Evidence Gaps Research Articles

Improving the adoption of a school-based nutrition program: findings from a collaborative network of randomised trials

Abstract Background Public health nutrition interventions, including school-based programs, are a recommended approach to improve child dietary behaviours. However, the adoption of effective school-based nutrition programs face numerous challenges, including the limited evidence on effective strategies to maximise implementation and adoption of such programs. This study aimed to address this evidence gap by employing a novel collaborative network trial design to evaluate a series of implementation strategies employed by three NSW Local Health Districts, to improve school adoption of an effective school-based nutrition program (‘SWAP IT’). Methods Three independent, two arm parallel group randomised controlled trials were conducted simultaneously to examine the potential effectiveness of implementation strategies on school adoption of SWAP IT. Schools were randomised to either a high intensity (various implementation strategies), or a business as usual (minimal support) group. Measures and data collection processes were harmonised across the three trials to provide individual school-level data for planned pooled analyses. The primary outcome was school adoption of SWAP IT, objectively measured via electronic registration records. Logistic regression analyses were used to assess school adoption of SWAP IT for each trial. Meta-analyses were also conducted to pool the effects of the three trials and allow the comparison of the potential relative effects of the different strategies. Results A total of 287 schools were included in the study: Trial 1 (n = 164), Trial 2 (n = 64) and Trial 3 (n = 59). Relative to control, we found increased odds of adoption in Trial 1 that employed a combination of the educational materials and local facilitation strategies (OR 8.78; 95%CI 2.90, 26.56; p < 0.001), but no significant differences in adoption in Trial 2 or 3 that employed solely the educational materials strategy. Pooled data suggests the combination of educational materials and local facilitation has a greater effect on adoption compared to educational materials alone (OR 4.18; 95%CI 1.60, 10.04; n = 3 studies; indirect effect). Conclusion Findings of this study indicate that local facilitation is an important strategy to increase school adoption of SWAP IT, and potentially other health promotion programs. Trial registration The trials were prospectively registered with Australia New Zealand Clinical Trials Register: ANZCTR, ACTRN12622000257763, Registered 11/2/2022, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383515&isReview=true ANZCTR, ACTRN12622000406707, Registered 9/3/2022 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383701&isReview=true ANZCTR, ACTRN12622000252718, Registered on 11/2/2022, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383513&isReview=true

Expanding the Boundaries of Representative Bureaucracy

Representative bureaucracy scholarship has operated in an academic silo, largely separate from the policy subfields where it is applied, specifically when testing passive and active representation. Despite scholarly research around representation in health, social work, environmental policy and other fields, representative bureaucracy has not fully used the theoretical and empirical findings from these fields to inform its own body of knowledge. Reviewing research from policy subfield experts can enhance our understanding of the benefits and limits of bureaucratic representation. This can allow us to (i) better understand how representation shapes service outcomes in less explored policy fields, (ii) identify gaps in empirical evidence, (iii) identify shortcomings in the current methodology and understanding, and (iv) identify future directions for the field. We review existing theoretical and empirical work across health services and environmental justice to find new ways of conceptualizing the benefits, mechanisms, and limits of a representative workforce. In conceptualizing representation, the paper's primary focus is on workforce demography, specifically gender and minoritized identities. These two subfields were selected for several reasons. Administrative actors in both fields exercise considerable discretion linked to salient identities. Further, health and environmental inequities experienced by marginalized groups have long been acknowledged and actively prioritized by scholars and practitioners in these fields. We find key areas of overlap and differences between the subfields and representative bureaucracy. We use these areas of overlap and difference to better understand current limitations and direct new areas of research in the field of representative bureaucracy.

