Abstract Background Literacy is the ability to read, understand, and utilize information and to communicate through verbal and written communication. Health literacy applies these skills in a healthcare context. Healthcare professionals’ (HCP) perceptions of patients’ health literacy levels are crucial to allow delivery of information in a clear and accessible manner. Methods This was a cross-sectional study in secondary care with opportunistic recruitment of HCPs and patients. Patients completed a demographic questionnaire and the Medical Term Recognition Test (METER), a validated measure of functional health literacy. HCPs provided an estimation of the patient’s health literacy after their care interaction. Comparisons between METER results and HCP estimations were made to assess HCPs’ estimations accuracy. Results Health literacy was assessed for 142 patients. Of the 220 estimations by HCPs, 55.5% were correct. Consultants had the highest accuracy (70%). Other HCP groups’ accuracy ranged between 44.7% and 55.8%. The intraclass correlation coefficient (ICC) assessed the agreement between HCPs’ estimations and patient’s health literacy, revealing poor agreement (ICC = 0.2; CI = 0.074, 0.327; P = .00117). Conclusions This reveals disparities between HCPs’ estimation and METER-assessed functional health literacy. Addressing this gap is crucial in allowing HCPs to provide more tailored communication to empower patients in decision-making.
Given the adverse health outcomes and barriers to healthcare associated with homelessness, this study aimed to explore its impact on health, identify barriers to healthcare access, and examine perceived needs and effective interventions from the perspectives of people experiencing homelessness, individuals with lived experience of homelessness, and professionals working in health and social services. A qualitative study was conducted in Zaragoza, Spain, using semi-structured interviews with 27 participants, including people experiencing homelessness (n = 11), individuals with lived experience of homelessness (n = 7), and professionals (n = 9). Participants were recruited through purposive sampling. Data were analysed using thematic analysis. Participants described homelessness as having a substantial impact on physical, mental, and social well-being. Mental health emerged as a major concern, with depression, anxiety, emotional distress, suicidal ideation, and loneliness frequently reported. Physical health problems included chronic diseases, respiratory conditions, pain, injuries, poor nutrition, sleep deprivation, and substance use disorders. Barriers to healthcare access included administrative requirements, lack of documentation, digital exclusion, long waiting times, stigma, discrimination, and limited availability of specialized mental health services. Participants identified multidisciplinary care, continuous psychological support, community-based interventions, and stable housing combined with personalized psychosocial support as key components of effective care. Homelessness requires integrated, trauma-informed, and person-centred public health responses. Reducing barriers to healthcare, strengthening mental health services, and expanding multidisciplinary interventions may reduce health inequalities and improve health outcomes and social inclusion among people experiencing homelessness.
To synthesise evidence on experiences of artificial intelligence (AI) chatbot-supported smoking cessation interventions and evaluate the extent to which behaviour change theory is integrated into their design and implementation. A systematic review was conducted of studies published between 2016 and 2026 that examined AI chatbot-supported smoking cessation interventions. Eligible studies explored behaviour change processes and reported outcomes related to user experience, engagement, continuance intention, or smoking reduction. Study identification, screening, quality appraisal, and synthesis were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure methodological transparency and rigour. The systematic review found that perceived anonymity, accessibility, usefulness, and quality of interaction were key factors shaping users’ experiences and ongoing engagement with chatbot interventions. Personalised support, timely feedback, and conversational communication were associated with greater user satisfaction and stronger cessation outcomes. Behaviour change techniques were embedded within some interventions; however, the application of behaviour change theories was often inconsistent and insufficiently reported. The evidence also highlighted the need for greater attention to diverse socio-economic and geographical contexts, given the influence of digital health literacy on intervention uptake and effectiveness. AI chatbot interventions show promise as accessible and acceptable tools for supporting smoking cessation. Positive user experiences were associated with sustained engagement and more favourable cessation outcomes. However, stronger theoretical integration, more consistent evaluation approaches, and greater consideration of socio-economic and geographical diversity are needed to strengthen the evidence base and support the development of effective, user-centred digital cessation interventions.
Developmental language disorders (DLD, ICD-11 6A01.2) represent the most common indication for speech and language therapy in children. In Germany, language therapy is predominantly delivered as individual, face-to-face sessions. Within the framework of the project “Effectiveness of an Online Interval Small-Group Therapy for Children with Developmental Language Disorders” (THEON), this study is being conducted to investigate whether video-assisted group language therapy is as effective as conventional face-to-face individual treatment in children with DLD. Prior to the implementation of the randomized controlled trial (RCT), a preliminary qualitative interview study was conducted with parents, speech and language therapists (SLTs), and physicians to explore their attitudes, requirements, and perceived barriers regarding this novel form of therapy delivery. This manuscript presents the findings of this preparatory qualitative study. Ten semi-structured interviews were conducted by two trained researchers with four parents of children with DLD, four SLTs, and two physicians. Participants were asked about their views on online group speech and language therapy. A semi-structured interview guide served as the basis for the virtual interviews. The guide addressed themes that were identified in advance through a literature search while also allowing room for open discussion and the emergence of additional relevant aspects. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis supported by MAXQDA. Online therapy was perceived as particularly suitable for older children and children with clearly defined speech or language disorders. The advantages perceived included improved access to care, no travel time, and the possibility of recording sessions. Concerns related to reduced concentration and compliance, technical problems, limited methodological flexibility, and changes in therapeutic relationships due to the required presence and active role of caregivers. The findings informed the development of a mixed-methods process evaluation accompanying the THEON trial, including a standardized questionnaire assessing feasibility, satisfaction, acceptance, and implementation barriers among parents and SLTs. Overall, stakeholders perceived online group therapy as a feasible complementary approach under specific conditions, particularly for older children and clearly defined disorders. At the same time, the interviews highlighted the importance of adequate technical infrastructure, active caregiver involvement, and careful patient selection for successful implementation into routine care.
Abstract Background Spatial planning is increasingly recognized as a key mechanism for addressing general health determinants. However, persistent gaps between policy intent and implementation exist. Understanding practitioner perspectives is essential for identifying the factors that influence actions. Methods A survey was conducted to capture the views of health and built environment professionals. Questions were structured using the system–context–capability framework to examine how governance, context, and capacity impacted on healthy planning. Analyses focused on responses and stratified findings for planning and health professionals working in England. Results Respondents expressed strong consensus for planning’s role in improving health and reported high awareness of national policy requirements for health. However, confidence in implementation was limited. Barriers identified were lack of capacity and resources and weaknesses in policy. Findings included misalignment between influence and responsibility where planning actors were viewed as highly influential, while health bodies were seen as responsible for health outcomes but constrained in their ability to shape decisions. Capacity building was identified as opportunities to strengthen delivery. Conclusions Effective implementation of healthy planning depends not only on policy frameworks, but on system readiness, governance alignment, and professional capacity. Addressing these factors is critical for translating policy ambition into planning actions.
