The nominal group technique has been shown to be an effective method for reaching consensus among a group of healthcare experts when selecting clinical indicators for application in primary care research, especially where there are competing prioritisation criteria being considered. In the context of manifest barriers to traditional face-to-face meetings, and with the advent of evolving and improved digital tools, alternative approaches are being more commonly utilised to overcome these challenges. In this study, we sought to prioritise a set of existing, validated clinical indicators proposed for inclusion in ACTMed (ACTivating primary care for MEDicine safety), a clinical trial aiming to reduce medicine-related harm in primary care. A modified nominal group technique, using a fully online approach, was employed to facilitate consensus among a group of pharmacists and general practitioners. Quantitative data were obtained using an online survey platform both prior to the structured virtual forum and again following group discussion. Qualitative material was gathered from written feedback included in the pre-forum questionnaire and through verbal contributions made during the online forum. The highest priority indicators determined by the two-staged survey process were for myocardial ischaemia, cerebrovascular ischaemia related to atrial fibrillation, heart failure, asthma/chronic obstructive pulmonary disease and falls with fracture. Qualitative reasoning behind the participants' evaluation of the clinical indicators included value for money, impact of the intervention, consequences of clinical outcomes and ability to implement the intervention in practice. In this study, the interactive component of the nominal group technique process had little impact on the final prioritisation of the clinical indicators. Potential explanations for this might include previously established strong participant views and preferences or relative group homogeneity based on similar learning, research or clinical experience.

Vaccine hesitancy among midlife and older adults in the United States.

ABSTRACT The balance of primary sport practice and multisport participation during childhood for later success in sport has been debated in models of athlete development. Various mechanisms have been proposed regarding why activity diversity would aid development, including motivation. Here we test this mechanism by assessing childhood sport and other types of activity diversity (within-sport and non-sport activity) among female competitive adolescent athletes in soccer (N = 211; 12–19 yr) and measures of motivation. Athletes in four skill groups (grassroots/Div. 2 to Nationally competitive) completed an online survey about their practice history in soccer (number of teams, positions and play hours), other sports and non-sport activities, and motivation and commitment. Not surprisingly, higher skill groups participated in more childhood soccer practice than lower skill groups, but they showed less sport diversity and there were no differences in non-sport activity participation. The higher skill groups reported more soccer play and more team diversity than lower groups, but showed greater position specialization in childhood. Total (and relative) hours in soccer practice and play (compared to non-soccer) were positively correlated with soccer motivation. These data are consistent with pathways of skill development in soccer based on early majority engagement in the primary sport; without exclusive engagement and high amounts of play. Sampling between sport or other activities was not related to skill or motivation, so there was no evidence of between-activity transfer related to enhanced motivation for soccer.

