Pilot Program Research Articles

Long-term care dependency and intergenerational living arrangements of elderly households: evidence from China

ABSTRACT Using panel data from the China Health and Retirement Longitudinal Study from 2011 to 2018, we examine the impact of long-term care (LTC) dependency on the intergenerational living arrangements of elderly households, including co-residence, adjacent residence, and long-distance residence. We find that elderly households with disabled members are more likely to co-reside with their adult children, while the likelihood of adjacent residence decreases. This trend intensifies with increasing disability severity. Only households with severe LTC dependency reduce the possibility of long-distance residence. The observed increase in co-residence is largely attributable to the relocation from adjacent residences to co-residence. The substitution effects of spousal assistance and LTC insurance pilot programmes reduce the need for co-residence with children. The gravitational effects of economic incentives and Confucian filial piety increase the possibility of co-residence with children. These findings suggest that policymakers could, on the one hand, expand the LTC subsidy range to include family caregivers, and on the other hand, promote co-residence through incentives and cultural advocacy to jointly strengthen formal and informal support networks in addressing LTC dependency.

Evaluation of the effectiveness and cost-effectiveness of the chronic disease co-care (CDCC) Pilot Scheme: a study protocol

BackgroundThe Chronic Disease Co-Care (CDCC) Pilot Scheme is a government-subsidized program that aims to provide targeted copayment for the screening and management of hypertension, diabetes mellitus and pre-diabetes in the private healthcare sector. Studies have found that concurrent screening and management with a multi-disciplinary intervention is cost-saving because of the reduction in the rates of premature mortality, complications and utilization of public health services. This study aims to evaluate the quality of care, acceptability, effectiveness and cost-effectiveness of the CDCC Pilot Scheme.MethodsQuality of care will be evaluated by the standards achieved by the program in each criterion in the domains of structure, process and outcomes of care. Site visits and two serial questionnaire surveys at 6 and 12 months will be conducted for the structure of care. Operational data, including the provision of diagnosis and treatment, as well as participants’ health status will be extracted to evaluate the process and outcomes of care. Participants’ acceptability will be evaluated on experience (accessibility, facility, continuity of care and communication), satisfaction (perceived usefulness, continuation and recommendation) and enablement in 548 CDCC participants at 3 and 12 months by telephone surveys. Evaluation of the effectiveness and cost-effectiveness is a 1-year comparative cohort study using longitudinal data on changes in disease control parameters between CDCC and non-CDCC participants at baseline and 12 months. Costing questionnaires on the set-up and operation costs of the Scheme among service providers, and direct medical costs incurred from public and private service utilization among participants within 12 months from enrolment will be assessed. The incremental costs incurred for an additional participant in the CDCC Pilot Scheme to achieve target disease control outcomes after 12 months will be reported as an indicator for cost-effectiveness.DiscussionThe quality of care and effectiveness of the CDCC Pilot Scheme in enhancing the health outcomes of the Scheme participants will be examined. Standards of good practice and recommendations for quality enhancement will be established to inform service planning in similar cross-sector screening and management programme.Trial registrationNCT06310148; 2024-03-22.

Research on the Impact of Carbon Emission Trading Policies on Urban Green Economic Efficiency—Based on Dual Macro and Micro Perspectives

In the context of global climate change, carbon emission trading (CET) has become a critical tool for driving urban green economic transformation. Since 2011, China has launched CET pilot programs, supporting the achievement of the “dual carbon” goals. Studying the relationship between CET and urban green economic efficiency is essential for advancing urban green economic transitions. However, the existing research is limited by its single-perspective approach, insufficient exploration of mechanisms, and weak heterogeneity analysis, which restricts a comprehensivethe comprehensiveness of our understanding of policy effects. To address these gaps, this study is the first to integrate macro-regional data with micro-enterprise behavior, evaluating the impact of CET on urban green economic efficiency from a dual macro–micro perspective, thereby filling the research void in macro–micro data integration. At the macro level, this study employs panel data from 281 Chinese cities spanning 2007 to 2020, using fixed-effects and difference-in-differences (DID) models to assess the impact of CET on urban green economic efficiency. At the micro level, a game-theoretic pricing decision model is constructed to reveal behavioral differences among enterprises in complete and incomplete information markets and their indirect effects on green economic efficiency. The findings indicate that CET significantly enhances urban green economic efficiency, with technological innovation, green finance, and industrial structural upgrading serving as mediating mechanisms. Heterogeneity analysis shows that the effects are more pronounced in eastern, non-resource-based, small-to-medium-sized, and non-old industrial cities. The game-theoretic model further demonstrates that enterprises in complete information markets more effectively indirectly enhance green economic efficiency through CET mechanisms. By combining macro and micro perspectives, this study provides a new theoretical framework and practical insights for understanding the policy effects of CET. However, limitations such as data confined to Chinese pilots and model simplifications remain. Future research should expand data dimensions, allowing researchers to more comprehensively evaluate policy outcomes.

