BACKGROUND:The COVID-19 pandemic significantly impacted primary care, including childhood infection management. Public health measures reduced respiratory infections, raising concerns about an 'immunity debt' in children. General practitioners (GPs) faced fewer in-person consultations, evolving diagnostic routines, and changing parental expectations. While hospital data are available, effects in general practice are less studied. METHODS:A cross-sectional online survey was conducted among Dutch GPs with experience before and after the pandemic. The 35-item questionnaire addressed infection patterns, management, parental behaviour, and communication. RESULTS:Of 166 GPs, 32% noted changes in infection management and 44% observed altered seasonal trends. While consultation rates remained stable, diagnostic testing and antibiotic use increased. GPs reported longer consultations and rising parental demands, especially among those with lower health literacy or migrant backgrounds. CONCLUSION:GPs reported key shifts in managing childhood infections. Strengthening communication and further qualitative research may enhance care and equity.
AIM:This study aims to evaluate the feasibility and educational impact of utilizing SHCs as primary care training sites in undergraduate medical education, with the goal of enhancing clinical competencies in young adult healthcare. BACKGROUND:Family Medicine (FM) is essential for integrating community-based health services into medical education. In Turkey, final-year medical students complete a one-month rotation at Family Health Centers (FHCs). However, young adults often utilize Student Health Centers (SHCs) on university campuses, resulting in a gap in students' experience with this age group. Addressing this, our programme initiated the inclusion of SHCs in the FM internship rotation for the 2024-2025 academic year. METHODS:A mixed-methodology study was conducted in two phases. A retrospective analysis was performed on medical records of patients aged 18-25 who attended the SHC over a one-month period. A prospective 9-item online survey assessed the educational impact on final-year medical students following their FM internship, which included the SHC rotation. Descriptive and qualitative statistical analyses were performed to summarize the survey and clinical data. FINDINGS:A total of 1228 patients were seen at the SHC, mirroring FHC trends. All 87 interns surveyed rated the FM programme initiative positively, with 94.1% highly satisfied and 85.9% reporting improved primary care skills. Qualitative feedback highlighted the value of practical experience and called for longer rotations. CONCLUSION:Integrating SHC rotations into undergraduate medical education is both feasible and beneficial, providing relevant primary care experience for medical students and enhancing training in the care of young adult populations.
PURPOSE:It was aimed to determine the competencies of Family Medicine residency students regarding the treatment planning of diseases coded with diagnosis-treatment in the 'National Core Education Programme' (NCC) in Turkey. We aimed to identify areas where residents feel less competent, which can inform curriculum improvements to better address gaps in treatment planning skills for core diseases. METHODS:The study was conducted with Family Medicine residency students from one medical school selected from each geographical region of Turkey. Students were asked to assess themselves at the time of graduation from medical school and currently during their residency training, in terms of 'appropriate drug selection', 'prescribing', 'non-drug treatment planning' and 'processing treatment management and giving information' competencies for 59 diseases in the NCC. RESULTS:The rate of Family Medicine residency students who felt competent in treatment planning/management when they graduated from medical school was very low; although this rate increased to a certain extent with residency training, it could not reach an acceptable rate. Despite partial improvements after graduation, the results suggest potential gaps in achieving the desired competency levels, even after 1-3 year of residency training. The residency students' competency perceptions ranged from 10-30% to 60-80% across different diseases. CONCLUSION:It is important to review and reconstruct the six-year medical education and Family Medicine residency training programs, based on the framework drawn by NCC, focusing on rational treatment planning/management to reconceptualize treatment planning/management and decision-making.
AIM:This study aimed to determine the effect of a single-session music intervention on pain intensity, state anxiety, and vital signs in cancer patients receiving palliative care. BACKGROUND:While music therapy is recognized as a non-pharmacological complementary tool, its simultaneous effect on both physiological and psychological parameters requires robust methodological evaluation within specific palliative care settings. METHODS:A cluster quasi-experimental pre-test/post-test control group design was conducted across two palliative care centres. The sample comprised 32 patients (Intervention: 16, Control: 16). To prevent treatment contamination, allocation was systematically performed at the room level rather than the individual level. The intervention group received a 30-minute session of instrumental Turkish classical music (Hicaz and Buselik maqams) via headphones, while the control group rested in bed. Data were collected using a Patient Description Form, Visual Analog Scale (VAS), State-Trait Anxiety Inventory (STAI), and a Physiological Parameter Monitoring Form. Linear Mixed Models (LMM) analyzed group × time interactions to account for clustering effects and baseline socio-demographic imbalances. FINDINGS:Analysis revealed significant group × time interactions Post-intervention, the intervention group showed statistically significant reduction in pain intensity and state anxiety scores compared to the control group (p < 0.05). Vital signs (pulse rate, respiratory rate, and blood pressure) demonstrated significant stabilization, alongside a significant increase in oxygen saturation (SpO2) in the intervention group. A 30-minute maqam-based instrumental music session shows potential as a stabilizing, non-pharmacological adjunct for acute symptom management in palliative cancer patients. Due to the small sample size and cluster-allocation, findings provide preliminary evidence.
