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Virtual health assistants (VHAs), interactive digital programs that emulate human communication, are being increasingly used in health care to improve patient education and care and to reduce the burden on health care providers. VHAs have the potential to promote cancer equity through facilitating patient engagement, providing round-the-clock access to information, and reducing language barriers. However, it is unclear to what extent audience-centeredness is being considered in the development of cancer-related applications. This systematic review identifies and synthesizes strategies used to make VHA-based cancer prevention and screening interventions audience-centered. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched 4 databases (PubMed, Embase, Web of Science, and EBSCOhost) for peer-reviewed studies on VHA interventions promoting cancer screening (January 2022). Included studies focused on adult populations in primary care settings, with interventions emphasizing interactivity and immediacy (key VHA features). Excluded studies were on cancer treatment, noninteractive decision aids, or technical VHA development. Screening, data extraction, and quality assessment (Mixed Methods Appraisal Tool) were performed independently by multiple reviewers. Thematic synthesis was used to analyze audience-centered strategies. Of 1055 records screened, 17 studies met inclusion criteria. Most (n=11) targeted colorectal cancer, with others addressing prostate, breast, cervical, or lung cancer. A total of 16 studies were US-based; 1 study focused on Uganda. Key strategies for audience-centered design included: (1) Demographic Concordance: Race or gender alignment between VHA and users (eg, African American participants interacting with Black-coded avatars); (2) User Feedback: Iterative testing via interviews, think-aloud protocols, or pilot studies to refine interventions; (3) Preintervention Needs Assessment: Identifying cultural, linguistic, or literacy barriers (eg, myths about screening in Ugandan communities); (4) Theoretical Frameworks: The Health Belief Model (most common), the Modality, Agency, Interactivity, and Navigability (MAIN) model, or tailored messaging theories guided design; (5) Information Customization: Culturally adapted content (eg, Spanish-language interfaces, narratives addressing racial disparities); and (6) Feature Customization: Adjusting VHA appearance (eg, animations and fonts) based on user preferences. Notably, 7/17 studies focused on racially minoritized groups (eg, African Americans, Hispanic farmworkers), addressing systemic barriers like mistrust in health care. However, gaps persisted in intersectional tailoring (eg, rurality and income) and non-English languages (only 2/17 studies). Recruitment methods influenced diversity; community-based strategies yielded more representative samples than solely internet-based recruitment approaches. The systematic review identified the audience-centered development practices currently being used for VHA-based interventions in preventive cancer care. The majority of the studies included processes to diversify and segment the intended audience, focused on medically underrepresented population groups, and implemented strategies to be culturally sensitive to the population of interest. However, opportunities remain to address multidimensional inequities (eg, rural access and low literacy). Future interventions should integrate intersectional frameworks, expand language diversity, and measure social presence to enhance engagement. This review provides a roadmap for developing equity-focused eHealth tools in cancer prevention.

This book provides insight and findings from leading psychoanalysts who are involved in early prevention research and clinical work. Advances in the sciences of early development have brought a heightened awareness to the crucial importance of early experiences for health and development as well as building strong foundations for education and preventing disorder. New approaches are applied in home visitation, working with immigrant families, and those stressed by trauma, conflicts and economic disadvantage. Examples of clinical application and the implementation of promising programs in an outreach psychoanalysis are also provided.

