Despite the rapid rise of short-video platforms as health information sources, the informational quality of robotic-surgery videos-an area requiring precise clinical explanation-remains insufficiently studied. To compare the quality and reliability of robotic-surgery videos on TikTok and Bilibili and determine how platform features and uploader identity shape content quality. We conducted a cross-sectional analysis of 200 videos (100 per platform) scored using the Global Quality Score (GQS) and modified DISCERN (mDISCERN). Videos were coded by uploader type and theme, and group differences and predictors were examined with nonparametric tests and multivariable regression. TikTok videos drew more engagement, but Bilibili posts were longer and scored higher on GQS and mDISCERN. Professional uploaders produced the most reliable content. Engagement metrics correlated with each other yet did not predict quality in regression. On short-video platforms, visibility and scientific accuracy diverge-highlighting the need for professional involvement, quality-sensitive governance, and stronger public digital health literacy.

BackgroundSocial media has revolutionized healthcare communication, giving nurses unprecedented visibility and influence in shaping public perceptions of health and professionalism. Among these emerging figures are "nurse digital content creators"-nurses who use social platforms to communicate health information, advocate for the profession, and engage with large online audiences. Yet, their online presence challenges traditional ethical frameworks and professional boundaries.AimThis study explores how Italian nurse digital content creators perceive and negotiate ethical and professional boundaries in digital environments, focusing on their motivations, challenges, and the implications for nursing ethics and public health.Research designA qualitative reflexive thematic analysis was used to capture the lived experiences of four Italian nurse digital content creators.Participants and research contextParticipants were purposively selected based on defined criteria and interviewed through semi-structured video calls. Data were transcribed verbatim and analyzed using Braun and Clarke's six-step thematic analysis. Rigor was achieved through member checking, peer debriefing, and transparent coding.Ethical considerationsEthical approval was obtained. Participants provided informed consent electronically. All data were anonymized during the analysis.ResultsFive interrelated themes emerged: (1) Professional Purpose and Digital Advocacy; (2) Ethical Boundaries and Institutional Silence; (3) Privacy, Confidentiality, and Self-Protection; (4) Emotional Labour and Public Exposure; and (5) Health Misinformation and Moral Duty. Participants viewed digital communication as an ethical extension of care but struggled with ambiguous institutional guidance, fear of reputational risk, and the emotional toll of constant visibility.ConclusionNurse digital content creators play a crucial role in improving health literacy and reshaping the image of nursing in society. However, their engagement raises ethical questions that demand updated professional guidelines and institutional recognition. Integrating digital ethics and social media communication into nursing curricula and institutional policies is essential to safeguard professional integrity and enhance the educational potential of online engagement.

Throughout the COVID-19 pandemic, correctional officers not only experienced high rates of COVID-19 infection but concomitantly demonstrated low vaccine uptake and high government mistrust, placing correctional staff and the incarcerated at risk for viral transmission. To support behavioral change, a multi-pronged dialogic health education intervention was developed for correctional officers in a New York county jail. One-hour facilitated discussions took place during mandatory training days. The research team collected pre- and post-surveys to assess whether the sessions impacted intention to change COVID-19 preventive behaviors, perceived effectiveness of behaviors recommended by public health professionals, and overall health literacy. Participants were also invited to participate in an interview 3-7 months after the session regarding behavior change and perceived effectiveness of the dialogic approach. Surveys were analyzed for pre-post changes, and interview notes were analyzed using thematic content analysis. The data indicate that officers were more likely to demonstrate increased health literacy and an intention to improve or maintain their non-pharmacological health behaviors following participation in a dialogue-based health information session. Outcomes suggest that when delivering sensitive health information to populations often mistrustful of governmental initiatives, information sessions that employ discussion strategies, facilitated by credible messengers, are likely to be the most effective in improving health-related knowledge and attitudes; further study is needed to understand these strategies' effect on behavioral change.

