BackgroundOstomy creation for cancer treatment negatively impacts the quality of life of both patients and caregivers. Hispanic patients with cancer and caregivers often face additional challenges, including limited access to supportive care programs.ObjectiveThis study aimed to examine the experiences and preferences of Hispanic patients with cancer living with ostomies and their caregivers to inform the cultural adaptation of an existing intervention program and the design of Ostomy Self-Care Program (Programa de AutoCuidado de Estoma [PACE]).MethodsIn this 2-stage study, conducted between March and August 2023 in San Antonio, Texas, we used a qualitatively driven mixed methods design, starting with an initial survey followed by qualitative interviews to explore the experiences, needs, and intervention preferences of Hispanic patients and caregivers managing ostomy care. We used Braun and Clarke’s 6-phase thematic analysis approach to analyze the qualitative data and performed descriptive analysis for the quantitative data. Subsequently, we applied affinity diagramming and persuasive systems design principles to guide the design of PACE.ResultsIn total, 14 Hispanic participants managing an ostomy (9 patients with cancer and 5 caregivers) completed a survey and participated in interviews, continuing until data saturation was reached. Participants had a mean age of 58.9 (SD 13.01, range 37‐79) years, and most (n=12) reported a high school diploma or General Educational Development as their highest education level. Around 5 (36%) participants scored below 26 on the eHealth Literacy Scale (eHEALS), indicating low digital health literacy, and the average Charlson Comorbidity Index (CCI) was 3.21 (SD 1.86, range 0‐6). Overall, 3 major themes emerged from the qualitative data analysis, namely perceptions of living with an ostomy, seeking support, and postsurgery challenges. Additionally, two primary themes emerged from participant interviews: (1) importance of preferred language and multimedia delivery and (2) patients and caregivers desire early introduction, multimodal delivery of materials, and inclusion of peer and family support. These themes informed the design and development of a culturally appropriate, web-based, bilingual PACE intervention that integrates content visualization, cultural adaptations, and persuasive technologies—strategies designed to encourage user engagement.ConclusionsOur findings emphasize the importance of understanding the ostomy care experiences, supportive care needs, and intervention preferences of Hispanic patients and caregivers. Informed by stakeholders’ insights, we culturally adapted the original intervention program using persuasive systems design principles to design and develop the PACE intervention, aiming to enhance engagement among Hispanic patients with cancer and caregivers, support effective self-management of ostomy care, and improve health outcomes.

BackgroundHealth literacy, defined as the ability to obtain, understand, evaluate, and use health information, influences health behaviors and outcomes. Low health literacy (LHL) is associated with misunderstandings of treatment instructions, poor adherence, and inadequate preventive behaviors, all of which contribute to health disparities. Although universal precautions such as plain language and the teach-back method are recommended, recent studies indicate that these measures alone cannot fully address the challenges faced by patients with LHL. Previous qualitative studies have examined psychosocial processes through which shame and concealment shape patient-provider communication; however, these findings remain fragmented across settings and disciplines, and no scoping or systematic review has yet synthesized this evidence.ObjectiveThis review aims to map how patients with LHL experience shame and concealment, how health care providers’ behaviors and communication influence these experiences, and how these processes affect patient-provider communication and care. It also seeks to identify strategies to reduce the impact of shame and concealment in clinical practice.MethodsThis review will be conducted and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed, MEDLINE, CINAHL, PsycInfo, Web of Science, and Academic Search Complete will be searched using terms related to health literacy, patient-provider communication, and qualitative research. Qualitative and mixed methods studies with qualitative findings will be included, and quantitative-only studies will be excluded. The participants may include patients, health care providers, or both. Data extraction will include specific manifestations of shame (eg, embarrassment, fear of judgment, and self-blame), concealment behaviors (eg, silence, avoidance, and impression management), provider communication behaviors (eg, time pressure, use of jargon, dismissiveness, and validation), and key findings. The accuracy of the data will be verified by multiple reviewers. Data will be synthesized using thematic synthesis, with the findings presented in tables; narrative synthesis; and a conceptual model depicting the interactions among shame, concealment, and provider communication. The findings will describe how shame and concealment are conceptualized, how they shape communication and care, and strategies suggested to reduce their effects. A conceptual diagram will illustrate these dynamics.ResultsThis study was funded in April 2025. Database searching is scheduled for October 2025, with study selection and data extraction planned for November 2025. As of September 2025, no data extraction has been completed. Data synthesis is expected to be finalized by December 2025, and results are planned for publication between June and August 2026.ConclusionsThis will be the first scoping review to systematically map the roles of shame and concealment in health care communication among patients with LHL. Synthesizing qualitative evidence will provide insights into relational dynamics, inform professional education and training, and guide organizational- and policy-level strategies to promote equitable and patient-centered health care communication.