AIM:To review the current diagnosis and treatment of hypertension (HTN) and explore alternative care management options. BACKGROUND:HTN is underdiagnosed and poorly managed in the UK. With an increasing emphasis on teamwork in primary care (PC), what is the evidence base supporting the partial or complete management of HTN by practice nurses (PNs)? METHODS:Using the PRISMA-Scr checklist as a framework, six database searches (BNI, CINAHL, Embase, Emcare, Medline, and PubMed) were conducted using Boolean Operators between December 2023 and February 2024, employing four search structures to find literature on independent or collaborative HTN management by PNs. Qualitative and quantitative research studies, reports, and articles were all considered. FINDINGS:HTN is a significant risk factor for mortality and morbidity. Despite clear national guidelines on the diagnosis and management, many patients affected by this condition remain undiagnosed, with the majority of those diagnosed inadequately treated. PC is struggling to manage the workload due to an ageing population and reduced general practitioner (GP) numbers. The development of new roles to support GPs in their work is underway, but current roles remain vague and without nationally agreed remits or working practices. PNs currently manage most chronic non-communicable diseases, such as diabetes, asthma, and chronic obstructive pulmonary disease; however, HTN is not typically part of their remit. There is strong quantitative and qualitative evidence supporting PNs' involvement in HTN management as care coordinators. Such a move could improve patient outcomes and release GP time, but institutional barriers need to be addressed.
This study investigates family physicians' attitudes toward lifestyle medicine, focusing on how these attitudes manifest in their health-promoting lifestyles and the moderating role of their healthcare sector attainment. Employing a quantitative, cross-sectional design, multicentric data were collected from 215 family physicians via an online survey accessed through professional networks. Data were collected using a study-specific demographic and healthcare sector information form, a custom questionnaire designed for attitudes toward lifestyle medicine, and The Health-Promoting Lifestyle Profile II. Findings revealed a positive association between health-promoting lifestyles and attitudes toward lifestyle medicine. The healthcare sector attainment significantly moderated this relationship, with private practice physicians showing a significant link between their health-promoting lifestyles (specifically, personal stress management, health responsibility, physical activity, and nutrition behaviours) and their attitudes toward lifestyle medicine. Conversely, this connection was not statistically significant in the public sector. The findings were discussed within the framework of social and organizational psychology theories and relevant literature. These results suggest that while physicians generally acknowledge lifestyle medicine, its embodiment through personal health behaviours is more pronounced in specific professional contexts. Our study underscores the need for sector-specific strategies to integrate lifestyle medicine more effectively into clinical practice. Policy initiatives should address structural barriers in the public sector that might hinder physicians' personal engagement with health-promoting behaviours, thereby impacting their professional advocacy for lifestyle medicine. Future research should explore the underlying mechanisms within different healthcare sectors and employ longitudinal designs to establish causality, ultimately aiming to enhance physician well-being and advance preventive care across all settings.
The lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related communities (LGBTQIA+) possess rich and diverse lived experiences yet continue to face systemic barriers to safe and affirming healthcare. This study examined the key features of such care from the perspective of primary care providers who deliver affirming care to LGBTQIA+ people. Thirty-one clinicians across varied disciplines shared their insights through semi-structured interviews. These were analysed using reflexive thematic analysis informed by queer theory and a relativist epistemology. Two overarching concepts were identified across participants' experiences: their values (purpose, principles and qualities) that underpinned their practices (ways of providing affirming care) that were grounded in intentionality, reflection and relationality. Four key themes were generated that intersected with practices and values: 1) values-driven healthcare, 2) (un)learning biases, reflection, and sociocultural awareness, 3) mitigating the power imbalance in the patient-provider relationship, and 4) valuing lived experience. These themes describe key features of delivering safe and affirming healthcare for participants. The findings highlight the importance of addressing both the observable (behaviours and practices) and unobservable (values) when implementing interventions to improve healthcare provision for LGBTQIA+ people.