BackgroundBoth internet gaming disorder (IGD) and internet addiction (IA) have been associated with diverse psychopathological symptoms. However, how the 2 conditions relate to each other and which is more strongly associated with psychopathology remain unclear.ObjectiveThis study aimed to examine the association between IGD and IA and compare the strength of their associations with various types of psychopathological symptoms.MethodsThis cross-sectional study surveyed 3 independent samples of Chinese adolescents: the first sample (S1) comprised 8194 first-year undergraduates at a comprehensive university in Chengdu, the second sample (S2) comprised 1720 students from a high school in Hangzhou, and the third sample (S3) comprised 551 inpatients aged 13 to 19 years recruited from 2 tertiary psychiatric hospitals in Hangzhou and Chengdu. IGD was defined as a score of 22 or more on the Internet Gaming Disorder Scale–Short Form (IGDS9-SF), whereas IA was defined as a score of 50 or more on Young’s 20-item Internet Addiction Test (IAT-20). Symptoms of depression, anxiety, psychoticism, paranoid ideation, and attention-deficit or hyperactivity were assessed using internationally validated scales including 9-item the Patient Health Questionnaire, 7-item Generalized Anxiety Disorder, psychoticism and paranoid ideation subscales of the Symptom Checklist 90 (absent for S2), and Adult ADHD Self-Report Scale (absent for S1), through online surveys in S1 (October 2020) and S3 (January 2022 to February 2025) and via an offline survey in S2 (March 2024).ResultsThe prevalence estimates (95% CI) of IGD were 4.8% (4.3%‐5.2%) in S1, 15.8% (14.0%‐17.5%) in S2, and 32.3% (28.4%‐36.2%) in S3, whereas prevalence estimates (95% CI) of IA were consistently higher across samples, ranging from 7.3% (6.8%‐7.9%) in S1 and 18.8% (17.0%‐20.6%) in S2 to 45.9% (41.8%‐50.1%) in S3. The IGDS9-SF and the IAT-20 were moderately correlated (Pearson r=0.51‐0.57; all P<.001) and were associated with the severity of most psychopathological symptom domains, with consistently stronger associations observed for IAT-20 scores. In multivariate models including all psychopathological symptoms as independent variables, the coefficients of determination (R², 95% CIs) were consistently higher for the IAT-20 than for the IGDS9-SF in S1 (0.33, 0.30‐0.35 vs 0.13, 0.11‐0.16) and S2 (0.44, 0.39‐0.49 vs 0.23, 0.18‐0.27), with a similar but nonsignificant pattern observed in S3 (0.13, 0.06‐0.26 vs 0.06, 0.03‐0.16). Post hoc analyses indicated that psychopathological symptoms were generally more severe in individuals with IA, either alone or comorbid with IGD, than in those with IGD only.ConclusionsThis study provides additional evidence that IGD and IA are distinct yet interrelated constructs, and further demonstrates that IA consistently exhibits stronger associations with the severity of psychopathological symptoms than IGD. These findings underscore the importance of recognizing and addressing compulsive and problematic online behaviors that extend beyond gaming, highlighting the need to refine diagnostic frameworks and prioritize targeted clinical interventions.

Physician-based prehospital teams provide advanced critical care services in the UK (eg, prehospital anaesthesia). The last review of such teams in 2009, which included England, Wales and Northern Ireland, reported only one physician-based prehospital team available 24/7. Helicopter Emergency Medical Services (HEMS) across the UK offer paid physician-based teams, while other organisations may provide physician-based teams on a voluntary ad hoc basis. The primary aim of this study was to determine if access to a physician-based HEMS team has changed in the past 12 years. An online survey was distributed to all UK HEMS organisations in January 2024. The primary outcome measure was the number of physician-based teams operated by HEMS in 2024 and the operational hours of such teams. Secondary outcomes included interventions offered by HEMS teams and any additional medical teams offered (eg, paramedic only). All 21 HEMS responded. The number of potentially available physician-based HEMS teams has increased from 11 in England, Wales and Northern Ireland in 2009 to 28 in 2024, with two services in Scotland (total=30). HEMS providing consistent 24/7 physician-based prehospital teams increased from one (5.9%) in 2009 to 11 (52.4%) in 2024. The East of England has the highest 24/7 availability, with Northern Ireland, South West England and Northern England the least. Within physician-based teams, variation remains in advanced interventions available-for example, 19 services (90.4%) offer blood transfusion while only one (4.7%) offers resuscitative balloon occlusion of the aorta. Only one service is completely government funded; the others are funded by charity alone or a combination of charity and government sources. Both geographical and temporal variations in access to a physician-based HEMS remain across the UK, although there has been improvement since 2009. However, within this provision, variation exists in terms of interventions provided such as the provision of blood products.

Abstract Background Proper initial care for sexual assault victims within the healthcare system is critical, as mishandling may cause lasting trauma. Professionals must be trained through evidence-based simulations designed with instructional design principles. These include authenticity, supportive information, and just-in-time procedural guidance. Visual aids with appropriate language, actions, and questions can enhance this training. Objective This study aimed to assess the needs for developing an authentic visual aid to support healthcare professionals during simulation training on the initial approach to sexual assault victims. Methods A descriptive observational study was conducted using an online survey. Healthcare professionals evaluated the relevance of proposed items for the visual aid using a five-point Likert scale (1 = least, 5 = most relevant). Items were based on a literature review and reviewed by experts. Data was analyzed by rating frequency and further refined through a Delphi consensus round. Ethics approval was granted by the Faculdade Pernambucana de Saúde (CAAE: 75552723.8.0000.5569). Results A total of 186 professionals participated. The most highly rated items were: “show respect” (98.4%), “demonstrate empathy” (96.2%), “listen without interrupting” (83.9%), and “not blame the victim” (78.5%). These insights informed the development of the visual aid. Conclusion Evidence-based simulation training for healthcare professionals should incorporate instructional design elements, including authentic visual aids for just-in-time consultation, to enhance the initial response to sexual assault victims. Take-home message Authentic visual aids should be part of simulation training to better prepare healthcare professionals in the sensitive and critical initial care of sexual assault victims. Financing No conflict.

