Background: Large language models have accelerated the adoption of generative artificial intelligence (AI), making AI tools more widely accessible through conversational prompting. One emerging application is vibe coding, in which users use natural-language prompts to generate code and desired outputs rather than manually writing traditional code. Objective: To examine AI-assisted, human-in-the-loop (HITL) vibe coding as a proof of concept for data analysis, describe its components and a proposed workflow with explicit safeguards, and present a case study illustrating its use and potential failure points. Methods: We used a proposed workflow that included framing research questions, operationalizing variables, organizing project folders, documenting decisions, applying retrieval-augmented generation, and using prompt engineering techniques. We used Cursor (v1.5.11) on a limited, clean admissions data set, in which admission status was modeled as a function of the Graduate Record Exam, grade point average, and undergraduate rank. Logistic regression was generated via conversational prompts, implemented in R, and the results were compared with a published reference output on a publicly available website. Results: AI-assisted, HITL vibe coding produced statistical codes that included schema checks, range validations, data cleaning, exploratory analyses, regression modeling, and visualization. There were mixed results of both valid and invalid outputs. Regression coefficients, p values, and model fit statistics matched the outputs posted on the published reference output website. However, an error was identified in the predicted-probability confidence interval output, which was missed during the initial review of outputs. Discussion: While vibe coding has the potential to reduce barriers to data analysis for researchers, this case study demonstrated that it can produce both valid and invalid outputs and that foundational statistical training, knowledge, understanding, and methodological expertise remain paramount when using it. Future studies should address important empirical questions about the use of vibe coding, such as under what conditions it can be safely used in research and what kinds of errors are most commonly generated when using it. AI-assisted HITL vibe coding should be used with caution and only with structured verification and safeguards, transparent reporting, and appropriate statistical and methodological oversight.
BACKGROUND:Pediatric obesity is a major public health concern with important implications for acute care and long-term health outcomes. National estimates of obesity among hospitalized children using recent data are limited. OBJECTIVES:To estimate the prevalence of documented obesity among hospitalized children and examine associated sociodemographic differences and comorbidity patterns using the 2021 National Inpatient Sample. METHODS:We conducted a cross-sectional analysis of pediatric discharges (ages 2-17 y) in the 2021 National Inpatient Sample. Obesity was defined using the International Classification of Diseases, 10th Revision, Clinical Modification codes. Survey-weighted analyses were used to estimate prevalence and examine comorbidity patterns. Multivariable logistic regression models were used to evaluate sociodemographic correlates of obesity. RESULTS:Among an estimated 961,529 pediatric hospitalizations, 6.29% had a documented obesity diagnosis. Obesity prevalence was higher among Black, Hispanic, and Native American children and increased with decreasing neighborhood income. In adjusted analyses, older age and Medicaid coverage were associated with higher odds of obesity, while females had lower odds than males. Children with obesity had substantially higher prevalence of cardiometabolic, respiratory, and mental health comorbidities compared with nonobese children. DISCUSSION:Pediatric obesity among hospitalized children is associated with significant sociodemographic disparities and a high burden of comorbidities. Hospitalization represents a vital opportunity for identification and linkage to care.