Heart Health Hub virtual care program for newly diagnosed heart failure patients.

BackgroundThe Heart Health Hub (HHH) is a virtual model of care for patients with newly diagnosed heart failure. A program pilot commenced in April 2020 and aimed to achieve acceptable titration rates for heart failure medications while improving patient access to services. This study aimed to investigate whether the virtual HHH service could deliver feasible, safe and acceptable titration outcomes.MethodsA single-arm observational cohort study design was adopted. Eligible heart failure patients currently receiving care could consent to be enrolled in the pilot virtual HHH program based on pre-defined inclusion and exclusion criteria. Data on patient demographics, clinical characteristics and heart failure medication titration rates were obtained from routine health system databases and patient notes. Patient satisfaction data were collected using a Likert-scale questionnaire. Overall health service use and costs for each patient were obtained from health system databases for a period of 12 months following enrolment in the virtual HHH program.ResultsA total of 89 heart failure patients were included in the evaluation. Of these, 95% reached titration to either guideline-recommended target doses or maximum tolerated doses for both angiotensin-converting enzyme inhibitor/angiotensin receptor blockers/angiotensin and angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI) and beta-blockers combined. The mean number of days to achieve titration ranged from 20.2 days for mineralocorticoid receptor antagonist drugs, between 27.5 to 32.3 days for ACEI/ARB/ARNI drugs and 41.0 days for beta-blockers; 70 (79%) patients completed the satisfaction survey at least once, with more than 98% of survey questions receiving a positive response. The average monthly equipment and consumables cost per patient was $277 in year 2021/22.ConclusionThis study provides evidence that a virtual model of care for newly diagnosed heart failure patients was feasible, safe and acceptable, with high titration rates, relatively rapid times to titration, strong patient satisfaction outcomes and relatively low equipment costs.

Lifestyle Medicine and Universal Health Care Intersection: History and Impact of the Philippines Initiative.

The Philippines is facing a dual burden of managing both infectious and non-communicable diseases (NCDs). The Universal Health Care (UHC) Act mandates a transformative shift from curative focus to health promotion and disease prevention, where lifestyle medicine plays a crucial role. This paper outlines the initiatives taken by the Philippines to address the exponential burden of NCDs by integrating lifestyle medicine into the healthcare system. Specifically, we focus on: 1. Discussing the history and current state of evidence-based lifestyle interventions within the UHC framework. 2. How we have developed interprofessional competency-based lifestyle medicine education (CBME) programs for healthcare providers. 3. Our experience in establishing cross-sectoral collaboration and policy support for sustainable implementation of lifestyle interventions. The Philippine College of Lifestyle Medicine initiated the CBME framework integrated into hospitals, medical schools, and universities with pilot programs. Culturally relevant, community-engaged lifestyle medicine programs were initiated, resulting in the declaration of local ordinances. The realization of UHC priority goals can be enhanced by embedding lifestyle interventions within the healthcare system. Pilot programs demonstrate the scalability of lifestyle medicine interventions that require policy support, extensive cross-sectoral collaboration, community engagement, and recognition of lifestyle medicine as a reimbursable healthcare service.

Peer Mentorship for Survivors of Intimate Partner Violence: A Pilot Program Highlighting Challenges and Opportunities for Further Refinement.

The aim of this study is to describe the collaborative development and pilot implementation of a peer-support program for survivors of intimate partner violence (IPV). The program paired six IPV survivors who were actively in crisis with four survivors who identified as equipped to support other survivors. The program was piloted for 6 months and pre- and post-intervention in-depth interviews were conducted with mentors and mentees. In in-depth interviews, survivors and mentors discussed the value they saw in the peer-support model and described strong motivations for participation. However, program engagement was limited and drop-out was high among mentors (n = 3; 75%). Mentors cited difficulty establishing boundaries with mentees and engaging with mentees' experiences of IPV given their own histories. This study highlights the value of the peer-support mentorship model while also revealing significant challenges associated with the implementation of such a model in a community-based IPV crisis organization. Adaptations in structure, recruitment, training, and monitoring are necessary for future peer-support programs to effectively meet the needs of survivors.