As part of a large mixed-methods study, we aim to develop culturally relevant additional dimensions (bolt-ons) for the EQ-5D-5L in China. In the qualitative phase, we developed seven candidate bolt-ons. In this first quantitative phase, we aimed to test the psychometric properties of these bolt-ons in the Chinese adult general population. An online survey was conducted among a representative sample of the Chinese general population (n = 1,037) to collect data on the EQ-5D-5L + bolt-ons, SF-6Dv2, EQ-HWB-9, general health status, and socio-demographics. Psychometric analysis was performed to assess the EQ-5D-5L + bolt-ons, including ceiling, informativity, convergent and divergent validity, known-group validity and explanatory power. Adding bolt-ons reduced the ceiling of the EQ-5D-5L by 2.3%-points (adaptation to society) to 7.6%-points (tiredness/lack of strength). Tiredness/lack of strength had the highest relative informativity (Shannon's evenness index = 0.67). Appetite and social relationships showed the best divergent validity from the five core dimensions. Tiredness/lack of strength demonstrated strong or moderate correlations with SF-6Dv2 vitality (r = 0.648) and EQ-HWB-9 exhaustion (r = 0.541) dimensions. Adding tiredness/lack of strength, climate adaptation and emotional control improved the explanatory power for the EQ VAS score. Tiredness/lack of strength enhanced the known-groups validity for differentiating between respondents based on the presence of chronic diseases and in group comparisons by SF-6Dv2 level sum scores. The tiredness/lack of strength bolt-ons performed best, but the sleep problems and appetite bolt-ons also improved several psychometric properties of the EQ-5D-5L in the Chinese general population. Combined with patient evidence, these findings may inform evidence-based bolt-on selection in the Chinese context.

Vasovagal reactions (VVRs) are the common donor adverse reaction, especially in young and first-time donors, affecting donor return. Despite evidence-based physiological and psychological mitigation strategies (MSs), their awareness and implementation remain variable. This study aimed to assess the awareness and practice of VVR MSs across licensed blood centres in India. A cross-sectional online survey was conducted between January and March 2025. A pre-validated questionnaire was distributed via a Google Form link. Data included demographic details of respondents, centre type, annual collection and voluntary donors. It was also focused on awareness, types and usage of VVR MSs. Data were analysed using descriptive statistics, and associations were tested using χ2 and logistic regression. This survey was reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines. Of 4153 blood centres, 439 were included in the final analysis, having fulfilled the inclusion criteria. Among them, 370/439 (84.3%) were aware of VVR MSs, while only 298/439 (67.9%) implemented them. Water/fluid ingestion was the most common physiological strategy (254/268, 94.8%), followed by applied muscle tension (110/268, 41.1%). Among psychological strategies, primarily audiovisual distraction combined with psychosocial support was reported by 143/210 (68.1%) centres. Of the 298 centres, 213 (71.5%) offered special attention to high-risk donors, 205 (68.8%) focused on delayed VVR prevention and 132 (44.3%) had dedicated counsellors. Despite good awareness, implementation of VVR MSs in Indian blood centres remains inconsistent. Nationwide policy, awareness programmes and structured training could promote uniform, evidence-based donor care and improve donor safety and retention.