Mobile chatbot technology is a promising tool for delivering prenatal education, particularly during public health crises such as the COVID-19 pandemic. However, little is known about pregnant women's firsthand experiences with such digital tools in clinical settings. The purpose of this study was to explore women's perceptions of a specific chatbot intervention. A qualitative descriptive study was conducted with 11 first-trimester pregnant women recruited from a university-affiliated hospital in Taipei, Taiwan. Participants used a maternal chatbot for approximately 30 minutes while waiting for their scheduled outpatient consultation, followed by semi-structured, face-to-face interviews. Data were analyzed using thematic analysis supported by MAXQDA software. Three main themes emerged: initial perceptions, usability, and acceptability of the maternal chatbot. Participants found the chatbot convenient and helpful for learning about early pregnancy, and expected it to be especially useful during wait times. They also identified certain limitations, such as inadequate keyword search, a lack of personalized content, and the absence of empathetic human interaction. Some preferred the immediacy and familiarity of Google searches, while others valued the credibility of the vetted health information provided by the chatbot. The maternal chatbot was generally perceived as a useful supplementary tool for prenatal education. However, users' expectations of emotional engagement and system functionality were found to influence its perceived effectiveness. Designs in the future should incorporate improved searchability, broader health topics, and optional human support to enhance users' experiences of digital maternal care.

Abstract Background: This study aimed to examine the relationship between individuals’ health literacy levels and rational drug use behaviors and to evaluate this relationship within the context of socio-demographic variables. Materials and Methods: The study was conducted using a descriptive and correlational research design, with data collected from 306 volunteer participants aged 18 years and older. Descriptive statistics, independent samples t-test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data. Results: A positive, moderate, and statistically significant relationship was found between health literacy and rational drug use (r = 0.387, p < 0.001). Approximately 15% of the variance in rational drug use was explained by health literacy levels. Participants’ overall health literacy and rational drug use scores were found to be above the average. Age, education level, place of residence, health insurance status, chronic disease, and method of accessing health information were determined to have significant effects on both variables. Conclusion: An increase in health literacy strengthens rational drug use behaviors. Accordingly, health literacy education programs should be planned for different segments of society, and policies encouraging the use of reliable and evidence-based health information sources should be developed.

Objectives To explore linguistic characteristics of patient education materials (PEM) in paediatric dentistry.Methods A convenience sample of 52 PEM articles (2013-2023) was obtained from four sources: plain language summaries of Cochrane systematic reviews (n = 25), Journal of American Dental Association patient pamphlets (n = 15), online patient health information from the Canadian Dental Association (n = 7), and MedLine Plus (n = 5) websites. Two investigators manually evaluated articles using the Patient Education Materials Assessment Tool (PEMAT) - printed materials. Additional computerised analyses included five Linguistic Inquiry and Word Count (LIWC) measurements and two readability measurements (Flesch Reading Ease and Simple Measure of Gobbledygook). Descriptive and comparative statistics were undertaken.Results PEM articles from all four sources scored above the recommended 70% threshold for both PEMAT composite measurements (understandability/actionability) but minimal use (21%) of visual aids was identified. Mean values of LIWC summary measures (analytical thinking = 84, authenticity = 46, clout = 53, emotional tone = 29, big words = 26) indicated scope for linguistic improvement of PEM articles. Readability analyses indicated PEM articles were generally easy to read (≤Grade 6 level) except for Cochrane articles (Grade 9 level).Conclusions PEM articles evaluated in present study were sub-optimal thereby reducing parental ability to make well-informed decisions for their children.

The unexplored quality of evidence supporting online video claims by medical professionals creates a credibility-evidence gap that threatens the principles of evidence-based medicine. To systematically evaluate the evidence hierarchy supporting medical claims in health care professional-created online videos using a novel evidence classification framework. In this quality improvement study using a cross-sectional analysis, YouTube was searched using cancer- and diabetes-related terms. A total of 309 videos met the inclusion criteria. The video search, data extraction, and archiving were conducted between June 20 and 21, 2025, to create a static dataset. Videos were assessed using the newly developed Evidence-GRADE (E-GRADE [Grading of Recommendations Assessment, Development and Evaluation]) framework, categorizing evidence into 4 levels: grade A (high certainty from systematic reviews and/or guidelines), grade B (moderate certainty from randomized clinical trials, cohort studies, and high-quality observational studies with clear citations), grade C (low certainty from limited observational studies, physiological mechanisms, or case series without critical appraisal), and grade D (very low or no certainty from anecdotal evidence). Videos that had a minimum of 10 000 views, were created by health care professionals, had a minimum duration of 1 minute, and contained specific health claims. Primary outcomes included the distribution of evidence grades (A-D) supporting medical claims. Secondary outcomes included correlations between evidence quality and engagement metrics (views and likes) and traditional quality scores (DISCERN, JAMA benchmark criteria, and Global Quality Scale). Among the 309 videos included, which had a median of 164 454 (IQR, 58 909-477 075) views, most medical claims (193 [62.5%]) were supported by very low or no evidence (grade D), while only 61 claims (19.7%) were supported by high-quality evidence (grade A). Moderate (grade B) and low (grade C) evidence levels were found in 45 (14.6%) and 10 (3.2%) videos, respectively. The correlation with view counts was statistically significant for grade D videos, which were associated with a 34.6% higher view count (incidence rate ratio, 1.35; 95% CI, 1.00-1.81; P = .047) than grade A videos. Traditional quality tools showed only weak correlations (range of coefficients, 0.11-0.23) with evidence levels, thus failing to detect important qualitative differences. In this quality improvement study, a substantial credibility-evidence gap was found in physician-generated video-sharing content, where medical authorities often legitimized claims lacking robust empirical support. These findings emphasize the need for evidence-based content guidelines and enhanced science communication training for health care professionals to maintain scientific integrity in digital health information.