BackgroundWidespread misinformation and low critical health literacy pose major barriers to public health worldwide. Rapid, scalable, and evidence-informed digital interventions are urgently needed to strengthen the public’s ability to make informed health decisions.ObjectiveInformed by critical health literacy frameworks, we developed and tested a brief, story-based critical thinking podcast, Parents Making Informed Health Choices, that was designed to improve critical health literacy and decision-making among US parents.MethodsWe conducted a 2-phase study. First, 5 parents participated in the user testing of the prototype podcast and provided qualitative feedback to refine content and delivery. The final podcast delivered 9 evidence-based practice principles through relatable scenarios about mental and physical health. In the second phase, we conducted a 2-arm randomized controlled trial (N=250) with a national online sample of US parents. Participants were randomly assigned to listen to either the critical thinking podcast (n=128, 51.2%) or a control podcast (n=122, 48.8%). There were no significant preintervention group differences except for age, which was controlled for in all analyses. Primary outcomes included critical thinking about health claims, intended health behaviors, attitudes toward evidence-based mental health practices, and treatment preferences.ResultsOn average, parents were aged 35 (SD 7.8) years; 49% (121/247) were female, 75% (185/248) were White; and 60.0% (148/248) had a bachelor’s degree or higher. Parents who listened to the critical thinking podcast demonstrated significantly improved critical thinking about health information compared to the control group (B=2.56; P<.001; ∆R2=0.06). They also reported stronger critical thinking–aligned intended behaviors (B=0.252; P=.001; ∆R2=0.015), and more evidence-informed treatment preferences (B=4.89; P=.038; ∆R2=0.02). The effect sizes were small to moderate across outcomes.ConclusionsFindings suggest that a brief, story-based digital podcast can meaningfully improve critical thinking about health information, intended behaviors, and evidence-based practice attitudes. Podcasts represent a promising, low-cost, and scalable strategy for promoting critical health literacy and countering health misinformation in the general public.

Abstract Purpose There is social inequity in the distribution of digital health literacy (DHL), and patients with chronic disease have also been shown to have lower general health literacy. The study aimed to examine the associations between low socioeconomic status (SES) [measured by self-reported educational level], chronic disease and low DHL and whether chronic disease modifies the effect between SES and DHL. Methods Cross-sectional study from the Danish HLS 19 survey, a stratified random sample of 3,644 respondents from the Danish population. A questionnaire collected information on educational level and the prevalence of 13 specific chronic diseases. The number of self-reported chronic diseases were counted. DHL was measured using the HLS 19 digital health literacy scale from the WHO-Action Network M-POHL. Linear regression models were used to estimate the association between chronic disease and DHL and between education level and DHL, adjusted for sex and age. The potential effect modification between SES, chronic disease and DHL was analyzed. Results Having two or more chronic diseases was associated with a lower level of DHL (beta (95%CI)) (-3.88 (-5.68; -2.08)) compared to having no chronic disease. Both bachelor-level education (6.49 (4.68; 8.30)) and master-level or above (9.39 (7.43;11.36)) were associated with a higher DHL than respondents with vocational education. No statistically significant interaction was found between chronic diseases and education level on the level of DHL. Conclusions SES and the presence of chronic diseases were independently associated with DHL but did not interact.