A Protocol for AI-Powered Tools to Enhance Mobility and Function in Older Adults: An Evidence and Gap Map

Introduction: Artificial intelligence (AI) is transforming healthcare by enhancing diagnostic accuracy, treatment, and patient monitoring, benefiting older adults by offering personalized care plans. AI-powered tools help manage chronic conditions and maintain independence, making them a valuable asset in addressing aging challenges. Objectives: The objectives are as follows: 1. To identify and describe AI-power-based exercise programs for older adults. 2. To highlight primary evidence gaps in AI interventions for functional improvement and mobility. 3. To evaluate the quality of existing reviews on this topic. Methods: The evidence gap map (EGM) will follow the five-step method by Welch et al. (2021), adhering to the Campbell Collaboration guidelines and, if available at the time of reporting, PRISMA-AI standards. Guided by the Metaverse Equitable Rehabilitation Therapy framework, this study will categorize findings across domains like equity, health service integration, interoperability, governance, and humanization. The study will include systematic reviews, randomized controlled trials, and pre-and post-intervention designs. Results will be reported following PRISMA-AI guidelines. We will use AMSTAR-2 Checklist for Analyzing Systematic Reviews on AI Interventions for Improving mobility and function in Older Adults to evaluate the reliability of systematic reviews and focus on internal validity. Conclusions: This comprehensive analysis will act as a critical resource for guiding future research, refining clinical interventions, and influencing policy decisions to enhance AI-driven solutions for aging populations. The EGM aims to bridge existing evidence gaps, fostering a more informed, equitable, and effective approach to AI solutions for older adults.

Service delivery and the role of clinical pharmacists in UK primary care for older people, including people with dementia: a scoping review

ObjectiveAs populations age globally, there is increasing prevalence of multiple long-term conditions, such as dementia, leading to many challenges. The burden on health and care services, economic pressures, and the necessity for innovative policies to better support older people and people with dementia becomes paramount. This review explores how clinical pharmacists working in UK primary care support older people and people with dementia.DesignScoping review.MethodThis review was conducted following the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. The search of Scopus, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane was initially conducted in September 2022, and updated in August 2024. Searches included literature exploring the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences.ResultsA total of 30 articles were included. These detail the multifaceted responsibilities of clinical pharmacists in primary care for older people. Stakeholder perspectives, including healthcare professionals and patients, emphasised the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps, concerns about competence from other healthcare professionals, and the need for clear role definitions emerged as challenges. Research focused on the experiences of underserved groups, such as people with dementia or from minority ethnic backgrounds, is lacking.Conclusions and implicationsThe review enhances our understanding of the primary care clinical pharmacist service in the UK and identifies gaps in evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. It provides insights into what makes an effective clinical pharmacist service, such as training and communication, which may help to inform international policy and practice and improve service provision globally.

Capacity-building interventions for health extension workers in Ethiopia: A scoping review.

Capacity-building interventions for health extension workers (HEWs) are key to providing quality health services to the community. Since Ethiopia's Health Extension Program was established, several types of capacity-building interventions have been developed to build HEW competencies. However, no comprehensive study has mapped the types of capacity-building interventions being used or the competencies targeted. To (1) identify and characterize evidence on capacity-building interventions for Ethiopian HEWs, including the competencies measured; (2) clarify evidence gaps in this area; and (3) explore how successful the interventions have been to inform the design of health extension programs and further research. We used keywords (health extension workers, capacity building, competencies) and related terminologies to search PubMed, Scopus, and Embase for published studies on capacity-building interventions for Ethiopian HEWs, and Google Scholar for unpublished studies and reports. Our search was limited to studies and reports published in English from 2003 to present. We used the JBI scoping review methodology to conduct this scoping review in a stepwise approach and a categorization approach to synthesize the evidence. Our search strategy identified 20 articles, all published except for one program report. The most common capacity-building intervention designed for HEWs was training, followed by supportive supervision, performance review and clinical mentoring meetings, and equipment supply; the most salient competency domains investigated were knowledge and skills. The interventions significantly improved immediate outcomes (knowledge, skills, attitude change among HEWs) and intermediate outcomes, such as increased service utilization and health-seeking behavior among community members. Only one study assessed whether capacity-building interventions improved inter- and intra-personal domains of capacity/competency. Capacity-building interventions for Ethiopian HEWs were found to be effective, but they mainly focused on improving technical competencies, such as knowledge and skills. Little attention has been paid to other competency domains, including motivation, leadership, and communication. Thus, future research could focus on a comprehensive set of capacity-building initiatives that addresses motivation, job satisfaction, communication, commitment, and resource allocation.