Predicting White Matter Hyperintensity: Leveraging Portable Magnetic Resonance Imaging for Accessible Brain Health Screening.

Portable MRI (pMRI) has emerged as a cost-effective and accessible tool for the identification of white matter hyperintensities (WMH), an independent risk factor for stroke and dementia. Our objective was to confirm that pMRI can produce accurate WMH measurements and to develop and validate a risk model to predict WMH on pMRI for the purpose of identifying patients who may benefit from pMRI screening. The development (N=143) and validation (N=127) cohorts included patients without acute neurologic pathology who received a pMRI at a tertiary care hospital between May 2020 and July 2024. The development cohort included pMRIs collected as part of a prospective WMH screening pilot program in the emergency department. The validation cohort was a retrospective collection of pMRIs obtained for separate research purposes. Conventional MRIs (cMRIs) in the validation cohort obtained within 3 months of pMRIs were used for additional validation and device agreement. The primary outcome was WMH burden greater than 10 mL, assessed via an axial T2-FLAIR sequence acquired on a 0.064 T pMRI and quantified using a WMH segmentation software developed to process sequences of any resolution. We used backwards selection to screen candidate variables and report the area under the curve of the resulting model. The final model, which included age, systolic blood pressure >140, atrial fibrillation, and tobacco use, achieved an AUC of 0.83 (95% CI 0.75-0.90) in the development cohort (N=143, 62.4±12.6 years, 44% female, 36% non-white race) and 0.85 (95% CI 0.77-0.92) in the validation cohort (N=127, 65.2±16.8 years, 51% female, 34% non-white race), with similar results using WMH measurements derived from cMRI (N=120, p=0.98, AUC=0.86, 95% CI 0.77-0.93). Additionally, we confirmed agreement in WMH volumes between pMRI and cMRI (N=120, r=0.93, 95% CI 0.90-0.95, p<0.001). The WMH risk score demonstrated accurate performance and reproducibility across cohorts, supporting its potential as a screening tool for identifying patients at risk of significant WMH burden. Appropriately targeted pMRI screening in high-risk individuals could allow providers and patients to proactively manage vascular risk factors and improve neurological outcomes. pMRI = portable magnetic resonance imaging; cMRI = conventional magnetic resonance imaging; WMH = white matter hyperintensity; hypertension = HTN; diabetes = DM; atrial fibrillation = AFib; systolic blood pressure = SBP; hyperlipidemia = HLD; area under the curve = AUC; receiver operating characteristic = ROC.

Effects of behavioral economics on public policy

This paper examines how behavioral economics influences public policy implementation through a comprehensive review of open-access academic and public materials. It investigates the effectiveness of policies that consider non-rational factors in human behavior, including cognitive biases, emotions, social norms, and habits. It emphasizes the need for policymakers to incorporate behavioral economics principles through training, expert guidance, pilot programs, impact studies, incentives, specialized units, and continuous evaluation. The paper proposes strategies for understanding behavioral psychology, designing incentive systems, creating environments that facilitate sound decision-making, and promoting awareness about the irrational factors that influence human conduct.

Protocol for a randomised controlled feasibility trial of an integrated psychosexual intervention for sexual difficulties in people with Multiple Sclerosis: the PIMS trial