More than 15% of US adults with type 2 diabetes have persistent hyperglycemia. Adults with persistent hyperglycemia and type 2 diabetes have an elevated health risk of a variety of outcomes, including amputation and mortality from cardiovascular disease and from all causes. Nutrition-focused interventions can be effective for improving glycemic control, reducing antihyperglycemic medications, and reducing body weight, all of which are critical outcomes for adults with type 2 diabetes. Carbohydrate intake impacts postprandial glycemia more than any other dietary factor. The American Diabetes Association now recommends a very low-carbohydrate diet, because of its ability to improve glycemic control, for the treatment of type 2 diabetes. However, typical nutrition-focused interventions can be burdensome, as the interventions often have complex instructions and require changing one's diet completely. Additionally, adults with type 2 diabetes and persistent hyperglycemia may be more likely to have low health literacy levels, which can be a barrier to adherence to complex interventions. This study aimed to evaluate the effectiveness of a digital, small-steps intervention that focuses on implementing a very low-carbohydrate dietary pattern specifically at breakfast for adults with type 2 diabetes and persistent hyperglycemia. The goal is to determine whether this targeted dietary modification can lead to reductions in hemoglobin A1c levels and decreased use of antihyperglycemic medications, without requiring participants to change their entire diet. The Breakfast Study will enroll adults with a hemoglobin A1c (HbA1c) of 7.0% or higher to our online, 4-month intervention, which will teach participants to change their breakfasts to be very low in carbohydrates. We will measure acceptability and feasibility, plus critical efficacy outcomes, such as changes in HbA1c, antihyperglycemic medications, glycemic variability, body weight, blood pressure, and lipids. We will also test whether factors such as sex and baseline insulin resistance significantly moderate the impact of the intervention on change in HbA1c and antihyperglycemic medications. If the results are promising, we will conduct a follow-up, powered, longer randomized controlled trial of this approach. As the prevalence of type 2 diabetes and the understanding of personalized interventions continue to increase, there is a critical need to provide additional effective options for population-level type 2 diabetes treatment strategies, especially for adults with type 2 diabetes and persistent hyperglycemia. As of October 2025, we have enrolled 119 participants. The results will be published separately. The Breakfast Study is a nonrandomized, pre-post trial to assess the acceptability, feasibility, and preliminary effectiveness of an accessible, very low-carbohydrate breakfast for adults with type 2 diabetes and persistent hyperglycemia. This study could provide support for continued research investigating how to lower barriers to dietary interventions for type 2 diabetes. ClinicalTrials.gov NCT05986097; https://clinicaltrials.gov/study/NCT05986097. DERR1-10.2196/81041.

Examining the Relationship Between Surgical Fear and Health Literacy in Patients Undergoing Open-heart Surgery: A Multicenter Cross-sectional Study.

ABSTRACT Telemedicine holds significant potential to transform healthcare delivery in rural Nigerian communities; however, its adoption remains constrained by various barriers. This study explores patient-level barriers, including technological access, health literacy, and cultural attitudes, as well as provider-level challenges such as training, infrastructure, and organizational support. Additionally, it investigates the role of socio-economic factors and community dynamics in shaping perceptions of telemedicine. Using qualitative interviews with 39 participants (24 patients and 15 providers), the study identifies key obstacles, including the high cost of devices and internet data, unreliable connectivity, low health literacy, and cultural stigma surrounding remote healthcare consultations. The findings align with Rogers’ Diffusion of Innovation theory, revealing that barriers related to relative advantage, complexity, and compatibility significantly affect the adoption process. Strategies to mitigate these barriers include subsidizing technology costs, implementing digital literacy programs, providing culturally tailored telemedicine models, and ensuring better infrastructure and technical support for healthcare providers. Recommendations also emphasize the importance of community-centered engagement to enhance acceptance and usage. This study highlights the need for systemic interventions and participatory approaches to design context-specific solutions that address both patient and provider challenges. Future research should focus on participatory action research to develop and implement effective interventions for telemedicine adoption in rural areas.