AIM:To translate, culturally adapt, and validate the Capability Cards into Spanish for use with adults living with multimorbidity in community health settings. BACKGROUND:Adults with multimorbidity face complex self-management challenges arising from multiple conditions, clinical demands, and everyday priorities. Despite this complexity, tools to support meaningful dialogue and reflection on what individuals are able to do and be in daily life are scarce. Capability Cards support structured conversations on capabilities, well-being, and life goals, fostering empowerment, reflection, and shared decision-making. Cultural adaptation to the Spanish context is essential to ensure relevance and usability in community-based care. METHODS:A methodological validation study was conducted in Lleida (Spain) following four phases: literature review to inform translation and cultural adaptation, development of instruments to assess content validity and usability, evaluation by expert and community health professional panels, and assessment with the target population. Participants included 12 experts, 19 community health professionals from nursing, physiotherapy, nutrition, and psychology, and 25 adults aged 62-81 years with multimorbidity. Content validity was evaluated using the Content Validity Index (CVI), and usability was assessed with the System Usability Scale (SUS). FINDINGS:High content validity was observed across all groups, with CVI scores above the recommended threshold (experts: 0.88; professionals: 0.96; target population: 0.98). The SUS indicated excellent usability. The Spanish version of the Capability Cards demonstrated strong content validity, cultural appropriateness, and usability, supporting its suitability as a tool for facilitating structured, person-centred conversations, with potential to promote empowerment and participatory care in community primary health care for adults with multimorbidity.
This study investigates long-term trends in infant mortality rates (IMRs) in the case of 15 post-Soviet countries, with the aim of testing the Matthew Effect hypothesis, which suggests that inequality in health outcomes tend to persist or even widen over time. To assess these trends comprehensively, we employed various unit root tests, including traditional augmented Dickey-Fuller (ADF), non-linear (KSS, Kruse, Sollis, and Hepsag), and Fourier-based approaches (Fourier KPSS, Fourier ADF, flexible Fourier ADF, flexible fractional Fourier ADF, Fourier KSS, Fourier Kruse, and Fourier Sollis) to the data period from 1982 to 2022. Additionally, the multi-criteria decision analysis (MCDA) methods, such as equal weighting, entropy weighting, and TOPSIS, were utilized for a robustness check. The findings demonstrated that stationarity is validated in Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan, thereby corroborating the Matthew Effect. Conversely, Belarus, Estonia, Moldova, and Russia exhibit non-stationary IMR series, indicating continued fluctuations or structural changes in their infant mortality patterns. The findings indicate that infant mortality has plateaued in several countries, pointing to stagnation in policy effectiveness. Conversely, some countries show dynamic change, possibly indicating responsive health systems. These insights provide important direction for country-specific health policy design to reduce IMR and health inequality more effectively.
Aim: To develop and assess interpretable machine-learning models for sarcopenia risk assessment among physically inactive middle-aged and older adults using two large population-based datasets from the UK and the US.Background: Physical inactivity represents a major modifiable risk factor for sarcopenia in aging populations, yet prediction models specifically targeting this high-risk subgroup remain limited. This study developed and evaluated interpretable machine-learning models for sarcopenia risk stratification in physically inactive middle-aged and older adults using large-scale UK and US population-based data.Methods: We analyzed physically inactive participants from the English Longitudinal Study of Ageing (ELSA, 2012; n = 1,146) and the US National Health and Nutrition Examination Survey (NHANES, 1999-2006 and 2011-2018; n = 2,733). Sarcopenia and physical inactivity were defined using cohort-specific measurements and cutoffs. Within each cohort, six machine-learning algorithms were trained using 70/30 training-testing splits, Synthetic Minority Oversampling Technique to address class imbalance, and five-fold cross-validation for hyperparameter optimization. Model performance was evaluated using area under the curve, accuracy, precision, recall, and F1 scores. Shapley Additive Explanations quantified predictor contributions, and stratified analyses explored heterogeneity by age and body-composition strata.Findings: Random forest demonstrated optimal performance across both cohorts (area under the curve: 0.817 and 0.801; accuracy: 83.8% and 83.1%). Shapley Additive Explanations analysis revealed waist-to-height ratio as the dominant predictor, followed by age, frailty score, and poverty-income ratio. Stratified analyses showed heterogeneous risk patterns across age groups and body-composition categories.