BackgroundMultiple Sclerosis (MS) is a long-term condition that significantly diminishes quality of life (QoL). Sexual difficulties (SDs) are common, but often overlooked symptom, affecting 50–80% of people with MS (PwMS). The emergence of SDs in MS results from the intricate interplay of disease processes, treatments, and psychosocial factors, contributing to a further decline in QoL and adverse effects on body image, relationships, and psychological well-being. Despite the limited treatment options, which mainly include medications and physiotherapy, there is promise in psychological interventions for addressing SDs in PwMS, although integrating them into routine care poses challenges. This protocol details the trial assessing the acceptability and feasibility of an eight-session, clinicians supported integrated Psychosexual Intervention for people with Multiple Sclerosis (PIMS).MethodsThis is a multicentre interventional two-arm randomized feasibility trial with a nested qualitative study to gather preliminary data about the intervention and the feasibility of conducting a full-scale trial. We aim to recruit 50 PwMS across three research sites in England’s National Health Service (NHS). Participants will be randomised to either the PIMS intervention (comprised of 8 sessions: 6 self-led and 2-facilitator led over the course of 12 weeks) or psychosexual education (one appointment with a facilitator to discuss treatment options). Feasibility will be assessed by collecting descriptive data on recruitment and retention rates and willingness to be randomised according to Consolidated Standards of Reporting Trials (CONSORT) feasibility and pilot trial guidelines. Patient reported outcomes (e.g., measures of sexual functioning and distress, psychological functioning, and quality of life) will be measured at baseline and follow up 14-weeks after randomisation. We will also use a nested qualitative study will use inductive thematic analysis to identify barriers to engagement with and delivery of the intervention, and to make appropriate modifications to PIMS.DiscussionThe PIMS intervention will be the first integrated psychosexual intervention developed for people with Multiple Sclerosis in the UK. Assessing the feasibility of PIMS is an important first step to establishing future implementation and efficacy via a definitive randomised controlled trial.Trial registrationThis trial is registered at ISRCTN: 12202900.Registration date: 28th February 2023; Retrospectively registered.IRAS identification: 305830.NIHR award reference: NIHR202006.Trial sponsorship: This trial is co-sponsored by South London and Maudsley NHS Foundation Trust and King’s College London. Contact: slam-ioppn.research@kcl.ac.uk.Protocol version: 2.0, 10th February, 2025

The Rare Therapies Launchpad: a pilot program for individualized medicines in the UK

The Rare Therapies Launchpad: a pilot program for individualized medicines in the UK

Development of tele-lifestyle-based multidisciplinary survivorship program for gynecologic oncology practice.

We assessed the recruitment and retention of a short 8-week telemedicine-based group peri-habilitation program for gynecologic cancer survivors. Multidisciplinary team included: a gynecologic oncologist with additional board certification by the American College of Lifestyle Medicine, cancer-specific nutritionist, culinary medicine chef, physical therapist, exercise physiologists, mental health counselor, body image aesthetician, pelvic floor therapist, and sex therapist. Pre- and post-self-administered questionnaires assessed conformity to lifestyle medicine pillars and a general medical symptom questionnaire (MSQ). Recruitment was suboptimal (11.7%). Neither provider referrals nor flyers sufficiently directed patients to the program, but those that completed the program expressed meaningful impact on lifestyle behavioral change and improved quality-of-life across multiple parameters including MSQ (40.0 vs 20.75) and 85% participants reported compliance with recommendations. This pilot program suggests that a multidisciplinary tele-lifestyle-based survivorship program beyond just diet and exercise to improve quality-of-life in gynecologic cancer survivors, though novel and well received, needs physician buy-in and enhanced marketing strategies.

The Effect of Kennel Viewing on the Adoption of Slow-Track Dogs

The Orange County (California) animal shelter allowed adopters to peruse dog kennels until early 2020 but suspended visitor access to dog kennels during the COVID-19 pandemic. Except for a late 2023 pilot program, the restrictions remained in place through 2023. Then, in January 2024, partial daily viewing sessions were instituted. We study the effect of this change on adoptions of dogs with length of stay (LOS) ≥ 9, who account for 42% of adoptions but 72% of inventory excluding dogs returned to owner. Adoption counts in 2024 are 40% higher than expected in viewing sessions using 2023 as a reference, or 57% higher using 2022 as a reference, and these results are statistically significant (P = 0.009, P = 0.0009, respectively). Adoption rates are computed as a percent of inventory (equivalently, adoption probabilities per animal per session). In the period 2019–2024 but excluding 2020, adoption rates were 1.04% – 1.18% per session (with an average of 1.10%) in viewing sessions versus. 0.68% – 0.80% (with an average of 0.74%) in non-viewing sessions. The evidence suggests that kennel viewing enhances opportunities for increasing adoptions of dogs with LOS ≥ 9.

Pilot Programme for Keratoconus Screening and Management in Adolescents with Down Syndrome

