive practices toward skin cancer, measured using the validated KAP-SC-Q (Knowledge, Attitude and Practice of Skin Cancer Questionnaire) and categorised as poor, moderate or good. Secondary outcomes included differences in KAP across socio-demographic and clinical characteristics, analysed using independent t-tests and ² tests.

Over half of participants demonstrated poor knowledge of skin cancer (56.0%) and the vast majority showed inadequate preventive practices (84.2%), while attitudes toward skin cancer were predominantly positive (62.4%). Significant differences in mean KAP scores and categorical levels were observed across several socio-demographic variables. Participants with tertiary education had higher knowledge (14.32 vs 12.61) and attitude scores (20.01 vs 15.95; p

Malaysian adults exhibited limited knowledge and very poor preventive practices toward skin cancer despite generally positive attitudes. These findings highlight substantial gaps between awareness and behaviour and support the need for targeted public health interventions to correct misconceptions, improve risk perception especially in high-risk groups and promote effective ultraviolet protection behaviours.

The transition from clinical practice to an academic role presents a multifaceted challenge for anaesthesia master’s students in Iran, as it demands not only clinical expertise but also the development of educational competencies. This protocol outlines a sequential multimethod study designed to explore the dimensions of this role transition, identify the challenges and facilitators inherent in assuming a clinical educator role, and ultimately provide a foundation for evidence-based educational interventions.

This sequential multimethod protocol comprises three phases. Phase I involves qualitative thematic content analysis using semistructured focus groups and, where necessary, individual interviews with MSc anaesthesia students to explore experiences of role transition. Qualitative data will be analysed using Braun and Clarke’s six-phase approach. Phase II consists of an integrated review of the literature to synthesise existing evidence on transition to clinical educator roles in anaesthesia and related healthcare disciplines. Phase III integrates findings from both phases using the Pillar Integration Process to generate a comprehensive, evidence-informed framework of role transition.

Ethical approval for the study has been obtained from Tehran University of Medical Sciences (IR.TUMS.SPH.REC.1403.236), and written informed consent will be secured from all participants. Findings will be disseminated through publications in reputable peer-reviewed journals and presentations at national and international conferences, contributing to the refinement of training programmes for clinical educators within anaesthesia education.