BackgroundThe German electronic health record (EHR) aims to enhance patient care and reduce costs, but users often worry about data privacy and security. To mitigate disease-related privacy concerns, for instance, surrounding stigmatized diseases, we test the effect of privacy fact sheets (PFSs)—a concise but comprehensive transparency feature designed to increase users’ perceived control over their data—on increasing EHR use in a simulated online study.ObjectiveThe study aimed to investigate whether displaying a PFS shortly before upload decisions must be made mitigates disease-related privacy concerns and makes uploads more likely.MethodsIn an online survey study, 393 German participants from the recruitment platform Prolific were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and time course (TC; acute vs chronic). They were then asked to decide whether to upload the report to an EHR click dummy, while we systematically varied the presentation of privacy information (PFS vs no PFS). Participants were randomly (single-blinded) assigned to one of the 2×2×2 conditions (stigma, TC, privacy information).ResultsAll 393 participants were randomly assigned to one of the following groups: low, acute, no PFS (n=52, 13.2%); low, chronic, no PFS (n=45, 11.5%); high, acute, no PFS (n=46, 11.7%); high, chronic, no PFS (n=55, 14%); low, acute, PFS (n=44, 11.2%); low, chronic, PFS (n=41, 10.4%); high, acute, PFS (n=56, 14.2%); and high, chronic, PFS (n=54, 13.7%). The results show that, in general, upload behavior is negatively influenced by disease-related stigma (odds ratio [OR] 0.130; P<.001) and positively influenced when a PFS is given (OR 4.527; P<.001). This increase was particularly pronounced for stigmatized diseases (OR 5.952; P=.006), but independent of the TC of the diseases.ConclusionsOur results demonstrate that PFSs may help to increase EHR uploads in people interacting with a realistic EHR click dummy, by mitigating privacy concerns in scenarios involving stigmatized diseases. Results further indicate that a PFS is mainly relevant and effective for people with increased privacy risk perceptions, whereas they neither benefit nor hurt others. Thus, implementing PFSs may increase the likelihood that users who perceive high privacy risks when confronted with sensitive or stigmatized health information decide to upload their data to the EHR, ultimately increasing digital health equity.

The Institute for Quality and Efficiency in Health Care (IQWiG) examines the benefits and harms of medical interventions for patients. It was founded in 2004. IQWiG also fulfills part of its statutory mandate to inform the public about health issues with the website gesundheitsinformation.de/informedhealth.org. The website addresses awide range of health topics and is aimed at both ill and healthy individuals. IQWiG's work is fundamentally oriented towards the needs of affected people (patients, family members, and other healthy target groups). IQWiG utilizes arange of methods to obtain information and data from affected individuals or representatives of patient organizations and draw on in its work. The spectrum of methods includes verbal survey methods such as individual interviews or focus groups, written surveys, and published qualitative research results. This article focuses on the integration of the perspectives of those affected people in the development of health information. IQWiG supposes that this integration is one important reason for the high level of acceptance of gesundheitsinformation.de. This is reflected, among other things, in the results of regular user testing, feedback from support groups, patient representatives, professionals, and, last but not least, the fact that the website has such afar-reaching digital presence.