Background: Reproducibility, the ability for independent investigators to obtain consistent results using the same data and analytic procedures, is foundational to scientific integrity, yet remains a challenge across research settings. Common practices such as manual data cleaning, point-and-click analyses, and creating tables by manually copying and pasting values from output to table shells increase the likelihood of error, reduce transparency, and impede efficient collaboration. As data become more complex and expectations for reproducibility from journals, funders, and the scientific community grow, researchers need practical, accessible guidance on implementing reproducible workflows. Objectives: To provide actionable steps to improve the reproducibility of data management, statistical analyses, and reporting, and demonstrate reproducible workflows using both R and IBM SPSS Statistics. Methods: We outline five steps toward reproducibility: (1) project organization and file structure, (2) use of ReadME documentation, (3) clear traceability from raw to analytic data sets, (4) use of syntax for all data cleaning and management, and (5) reproducible generation of tables and reports. A synthetic data set is used to illustrate these principles in both R and SPSS, highlighting how fully syntax-based workflows in R and syntax-supported workflows in SPSS can move researchers toward greater transparency and efficiency. Results: Implementing reproducible workflows reduces error, saves time, and strengthens scientific rigor. Syntax-based approaches create a complete, defensible record of every analytic decision, supporting clearer team communication and easier project hand off. Even small changes, such as maintaining untouched raw data, standardizing folder structures, and documenting decisions in ReadMe files, substantially improve transparency. Across platforms, the guiding principle holds: anything that is done manually can be done with syntax, enabling faster, more accurate, and fully repeatable results. Discussion: Reproducibility is both an ethical and methodological imperative. Incremental improvements can reshape research culture, producing more trustworthy work. Integrating reproducibility into education, mentorship, and team science can help ensure that rigorous, transparent analytic practices become standard in research.
BACKGROUND:Women with breast cancer experience high symptom burden from a psychoneurological symptom cluster consisting of fatigue, anxiety, depression, sleep disturbances, and pain. Interventions to manage this symptom cluster are limited as its etiology is not well understood. One system that has been linked with this symptom cluster in both healthy and other chronically ill populations but has not been explored in breast cancer is the oral microbiome. OBJECTIVE:We examined differences in oral microbiome diversity and composition between women with breast cancer who reported high versus low levels of psychoneurological symptoms. METHODS:Oral microbial changes based on bacterial diversity and relative abundance were estimated from 16S rRNA gene sequencing data of oral tongue swabs from 22 women with breast cancer prior to mastectomy. The fatigue, anxiety, depression, sleep disturbance, and pain interference subscales of the Patient-Reported Outcomes Measurement Information System 29 scale were used to calculate the symptom groups. RESULTS:Observed amplicon sequence variants were lower in the high-symptom group than in the low-symptom group, but no differences between groups were seen in other alpha diversity metrics (Shannon, Inverse Simpson). No differences in beta diversity were found between the high- and low-symptom groups. For differential abundance, three genera were more abundant in the high-symptom group than the low-symptom group: Aggregatibacter, Lautropia, and Prevotellaceae UCG-001. DISCUSSION:Preliminary associations were identified between the psychoneurological symptom cluster and oral microbiome diversity and composition. Of the differentially abundant genera, Lautropia has been previously linked with anxiety, and Aggregatibacter has been researched due to its pro-inflammatory potential. As inflammation is posited to influence psychoneurological symptom cluster severity, further research on the relationship between the oral microbiome and the psychoneurological symptom cluster, specifically in relation to potential causal mechanisms, is warranted. Enhanced insight into this relationship could inform targeted interventions to improve the symptom experience for women with breast cancer.