Mechanical circulatory support: when, how, and for whom.

Cardiogenic shock represents a critical condition in which the heart is unable to maintain adequate circulation leading to insufficient tissue perfusion and end-organ failure. Temporary mechanical circulatory support offers the potential to stabilize patients, provide a bridge-to-recovery, provide a bridge-to-decision, or facilitate definitive heart replacement therapies. Although randomized controlled trials have been performed in infarct-related cardiogenic shock and refractory cardiac arrest, the optimal timing, appropriate patient selection, and optimal implementation of these devices remain complex and predominantly based on observational data and expert consensus, especially in non-ischaemic shock. This review explores the details of 'when, how, and for whom' temporary mechanical circulatory support devices should be used, examining specific clinical scenarios, the mechanisms by which they operate, and the patient populations that may benefit. The review also highlights the many gaps in evidence and need for better understanding of the interaction between human biology and these devices.

Revealing gaps in marine evidence with a natural capital lens.

The natural capital concept positions the natural environment as an asset, crucial for the flow of goods and benefits to humanity. There is a growing trend in applying this concept in marine environmental management in the United Kingdom (UK). This study evaluates six varied marine decisions across England, Scotland and Wales. It focuses on the evidence informing these decisions and the extent to which they represent the complete spectrum of marine natural assets and ecosystem services. We identified a reliance on various evidence types, including consultations, data and statistics, maps and literature reviews. Natural assets such as aquatic resources and energy sources were most frequently evidenced. Fishing was the predominant provisioning ecosystem service benefit. There was a notable gap in evidence on marine habitats' water quality regulation service. Recreation and tourism dominated the cultural ecosystem service evidence, with less focus on indirect uses such as spiritual nature connections. We reveal gaps in the evidence in marine decisions on significant marine ecosystem service benefits. Our study provides additional evidence to an already identified need to fill evidence gaps in marine water regulation and non-use values of the UK's marine environments.This article is part of the discussion meeting issue 'Bending the curve towards nature recovery: building on Georgina Mace's legacy for a biodiverse future'.

Screening for Health-Related Social Needs: American College of Preventive Medicine's Practice Statement.

Interest is rapidly growing around screening for health-related social needs (HRSN) in direct patient care settings. The screening and provision of HRSN is often done in the context of trying to address social determinants of health (SDOH). While there is emerging evidence that screening and referral for HRSN can improve health outcomes, there are educational, operational, and systemic gaps that need to be filled in order for HRSN screening and referral to be implemented system-wide and result in meaningful improvement in population health outcomes. The American College of Preventive Medicine recommends HRSN screening and referral in patient care settings only when there are sufficient systems in place to support addressing those needs. This paper identifies key considerations to take into account when implementing HRSN screening and referral in health care settings and makes recommendations to address those key considerations. The recommendations also frame the broader need to address SDOH at a population level. Finally, the paper identifies several knowledge and evidence gaps in the existing literature on the topic of HRSN, which will hopefully drive future research in this area, and result in an evidence-based, population approach to the issue.

Timing of Delivery of Low-Risk Persons and the Risk of Attention-Deficit Hyperactivity Disorder in Offspring: Sweden and British Columbia, Canada.