This letter addresses the study by Albayrak and Öz evaluating the quality and reliability of YouTube videos on Raynaud’s phenomenon, which found that nearly one-third of the content was of low quality and that popularity was not associated with accuracy. Using the framework of quinary prevention, the authors highlight the risks posed by digital health misinformation. Quinary prevention aims to reduce harm caused by unreliable health information and to promote accurate, evidence-based content. Within this context, misleading online resources related to Raynaud’s phenomenon are considered a potential source of informational iatrogenic harm. Such content may increase patient anxiety, encourage unverified self-care practices, delay appropriate medical consultation, and hinder effective patient–physician communication. The letter emphasises the responsibility of healthcare professionals, particularly rheumatologists, to actively counter misinformation by producing and disseminating scientifically accurate, patient-centred educational materials on digital platforms. In addition, scientific journals and academic institutions are encouraged to support research that monitors online content quality and develops strategies to address misinformation. The authors conclude that adopting a quinary prevention perspective is essential for improving patient safety, strengthening digital health literacy, and maintaining evidence-based clinical practice in the contemporary information environment.

Hospital Variation in Postoperative Mortality Among Preterm Infants.

Abstract Uganda adopted the District Health Information Software 2 (DHIS2) in 2012 to monitor public health programs. More than a decade later, the factors that facilitate or hinder the adoption and use of DHIS2 have not been well documented. This study uses a mixed methods design to understand these factors. Ugandan districts were categorized into high, medium and low performance based on weekly reporting, timeliness and completeness into DHIS2. Two districts were selected across each category of high (Yumbe and Maracha), moderate (Kakumiro and Budaka), and low performers (Jinja and Buikwe). in-depth interviews were conducted at national, district, and health facilities with program (immunization, HIV/AIDS, TB, and malaria) managers, district biostatisticians, district health officers, planners, and health facility managers. Data were analyzed thematically. Across the selected districts, the average adoption score (average of all three indicator scores listed above) ranged from 97% for high adopters to 60.3% for low adopters. Enablers of DHIS2 adoption included strong digital infrastructure, adequate and competent human resources, support from implementing partners, and financial incentives. Barriers to DHIS2 adoption were infrastructural challenges and system errors, including a lack of access rights to key cadres and server breakdown. Human resource limitations were also important barriers. Despite DHIS2’s role in assessing program performance and real time monitoring of campaigns, data use for decision making remains limited. Findings indicate that a limited investment in operationalization impedes effective use. This implies improving in-country ownership to routinely upgrade equipment, provide reliable network, and recruit trained personnel.

Introduction Individuals from historically marginalized communities have less access to genetic testing services. Incomplete family history information in electronic health records contributes to under-identification of those eligible for genetic testing of hereditary cancer genes. Digital health tools can aid in collecting family history information, but there is a lack of information about how to integrate these tools in ways that are effective for different communities. This study investigated experiences with family history collection as well as acceptability and approaches for cultural adaptation of a chatbot for family history collection. Methods Seven community engagement studios were conducted with community leaders (N=48) representing historically marginalized communities, specifically Hispanic and Pacific Islander. The studios were conducted by trained facilitators in English (n=4) or Spanish (n=3) with 5-8 participants per studio. Transcripts of recorded studios were analyzed using inductive thematic analysis. Results Two domains, each with underlying themes, were identified: (1) previous family history collection experience and (2) chatbot impressions and feedback. Community leaders saw value in using a chatbot for family history collection and also expressed the importance of addressing accessibility of the tool. They emphasized interpersonal interactions together with the use of digital health tools and the importance of trusting relationships with healthcare professionals regardless of chatbot integration. Conclusion Community leaders highlighted specific strengths and limitations of the chatbot. The importance of human connection with healthcare professionals to build trusting relationships was emphasized. Successful integration of this tool into historically marginalized communities will require ongoing conversations and investment in communities.

While health-related awareness has been extensively studied, the concept of health uncertainty in the general population remains inadequately conceptualized and operationalized. This study aims to develop a conceptual framework and measurement tool for health uncertainty, and to examine its associations with health anxiety and health behaviors. The research comprised two studies conducted in China. Study 1 developed and validated a health uncertainty scale using data from 709 participants. The scale, which comprises dimensions of health status uncertainty, health changes unpredictability, and health threat and information ambiguity, demonstrated good reliability and validity. Study 2 employed a questionnaire-based approach with 345 participants and showed that health uncertainty negatively predicted health behaviors, with health anxiety acting as a mediator. The findings highlight the impact of health uncertainty on psychological and behavioral responses, emphasizing the need for strategies to reduce uncertainty during public health crises to promote healthier behaviors and achieve public health goals.