Background: Subjective cognitive decline (SCD) and fear of falling share similar mental health consequences (e.g. increased depression and anxiety), but limited research evaluates their relationships in racially diverse older adults living in low-income settings. Objectives: We examined associations of older adults’ SCD and SCD-related functional difficulties with fear of falling and the moderating effects of depressive and anxiety symptoms. Methods: A cross-sectional study, part of a larger clustered randomized controlled trial, was conducted. The sample consisted of racially diverse adults aged 60+ with the ability to stand without assistance, living in residential units and apartments in Central Florida ( N =91; 89% female, M age =73.26, SD ±6.99, 96.7% non-White). The short Fall-Efficacy Scale International assessed fear of falling. SCD was evaluated using a single question regarding confusion or memory loss, followed by a follow-up question that captured SCD-related functional difficulties on a Likert scale. The Patient Health Questionnaire assessed depressive symptoms. The Geriatric Anxiety Inventory-Short Form assessed anxiety. A Poisson regression analysis examined associations among SCD, SCD-related functional difficulties, fear of falling, and interactions with depressive and anxiety symptoms. Results: Depressive symptoms were independently associated with fear of falling, while SCD, SCD-related functional difficulties, and anxiety symptoms were not. Older adults with SCD-related functional difficulties who reported higher anxiety also reported greater fear of falling, whereas those with lower anxiety reported fewer fall-related concerns The interaction of SCD-related functional difficulties with depressive symptoms was not significantly related to fear of falling, but its interaction with anxiety symptoms was. Simple slope analysis showed the association between SCD-related functional difficulties and fear of falling was accentuated with higher anxiety symptoms and attenuated with lower anxiety. Discussion: Among racially diverse older adults, SCD was not independently associated with fear of falling; however, accounting for co-occurring affective symptoms provided a more comprehensive understanding. Although depressive symptoms were associated with fear of falling, it was anxiety that contributed to concerns about falling when older adults experienced functional difficulties due to SCD. Future studies should use larger, more representative samples to evaluate whether older adults’ fear of falling and affective well-being changes over time, particularly among those experiencing SCD.
BACKGROUND:Fluid overload is a major contributor to symptoms and hospitalization in patients with heart failure (HF). Home-based exercise interventions designed to enhance lymphatic drainage may reduce thoracic congestion and fluid overload symptoms, yet limited research has investigated the effectiveness of these exercises using objective measures of thoracic fluid content and body water composition in this population. OBJECTIVE:To evaluate the effectiveness of The-Optimal-Lymph-Flow (TOLF) intervention, a nurse-led, home-based, and structured exercise program designed to enhance lymphatic drainage and fluid overload, in patients with HF. METHODS:A parallel randomized clinical trial design was used. A total of 80 participants were recruited, randomly assigned to either the TOLF intervention or usual care and followed for 4 weeks. Primary outcomes included thoracic fluid content measured by a dielectric sensing device; total body water and extracellular water measured by a bioimpedance device; fluid overload symptom prevalence and burden assessed using a self-reported questionnaire; and hospital readmission rates. Mixed-effects models were used to estimate treatment effects, adjusting for health behaviors. RESULTS:Compared with the control group, participants receiving the TOLF intervention demonstrated significantly greater reductions in thoracic fluid content at 4 weeks post-intervention. Significant treatment effects were also observed for fluid overload symptom prevalence and symptom burden. These effects remained substantial after adjustment for health behaviors. A sizable reduction in rehospitalization rates was observed in participants receiving intervention. No significant treatment effects were observed for body water composition, although within-group reductions were noted in the intervention arm. In addition, findings also demonstrated feasibility and acceptability with 79% retention, > 80% protocol adherence, and 98% participant satisfaction. DISCUSSION:The home-based lymphatic exercise intervention is effective in reducing thoracic congestion, fluid overload symptoms, and hospital readmission. These findings align with the emerging evidence supporting the role of lymphatic system in HF and warrant further evaluation in a larger trial.
BACKGROUND:Perceived control is a construct relevant to emotional and clinical outcomes among individuals with chronic illnesses. We previously demonstrated the reliability and validity of the Control Attitudes Scale-Revised (CAS-R), and it has been used extensively in research to measure perceived control. Yet, there is a gap in interpretation of CAS-R scores. A standardized cut point has not yet been established to facilitate classification of patients into distinct high- and low-perceived control categories. Identifying this cut-off point will be of significant value to clinicians and researchers. OBJECTIVES:To identify an evidence-based cut point for the CAS-R to define lower and higher levels of perceived control among patients with a variety of cardiac diagnoses. METHODS:In this psychometric secondary analysis, we used data from patients with heart failure or coronary heart disease, which included 4,555 patients from three countries. Data were collected on perceived control, depression and/or anxiety, and/or cardiac events (cardiac hospitalization and cardiac death). We used receiver operating characteristic (ROC) curves and area under the ROC area under the curve (AUC) to test the accuracy of using the CAS-R scores to separate the patients into anxious or non-anxious groups and depressed or non-depressed groups. Kaplan-Meier plots with log-rank tests and Cox-survival analyses were used to compare cardiac event-free survival outcomes between higher and lower perceived control groups. RESULTS:Two possible cut points were identified using ROC curves and AUC. Cut points were identified using anxiety or depression as the state variable and CAS-R scores as the test variable. Using Kaplan-Meier analyses and log-rank tests, we determined that 29 was the cut point that demonstrated patients in the higher CAS-R group had significantly better cardiac event-free survival than those in the lower CAS-R group. Using the cut point of 30, the differences in cardiac event-free survival between groups did not reach a significant level. DISCUSSION:Identifying a CAS-R cut point enhances the practical application of the CAS-R and makes it a valuable instrument for assessing the effect of targeted interventions among cardiac patients with lower perceived control.