IntroductionUrolithiasis and renal colic-like pain symptoms are prevalent conditions influenced by many factors, including diet. Regional assessments, particularly in culturally distinct areas, are essential for understanding specific risk patterns and for developing targeted public health strategies and educational programs. Therefore, the aim of this study was to identify associations between urolithiasis, renal colic-like pain symptoms, and diet, including body weight, in a representative sample of adult Poles.MethodsA population-representative online survey of 10,029 adults was conducted using census-based quota sampling to ensure balanced representation by age, sex, and residence across all 16 Polish voivodships, including urban and rural areas.ResultsNormal-weight individuals had the lowest prevalence of urolithiasis and renal colic-like pain symptoms; overweight, obese, and underweight persons had higher prevalences (p < 0.001). Eighteen food items were linked to urolithiasis, with beef, legumes, soy, soda, coffee, and fast food found as independent predictors of urolithiasis. Nineteen foods were associated with renal colic-like pain symptoms, with processed meat, soy, legumes, fruit juices, soda, instant meals, and fast food identified as independent predictors of symptoms. Fast food showed the strongest effects, with daily consumption nearly tripling the risk of urolithiasis (OR=2.847; p = 0.001) and increasing renal colic-like pain symptoms by 64.5% (OR=1.645; p = 0.006) compared with no consumption of fast food.ConclusionsThis study provides the first comprehensive, population-based analysis of urolithiasis, renal colic-like pain symptoms, and dietary patterns in Central and Eastern Europe. Our findings demonstrate that both conditions are influenced by body weight and a range of dietary factors.

In the context of donating surplus frozen eggs (SFE) to research, what level of information disclosure, and associated consent model, do the public believe most effectively allows donors to make an informed decision, exercise autonomy, and be treated morally? The public supports the information disclosure requirements of both a specific and broad consent model in this context, with the latter considered to better enhance autonomy and facilitate the moral treatment of SFE donors. Despite research indicating that many individuals' first preference is to donate their SFEs to research, donation rates remain low. One possible reason for this is the way consent processes for the donation of SFEs to research are currently regulated, specifically that their high information requirements limit opportunities to donate. There is a notable lack of research on how consent processes should operate, and more specifically, how much information a person should be provided before providing consent, in the context of donating SFEs to research. An online experimental survey of 225 participants was conducted. The survey assessed the impact of two variables-Information Disclosure and Preference Fulfilment-on participants' views towards whether a consent process allowed for informed, autonomous consent and the moral treatment of donors. A nationally representative sample of the UK public was recruited using the online platform Prolific. The survey consisted of a vignette-based experimental design, one free-text question, and demographic data collection. Quantitative data were summarized using descriptive statistics and the relationship between variables was tested using ANOVAs and t-tests, where appropriate. Inductive content analysis through manual coding was performed on the free-text question. Participants considered both specific and broad information disclosure as sufficient for informed consent (mean Consent Judgements M = 6.49/7 and M = 5.79/7, respectively). The ability to fulfil disposition preferences was critical to the public's assessment of whether a consent process enabled donors to act autonomously and be treated morally. Participants agreed that a potential donor was able to make an autonomous decision if their preference to donate their SFEs to research was fulfilled (mean Autonomy Judgement M = 5.46/7, mean Moral Judgement M = 5.63/7), but not when it was not (mean Autonomy Judgement M = 3.96/7, mean Moral Judgement: M = 4.76/7). Ecological validity of online surveys is limited, and data may be subject to response biases. Additionally, the sample size was relatively small. Finally, since the sample population was based in the UK, the generalizability of the survey findings to other countries may be limited. Our findings underscore the need to review and possibly update consent processes for the donation of SFEs to research. We encourage policy discussion in light of our findings, specifically the consideration of a shift towards a broad consent model. Doing so may allow more donors to fulfil their disposition preference, facilitate the movement of SFEs out of storage, and respond to the shortage of eggs currently available for research. This research was supported by The British Academy (grant number KF8\230096). The survey component of this study was funded by the Uehiro Oxford Institute. M.J. has received research funding from Monash IVF and Ferring Pharmaceuticals. She reports honorarium and travel support from Gideon Richter. N/A.

Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.