Background/Objectives: To screen a group of adolescents with Down Syndrome (Trisomy 21) for keratoconus and assess the feasibility of setting up a national screening service. Methods: Twenty-seven patients with Down Syndrome between 9 and 18 years of age attended our pilot keratoconus screening clinic. We recorded demographics, medical history, risk factors, best-corrected distance visual acuity, clinical examination results and corneal tomography results. The presence of keratoconus was confirmed by one of three corneal specialists based on clinical and tomographic findings. Tomographic analysis included zonal Kmax, thinnest point, inferior–superior asymmetry (IS Values), Belin/Ambrosio deviation value (BAD-D) and anterior and posterior elevation maps. Results: Early keratoconus was detected on tomography in 8 out of 54 eyes (15%) at the first review. These eyes were listed for crosslinking. The mean age of diagnosis was 14.6. Corneas in the Down Syndrome screening group were thinner and steeper (mean central corneal thickness (CCT) 479 µm vs. 536 µm and mean Kmax 49.2D vs. 45.8D, respectively) than healthy, age-matched controls from the literature. Conclusions: Fifteen percent of eyes (5 out of 27 patients) screened had tomographic evidence of keratoconus requiring treatment at their first review. We found an increased incidence of keratoconus in European individuals with Down Syndrome. Screening this vulnerable, high-risk population with corneal tomography can diagnose early keratoconus and enable corneal crosslinking to safely and effectively stabilise the disease. We advocate tomographic keratoconus screening for individuals with Down Syndrome in their mid-teens.

Potential and limitations of school vaccination programs to increase HPV vaccination rates in Germany

Even more than 15years after the first vaccination recommendation by the Standing Committee on Vaccination (STIKO) against human papillomaviruses (HPV), vaccination coverage in Germany remains low. As apossible measure to increase HPV vaccination coverage in Germany, the widespread introduction of HPV school vaccination programs, as they exist in other European countries, is often called for. However, any implementation of awidespread health intervention should be preceded by an evidence assessment that also takes national circumstances into account. This article provides an overview of the evidence available to date on the effect of school vaccination programs in Germany and discusses the results. Corresponding evidence is so far limited and comes from three local (pilot) programs. These show that about one-third of those not vaccinated took up the school vaccination offer, while two-thirds did not. No program in Germany has yet collected data on the reasons for not accepting the vaccination offer or whether any hesitancy that may exist relates to the place of vaccination (school) or the vaccination itself. Furthermore, there is alack of cost-benefit analyses of school vaccination programs. This would be important for their evaluation due to the structures that would have to be newly established in Germany for this purpose. Based on the evidence available to date, it seems rather unlikely that the introduction of acomprehensive school vaccination program could significantly increase HPV vaccination rates in Germany. However, in addition to other measures, school vaccination programs could possibly be part of astructured vaccination system for specific target groups or in certain defined regions. In contrast to the existing vaccination system in Germany, such astructured vaccination system could ensure that all members of the target group are actively offered HPV vaccination.

Solving Problems of Practice: Rethinking the Doctoral Dissertation Using Deweyan Reflection

This article describes the implementation of a doctoral dissertation pilot program that integrates Deweyan reflective practice to ground social science dissertations in problems of practice. The dissertation approach was named the Impact Dissertation. Three main themes that emerged during the Impact Dissertation pilot are discussed, including creating and revising dissertation artifacts, changing stakeholder mindset, and ensuring rigor. The authors also provide some additional details that university administrators could use to replicate this pilot approach for their scholar-practitioner doctoral programs. Recommendations for future research include conceptually comparing our pilot approach to other existing approaches, developing reflective practice as a method, and exploring additional strategies for facilitating stakeholder mindset shifts, since this was one of the more challenging aspects of the pilot.

Analyzing the Integration of Artificial Intelligence in Higher Education: A Study on Teachers' Attitudes and Perspectives

The current descriptive study explored teachers' perspectives on integrating artificial intelligence in higher education institutions. The study's population was comprised of all males and females (N = 220). Instructors are working in various departments of the faculty of social sciences at public universities in Multan, Punjab, Pakistan. A sample of one hundred and sixty teachers (N= 160), including forty-one males (M, 41) and one hundred and nineteen females (F, 119), were chosen through convenient sampling from the faculty of social sciences departments to accomplish this research. The questionnaire was utilized as a research tool to collect data. The data was analyzed using descriptive statistics, mean, standard deviation percentage, and frequency utilizing the Statistical Package for Social Sciences (SPSS) version 25. The results indicated a positive perception of teachers towards the integration of Artificial Intelligence in Higher Education Institutions. Based on the findings, the study recommended that higher educational institutions should focus on organizing AI-focused teacher training, ensuring access to essential AI resources, integrating AI into curricula, addressing ethical concerns, and launching pilot programs to facilitate effective AI adoption in education. These steps can support educators in leveraging AI tools to enhance teaching and learning experiences.

Increasing access to self-managed abortion through pharmacies: programmatic results and lessons from a pilot program in Oromia, Ethiopia.