BACKGROUND:Asian adults in the U.S. face increased burdens of cardiovascular risk factors and cardiovascular disease (CVD). However, trends in cardiovascular health among Asian subgroups remain understudied. OBJECTIVES:The purpose of this study was to examine 15-year trends in CVD risk factors and CVD among Chinese, Filipino, and Asian Indian adults living in the U.S. METHODS:We conducted a retrospective secondary analysis using data from the 2004-2018 National Health Interview Survey. Age-standardized prevalence rates were calculated for eight variables: hypertension, type 2 diabetes, overweight/obesity, short sleep, alcohol use, smoking, insufficient physical activity (PA), and CVD (defined as having coronary heart disease, heart attack, stroke, or other cardiovascular conditions). Annual percent change and average annual percent change were employed to summarize and compare the trends of each variable over 15 years. RESULTS:The sample consisted of 14,073 adults, with the majority aged 65 years or older and half being female. Filipino adults showed the highest prevalence for most variables, except for diabetes and insufficient PA, compared to Chinese and Asian Indian adults. From 2004 to 2018, Asian adults overall experienced increases in the prevalence of diabetes, overweight/obesity, and alcohol use, and decreases in the prevalence of smoking and insufficient PA. Specifically, Chinese adults exhibited significant upward trends in short sleep. Asian Indian adults exhibited upward trends in overweight/obesity and alcohol use, but downward trends in smoking and insufficient PA. Filipino adults demonstrated similar trends to Asian Indian adults in alcohol use and smoking. No significant trends were found for other study variables in all three groups. DISCUSSION:U.S. Asian adults from different cultural backgrounds experience varying patterns of cardiovascular health. Public health strategies are recommended to be customized to address the specific cardiovascular risk profiles of each Asian subgroup.
Background: Sleep disturbance is highly prevalent among caregivers of persons with dementia (PWD), affecting approximately 67% of the more than 10 million adults in this role in the United States. Accurately characterizing these disturbances is essential to identify individuals at increased risk for chronic sleep problems and related health consequences. However, few studies have examined how sleep disturbance manifests across diverse caregiver characteristics and contexts. Objectives: To address this gap, we applied clustering analyses using wearable sleep data to identify distinct subtypes of sleep disturbance among dementia caregivers. Methods: Clustering analyses were conducted using sleep parameters—total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL)—derived from 14 days of Oura Ring data collected from 143 caregivers of PWD. For each participant, the minimum, maximum, mean, and standard deviation of each sleep metric were computed during the 14-day period. Subsequent one-way ANOVA and chi-square tests were performed to explore differences in caregiver characteristics, caregiving demands, and caregiving support availability across the identified subgroups. Results: The analytic sample included 143 adults. Three distinct sleep disturbance subtypes emerged. Cluster 1 (Optimal Sleep) demonstrated the least nocturnal wakefulness, the most efficient sleep, and ease in falling asleep relative to the other clusters. Cluster 2 (Disturbed Onset & Maintenance) exhibited the greatest difficulty both falling and staying asleep, whereas Cluster 3 (Insufficient Sleep) was characterized by markedly reduced sleep duration. Key contextual characteristics differentiated the clusters. Cluster 2 had the highest prevalence of comorbid conditions, including hypertension, diabetes, and other chronic illnesses, whereas Cluster 3 was predominantly male and had the lowest support availability. Discussion: Findings highlight the potential of wearable-derived nocturnal data to characterize distinct sleep disturbance subtypes using clustering analyses. This work underscores the value of building a risk-profiling framework that integrates sleep disturbance subtypes, caregiver characteristics, caregiving demands, and caregiving support availability to inform the development of more precise and effective sleep interventions for dementia caregivers.