An evidence gap exists concerning the timing of delivery at 37-42 weeks and the risk of attention-deficit hyperactivity disorder (ADHD) in offspring. To determine the association between timing of delivery in low-risk pregnancies at term (37-42 weeks) gestations and ADHD in offspring. This population-based cohort study comprised 1,424,453 singletons in Sweden and 403,765 in British Columbia (BC), Canada, live-born at 37-42 completed weeks to low-risk pregnant women between 2000 and 2018. Children were followed up from age 1 until the date of death, emigration, their first diagnosis, or December 2020 (study's end date). The exposure was time of delivery assessed through gestational age, and the outcome was the diagnosis of ADHD. Cox regression models were used to examine the association between gestational age at delivery and ADHD. During the follow-up period, 59,989 children in Sweden were diagnosed with ADHD (4.5 per 1000 child-years). Correspondingly, in BC, during the same period, there were 27,445 children diagnosed with ADHD (7.4 per 1000 child-years). In Sweden, the adjusted hazard of ADHD was 10%, 6%, and 3% higher at 37, 38, and 39 weeks gestation compared with those born at ≥ 38, ≥ 39,and ≥ 40 weeks, respectively. In BC, the corresponding hazards were 9%, 6%, and 3%, respectively. Both regions showed no elevated ADHD risks for infants born at 40 weeks compared to those born at ≥ 41 weeks, with slightly lower rates at 40 weeks. In low-risk pregnancies, births at 37 and 38 weeks were associated with a higher ADHD risk, while births at 40 weeks showed no increased risk compared with those born at later gestations.

Sexual Health, Pleasure, Justice, and Well-Being in People With Rheumatic and Musculoskeletal Diseases: A Scoping Review Protocol.

Sexual health, pleasure, justice (equity in sexual rights and experiences), and well-being are crucial determinants of health and life quality, yet often overlooked in the rheumatic and musculoskeletal diseases (RMD) field. However, this topic has received more attention recently, and there is a need to map the current literature to inform the direction of future studies. Hence, this protocol outlines a scoping review to systematically map existing evidence on sexual health in people with RMD, exploring key themes and identifying evidence gaps across multiple dimensions, including sexual well-being, justice and pleasure. This scoping review will follow the methodological guidance of the Joanna Briggs Institute and be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The search strategy will involve PubMed, Embase, Cochrane Central, CINAHL, PsychInfo, LGBTQIA+Source, Web of Science, and the grey literature. Identified articles will be reviewed based on the eligibility criteria. The results will be narratively synthesised and aligned with the framework proposed by Mitchel etal. (2021), identifying four pillars of comprehensive public health for sexuality: 'Sexual Health', 'Sexual Pleasure', 'Sexual Justice', and 'Sexual Well-Being'. The scoping review will synthesise the scientific literature published on sexual health, pleasure, justice and well-being in people with RMD. This review will provide an understanding of how sexual health is addressed in the literature to inform future research and clinical practices. The findings will be disseminated as research publications, including peer-reviewed article(s), conference abstract(s)/presentation(s), and plain language summaries.

The Psychometric Performance of State Mindfulness Scales Around Sitting and Walking on Desert Trails: A Pilot Study

State mindfulness is a dynamic construct reflecting current mindfulness, or purposeful attention to the present moment with openness, non-judgment, non-reactivity, and acceptance. Despite its popularity and research in psychology and medicine, measuring state mindfulness remains a challenge. Validity and reliability of the State Mindfulness Scale (SMS) and State Mindfulness Scale for Physical Activity (SMS-PA) in applied settings like nature require more data to be established. This pilot study aimed to evaluate these scales and introduce a new, one-item scale, the Visual Analog Scale-Mindfulness (VAS-M), for quicker mindfulness assessment. Participants completed the SMS, SMS-PA, and VAS-M upon arrival at a desert trail, after 10 minutes of sitting, and after 10 minutes of walking. A subset repeated the intervention 24 hours later. The study found that the SMS and SMS-PA could be given before, during, and after nature immersion. The SMS-PA showed evidence of concurrent validity with the SMS (ρ = .89, p < .001). However, the VAS-M did not meet the criteria for concurrent validity with the other scales. None of the scales met the criteria for test-retest reliability. This study underscores the need to validate state mindfulness scales, especially in non-laboratory settings. While the SMS-PA shows promise, further validation and refinement of the VAS-M are needed. The findings enhance our understanding of measuring state mindfulness, particularly in natural environments. While the scales are already in use, our study helps address gaps in evidence and informs future decisions about their application.