The elderly are a vulnerable age group that experiences a decrease in physical, psychological, and social functions, which has an impact on the ability to carry out daily activities (Activity of Daily Living) so that the elderly need the help of others in fulfilling their daily needs. Nurses have an important role in providing health education to improve the independence of the elderly, especially in primary care areas such as the Oekabiti Health Center. This study aims to explore nurses experiences on improving the Activity Daily Living of elderly. This study used a qualitative approach with a phenomenological method. Participants were collected by purposive sampling. Data were collected through in-depth interviews with 7 nurses who have more than 6 months of experience and are active in providing health education to the elderly. Data analysis was carried out with a thematic approach. This study resulted in five main themes, namely: (1) Nurses have a good understanding of health education; (2) health education is needed to improve the ADL of the elderly, (3) strategies for providing health education for the elderly, (4) challenges in providing health education for the elderly, (5) unavailability of health education media. This study shows that nurses have a good understanding of the importance of health education to improve the ADL skills of the elderly. Educational strategies are carried out personally and contextually, although they still face obstacles such as low health literacy and lack of educational media. Institutional support and media provision are needed to optimize elderly education.

Mask-wearing shows a reduced spread of SARS-COV-2, yet accurate recommendations were not effectively communicated early in the pandemic. Lower health literacy, depression, and anxiety symptoms may play a role in the uptake and utilization of mask-wearing. Additionally, health beliefs regarding perceptions of the severity of and susceptibility to COVID-19, and benefits and barriers to mask-wearing, may also contribute to mask-wearing behaviors. This study aimed to investigate correlations between health beliefs as defined by the Health Belief Model (HBM), depression, anxiety, health literacy, and mask-wearing during the COVID-19 pandemic. We conducted a secondary analysis from the Behavioral Outcomes During Social Distancing cohort study. Data were collected at 2 timepoints between March and August 2020 in 346 adults in the United States and analyzed through bivariate Pearson and Spearman correlations. Participants perceived COVID-19 as somewhat severe, felt somewhat susceptible to infection, saw more benefits than barriers to mask-wearing, reported moderate depression and anxiety symptoms, and had high electronic health literacy. Adherence to mask-wearing was positively associated with perceived severity, susceptibility, and benefits of mask-wearing, and negatively associated with perceived barriers. Depression, anxiety, and health literacy were not significantly associated with mask-wearing. These findings suggest that health beliefs play a crucial role in mask-wearing behaviors. Further research is needed to explore how health beliefs influence other mitigation measures, such as immunizations, social distancing, and hand hygiene. Interventions targeting HBM concepts could potentially improve mask-wearing and other health actions, reducing the spread of viral illnesses.

Socioeconomic disparities in hospice care access are well recognized, but their structural drivers remain underexplored. Low-income patients with cancer often face compounded informational, psychosocial, and financial barriers at the end of life. To examine how limited cultural capital, disease-related stigma, and class-based disadvantage may be jointly associated with hospice care access among low-income patients with cancer in China. This descriptive qualitative study was conducted at a tertiary hospital in southwestern China from July 2024 to July 2025. Adult patients with advanced cancer receiving government social assistance were purposively sampled. Semistructured in-depth interviews were conducted, transcribed verbatim, and thematically analyzed using a 6-phase approach. Two researchers independently coded transcripts, with analytic consensus achieved through iterative discussion. NVivo 12 software was used for data management. Analysis occurred from August to October 2025. Among 16 adults with advanced cancer (median [range] age, 55 years [late 30s to early 70s]; 9 men [56.2%]), 4 themes emerged: (1) Limited cultural capital was associated with cognitive and communicative barriers, including low health literacy, reliance on informal sources, and poor digital navigation. (2) Stigma surrounding cancer and death was associated with moral dilemmas and inhibition of open discussion of hospice. (3) Economic deprivation was associated with restricted care options, reinforced curative treatment priorities, and weakened access to social support. (4) Patients and families used resilience strategies, including peer networks, communication tactics, and value redefinition. These domains interacted synergistically; poverty was associated with reduced access to education and digital literacy, with exacerbated stigma internalization and discouraged care-seeking. This study found that cultural capital deficits, stigma, and socioeconomic hardship were jointly associated with a self-reinforcing cycle of hospice exclusion. These outcomes suggest that interventions must address these factors simultaneously by improving health literacy, reducing stigma, and expanding financial and systemic support.