BACKGROUND:Emotional and physical demands of caregiving can affect nutritional intake, particularly of vitamin B9 (folate), which is important in the functioning of the nervous and skeletal systems. Non-caregivers studies in Puerto Rico, a folate-fortified region since 1998, have reported low consumption of folic acid (folate added to foods or taken as a diet supplement) consumption among women, which can potentially affect individuals' subjective mental/physical health well-being. Serum folate levels are a widely used, low-cost, modifiable marker of recent folate status, yet a relationship between serum folate levels and mental/physical health among informal caregivers of patients with chronic diseases in Puerto Rico has not been established. The latter study can be especially vital, as it may allow us to contribute to the initial understanding of caregivers' mental/physical health phenotypes. OBJECTIVE:To evaluate cross-sectional relationships between serum folate levels and subjective mental health and physical health in informal caregivers of patients with chronic diseases in Puerto Rico. METHODS:An observational cross-sectional study from July 2024 to May 2025 was conducted with 69 caregivers. Participants provided blood samples for serum folate levels and answered the PROMIS-10 questionnaire. Descriptive statistics, independent samples t-tests, and multiple regression models were conducted. RESULTS:The sample included 69 participants. In regression analyses, higher folate levels were significantly associated with higher mental health in both unadjusted and fully adjusted models. Folate levels were also positively associated with physical health in unadjusted and partially adjusted models; however, this association was attenuated and no longer statistically substantial after further adjustment for perceived stress. DISCUSSION:Findings suggest that low serum folate levels are a risk factor to consider while assessing the physical/mental health of informal caregivers, with future studies aimed at validating the findings in a larger cohort and with future clinical applications such as screening for folate deficiency, dietary counseling, and supplementation programs to address and mitigate these specific health risks.
Background: Older adults frequently experience acute and long-term cognitive impairment following critical illness hospitalization in an intensive care unit (ICU). Delirium affects up to 80% of ICU patients and is linked to cognitive dysfunction and increased risk of cognitive decline associated with Alzheimer's disease and related dementias (ADRD). Sleep and circadian rhythm disturbances are present in about 75%-80% of ICU patients and may exacerbate delirium and undermine cognitive interventions. Nonpharmacological interventions such as earplugs, eye masks, and computerized cognitive training show promise in reducing delirium and improving sleep but have not been rigorously tested-separately or combined-in older adult ICU survivors. Moreover, prior studies have not leveraged chronotherapeutic timing to align cognitive training with individual circadian rhythms.Objectives: We propose a multimodal combination of sleep promotion intervention [SLEEP] and computerized cognitive training program timed daily according to individual chronotype [COG], to improve cognitive function in hospitalized older adult ICU survivors. The primary aim is to test the feasibility, acceptability, and preliminary separate and combined effects of SLEEP and COG [SLEEP, COG, SLEEP+COG] versus an active control condition [AC] in improving cognitive function after the intervention period. The secondary aims are to explore (1) circadian rhythm parameters of continuous body temperature to determine the optimal window for chronotherapeutic timing of cognitive interventions; (2) if the effects of each intervention on cognitive function are mediated by sleep and activity; (3) if biopsychosocial and clinical factors moderate the effects of each intervention on cognitive function; and (4) the effects of each intervention on cognitive function at 1, 6, and 12 months.Methods: After discharge from ICU, English- or Spanish-speaking older adult ICU survivors (n=100) are randomly assigned to 7 days of (1) SLEEP, (2) COG, (3) SLEEP+COG, or (4) AC. Cognitive function, delirium severity, sleep and circadian rhythms, patient-reported symptoms, and data regarding biopsychosocial and clinical factors are collected.Results: Results are pending study completion.Discussion: We aim to target sleep and circadian rhythm disturbances, mitigate ICU delirium, and reduce cognitive decline associated with ADRD. If hypotheses are supported, this combination of low-cost, nonpharmacological interventions could be integrated into standard care to accelerate cognitive recovery during hospitalization.
