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Formative evaluation is widely used in implementation science to anticipate barriers and facilitators prior to the deployment of health technologies, typically relying on stakeholders' reported beliefs collected before real-world exposure. This approach has proven informative for many digital health tools; however, its application to immersive and embodied technologies such as extended reality (XR) warrants closer scrutiny. Most XR interventions in health care are delivered through head-mounted displays, which depend on spatial perception and sensorimotor engagement. Several implementation-relevant properties, including comfort, perceived intrusiveness, safety, and workflow disruption, often become apparent only through direct interaction. At the same time, large segments of the health care workforce remain XR-naive, such that preuse judgments are frequently shaped by anticipation rather than experience. Drawing on concepts from implementation science, grounded cognition, and human-computer interaction, this Viewpoint examines a plausible interpretive problem in XR adoption and argues that perception-based formative evaluation, when applied through frameworks developed for screen-based technologies, may misclassify barriers and facilitators. Rather than questioning formative evaluation as a methodological approach, we identify a boundary condition for its interpretability in experience-dependent technologies and propose a pragmatic refinement: incorporating brief experiential familiarization before eliciting stakeholder perceptions to strengthen early-stage assessment and improve alignment with real-world implementation decisions.

Background Unsafe sex is one of the main morbidity and mortality risk factors associated with sexually transmitted infections (STIs) in young people. Behavioral change interventions for promoting safe sex have lacked specificity and theoretical elements about behavior in their designs, which may have affected the outcomes for HIV/AIDS and STI prevention, as well as for safe sex promotion. This study offers an analysis of the barriers and facilitators that, according to the university students who participated in the focus groups, impede or promote the success of interventions promoting healthy sexuality from the perspective of the actions stakeholders should undertake. In turn, this study proposes intervention hypotheses based on the Behavior Change Wheel which appears as a useful strategy for the design of intervention campaigns. Methods Two focus groups were organized with students from Universidad de Santiago de Chile (USACH). The focus groups gathered information about the perceptions of students about sex education and health, risk behaviors in youth sexuality, and rating of HIV/AIDS and STI prevention campaigns. In the focus groups, participants were offered the possibility of presenting solutions for the main problems and limitations detected. After identifying the emerging categories related to each dimension, a COM-B analysis was performed, identifying both the barriers and facilitators of safe sex behaviors that may help orient future interventions. Results Two focus groups were organized, which comprised 20 participants with different sexual orientations. After transcription of the dialogues, a qualitative analysis was performed based on three axes: perception about sex education, risk behaviors, and evaluation of HIV/AIDS and STI prevention campaigns. These axes were classified into two groups: barriers or facilitators for safe and healthy sexuality. Finally, based on the Behavior Change Wheel and specifically on its ‘intervention functions’, the barriers and facilitators were integrated into a series of actions to be taken by those responsible for promotion campaigns at Universidad de Santiago. The most prevalent intervention functions are: education (to increase the understanding and self-regulation of the behavior); persuasion (to influence emotional aspects to promote changes) and training (to facilitate the acquisition of skills). These functions indicate that specific actions are necessary for these dimensions to increase the success of promotional campaigns for healthy and safe sexuality. Conclusions The content analysis of the focus groups was based on the intervention functions of the Behavior Change Wheel. Specifically, the identification by students of barriers and facilitators for the design of strategies for promoting healthy sexuality is a useful tool, which when complemented with other analyses, may contribute improving the design and implementation of healthy sexuality campaigns among university students.

Background This study investigated the perceptions of care psychologists regarding the adoption of generative artificial intelligence (GenAI) in therapeutic practice. As AI continues to be integrated into various sectors, including healthcare, understanding how psychologists perceive its implementation in therapeutic settings is essential. The study explores the factors that act as barriers and facilitators to GenAI adoption and examines their impact on the future of therapeutic interventions. Methods A qualitative study design was adopted, involving semistructured, in-depth interviews with 14 private care psychologists in Spanish cities. The study focused on urban private care settings. The interviews were designed based on TDF domains to identify barriers and enablers. All sessions were recorded and transcribed. Data were analysed using a content approach, with the identified topics mapped onto the TDF and COM-B components. Results Eighteen factors were identified that influenced the decision to accept or reject GenAI in therapy, with 12 factors acting as barriers and 6 acting as facilitators. These factors are classified within the TDF domains. Highlighted barriers included a lack of understanding of AI and concerns about the confidentiality and privacy of information shared in therapy, while the main facilitators were training in AI skills and the possibility of having a digital assistant. Conclusion This study reveals the need for greater understanding of training in AI among psychologists. The acceptance of AI varies depending on the training and experience of professionals; some show concern for the future of their profession, while others highlight that it is an opportunity to improve interventions. Information privacy concerns are significant and have been identified as key factors for enabling AI deployment.