Utilization of patient-reported outcome measures for women with low health literacy in gynecologic oncology - A mixed-methods study.

Children with medical complexity (CMC) are a high-risk population for many reasons including polypharmacy, which predisposes to medication errors. Parental comprehension of discharge medications is essential to reducing the risk for medication errors in CMC. The aim of this study was to determine whether parental health literacy is associated with comprehension of discharge medications among CMC. This was an observational cross-sectional study of English- and Spanish-speaking parents (n = 60) of CMC younger than 18years admitted to the pediatric intensive care unit or acute care floor of 2 affiliated hospitals. Surveys were self-administered at time of discharge. Newest vital sign is a validated tool that identifies patients at risk for low health literacy. A score less than or equal to 3 indicated low health literacy. Comprehension was a composite score encompassing 6 domains (medication name, indication, dose, frequency, duration, and side effects) and was measured as a continuous variable. Simple and multiple linear regression models assessed the association between health literacy and comprehension, accounting for covariates. The unadjusted parental comprehension score was 1.16 higher (SE 0.33) in caregivers with appropriate health literacy (P < .01). Health literacy explained 17% of the variance in comprehension. Once adjusting for income, the association between health literacy and comprehension was no longer significant (P = .05). Low parental health literacy is associated with worse comprehension of discharge medications for parents of CMC, but the relationship is confounded by income. Initiatives to improve medication comprehension with special attention to health literacy and social determinants of health may help address this problem.

Type 2 diabetes mellitus (T2DM) constitutes a rapidly expanding global epidemic whose societal burden is amplified by deep-rooted health inequities. Socio-economic disadvantage, minority ethnicity, low health literacy, and limited access to nutritious food or timely care disproportionately expose under-insured populations to earlier onset, poorer glycaemic control, and higher rates of cardiovascular, renal, and neurocognitive complications. Artificial intelligence (AI) is emerging as a transformative counterforce, capable of mitigating these disparities across the entire care continuum. Early detection and risk prediction have progressed from static clinical scores to dynamic machine-learning (ML) models that integrate multimodal data-electronic health records, genomics, socio-environmental variables, and wearable-derived behavioural signatures-to yield earlier and more accurate identification of high-risk individuals. Complication surveillance is being revolutionised by AI systems that screen for diabetic retinopathy with near-specialist accuracy, forecast renal function decline, and detect pre-ulcerative foot lesions through image-based deep learning, enabling timely, targeted interventions. Convergence with continuous glucose monitoring (CGM) and wearable technologies supports real-time, AI-driven glycaemic forecasting and decision support, while telemedicine platforms extend these benefits to remote or resource-constrained settings. Nevertheless, widespread implementation faces challenges of data heterogeneity, algorithmic bias against minority groups, privacy risks, and the digital divide that could paradoxically widen inequities if left unaddressed. Future directions centre on multimodal large language models, digital-twin simulations for personalised policy testing, and human-in-the-loop governance frameworks that embed ethical oversight, trauma-informed care, and community co-design. Realising AI's societal promise demands coordinated action across patients, clinicians, technologists, and policymakers to ensure solutions are not only clinically effective but also equitable, culturally attuned, and economically sustainable.

Background: Women living in riverine communities are affected by factors such as geographical and cultural distance that hinder access to and use of health services. In this context, access to the Pap smear is crucial for the early detection of cellular changes that may progress to cervical cancer, which underlines the importance of understanding riverine women’s subjective perceptions of this exam. Objectives: To analyze the perceptions of riverine women regarding cervical cancer screening through the lens of health literacy. Methods: Descriptive qualitative study conducted with 42 riverine women residents of the Brazilian Amazon who were registered at the Basic Health Unit on Cotijuba Island, Pará, Brazil. Data were collected through semi-structured individual interviews from January to May 2024 and analyzed using IRaMuTeQ software version 0.7 alpha 2. Results: Data were grouped into similar classes, yielding the following thematic axes: knowledge, feelings and perceptions about the Pap smear test; how health literacy and access to information affect self-care; access to health services. The study showed that limited participant knowledge about the Pap smear was reflected in low health literacy, which directly affected adherence to the exam. Conclusions: The study demonstrated that the riverine woman’s limited knowledge regarding the Pap smear was reflected in their poorly developed health literacy, which directly contributed to non-adherence to the exam.