Outdoor systems offer benefits to pig welfare but they also pose challenges and are less well researched than indoor. This study characterized, for the first time, current husbandry and management practices of outdoor pig production on the island of Ireland, in order to understand associated drivers, challenges and changes needed for sustainable development. An online survey conducted from December 2022 to April 2023 (n = 90 respondents) revealed that animal welfare, food quality, and traceability concerns were the primary reasons for raising pigs outdoors, regardless of whether the pigs were raised for sale (meat or live pigs) or other (e.g., personal meat consumption, pet, land management) purposes. Most of the respondents expressed concerns about animal welfare in conventional systems, and emphasized the importance of the “Five Freedoms”. A significant cohort of respondents (56%) adopted alternative health management strategies based on season and soil management (paddock rotation, use of straw bedding on muddy areas), and by avoiding the use of antibiotics and other chemicals. Farms were small (median: 20.5 pigs, 1.02 ha), half were engaged with pig societies, and used traditional/rare breeds, which are adapted to outdoor conditions and that farmers can sell as superior quality pigmeat. The most frequently reported challenges were feed costs, inclement weather, fencing and soil maintenance. The most mentioned “needs” of the industry were financial support and consumer education. While participants chose to raise pigs outdoors to improve animal welfare, meat quality and traceability; overcoming challenges related to finance, infrastructure, and education is vital to their future sustainability.

This study aimed to assess caregivers' awareness, use and acceptability of common infant behavioural sleep strategies/interventions and explore differences in awareness and acceptability based on country of residence. A cross-sectional online survey was conducted with caregivers (n = 914) of infants aged between 6 and 18 months residing in Australia, Canada, Turkey, the United Kingdom and the United States. Caregivers were provided descriptions of common infant behavioural sleep interventions and reported their awareness of, use, and level of acceptability (using a validated measure: the acceptability of intervention measure [AIM]) for each intervention. Awareness of interventions ranged from 50% to 70% of caregivers, with significant variability by country. Overall, 70% of caregivers had used at least one intervention, with usage rates varying from 25% to 80% depending on the intervention and 30% to 55% of caregivers ceasing use prematurely. Unmodified extinction (AIM = 2.12; 5 = high acceptability), parental presence (AIM = 2.75) and modified extinction (AIM = 2.85) had lower levels of acceptability compared to responsive settling with gradual reduction (AIM = 3.48) and response-based with settling in arms (AIM = 3.51) and bed (AIM = 3.23). Significant differences in acceptability (AIM) scores by country were evident for most of the interventions. As none of the interventions were universally acceptable, a model of care that provides caregivers with information about a range of interventions and the opportunity to choose based on their preferences, parenting styles and cultural beliefs may increase the likelihood of successful intervention adoption.

While artificial intelligence (AI) holds significant promise for health care, excessive trust in these tools may unintentionally delay patients from seeking professional care, particularly among patients with chronic illnesses. However, the behavioral dynamics underlying this phenomenon remain poorly understood. This study aims to quantify the influence of AI trust on health care delays through integrated survey-based mediation analysis and real-world research, and to simulate intervention efficacy using agent-based modeling (ABM). A cross-sectional online survey was conducted in China from December 2024 to May 2025. Participants were recruited via convenience sampling on social media (WeChat and QQ) and hospital portals. The survey included a 21-item questionnaire measuring AI trust (5-point Likert scale), AI usage frequency (6-point scale), chronic disease status (physician-diagnosed, binary), and self-reported health care delay (binary). Responses with completion time <90 seconds, logical inconsistencies, missing values, or duplicates were excluded. Analyses included descriptive statistics, multivariable logistic regression (α=.05), mediation analysis with nonparametric bootstrapping (500 iterations), and moderation testing. Subsequently, an ABM simulated 2460 agents within a small-world network over 14 days to model behavioral feedback and test 3 interventions: broadcast messaging, behavioral reward, and network rewiring. The final sample included 2460 adults (mean age 34.46, SD 11.62 years; n=1345, 54.7% female). Higher AI trust was associated with increased odds of delays (odds ratio [OR] 1.09, 95% CI 1.00-1.18; P=.04), with usage frequency partially mediating this relationship (indirect OR 1.24, 95% CI 1.20-1.29; P<.001). Chronic disease status amplified the delay odds (OR 1.42, 95% CI 1.09-1.86; P=.01). The ABM demonstrated a bidirectional trust erosion loop, with population delay rates declining from 10.6% to 9.5% as mean AI trust decreased from 1.91 to 1.52. Interventions simulation found broadcast messaging most effective in reducing delay odds (OR 0.94, 95% CI 0.94-0.95; P<.001), whereas network rewiring increased odds (OR 1.04, 95% CI 1.04-1.05; P<.001), suggesting a "trust polarization" effect. This study reveals a nuanced relationship between AI trust and delayed health care-seeking. While trust in AI enhances engagement, it can also lead to delayed care, particularly among patients with chronic conditions or frequent AI users. Integrating survey data with ABM highlights how AI trust and delay behaviors can strengthen one another over time. Our findings indicate that AI health tools should prioritize calibrated decision support rather than full automation to balance autonomy, odds, and decision quality in digital health. Unlike previous studies that focus solely on static associations, this research emphasizes the dynamic interactions between AI trust and delay behaviors.

