To identify the main drivers of low-value medical imaging in Iran and explore potential strategies to reduce its use.

Qualitative study using semistructured interviews.

Public and private healthcare settings in Iran.

34 physicians, including general practitioners, radiologists and non-radiology specialists, selected using purposive and snowball sampling.

Semistructured interviews were conducted between October 2023 and February 2024 through face-to-face, telephone and video calls. Data were analysed using thematic content analysis with a hybrid inductive–deductive approach and organised using the five control knobs framework.

Participants identified multiple drivers of low-value medical imaging across five domains: organisation, financing, payment, behaviour and regulation. Key drivers included weaknesses in the referral system, limited oversight, financial incentives, defensive medical practice, patient demand and misconceptions about diagnostic value. Suggested mitigation strategies included public education, physician training, stronger referral pathways, improved insurance oversight, use of evidence-based guidelines and better regulatory monitoring.

Low-value medical imaging in Iran is sustained by interacting weaknesses in referral pathways, financial incentives, professional practice and oversight. Efforts to reduce overuse should therefore combine physician and public education with stronger referral systems, insurer monitoring and regulatory action.

To measure differences in hospital use between homeless adults using the homeless health peer advocacy (HHPA) service (clients) and non-clients in London.

We conducted a cohort study with linkage to Hospital Episode Statistics (HES) 1 year prior and postenrolment.

London, UK.

People who are homeless in London aged over 18 years residing in a hostel, attending a day centre or being referred by a homelessness service; experiencing difficulties accessing healthcare; and speaking either English or Polish. Participants were required to provide consent for linkage to HES. To be classified as a client, individuals must have used the HHPA service at least once between January and July 2021; non-clients were those who had never used the service.

Peer advocacy is the provision of support by volunteer-trained advocates with lived experience of homelessness to individuals to overcome barriers to accessing health services.

The primary outcome was not attending a scheduled outpatient appointment (‘did-not-attend’) over 12 months postrecruitment, commencing from their baseline interview date. Secondary outcomes included the number of accident and emergency (A&E) and inpatient admissions (all and planned admissions) during that same period.

We estimated the probability of non-attendance using Poisson regression and the number of inpatient admissions and A&E visits using negative binomial regression models. Models included: (1) propensity score weights and (2) propensity score weights and imbalanced confounders. Sensitivity analyses assumed that participants who did not link to HES had no hospital attendance. Exploratory analyses examined differential effects of peer advocacy by clients’ type of peer advocacy engagement (new vs ongoing clients; supported vs unsupported) and by clients’ anxiety or depression symptom scores measured with the Patient Health Questionnaire-4 (PHQ4).

153 clients and 158 non-clients were recruited between July and December 2021. Most were male (77.5%) with a median age of 48 years. Weighted regression models suggested no evidence of effect of peer advocacy on non-attendance (rate ratio (RR) 0.97 (95% CI 0.67 to 1.42)), no difference in the mean number of A&E visits (2.59 95% CI 1.93, 3.24 vs 1.76 95% CI 1.13, 2.40) but more inpatient admissions (1.65 95% CI 1.10, 2.20 vs. 0.53 95% CI 0.27, 0.82) for HHPA clients vs non-clients respectively. This was supported in sensitivity analyses. In exploratory analyses, clients with PHQ4 scores of 9–12 had greater probability of non-attendance at outpatient appointments (RR 1.98 (95% CI 1.0 to 3.89)) compared to non-clients. Those with scores of 6–8 had 5.86 (95% CI 2.73 to 9.0) completed appointments versus 1.87 (95% CI 0.41 to 3.34) among non-clients and 1.13 (95% CI 0.01 to 0.27) inpatient admissions compared with 0.13 (95% CI –0.01 to –0.27) among non-clients.

Following COVID-related disruptions to the work of peer advocates and health services, we found mixed evidence on the effect of peer advocacy: with no evidence of impact on outpatient appointments or use of emergency services; but increased inpatient admissions.

Delegation is a key nursing management skill that enhances staff empowerment, team performance and quality of care. In complex healthcare environments, effective delegation requires structured managerial strategies that balance responsibility with staff empowerment. This study aimed to explore nursing managers’ experiences of delegation strategies and practices in clinical settings.

A qualitative study using a conventional content analysis approach. Data were collected between 2024 and 2025 through semistructured, in-depth interviews and analysed concurrently using an inductive content analysis process, allowing iterative refinement of emerging categories.

The study was conducted in selected hospitals in Tehran, Iran.

Eleven nursing managers were recruited through purposive sampling and sampling continued until data saturation was achieved.

After analysing the data, three main categories and seven subcategories emerged. The first category, formalisation and executive framework, included (a) formal communication and introductions in meetings, (b) clarification of task descriptions and delegation objectives and (c) delineation of boundaries and non-delegable authorities. The second category, continuous mentoring and support, encompassed (a) gradual training to consolidate learning and (b) active guidance and advocacy. The third category, supervision and evaluation of the delegation process, comprised (a) performance monitoring to ensure accountability and (b) benchmarking outcomes against established standards and indicators.

Delegation allows nursing managers to focus on strategic duties while empowering nurses to participate actively and improve care quality. In challenging clinical settings with workforce shortages, strengthened managerial training and supportive organisational policies are essential. Future research should explore individual, cultural and organisational factors that influence delegation.