Breast cancer is the most common cancer worldwide, posing significant challenges for survivors, including long-term physical, emotional, and cognitive effects. Mobile health (mHealth) tools provide new opportunities to support these patients by enabling symptom tracking, side effect management, and personalized interventions. This study evaluated the feasibility and acceptability of the Xemio-Research mHealth application as a digital support tool for breast cancer survivors in a clinical setting. It assessed user adherence, system usability, and patient experience. A secondary objective was to compare self-reported side effects in the app with traditional quality-of-life questionnaires. This prospective study was conducted over one year within a European research project. Breast cancer survivors were recruited from a clinical setting, where they installed the Xemio-Research app and were guided on its use. During the study period, participants tracked symptoms, reported side effects, and engaged with the app. Adherence was measured through interaction logs and activity tracking. Usability was assessed using a validated scale, and patient feedback was collected through structured and open-ended survey questions. Among 61 enrolled participants, 49 actively used the app. Adherence was high in the first three months (96%) but declined to 35% by the final trimester. Usability was rated as excellent (82.78/100), and 87% of respondents recommended the app. The app enabled more detailed symptom tracking compared to traditional quality-of-life questionnaires, particularly for joint pain, tingling, and muscle weakness. The Xemio-Research app demonstrated feasibility and acceptability for breast cancer survivors, offering valuable insights into patient-reported outcomes and side effect management. However, sustaining long-term engagement remains a challenge. Integrating real-time symptom tracking with conventional assessments may enhance personalized care and survivorship outcomes. This study is a sub-study of the clinical trial registered under ClinicalTrials.gov (Identifier: NCT05401643).

Background: Sleep is an essential element for patients’ recovery during a period of hospitalisation. Hospital Clínic de Barcelona has developed the ClíNit project to promote patients’ sleep by identifying elements that affect the quality of sleep and implementing actions to improve rest at night. Objective: Our aim is to select actions to improve sleep quality. Methods: The study population included night-shift nurses from two clinical units where the pilot actions were to be carried out (n: 14). The nurses prioritised actions to improve sleep quality using the methodology proposed by Fogg: clarification, magic wand, crispification, and the focus-mapping technique. Results: Two sessions were organised for each unit and 32 actions considered high impact and easy to implement were proposed, of which 43.75% (14/32) were directly dependent on nurses. It was then agreed to implement four of these pilot studies. Conclusions: One aspect worth highlighting is that using prioritization techniques such as the Fogg technique is a good strategy to implement the general objectives of intervention programmes in large organizations in an easy way.

Background Behavior change is essential for promoting health and preventing illness; yet, motivating individuals to adopt and maintain healthy behaviors remains a significant challenge. Multiple models have been developed in Psychology and Behavioral Sciences to understand and encourage behavior change, including the Capability, Opportunity, Motivation, Behavior model (COM-B model), the Health Belief Model, the Behavior Change Wheel, the Theoretical Domains Framework (TDF), nudge theory, and Behavior Change Techniques (BCTs). Among these, the Fogg Behavior Model (FBM), developed by Dr. BJ Fogg, offers a specific and valuable framework for facilitating behavior change. This scoping review aims to analyze studies that apply the FBM in health, particularly its impact on changing health-related behaviors. By synthesizing the evidence, this review provides valuable insights into the use and impact of the FBM in promoting behavior change in health, with implications for future research and practice. Objective To investigate the application of the FBM within the health domain, focusing on its role in behavior change interventions. Methods A comprehensive search of multiple databases, including MEDLINE/PubMed, Cochrane Library, Epistemonikos, and PsycINFO, was conducted to identify studies applying the FBM in health-related interventions. The search strategy incorporated terms related to the FBM, health behavior change, and relevant health outcomes, with no restrictions on publication date. Unpublished and grey literature was also searched. Eligibility criteria included studies that applied the FBM in health interventions and reported outcomes. The review followed PRISMA-ScR and SAGER guidelines to ensure comprehensive reporting and consideration of sex and gender variables. Data were synthesized using a narrative approach, summarizing findings descriptively and thematically. Results Six studies met the inclusion criteria, covering sexual and reproductive health, vaccination, chronic disease management, general wellness, and healthcare adherence. The FBM was applied through motivation (anticipation, sensation, belonging), ability enhancement (reducing effort, increasing accessibility, integrating behaviors into routines), and prompts (reminders, calls to action, environmental cues). Effectiveness varied across studies. Gestational weight management reduced gestational diabetes (10.34% vs. 34.48%, p = 0.028), hypertension (3.45% vs. 27.59%, p = 0.030), and cesarean rates (41.38% vs. 72.41%, p = 0.017). HPV vaccination interventions increased intent to vaccinate (63.3–96.7%, p < 0.001), with 30% receiving the first dose within three months. Diabetes self-management improved dietary adherence (p = 0.04), physical activity (p = 0.005), and glucose monitoring (p = 0.02). Parental nutrition interventions increased knowledge (d = 1.07), beliefs (d = 0.61), and behavior change (d = 0.59). A vaginal birth intervention raised intention by 29% (p < 0.05). Conclusions Our scoping review highlights the FBM as an effective framework for promoting health behavior change across various domains. By systematically applying motivation, ability, and prompts, FBM-based interventions demonstrated positive outcomes. However, limitations such as the lack of long-term follow-ups and sex- and gender-disaggregated data indicate areas for future research. Expanding its application to diverse populations, integrating digital health technologies, and addressing structural and cultural barriers will enhance its impact. Strengthening methodological rigor and comparative analyses with other behavior change models will further refine its effectiveness for broader public health applications. Despite its potential, the FBM remains underutilized in public health research. Trial registration Open Science Framework osf.io/jpwxg.