Objective: The study examines changes across cohorts in terms of the timing and frequency of the full spectrum of reproductive events and explores whether these reproductive trajectories reflect broader trends towards the destandardisation of family formation. Furthermore, the study assesses the quality and limitations of Czech health registry data by comparing them with official vital statistics. Background: Analysing fertility alone is insufficient with respect to understanding individual reproductive trajectories since reproductive experiences are interconnected across the lifespan and may be influenced by other reproductive events that affect both the tempo and the quantum - especially within the context of fertility postponement. Method: This study employs individual data obtained from the Czech National Health Information System (NHIS) that enable the holistic analysis of reproductive trajectories including live births, induced abortions, in vitro fertilisation, miscarriages and stillbirths across selected cohorts of women (1976–1991). Results: The younger cohorts experienced delayed and less frequent reproductive events. However, the lower incidence of adverse events partly reflected fewer conceptions due to the postponement of reproduction to older ages. The most common combination of event types involved live births with induced abortions or miscarriages. Reproductive trajectories were found to diversify with age but exhibited limited variation across the cohorts, and an early live birth remained linked to higher completed fertility. The NHIS data were largely in line with the vital statistics, with the moderate underestimation of live births and the under-reporting of early miscarriages and induced abortions. Conclusion: The findings highlight the potential and limitations of health registry data in terms of capturing the full spectrum of reproductive events. Forming a deeper understanding of women's reproductive trajectories and experiences, enabled via the use of linked health register data, is essential in terms of developing policies on reproductive health and rights in the context of declining fertility levels and the postponement of childbearing to later ages.

BackgroundLarge language models (LLMs) are increasingly used by patients seeking cardiovascular health information through digital platforms. However, their accuracy and suitability for providing guidance on heart failure and cardiomyopathy remains inadequately evaluated.PurposeThis study systematically benchmarked six state-of-the-art LLMs in generating responses to patient-oriented heart failure and cardiomyopathy queries, focusing on clinical appropriateness and comprehensibility.MethodsWe tested six prominent LLMs–OpenAI GPT-4o, DeepSeek Chat, Gemini 2.5 Pro, Anthropic Claude 3.7 Sonnet, Perplexity Sonar Pro, and xAI Grok-3–on 50 curated questions covering disease understanding, diagnosis, treatment, prognosis and lifestyle concerns via standardized API interfaces. A web-based evaluation platform randomized and blinded responses for assessment by twelve reviewers (3 cardiologists, 3 medical students, 6 AI auto-graders). Responses were rated across nine domains (1-5 Likert scale): appropriateness, comprehensibility, completeness, conciseness, confabulation avoidance, readability, educational value, actionability, and tone/empathy. Reviewers chose their preferred model per question.ResultsLinguistic complexity and output length varied substantially. Gemini provided the most readable responses (Flesch-Kincaid Grade 11.9±1.8) but was most verbose (668.7±116.1 words), while Claude generated shortest responses (226.9±38.9 words) with higher complexity (Flesch-Kincaid Grade 35.2±20.5). Across 2,700 ratings, Gemini received the highest composite mean ratings (4.55±0.02), excelling in completeness and factual reliability, followed by xAI Grok (4.41±0.02), OpenAI GPT-4o (4.26±0.02), DeepSeek (4.20±0.02), Claude (4.15±0.02), and Perplexity (4.00±0.02). Confabulation avoidance scored consistently high across all models (4.49±0.02), while conciseness scored lowest (3.81±0.05). Consistently, evaluators selected Gemini as their preferred model in 43.7%, followed by xAI (30.3%) and OpenAI (11.7%). Rating tendencies varied by evaluator group: Auto-graders gave the highest average scores (mean 4.58 ± 0.60), followed by students (4.10 ± 0.88), while experts were more conservative (3.79 ± 0.93), reflecting stricter grading patterns closer to neutral. Discussion: Gemini achieved the highest overall performance across appropriateness, completeness, and actionability, suggesting strong potential for patient-facing cardiovascular communication. All LLMs showed good accuracy avoiding medical misinformation, though variability exists in readability and comprehensiveness. While major factual errors or hallucinations were rare in our blinded evaluation, they were not entirely absent. Differences in grading strictness between experts and other raters further emphasize the need for careful validation of chatbot outputs in clinical settings. LLMs hold promise for enhancing patient education but should be deployed with oversight and model-specific awareness.Key findings.Strengths and Weaknesses of LLMs.