ABSTRACT The rapid growth of peer-to-peer (P2P) accommodation platforms such as Airbnb has transformed the global lodging industry, emphasizing personalized experiences and cultural diversity. However, limited research has examined how the physical environment and cultural differences jointly influence consumer behavior in this context.This study aims to examine the effects of servicescapes on consumer satisfaction and loyalty in P2P accommodations and to explore the moderating role of Hofstede’s cultural dimensions. This study employs the stimulus-organism-response (S-O-R) model in conjunction with Hofstede’s cultural dimension theory to investigate the impact of culture on the association between servicescape, satisfaction, and loyalty in the context of P2P (Peer-to-peer) accommodation. Data were collected through an online survey of 945 participants from seven countries/regions. The findings substantiate the efficacy of the S-O-R model in elucidating consumer behavior within the realm of P2P accommodation. Servicescapes significantly influence consumer satisfaction, bolstering loyalty. Moreover, this study reveals the moderating role of Hofstede’s cultural dimensions (power distance (PDI), individualism-collectivism (IDV), uncertainty avoidance (UAI), long/short-term orientation (LTO), and indulgence (IND) in the relationship between servicescape and satisfaction. The results enrich theoretical understanding of environmental psychology in cross-cultural contexts and offer practical insights for designing culturally adaptive P2P accommodation experiences.

ABSTRACT This paper forms part of the broader Global South study, Personal and Family Coping with COVID‐19 in the Global South, which examines psychosocial and behavioral responses to the COVID‐19 pandemic. In Sub‐Saharan Africa, the pandemic posed significant psychological, social, and economic challenges, with important implications for preparedness for future public health crises. This study investigates how adults in Botswana coped during the pandemic, focusing on psychosocial factors such as boredom, loneliness, anxiety, well‐being, and concerns related to health and finances. A total of 422 adults participated in an online survey assessing coping levels (coping well/coping somehow vs. not coping). Measures included the Short Boredom Proneness Scale, Relationship Quality Index, WHO‐5 Wellbeing Index, Generalized Anxiety Disorder scale, and the Three‐Item Loneliness Scale. Data were analyzed using descriptive statistics, chi‐square tests, and multivariable logistic regression. Overall, 76% of participants reported coping to some extent during the pandemic. Bivariate analyses showed that coping was significantly associated with anxiety, exposure to COVID‐19‐related media, financial and health concerns, boredom, loneliness, and overall wellbeing. In the multivariable model, higher anxiety was associated with a lower likelihood of coping (AOR = 0.513; p &lt; 0.01), while participants reporting financial concerns were more likely to cope (AOR = 2.188; p &lt; 0.05). These findings highlight the complex relationship between psychological distress and socio‐economic vulnerability during public health emergencies and underscore the need for integrated interventions to strengthen mental health support and financial resilience.

There is an emerging body of evidence linking political conservatism and conservative political climate in the United States to COVID-19 vaccine hesitancy and uptake. The goal of the present research was to examine how political climate moderates the relationship between self-reported political conservatism and COVID-19 vaccine hesitancy and uptake. We collected online survey data from 683 participants between March 8 and April 19, 2023. Controlling for age, education, income, and race, there was an interaction between political conservatism and conservative political climate for both vaccine and booster hesitancy (β = .07, p = .03; β = .12, p < .001, respectively), such that liberals were less likely to be hesitant regardless of political climate. However, conservatives living in liberal political climates were less vaccine hesitant than their conservative counterparts living in conservative regions. A similar interaction was for the likelihood of receiving a COVID-19 booster (OR =.84, p = .049). Liberals were more likely to receive a booster regardless of political climate, while conservatives’ likelihood was associated with their political climate. Observed patterns linking liberal political climates with vaccine uptake among conservative individuals have important implications for vaccination efforts among conservative individuals in the United States.