BackgroundHypertension is a growing public health concern, particularly among white‐collar workers exposed to sedentary lifestyles and occupational stress. This study examines the prevalence and determinants of hypertension among commercial bank employees in Sunsari, Nepal, with a focus on lifestyle risk factors and health literacy.MethodsA cross‐sectional study was conducted among 240 bank employees using stratified random sampling. Data were collected through a self‐administered questionnaire adapted from the WHO STEPS survey and clinical measurements of blood pressure, BMI, and waist circumference. Hypertension was classified based on the JNC 8 guidelines. Descriptive statistics, chi‐square tests, and independent t tests were used for preliminary analysis. Logistic regression was performed to identify independent predictors of hypertension, controlling for potential confounders.ResultsThe prevalence of hypertension was 62.1% (95% CI 58.6–65.6), with 47.5% in Stage I and 14.6% in Stage II. Males had significantly higher odds of hypertension than females (aOR 2.237, 95% CI 1.170–4.276). Behavioral risk factors such as alcohol consumption (aOR 4.732, 95% CI 1.386–16.160) and frequent processed food intake (aOR 2.640, 95% CI 1.024–7.096) were significantly associated with hypertension. Overweight (aOR 1.819) and obesity (aOR 1.575) were also found to be the major risk factors. Lower health literacy scores, particularly in healthcare engagement and self‐management, were associated with hypertension.ConclusionThe high prevalence of hypertension among bank employees highlights the need for workplace interventions promoting healthy lifestyles, routine screenings, and health literacy programs to improve hypertension awareness and management.

IntroductionNon-communicable diseases (NCDs) accounted for 74% of global deaths in 2024, with over 41 million people dying. The WHO has identified reducing behavioral and metabolic risk factors as a priority intervention. In modern healthcare, patient-centered care plays a key role by addressing individual needs, lifestyles, and motivations, thereby enhancing the effectiveness of prevention and behavior change. Food-based dietary guidelines (FBDG), such as Hungary’s OKOSTÁNYÉR®, are vital in prevention and medical nutrition therapy. However, the effectiveness of such dietary interventions largely depends on individuals’ health literacy.ObjectivesThis study aimed to explore the relationship between health literacy, dieting habits, dietary counseling, and awareness of the local FBDG recommendations.MethodsThis cross-sectional study was conducted in February 2023 on a representative sample (N = 500) of the adult Hungarian population, using the CAWI method. Data were collected with the validated HLS-EU 47-item questionnaire and additional custom items on health status, dieting, and awareness of the local FBDG. Health literacy indexes were calculated using validated thresholds. Descriptive statistics, chi-square tests, ANOVA, and multivariate regression analyses were applied (p < 0.05).ResultsA total of 77.4% of respondents had low (insufficient or problematic) health literacy. Higher education levels and younger age were significantly associated with better health literacy. Chronic diseases were more prevalent in low health literacy groups. About 32.4% of respondents followed a medically indicated diet, and 36.8% had received dietary counseling. Awareness of the local FBDG was relatively low (20.8%), particularly among men and those with lower education.ConclusionPatient-centered care necessitates a high level of health literacy, enabling patients to actively participate in their therapy. Findings of the study highlight that low health literacy in the Hungarian population poses a major challenge to the success of dietary interventions. Targeted health communication strategies and tailored dietetic support are essential to improve the effectiveness of personalized nutrition care, particularly among vulnerable groups with limited health literacy.