Patient-Reported Outcome Measures for Pelvic Organ Prolapse: A Systematic Review Using the COnsensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Checklist.

Patient-reported outcome measures (PROMs) are recommended to measure the impact of a health condition or intervention effectiveness as they aim to capture what is most meaningful to patients. Several PROMs are used to evaluate pelvic organ prolapse (POP)-related domains, yet the measurement properties of these instruments have not been fully explored with a rigorous analysis of the methodological quality and quality of evidence. To conduct a systematic review reporting on the measurement properties of PROMs used for the assessment of POP-related domains in accordance with the COSMIN guidelines. Five databases were searched from inception to December 2023. Studies were eligible if they involved (1) at least one group of female adults diagnosed with or presenting with symptoms of POP; (2) a self-reported outcome measure (PROMs, questionnaires) to evaluate POP-related domains; and (3) at least one measurement property. Methodological quality and measurement quality were assessed using the COSMIN risk of bias (ROB) checklist and the COSMIN criteria for good measurement properties. A total of 13 PROMs were included. The BIPOP had the lowest ROB for Content Validity. The POP-SS was the only PROM with sufficient evidence of adequate construct validity and responsiveness to be used in both surgical and conservative management settings. This original work identified a gap in evidence regarding the measurement qualities of identified PROMs used in the POP population.

What is the current scope of research assessing patients’ and clinicians’ perspectives on clozapine treatment? A comprehensive scoping review

ObjectivesClozapine is continuously underused. The existing systematic reviews addressing barriers to clozapine prescribing primarily focus on clinical staff’s attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed...

Efficacy and safety of disease-modifying therapies in pediatric-onset multiple sclerosis: A systematic review of clinical trials and observational studies.

This study aimed to review the efficacy and safety profile of disease-modifying therapies (DMTs) in patients with relapsing pediatric-onset multiple sclerosis (POMS). A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published randomized controlled trials (RCTs), nonrandomized studies with a control group, large single-arm studies, and ongoing (unpublished) studies investigating the use of approved and unapproved DMTs in POMS were included. Eligible published studies were identified in MEDLINE (via PubMed), EMBASE, and the Cochrane Library, and unpublished studies were identified in a clinical trials registry (www. gov). A total of 13 published studies were included in the systematic review: 4 RCTs, 3 observational studies with a control group, and 6 large single-arm studies. The following DMTs for the treatment of POMS were evaluated in the included studies: interferon beta-1a, interferon beta-1b, teriflunomide, dimethyl fumarate, fingolimod, natalizumab, glatiramer acetate, and ocrelizumab. All DMTs were shown to be effective in reducing relapse rates, preventing disability progression, and reducing disease activity in MRI in patients with POMS. DMTs that are considered highly effective in adults with multiple sclerosis (natalizumab, fingolimod) were also shown to be more effective than interferon beta-1a in POMS. A total of 9 ongoing (unpublished) studies were identified, including 5 RCTs. The following drugs were evaluated: ozanimod, fingolimod, peginterferon beta-1a, ocrelizumab, ofatumumab, siponimod, alemtuzumab, and natalizumab. The number of DMTs approved for the treatment of POMS is limited, and some of the available DMTs are used off-label. The available evidence from published studies of varying reliability supports the efficacy of DMTs in POMS. However, well-designed, long-term RCTs in the pediatric population are needed. The results of ongoing studies may fill the existing gap in clinical evidence, possibly leading to the approval of more highly effective DMTs for patients with POMS.

Chronic postsurgical pain following gastrointestinal surgery - A scoping review.