BACKGROUND:Elevated glycosylated hemoglobin (HbA1c) levels have been associated with an increased risk for type 2 diabetes (T2D) complications. OBJECTIVE:The aim of this study was to examine the electronic health record (EHR) correlates of HbA1c levels among adults with T2D using Tribal health services. METHODS:EHR data from one Tribal health center were used for this study. Variables included driving distance to clinics, socioeconomic status, use of primary care and diabetes educators, age, sex, glycemic status, and HbA1c. Descriptive, bivariate, and linear regression analyses were performed. RESULTS:Nearly 40% of the 5,205 patients in the sample had HbA1c levels <7% in 2021. HbA1c in 2020 was a strong predictor of HbA1c in 2021. Older age was weakly associated with lower HbA1c. A lack of primary care visits or diabetes educator visits was associated with lower HbA1c, likely due to patients with lower HbA1c levels having less need for T2D-related primary care or diabetes educator visits. DISCUSSION:This study provided insight into factors associated with HbA1c levels that deserve further exploration, but it is important to note that factors included in social determinant of health frameworks specifically developed for Indigenous communities were not available in the EHR data set. Therefore, future studies are needed that examine Indigenous social determinants of health specific to the local community.
BACKGROUND:Multivariate risk prediction models are recommended for assessing cardiovascular disease (CVD) risk and developing effective management plans. The widely used Framingham Risk Score (FRS) requires validation before application, as the original cohorts primarily comprised White, middle-class individuals in the United States. OBJECTIVES:To evaluate the FRS's predictive accuracy over 10 years within the Korean National Health Insurance Service-National Health Screening Cohort. METHODS:This retrospective observational study involved 483,643 eligible participants. Discrimination and calibration were assessed using the c statistic, calibration slope, and intercept, supplemented by graphical calibration plots. RESULTS:Over 10 years, 23,681 men and 16,904 women experienced a CVD event. The FRS showed good discrimination in both men and women. It overestimated CVD risk for men, while showing good calibration in women. DISCUSSION:The observed discrepancy in calibration may be related to differences in risk factor profiles and CVD event rates between the original Framingham cohorts and the Korean validation cohort. In the absence of a Korean-specific model, the FRS remains a practical option for use in primary care. However, to enhance accuracy of risk prediction, the development and validation of a population-specific CVD risk model for Korea are recommended.
BACKGROUND:Cognitive impairment (CI) affects upwards of 70% of people with multiple sclerosis (MS) and influences daily living and quality of life. Standard assessments capture performance but provide limited insight into how cognitive changes are experienced. Photovoice may help surface these internal and less visible dimensions, yet its feasibility for CI-focused MS research is not well established. OBJECTIVES:To assess the feasibility and methodological utility of photovoice for examining CI as a lived experience in MS and to identify insights that can guide future qualitative study design. METHODS:Adults with MS who identified CI as a significant challenge were recruited from a private online support group. Three participants completed a 7-day photovoice activity (38 images with written reflections) and a 90-minute photo-elicitation interview. Analysis focused on methodological illustration rather than saturation. RESULTS:Participants generated images and narratives that depicted key aspects of CI in daily life. Photographs illustrated: (1) a mismatch between internal cognitive difficulties and outward appearances of wellness; (2) humor used to express forgetfulness and mental fatigue; (3) reliance on tools such as lists, reminders, and environmental cues; and (4) variation in how CI was framed, including changes in meaning following disability recognition. These findings show that participants were able to visually and narratively represent CI experiences. DISCUSSION:Visual narratives align with earlier photovoice work on invisible MS symptoms, suggesting that photovoice can document cognitive experiences that traditional methods may overlook. Results support photovoice as a complementary qualitative approach for understanding how adults with MS interpret and manage cognitive changes in daily life.