Cervical cancer is a serious public health issue worldwide, with screening playing a critical role in the prevention and early diagnosis of the disease. Despite its proven effectiveness, women's participation rates in screening remain insufficient. This systematic review aims to investigate the degree of compliance among women with cervical cancer screening and the factors associated with these attitudes. It also aims to examine the association between life satisfaction and general attitudes towards life with women's compliance with this screening. The PRISMA 2020 methodology was followed. The PICO framework was used to identify relevant studies in the PubMed and Scopus databases. The search was performed in November 2024. Five studies with quantitative design met the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale adapted for cross-sectional studies. Data were synthesized narratively presented in summary tables. Life satisfaction emerged as a positive predictor of participation in cervical cancer screening. In addition, factors such as high educational level, active employment status, and religiosity were associated with positive attitudes towards screening. Conversely, smoking habits, low health literacy, and fatalism beliefs about cancer were associated with reduced participation in screening. The small number of included studies (n=5), sample and variable heterogeneity, and the inability to do a meta-analysis, however, constituted important limitations of the review. In addition, restricting the search to English-language published studies may have excluded relevant evidence. Life satisfaction is an important predictor of preventive health behaviors. Interventions that aim to enhance life satisfaction and psychological well-being in general may improve compliance with cervical cancer screening and, by extension, prevent the disease.

Assessing pain science education; the measurement properties of assessment instruments of conceptual change: A narrative and rapid review.

Data from 211 hypertensive older adults in a community-based hypertension management project were analyzed. A hypothesized path model was tested to examine direct and indirect relationships among the variables. Of the participants, 12.4% reported food insecurity, and 13.8% had depressive symptoms. Food insecurity demonstrated a strong direct effect on depression and significant indirect effects through health literacy and perceived health status, indicating a double mediating effect. Food-insecure older adults are more vulnerable to depression, with low health literacy and poor perceived health contributing to this risk. Health literacy acted as a buffer. Transcultural nursing interventions should enhance intrapersonal reserve capacities like health literacy and adapt to cultural and behavioral contexts to boost engagement, reduce stigma, and improve well-being.

ObjectivesSouth Asian populations in the UK experience increased health risks related to long-term conditions, exacerbated by underdiagnosis, cultural differences in help-seeking behaviours, language barriers, low health literacy and a lack of culturally sensitive services. We know that group interventions that include education and rehabilitation, such as cardiac and pulmonary rehabilitation, are highly effective, but people from diverse communities often face barriers to access and engage with them. This review aims to synthesise evidence on the barriers and facilitators to education and rehabilitation interventions experienced by South Asian people living with long-term conditions.DesignA systematic review of qualitative studies using meta-ethnography as the analytical approach to synthesis was conducted, following Noblit and Hare’s approach, eMERGe Reporting Guidance for Meta-Ethnography, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were performed across MEDLINE, PsycINFO, CINAHL, CENTRAL, EMBASE and Applied Social Sciences Index and s from database inception through March 2024 (updated April 2025).Data sourcesMEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost platform), CENTRAL (Cochrane Library), EMBASE (Ovid), Applied Social Sciences Index and s (ProQuest platform) were searched from inception to March 2024 (updated April 2025).Eligibility criteriaWe included qualitative research exploring the attitudes, views and experiences of South Asian adults (outside of South Asia) with diabetes, cardiovascular disease or chronic obstructive pulmonary disease (COPD) regarding group treatments for these conditions.Data extraction and synthesisTwo independent reviewers searched, screened and coded studies, while remaining authors peer-reviewed. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data extraction and synthesis followed eMERGe and PRISMA reporting guidance, with findings synthesised qualitatively.ResultsOf 8348 identified citations, 17 studies met inclusion criteria, providing data from South Asian people living with cardiovascular disease and diabetes mellitus. No studies including people with COPD met the inclusion criteria. Synthesis revealed four overarching themes, each incorporating both barriers and facilitators: faith, culture, communication, and safe space and professional relationship.ConclusionsFindings indicate that current group education and rehabilitation interventions are not fully inclusive of South Asian needs, often lacking cultural sensitivity, which impedes engagement. Special attention is required for South Asian women, who can face additional cultural and societal barriers. Addressing these challenges through culturally sensitive care, such as flexible intervention scheduling around religious practices, gender-sensitive adaptations and culturally tailored communication strategies, has potential to improve engagement in education and rehabilitation interventions, and therefore long-term condition outcomes.PROSPERO registration numberCRD42024493644.