To identify perceived benefits, concerns, and challenges to adolescents with cancer accessing online patient portals. Semi-structured, qualitative interviews with 48 dyads of adolescents with cancer (12-17 years) and their parents. Interviews explored parental and adolescent experiences, motivations, and concerns to accessing the portal. Three team members analyzed interview transcripts using thematic analysis. Most adolescents (41/48, 85%) and parents (42/48, 87.5%) believed that adolescents should have access to their electronic health information (EHI), but that access should depend on certain factors, such as the adolescent's age, maturity level, or ability to understand portal content. Although most parents reported having accessed the portal (42/48, 88%), only 12 adolescents (25%) had previously accessed the portal. We identified seven themes related to both real-life and hypothetical benefits and concerns of adolescent portal access: promoting communication between adolescents, caregivers, and clinicians; providing reassurance to adolescents; supporting adolescent engagement and responsibility; supporting adolescent knowledge and understanding; creating confusion or misunderstanding; creating worry or fear; and potential for misuse. In our qualitative study, most adolescents with cancer and their parents believed that teens should have access to their EHI but expressed a diversity of opinions on when and under what circumstances teens should have access. Both parents and teens recognized that portals had the potential to both alleviate and contribute to anxiety and worries related to cancer care and prognosis. Our study found novel areas of concern relating to the potential for portal use to negatively impact adolescent mental health.

Objective: To understand shared-use mobile device deployment, management and usage challenges in healthcare delivery organizations (HDOs), including capabilities and unmet needs in Australia, Canada, the United Kingdom and the United States. Methods: Online survey of 400 HDO clinical and health information technology leaders with institutional responsibilities for the management of shared-use mobile devices. How the challenges identified in the survey can be overcome is explored by examining the deployment of a mobile device management platform. Results: Across nations 92% of respondents agreed that mobile devices are essential tools, yet only 56% had fully implemented shared-use device policies and procedures. Respondents stated improvement is needed in auditing facility device usage: 16% have no consistent policy/process for assigning devices at shift start; 46% use verbal or informal processes. Perceived mobile device benefits include: facilitates delivery of high-quality (94%) and accelerated care (51%) enabling reduced length of stay (86%); increased clinician satisfaction (94%) and reduced burnout (90%); enhanced care team coordination/communication (67%); and improved clinical application access (54%). Challenges in ease of use were endemic, including: securing sensitive information (44%); sharing of access credentials (79%); devices left logged in (74%); and ensuring rapid, frictionless access. Clinicians experience access issues, with frequent helpdesk contact (87%) for lockouts. Clinician frustration occurs when devices are unavailable (87%) or broken, uncharged, or missing applications (86%), delaying care delivery. Management issues included lack of visibility into mobile device usage (40%), assignment (48%), and applications accessed (55%); no centralized system for managing devices (39%); and time-consuming device setup (35%), with little variability by nation. When devices are unavailable or access difficult, 81% stated personal devices are used, an unsafe workaround. Substantial minorities across nations reported still relying on manual paper or digital log of device sign-out. A high mean annual rate of mobile device loss (23% across nations) ensures the negative impact of missing/unavailable devices is substantial, increasing risk of information security breach, delays in care communications and delivery, reduced productivity, shift change disruption, and increased staff frustration. Differences in responses by facility size (bed count) were few and modest. HDOs reported meaningful savings of $1.1 million per year on average by deploying shared-use mobile devices, with 92% indicating improved return on investment and reduced manual management workload. Conclusions: HDOs reported significant perceived challenges in effectively managing shared-use devices, but recognize they facilitate efficient clinical-operational workflows and increased clinician satisfaction. Need exists to overcome substantial capability gaps to systematically manage device fleets while ensuring a friction free, secure and efficient user experience.