Background Following a severe burn injury, individuals embark on a lifelong process of managing and integrating the physical, psychological, and social consequences, including functional limitations, fatigue, altered body image, and psychological trauma. To aid in this process, healthcare professionals can provide self-management support. To date, however, no self-management support intervention has been developed to meet the unique needs and preferences of burn survivors within the context of burn aftercare. In this article, we describe the process of developing a self-management support intervention for burn aftercare and present the resulting intervention. Methods A structured, multi-stage process was followed from May 2021 to December 2023 to develop the intervention, guided by established frameworks for the development and adaptation of complex interventions. The process included evidence review, stakeholder consultation, and participatory observations to identify needs, inform design decisions, and ensure contextual fit. A hybrid approach to intervention development was adopted, combining adaptation of an existing intervention with augmentation through five co-creative workshops involving burn survivors, healthcare professionals, researchers, and burn care decision-makers. The final prototype was refined through expert reviews and real-world pilot-testing to assess its feasibility and acceptability. Results The structured, multistage process resulted in a self-management support intervention addressing the physical, psychological, and social needs of burn survivors. The intervention was named BreeZe (Brandwonden en Zelfmanagement/Burns and self-management). Intervention Core components of the intervention include a holistic care approach, goal setting and action planning, solution-focused brief therapy, motivational interviewing, case management, and the acknowledgment and involvement of informal caregivers. BreeZe is supported by materials like the Self-Management Web, a patient booklet, training for healthcare professonials, and a comprehensive manual. BreeZe is delivered by trained healthcare professionals and is structured into five phases, focusing on holistic needs assessment, goal setting, progress monitoring, and ongoing motivational support. Conclusions The structured, multi-stage development process was thorough and carefully considered, balancing diverse stakeholder perspectives with scientific evidence and theory. BreeZe offers an evidence-based model tailored to the Dutch context that can be integrated into routine practice that shows the potential to enhance the effectiveness of care and support a more collaborative, patient-centred approach. Trial registration Not applicable.

ObjectiveTo provide researchers with guidance on actions to take during intervention development.Summary of key pointsBased on a consensus exercise informed by reviews and qualitative interviews, we present key principles and actions for consideration when developing interventions to improve health. These include seeing intervention development as a dynamic iterative process, involving stakeholders, reviewing published research evidence, drawing on existing theories, articulating programme theory, undertaking primary data collection, understanding context, paying attention to future implementation in the real world and designing and refining an intervention using iterative cycles of development with stakeholder input throughout.ConclusionResearchers should consider each action by addressing its relevance to a specific intervention in a specific context, both at the start and throughout the development process.

ObjectiveTo improve the quality and consistency of intervention development reporting in health research.DesignThis was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study.ParticipantsIntervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop.Resultse-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting.ConclusionsConsensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.

Background Widening health inequities in Belgium highlight the need for proactive, outreach-oriented primary care models. Large-scale community health worker programmes in low- and middle-income countries have demonstrated effectiveness in bridging healthcare access gaps and are increasingly recognised as potential reciprocal innovations for high-income countries. However, little is known about how such models can be successfully transferred across contexts, as these processes are rarely reported in sufficient detail, limiting replication and cumulative learning. Aim This study addresses these gaps by detailing the development of the Community Health Workers for Primary Healthcare Access (COMPASS) intervention—a CHW-based model adapted from Brazil and South Africa for the Belgian health system. Methods The COMPASS intervention was developed through a multi-phase, iterative process informed by the ADAPT guidance (Moore et al., 2021) and the Six Steps in Quality Intervention Development (6SQuID) (Wight et al., 2016). Three phases structured the process: (i) problem identification and exploration of potential solutions through qualitative fieldwork in Belgium and South Africa as well as field visits to Brazil and the UK; (ii) participatory adaptation and intervention design via co-creation workshops with stakeholders in Belgium; and (iii) pilot testing to refine the model and prepare for evaluation. Results Phase 1 fieldwork in Antwerp identified key access barriers in Belgium; complementary fieldwork in South Africa, and field visits to Brazil and the UK, highlighted mechanisms through which CHWs address such barriers: mechanisms included sustained, structured, and culturally sensitive support embedded in both communities and the health system. Phase 2 co-creation workshops determined which elements of the Brazilian and South African CHW models could be retained as core components and which required adaptation to align with Belgian primary care structures and local needs. Phase 3 pilot testing confirmed feasibility and led to final refinements, resulting in a COMPASS intervention that is both contextually appropriate and ready for evaluation. Conclusions By providing a detailed account of the COMPASS intervention’s adaptation and development, this study illustrates how established frameworks can be applied in practice to guide the design and transferability of complex health interventions. It offers practical guidance for adapting health service innovations across contexts in a transparent, systematic and context-sensitive manner.