COVID-19 posed a significant threat to the mental health of the population in general and college students in particular, severely disrupting their daily routines due to protective measures and lockdown policies. The abrupt transition from in-person to online learning further introduced uncertainty regarding academic performance. To comprehensively assess the impacts of the pandemic on college students, this study collected longitudinal data from June 2020 to June 2021, involving 184 undergraduate students at Worcester Polytechnic Institute. The dataset includes demographic and socioeconomic status information of participants, measures of mental health outcomes, online student engagement, computer and Internet performance, daily activity diary, general indoor environment satisfaction, Fitbit data, sensor measured indoor environment quality, facial expression, and GPA. To our best knowledge, this dataset is also the first dataset that covers multimodal assessment of mental health outcomes, online learning, and potential influencing variables during COVID-19. Data was gathered through online surveys, video recordings, IoT indoor environmental sensors, and Fitbit wristbands.

Cancer survivors with multiple chronic conditions (MCC) are a growing population with complex health needs, yet little is known about their care experiences and healthcare team trust. This mixed methods study used a convenience sample of 441 adult cancer survivors recruited through online survey platforms. Participants completed surveys assessing care coordination, care access, healthcare team trust, and whether their care team included a social worker, navigator, or care coordinator during the 12months after diagnosis. Twelve survivors also participated in semi-structured interviews. Relationships between care coordination and care access with healthcare team trust were examined using multivariable logistic regression followed by qualitative analysis of interviews. Overall 20.4% reported low trust in their healthcare team, 51.5% reported at least one care coordination problem, and 27.2% reported at least one care access issue. The adjusted prevalence odds ratios for low healthcare team trust were 14.5 times higher for cancer survivors who reported problems with care coordination (95% CI, 6.73, 31.29) and 6.3 times higher for care access problems (95% CI, 3.66, 10.69) compared with survivors reporting no problems. Having a social worker, coordinator, or navigator did not moderate these associations (p-values > 0.05). Participants described medical paternalism, transparency, honesty, established relationships, intergenerational trust, empathy and respect, and credibility as key experiences and attributes associated with trust. Experiencing care problems was associated with reporting lower trust in one's healthcare team among cancer survivors with MCC, which represents potential modifiable points for intervention to improve trust, health outcomes, and quality of life.

Purpose This paper aims to address the lack of industry-specific service recovery frameworks for internet service providers (ISPs) in South Africa by identifying essential service recovery attributes and evaluating the impact thereof on customer satisfaction and customer behavior. Design/methodology/approach This study focuses on the theory of perceived justice and determines how mobile ISPs in South Africa can effectively manage service recovery activities. A reputable marketing research business was used to collect data by means of an online survey sent to respondents who had previously complained about service failures with mobile ISPs in South Africa. In total, 484 surveys were gathered, and the data was analyzed to confirm or reject the proposed hypotheses using confirmatory factor analysis and Structural equation modeling. Findings The findings confirmed all the relationships in the suggested service recovery model, indicating that service recovery attributes, including compensation, response speed in dealing with service failure, apology from the service provider, and providing an explanation, can improve customer satisfaction after service failure. Practical implications Practical implications include the establishment of guidelines that mobile ISPs can follow to create successful service recovery plans that align with customer fairness expectations after a service failure occurred. Originality/value This research proposes a framework for servicing recovery in South Africa’s mobile ISP industry, illuminating the critical factors of customer satisfaction and loyalty in the wake of service failures. Furthermore, it serves as a counterargument to the one-size-fits-all application of the justice theory within diverse contexts, as customers show less concern for fairness in principle and more concern for prompt and transparent resolution in developing markets characterized by frequent service disruptions and unreliable infrastructure.