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Composite indices provide an opportunity to measure the reach of multisector strategies as countries progress towards Sustainable Development Goals and the achievement of nutrition, health and other sectoral targets. Composite measures allow for the measurement of nutrition and health intervention coverage across sectors and can be used to benchmark progress, track nutrition goals and assess inequities of multisector nutrition interventions. Of the many composite indices in use to measure health and nutrition intervention coverage and population status as a means of assessing progress in achieving health and nutrition targets, few have been previously documented in the nutrition and health literature, nor have these indicators been described in detail. This scoping review aimed to identify composite coverage indices that capture nutrition and health intervention coverage or status, summarise their estimation methodologies and validation approaches and evaluate their strengths and weaknesses.
Scoping review conducted in accordance with the Joanna Briggs Institute Reviewer Manual following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) verification list.
PubMed, EMBASE, Scopus, Google Scholar and Global Health registries were searched from 1980 to 3 March 2026.
We included studies of any design that described, used or developed a composite measurement of health or nutrition intervention coverage or status.
One reviewer screened the titles and abstracts and full text using Covidence and abstracted data from each article using Microsoft Excel using standardised methods.
We retrieved and screened a total of 7120 records of which 154 articles were included. We identified a total of 56 unique indices (25 universal healthcare coverage; 14 reproductive, maternal, newborn, child health (RMNCH) coverage; 10 nutritional status, food security or nutrition intervention coverage; 6 health service coverage and 1 combined universal healthcare, health risk factors and nutrition coverage measure). We identified three major formula construction methodologies: normative (n=34), statistical (n=13) and participatory (n=10). Together, the indices employed six different aggregation methods: weighted linear mean (n=28), geometric mean (n=13), linear mean (n=9), random-effects meta-analysis (n=6), summation (n=2) and weighted geometric mean (n=1). More than one third of the indices identified have not been validated in the literature (n=21).
Our review identified a significant gap in composite nutrition intervention coverage index availability, methodological frameworks for index design and index validation. There is a need for additional resources for guiding policy and programme actors to develop validated, fit for purpose composite nutrition-specific and nutrition-sensitive coverage indices. We propose that a framework be developed for stakeholders to guide composite index construction for multisectoral nutrition intervention coverage measurement.
Masculinising chest surgery, also known as top surgery, is the most requested gender-affirming procedure among transgender and gender-diverse (TGD) adolescents, yet research on patient experiences remains limited. This study explored the experiences of TGD adolescents who were seeking or had undergone masculinising chest surgery.
Qualitative secondary analysis using existing themes framework and data from the GENDER-Q (GQ) and GENDER-Q Youth (GQY) research programmes, which aim to develop comprehensive patient-reported outcome measures for gender-affirming care.
Participants were sampled from five high-volume gender-affirming care clinics, three in Canada and two in the United States. Interviews were conducted online.
35 GQ and GQY participants aged 13–18 years who were assigned female at birth, identified as trans men or non-binary, and were pursuing (n=19) or had undergone (n=16) masculinising chest surgery.
Three major themes emerged: chest appearance, health-related quality of life (HRQL) and gender practices. Most participants expected a flatter chest that aesthetically aligned with their gender identity. Presurgery participants anticipated that surgery would allow them to engage in previously avoided physical activities and would enhance their relationships. Postoperative participants reported increased physical activity, mental resilience, bodily connection and social comfort. Most reported binder use and related reliance or discomfort as motivators for pursuing surgery.
This study highlights the multidimensional experiences surrounding masculinising chest surgery on TGD adolescents with impacts on chest appearance, HRQL and gender practices. Centering adolescents’ perspectives, these findings underscore the importance of accessible, affirming surgical care and provide valuable insights for clinicians, policymakers and future research.
To examine and define the concept of moral distress among family caregivers by identifying its key attributes, antecedents and consequences.
Concept analysis.
This study was guided by Walker and Avant's concept analysis framework. A comprehensive literature search was conducted to identify relevant studies, with 12 articles included in this analysis.
PubMed, CINAHL, Scopus and PsycINFO databases were searched for articles published between February 2000 and May 2025.
Three defining attributes of moral distress in family caregivers were identified: self-directed negative emotions, internal conflict and feelings of powerlessness and helplessness. Antecedents included caregiving burden, role conflict, ethical dilemmas, complex decision-making and internal and external constraints. Consequences encompassed long-term health effects, social withdrawal, burnout and moral residue. These findings led to a conceptual definition of moral distress in family caregivers.
Moral distress in family caregivers is a significant and underrecognised issue that affects caregiver well-being and the quality of care they provide. This concept analysis offers a clear conceptual definition, providing a foundation for developing research instruments and interventions.
Healthcare professionals should recognise moral distress in family caregivers as a key factor impacting both caregiver well-being and patient care. Support through education, counselling and peer groups can reduce moral distress and foster more ethical, collaborative care environments.
This study addressed the lack of clarity surrounding moral distress in family caregivers. It identified key attributes, antecedents, and consequences, and developed a clear conceptual definition. These insights will inform research, practice and policy. The findings will benefit caregivers, improve patient care and support healthcare teams.
This study followed Walker and Avant's framework and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in article selection.
No patient or public involvement.
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