Chronic postsurgical pain (CPSP) has a great impact on quality of life and socioeconomic status. The mechanisms behind CPSP remain poorly understood, however type of surgical intervention seems to play a role. Gastrointestinal surgeries are common procedures, yet research in CPSP following gastrointestinal surgery is limited. The objective of this scoping review was to map the current literature on CPSP following gastrointestinal surgery, identifying how CPSP have been investigated, and which evidence gaps exist. This scoping review followed a pre-published protocol and PRISMA-ScR guidelines. A search was carried out in Medline, Embase, CINAHL, Cochrane Central, Clinicaltrials.Gov, and Google Scholar. Eligible studies were original studies involving adults, undergoing gastrointestinal surgery, who had a pain assessment ≥30 days postoperatively. A two-phase screening process and data charting were done by two independent reviewers. A total of 53 studies were included, published between 2001 and 2024, predominantly across Europe and Asia. The range of CPSP prevalence reported was 3.3%-46.1%. Only half the studies clearly defined CPSP, and the timing and manner of pain assessment varied considerably. Twenty-seven studies assessed risk factors for developing CPSP: preoperative pain and acute postoperative pain were consistently significant. There was a wide consensus on CPSPs' negative impact on quality of life. CPSP following gastrointestinal surgery is prevalent and significantly impacts quality of life. Standardized definitions and methodologies to improve the comparability and reliability of the findings across studies are needed. Future research should focus on CPSP following specific surgical procedures to develop tailored prevention and treatment strategies.

Appetite and childhood malnutrition: A narrative review identifying evidence gaps between clinical practice and research

Appetite and childhood malnutrition: A narrative review identifying evidence gaps between clinical practice and research

Exploring Vocational Interest Measurement Instruments in Indonesia: Insights from a Scoping Review

The difficulty of finding vocational interest measurement tools with good psychometric properties and relevance to modern developments is a current concern in Indonesia. Therefore, this scoping review aims to compile a list of vocational interest measurement tools available in Indonesia that have been psychometrically tested. For this purpose, a total of 2,196 articles were extracted from the Google Scholar, Garuda, and Scopus databases. The article selection procedure followed the PRISMA-ScR flow diagram, and the screening process resulted in 17 sample articles (2014–2024). The analysis showed that most vocational interest measurement tools in Indonesia use a top-down development approach, based on Holland’s Structure of Interests, and emphasize internal structure validity and internal consistency reliability as the tested psychometric properties. Further research is needed to address the gaps in validity evidence that remain among Indonesian vocational interest measurement tools.

Impact of Climate Change on Adolescents' Health Outcomes: An Evidence Gap Map Review.

The evolving impact of climate change on adolescents' health is a pressing global concern. Climate change's effects on their physical, mental, and social well-being worsen unique developmental challenges for adolescents. This study aims to map existing evidence, identify gaps, and highlight research and intervention needs. Following Campbell standards, an evidence gap map (EGM) review was conducted. We searched for global studies on adverse climate events and adolescents aged 10-19 using five databases such as Medline, EMBASE, Global Health, CINAHL, and Scopus from September 1946 to June 01, 2023. Two independent reviewers completed the screening using Covidence software, and a critical appraisal of all included studies. EGM was developed using EPPI Mapper software, which presents a comprehensive overview of climate events and their impact on adolescents' health outcomes. This study protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis (INPLASY) (# INPLASY202410119). We included 44 studies that explored the impact of climate change on adolescents' health. Most included studies were from Asia (35), with limited evidence from Africa, Australia, and South America (one study each). Earthquakes, hurricanes, and tornadoes were the major climate events impacting adolescents' health and well-being globally (37 studies). However, wildfires, droughts, and extreme heat got less attention. Most studies reported climate change's impact on adolescents' mental health (44), with few studies reporting the effect on physiological and psychosocial aspects of adolescents' health and well-being (10). The systematic examination reveals significant evidence gaps, particularly in Africa, Australia, and South America, and in climate events like wildfires, droughts, and extreme heat. Most studies focus on mental health, with limited research on physiological and psychosocial aspects. These gaps highlight key areas for future research and targeted interventions at the intersection of adolescent health and climate change.