BACKGROUND:Older adults increasingly rely on online health information; however, limited eHealth literacy may amplify health anxiety and cyberchondria, thereby compromising engagement in positive health behaviors. Understanding whether eHealth literacy buffers these adverse psychological influences can inform targeted interventions for aging populations. OBJECTIVE:To examine whether eHealth literacy moderates the association between health anxiety and health behaviors among older adults, and to identify demographic and psychological predictors of health behaviors. METHODS:This was a cross-sectional correlational study reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines of a convenience sample of 400 community-dwelling adults aged ≥ 60 years. Data were collected via structured survey administration. RESULTS:Higher eHealth literacy was associated with more favorable health behaviors and lower levels of cyberchondria and health anxiety. In regression models, education, online health information‑seeking frequency, eHealth literacy, cyberchondria, and health anxiety emerged as independent predictors of health behaviors. Moderation analyses indicated that eHealth literacy buffered the negative association between health anxiety and health behaviors. DISCUSSION:eHealth literacy appears to function as a protective factor in later life by reducing the adverse association between health anxiety and engagement in positive health behaviors, while also relating inversely to cyberchondria. Although educational attainment remained a significant predictor, psychological variables accounted for substantial additional amount of variance in health behaviors. Integrating eHealth literacy training with anxiety-informed support in gerontological care may strengthen preventive and self-management behaviors among older adults in community and clinical settings.
BACKGROUND:Cervical cancer incidence and mortality in Appalachia exceed national averages, reflecting long-standing inequities in preventive care. Although cervical cancer screening (CCS) effectively reduces morbidity and mortality, participation among Appalachian women remains low. Understanding the multilevel factors that influence screening behavior is critical to inform culturally responsive and sustainable interventions. OBJECTIVES:To synthesize existing evidence on barriers to and facilitators of CCS among women residing in Appalachia using Levesque's Access to Care Framework. METHODS:A scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis and reported following PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched for studies published between January 2002 and August 2025. Eligible studies reported original empirical data on CCS among women aged 21-64 living in Appalachian counties. Editorials, reviews, gray literature, and studies lacking disaggregated Appalachian data were excluded. Extracted data were categorized into Levesque's five patient-level domains: the abilities to perceive, seek, reach, pay, and engage in care. RESULTS:Of 3,457 records identified, 27 met the inclusion criteria. Studies employed qualitative, quantitative, and mixed methods designs. Barriers included cost, lack of insurance, transportation challenges, medical mistrust, fatalism, low health literacy, and negative prior health care experiences. Facilitators included trusted and consistent patient-provider relationships, clear provider communication, social support, female clinician availability, and access to free or subsidized screening through Title X and the National Breast and Cervical Cancer Control Program services. DISCUSSION:Structural, interpersonal, and psychosocial factors intersect to shape screening behaviors in Appalachia. Findings highlight the importance of trust-building, trauma-informed, and culturally responsive communication, and system-level supports that address cost and access barriers. Expanding Medicaid, strengthening rural provider capacity, and increasing participation in Title X and national cervical cancer programs may reduce disparities and improve screening uptake. Future research should incorporate standardized measures of trust, health literacy, and psychosocial readiness to strengthen intervention design and cross-study comparability.