: This systematic review drew the significant findings of carefully selected interventions to promote the social and moral competence (SC and MC, respectively) of children and adolescents mostly by investigating the effect of these interventions and focusing on strategies used. : A number of English written, electronic databases (e.g., EBSCO, EBSCOhost Web, ERIC, Master FILE Premier, SPORT, SPORT Discus, and Web of Science) and grey literature – from 2005 to the present – were consulted from September 2021 to December 2021. School-based intervention studies that assessed moral competence (MC) or social competence (SC) were eligible for inclusion. The studies were stratified by pre-school and primary school children (<12 years of age) and adolescents (≥12 years of age). A total of N = 24 documents referring to different intervention studies were included in the review. N = 10 interventions focused on children; while N = 14 targeted adolescents. : The most used strategies in the interventions were the ones that included components of MC or evaluated SC using specific protocols and tools. : This review pointed at socio-emotional and moral skills which remained underdeveloped in school children unless physical education (PE) teachers adjusted teaching contents and methods during instruction; and implement them into interventions with strategies that targeted elements fostering the sound socio-moral development of a child into adulthood. A model-based approach appeared to be the most, but not the only effective designs in the examined interventions.

Background Delirium, closely linked to increasing age and frailty, is a growing concern in the aging population, yet there is little understanding about how to support recovery for individuals and their carers. This paper details the design and development of RecoverED, a home-based rehabilitation intervention for delirium recovery. Methods A realist-informed approach was used to develop a programme theory and logic model for RecoverED. A rapid realist review had identified strategies for delirium recovery, followed by interviews with stakeholders (older adults, carers, and professionals), and an expert panel discussion. The intervention was then developed based on the refined programme theory of what had worked to improve recovery from delirium, for whom, and in what context. Results The RecoverED intervention, described using the TIDieR checklist, was a complex, multicomponent, 12 week home-based programme delivered by a multidisciplinary team in up to 10 sessions. The intervention comprised cognitive, physical, and psychosocial components. An intervention manual and training programme had been developed to support delivery teams. Conclusion The RecoverED intervention was being evaluated in a multi-centre feasibility trial with a qualitative process evaluation. This paper describes theory-based rehabilitation interventions for long-term delirium recovery. Further research through a randomised controlled trial is needed to assess its effectiveness and cost-effectiveness before broader implementation.

Brenda C Lovette,1,2 Nadine Levey,1 Kozbi Bayne Cliff,1 Jafar Bakhshaie,1,2 Ronald Kulich,3 Hsinlin Thomas Cheng,2,4 Shuhan He,2,5 Ana-Maria Vranceanu,1,2 Jonathan Greenberg1,2 1Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Department of Psychiatry, Harvard Medical School, Boston, MA, USA; 3Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; 4Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; 5Lab of Computer Science, Massachusetts General Hospital, Boston, MA, USACorrespondence: Jonathan Greenberg, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 648, Boston, MA, 02114, USA, Email jgreenberg5@mgh.harvard.eduPurpose: Chronic orofacial pain (COP) is associated with substantial pain interference and emotional distress. Psychosocial treatments for COP are scarce, rely on talking, which is often painful for this population, and require intensive resources. There is a clear need for a novel, scalable, accessible, “talk free” intervention to reduce pain interference and emotional distress among individuals with COP. This study explored people with COP’s perceptions of a novel mind-body web-based intervention targeting pain interference and emotional distress (Face-Forward-Web) to inform its development and optimization.Patients and Methods: We conducted semi-structured focus groups (N=4 groups, 22 participants; 77% female; mean age 47 (SD = 15.9)) and used Rapid Data Analysis (RDA) to gauge perceptions of the intervention’s content structure, format, and barriers and facilitators to participation.Results: Perception of the intervention was largely positive, and participants perceived its value for increasing engagement in life activities. They emphasized the importance of tailoring the intervention to the unique characteristics of COP. They expressed that the self-paced web-based format was ideal given unpredictable pain flares and variable needs. Concurrently, they desired social connection. They perceived the content and skills as helpful and relaxing. They identified barriers and facilitators to participation, including technical considerations, reminders and incentives, and providers setting up realistic expectations for outcomes.Conclusion: This study elucidates insights that can inform psychosocial and mind-body interventions for people with COP. Findings give voice to the needs and perceptions of people with COP, guiding the development of tailored, patient-informed treatment approaches such as Face-Forward-Web.Keywords: orofacial pain, qualitative analysis, intervention development, web-based intervention