Barriers to PrEP use and adherence among adolescent girls and young women in Eastern, Southern, and Western Africa: a scoping review

BackgroundAdolescent girls and young women (AGYW) are disproportionately affected by HIV. Globally, in 2022, an estimated 4000 AGYW 15–24 were newly infected with HIV weekly, and nearly 78% of these infections occurred in sub-Saharan Africa. Oral Pre-Exposure Prophylaxis (PrEP) is a key HIV prevention option within an overall HIV combination prevention approach with an efficacy of over 90% when taken correctly. However, uptake of and adherence to PrEP remains low, particularly among AGYW. This scoping review aims to map available evidence on factors that limit PrEP use among AGYW in Eastern, Southern, and Western African countries to inform research, policy, and practice on delivery of PrEP. Our review identified factors that affect PrEP journey among AGYW along the HIV prevention cascade.MethodsGuided by Arksey and O’Malley framework and using the PRISMA extension for scoping reviews, we searched the Web of Science, Global Health, and PubMed databases. Our review focused on oral PrEP, specifically papers reporting on barriers to PrEP experienced by AGYW, and peer-reviewed English-language articles published between 2012 and 2023.ResultsOf 1063 papers screened, 25 were included. Over half (60%) of the studies were qualitative; 72% were conducted in Kenya and South Africa. The barriers affecting motivation were, fear of side effects and pill burden, percieved low HIV risk, perceived stigma, PrEP use disapproval from parents and partners. PrEP access was limited by healthcare providers' stigma, isolated clinic setup, and lack of resources. Effective PrEP use was limited by a lack of parental or partner support, stigma, and lifestyle changes.ConclusionsAdolescent girls and young women face multiple and often intersecting barriers to effective PrEP use with stigma being a factor cross-cutting all steps of the prevention cascade. Similarly, lack of social support, reflected through disapproval and judgmental attitudes and low HIV risk perception, also affected two steps of the prevention cascade. Our review identified gaps in available evidence, with most studies conducted in only two countries and few quantitative studies available. Improving PrEP uptake and adherence requires interventions that address barriers across the cascade, with a particular focus on stigma and social support.

Nursing care delivery models and their impact on emotional exhaustion and practice environment: A cross-sectional study in Saudi Arabia

Background: Nursing staff outcomes, such as job satisfaction, work quality, emotional well-being, intent to leave, and the practice environment, have been linked to improvements in patient outcomes and staff job satisfaction. However, existing studies have not captured the impact of nursing models on emotional exhaustion and practice environments in the context of Saudi Arabia. Additionally, there is a gap in empirical evidence regarding the effectiveness of organizing nursing work within a total nursing or team nursing care model in ensuring staff well-being. Objective: This study aimed to examine the nursing care models used in a government hospital and their association with nurses’ emotional exhaustion and perceptions of the practice environment. Methods: A cross-sectional study was conducted with 314 nurses working at a hospital. Data were collected from January to May 2024 using the Maslach Burnout Inventory™ (MBI) to measure emotional exhaustion and the Practice Environment Scale of the Nursing Work Index (PES-NWI) to assess perceptions of the practice environment. Regression analyses were performed to examine the relationships between the nursing care model, emotional exhaustion, and the practice environment. Results: Among the 314 nurses surveyed, 201 (64%) reported using a total care model, 103 (32.8%) used a team nursing model, and 10 (3.2%) were unsure of the model used. Regression analysis revealed a significant association between the nursing care model and emotional exhaustion (p <0.001), with 42.5% of the variance in emotional exhaustion explained by the nursing care model (R² = 0.425). For the practice environment, a significant association was observed with the nursing care model (p <0.001), explaining 85.9% of the variance in the practice environment (R² = 0.859). Conclusion: The findings may guide nurse managers and policymakers in adopting nursing care models that best suit their organizations to enhance the quality of care. It is essential for hospitals to implement more flexible nursing care delivery models to enable nurses to utilize their full range of training and capabilities. These results have implications for healthcare administration and strategies that support the effective delivery of sustainable and holistic nursing care.