Background Given the inherent complexity of rare paediatric diseases and the sensitive emotional context of the situations they create (due to the patients’ age and the tense uncertainty surrounding the progression of the disease), communication between the adults involved is a key tool in the efforts to provide these children and youths a better quality of life. We conducted ten interviews with families of children with rare diseases, in the aim of exploring how communication between doctors and patients affect their daily lives. All participants, members of FEDER (a Spanish federation of associations of patients with rare diseases) were invited by phone or email to participate in a semi-structured interview including questions on clinical information, communication experiences with healthcare professionals, and the impact these had on the interviewees’ relationships with them. To analyse these interviews, we used the ‘grounded theory’ methodology and open and axial text coding techniques, in addition to those identifying the properties and dimensions of the categories formulated. Results The core category we have proposed is ‘adjustment of mutual trust’, with said category describing the attitude and behaviour of doctors who inspire trust in the parents of paediatric patients diagnosed with a rare disease. More specifically, said behaviours or sources of trust are: appearing human, sensitive and empathetic; showing transparency and communicative openness; being supportive of parental proactivity; and being available to families at all times. Conclusions Trust is the cornerstone of parent-doctor communication in the field of children with rare diseases. If the sources of trust are present, they create a degree of trust that bolsters both parties in the search for a common goal: providing the child with the best possible care.

Background The long-term use of benzodiazepines (BZDs) poses significant health risks, including cognitive impairment, falls, and dependency, despite guidelines recommending against prolonged use. Effective deprescribing interventions are essential, but evidence on optimal strategies in primary healthcare remains fragmented. Objective This overview synthesizes evidence from systematic reviews of interventions aimed at reducing inappropriate BZD prescribing in primary care. It identifies barriers and facilitators, assesses the use of behavioral theories, evaluates intervention effectiveness, and appraises methodological quality. Methods A comprehensive literature search was conducted across four electronic databases (MEDLINE via PubMed, Cochrane Database of Systematic Reviews, Epistemonikos, and PsycINFO) up to September 15, 2024. Systematic reviews evaluating deprescription strategies targeting healthcare professionals in primary care settings were included. Two independent reviewers screened studies and extracted data on intervention characteristics, behavior change techniques, and outcomes. The AMSTAR-2 tool was used to assess methodological quality. Results From 2,577 records identified, 14 systematic reviews met inclusion criteria, comprising 279 primary studies with minimal overlap (Corrected Covered Area = 1.24%). The majority of interventions were randomized controlled trials from high-income countries, with only one review including a lower-middle-income country. Common deprescribing strategies were gradual dose reduction (71%), patient education (50%), cognitive-behavioral therapy (43%), and pharmacist-led interventions (36%). Only one review explicitly used a behavioral theory. Key barriers included patient dependency, fear of withdrawal, provider resistance, insufficient training, low self-efficacy, and limited healthcare resources. Facilitators were structured education, shared decision-making, pharmacist involvement, and goal-setting. Multifaceted interventions that integrated behavioral components, especially those involving pharmacists and structured patient education, consistently demonstrated greater and more sustained effectiveness. Conclusions This overview demonstrates that multifaceted interventions—particularly those integrating patient education, audit-and-feedback, and pharmacist involvement—are the most effective for reducing inappropriate benzodiazepine use in primary care. Evidence also suggests that even brief, theory-informed interventions can achieve moderate effectiveness. Despite this progress, most studies lack explicit theoretical frameworks, underscoring the need for theory-driven approaches to enhance intervention design, implementation, and sustainability. Future research should focus on patient-centered strategies, long-term adherence, and broader representation from diverse socioeconomic settings. Registered in PROSPERO (CRD42024548653).

This Commentary presents preliminary findings from an online survey of 54 breast cancer patients exploring preferences for supportive care content and delivery formats in digital health tools. Differences by age and disease stage underscore the need for personalization and cocreation in mHealth design. These insights contribute to the ongoing discussion on patient-centered digital interventions for oncology care.