Despite increased availability of safe abortion following legal reform in Ethiopia, one-half of public sector abortion services are treatment of postabortion complications, indicating challenges meeting women's needs. Self-managed abortion (SMA)-the ability of pregnant people to manage their unwanted pregnancies with or without the support of a health care provider-is a safe, feasible, and acceptable option for women at gestational ages up to 12 weeks. Seeing the potential of SMA to vastly expand access to safe abortion and reduce postabortion complications, a pilot initiative targeting private pharmacies was implemented by the Ethiopian Ministry of Health, the Oromia Regional Health Bureau, and a non-profit organization. From December 2021 to March 2023, implementers trained and supported 41 pharmacies to provide SMA counseling and medical abortion drugs, with and without prescriptions, which was considered to contradict the legal framework at the time. Pharmacy clients' SMA experiences were documented in logbooks and via 21-day follow-up phone surveys. Thirty-two pharmacies (78%) supported 1,457 self-managed abortions during the pilot. Among clients with complete follow-up surveys (n = 1,233), 98.3% had a complete abortion without needing additional treatment. Only four clients (0.3%) reported a complication. The pilot demonstrated high demand for and feasibility of increasing access to quality SMA through private pharmacies in Ethiopia, but challenges remain due to the lack of a legal framework. We recommend providing multi-sector support on SMA to private pharmacies so they can in turn improve safe abortion accessibility by bringing safe, acceptable services closer to the people that need them.

Cross-border data flow supervision in China’s free trade zones: security and compliance rules

ABSTRACT Following the implementation of the Measures for Security Assessment of Outbound Data (SAOD Measures), pilot programmes for the SAOD were launched in several of China’s free trade zones (FTZs). Building on this foundation, the Regulations on Promoting and Regulating Cross-Border Data Flow (PRCBDF Regulations) were introduced in March 2024, which revised certain provisions of the SAOD Measures and granted each FTZ the authority to establish a negative list for outbound data. Subsequently, the Tianjin and Beijing FTZs introduced their respective negative lists, while the Lingang Area of the Shanghai FTZ and the Pingtan Area of the Fujian FTZ implemented general data lists. As the regulatory framework for cross-border data flow continues to develop across China’s major FTZs, further clarification is needed on the relationship between negative lists and general data lists, as well as the interaction between the negative list, important data, and personal information. Additionally, the alignment of these pilot initiatives with high-standard international trade and economic regulations warrants further examination.

Improving Acute Stroke Care with an Implementation Science Guided Acute Stroke Nurse Pilot Project

Improving Acute Stroke Care with an Implementation Science Guided Acute Stroke Nurse Pilot Project

SWOT and PESTEL analyses in assessing the sustainability of In-stream wetlands in Egypt

ABSTRACT In-stream wetlands have emerged as a promising approach for improving drainage water quality. This paper assesses the efficiency and sustainability of natural in-stream wetlands (ISW) within two Egyptian drains (Tellin Drain and Faraa Al Bahwo Drain) for improving drainage water quality through a comprehensive SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) and PESTEL (Political, Economic, Social, Technological, Environmental, Legal) analysis. The study assessed internal factors, including the cost-effectiveness, performance, and institutional challenges of ISWs, emphasizing their demonstrated capacity to improve water quality and their cost efficiency in pilot programs. However, the study also found weaknesses in institutional frameworks, technical capabilities, and management structure. Both wetland areas face significant external pressures, including political instability, economic challenges such as inflation and funding availability, and the impacts of climate change. Political stability and consistent policy are crucial for the success of ISW projects, yet both wetland areas struggle with governmental inefficiencies and leadership transitions. Economic factors such as inflation and inequality, particularly in Faraa Al Bahwo Wetland, pose additional risks to sustainability. Social factors, including rising health awareness and urbanization, contribute positively to wetland success, but population growth and social resistance remain substantial obstacles. Technologically, both wetlands face challenges related to outdated infrastructure, although advancements in data analytics and technology adoption offer opportunities for improvement. Environmental threats, including climate change and resource depletion, are significant but may be mitigated through effective environmental regulations. A PESTEL-SWOT integration matrix was developed to visualize the interaction between external factors and internal strengths, providing a strategic framework for stakeholders to optimize ISW implementation. These insights emphasize the need for a comprehensive approach to wetland management, integrating internal and external factors for effective and sustainable drainage water quality improvement. The study recommends several strategies to tackle these challenges and enhance the sustainability of ISW. EPADP should concentrate on improving internal management by providing staff training and clearly defining roles to boost coordination and accountability. Additionally, it is essential to develop a diversified long-term financing plan that includes public-private partnerships and international climate funds to secure sustainable funding.