The COVID-19 pandemic amplified digital divides in Brazil, restricting vulnerable groups' online access to health information and preventive guidance, with limited intersectional analyses of these inequities. This study aimed to investigate inequalities in digital exclusion and access to online COVID-19 information among people experiencing homelessness and residents of urban communities in Brazil by using an intersectional multilevel analysis. A cross-sectional study (2021-2023) involving 2652 participants (n=1353, 51% experiencing homelessness and n=1299, 49% from urban communities across 26 state capitals) was conducted using the adapted COVID-19 Social Thermometer questionnaire administered via face-to-face interviews. Multilevel analysis of individual heterogeneity and discriminatory accuracy examined 115 intersectional strata (gender, race and ethnicity, schooling, income, and Brazilian Unified Health System use) with online COVID-19 information seeking as the binary outcome; multilevel logistic models estimated additive effects and between-strata variance. Most participants were men (1600/2652, 60.3%), self-identified as Black or Brown individuals (1942/2652, 73.2%), and were Unified Health System users (2433/2652, 91.7%) without private insurance (2469/2652, 93.1%). Over one-third (905/2652, 34.1%) had no formal schooling; 62.4% (1655/2652) reported low income. A total of 39.2% (1040/2652) sought online COVID-19 information. Being a woman (odds ratio [OR] 1.49, 95% CI 1.13-1.97), higher schooling (OR 1.78-5.59, 95% CI 3.52-8.88), and higher income (OR 2.37-4.54, 95% CI 2.59-7.93) showed a stronger association with online COVID-19 information seeking; public health system use was not associated with the outcome (OR 0.92, 95% CI 0.64-1.33). Predicted probabilities ranged between 14% and 85% across 115 strata, with the lowest among Black or Brown men (no schooling or low income) and the highest among women and higher schooling or income. The intersectional analysis (n=2405) null model showed 24% between-strata variance; the full additive model reduced it to 1% (proportional change in variance=97%). Intersectional analysis reveals structural informational exclusion driven by additive disadvantages in schooling, income, and gender among participants, calling for digital inclusion policies, critical health literacy programs, and equitable multichannel communication strategies to address persistent COVID-19 information seeking disparities.

BackgroundPerioperative patient-reported outcomes (PROs) allow patients to share their experiences of surgical procedures with their health care teams using standardized measures. Despite increasing recognition of their value, PROs are not routinely used in clinical practice, partly due to limited evidence of their impact on traditional clinical outcomes and uncertainty among clinicians about their use. Digital health tools offer a promising way to integrate PROs into clinical workflows and enhance patient-clinician interaction, but their success depends on person-centered design to ensure usability and relevance. Safe Surgery South Africa, a nonprofit organization, developed the Perioperative Shared Health Record (PSHR), a secure web-based tool that enables patients to share personal health information and PROs with their anesthetist and surgeon before and after surgery. Initial implementation revealed significant user experience challenges, which contributed to poor uptake.ObjectiveThis study aimed to explore factors influencing the PSHR user experience in a low- and middle-income country (LMIC) using human-centered design principles.MethodsThis observational qualitative user experience study followed the 5 design thinking stages: empathize, define, ideate, prototype, and test. Semistructured interviews were conducted with postoperative patients from both the public and private health care sectors, including those with and with no prior experience using the PSHR. Thematic analysis followed the 6-phase framework described by Braun and Clarke and was structured using Karagianni’s Optimized Honeycomb user experience model. A problem statement was developed, followed by ideation to explore solutions. Paper prototypes were created, refined, and tested through observation, interviews, and validated usability questionnaires.ResultsIn the empathize stage, 22 interviews were conducted in the private and public health care sectors in South Africa; 7 participants had previous experience using the PSHR. In the define stage, participants emphasized the need for connection, feedback, information, and support through their surgical journey. Contrary to expectations, patients were not discouraged by the length of questionnaires if they perceived them as purposeful. In the ideate stage, the team considered user expectations and PSHR integration into care processes. In the prototype stage, low-fidelity mock-ups were created and refined into paper prototypes. In the test stage, testing with 5 participants highlighted the importance of trust, communication, and user-friendly interfaces. Feedback loops and clinician engagement were identified as key motivators for sustained use. The mean usability questionnaire scores indicated excellent usability and high levels of user satisfaction across most domains.ConclusionsThis study is one of the first to apply human-centered design principles to a perioperative digital health tool in an LMIC setting, addressing usability challenges and patient engagement. Key user experience factors influencing patient engagement included communication, feedback, and access to information throughout the surgical journey. Digital health tools such as the PSHR can strengthen communication and support person-centered perioperative care by integrating PROs into clinical workflows and care processes.