AIM:This study aimed to explore the experiences of midwives providing care in primary care walk-in clinics (PCWCs) within refugee camps, examining the challenges they encounter, and the relevance the ORAMMA framework. BACKGROUND:Refugee camps present a complex environment for maternal care provision, due to limited resources, high population mobility, cultural and linguistic diversity, and increased psychosocial vulnerability among women. Midwives often being the primary providers of maternal care, must address both social and clinical needs. The ORAMMA framework was developed to support culturally sensitive and equitable maternity care for migrant and refugee populations. However, limited evidence exists regarding field experiences of ORAMMA-guided midwifery practice. METHODS:A qualitative study design was employed to capture midwives' in-depth experiences. Data were collected from 22 ORAMMA-trained registered midwives working in refugee camp PCWCs. Data were collected using semi-structured individual interviews (n = 15) and two focus groups (n = 7). Data were thematically analysed to identify recurring patterns and key themes. FINDINGS:Midwives reported persistent challenges, including inadequate infrastructure, shortages of essential medical supplies and disrupted care continuity. Language and cultural barriers limited effective communication, trust-building, and clinical decision-making. Despite these constraints, midwives demonstrated adaptability and professional resilience, through collaborative teamwork, creative problem-solving, and culturally sensitive care. ORAMMA training strengthened their confidence and awareness in providing care, although participants emphasised the need for enhanced material resources, interpreter services, and psychosocial support. Overall, findings highlight the value of ORAMMA-guided capacity-building to support midwives' resilience and commitment to quality care delivery.
BACKGROUND:Social prescribing (SP) is increasingly recognised as a key component of primary care, implemented in at least 25 countries by 2023. In England, SP has been nationally rolled out through Primary Care Networks (PCNs), though many areas, including Redbridge in East London, had pre-existing VCSE-led models. How national and local approaches integrate in practice remains underexplored. METHODS:This study used a two-step qualitative design. First, documentary analysis of service planning and evaluation documents mapped the SP referral pathway in Redbridge before and after the national rollout. Second, 16 semi-structured interviews were conducted with purposively sampled stakeholders from PCNs, RedbridgeCVS, the local authority, and the Clinical Commissioning Group, exploring service integration and delivery experiences. Data were analysed using the Framework Method, combining deductive coding against predefined themes with inductive identification of emergent categories. RESULTS:RedbridgeCVS was widely valued for its expertise, especially in managing complex cases, training link workers, and facilitating access to local services. However, integration across PCNs was inconsistent. Participants reported variation in GP engagement, referral processes, and support structures. PCN link workers faced capacity pressures, unclear role boundaries, and limited access to clinical supervision, affecting the sustainability and coherence of service delivery. CONCLUSIONS:Integrating national and local SP models requires clearer leadership, standardized referral pathways, and consistent support for link workers. Without greater alignment across primary care and VCSE partners, the full potential of SP risks being undermined. Link workers must be recognized and supported as core members of the primary care team.
Objectives: Older adults with multimorbidity (OAMM) commonly receive depression and pain management through primary care, where symptoms are typically assessed through retrospective recall. Even with validated questionnaires, recall bias has been reported in younger populations for both depression and pain. However, recall bias for depression and pain has not been explored in OAMM. We examined discrepancies between prospectively measured and recalled symptoms of depression and pain among OAMM.Methods: We analysed data generated from a 14-day pilot feasibility trial of ecological momentary assessment (EMA) in OAMM (N = 18, age range 67-95). We examined discrepancies between retrospectively assessed depression and pain intensity over two weeks compared to follow-up, baseline characteristics correlated with discrepancies, and recency effects.Results: We found overreporting across most symptoms, with the largest discrepancies between prospectively recorded and recalled symptom scores for pain intensity and fatigue (d = .49). There was no association between recalled and EMA-measured items for appetite and trouble sleeping. Pain intensity at day 14 was associated with discrepancies in recalled pain (r = -.52, p =.029), and both day 14 mood and negative self-thoughts were associated with discrepancies in trouble concentrating recall (r = -.67, p =.002 and p = -.72, p <.001, respectively) - suggesting recency effects.Conclusions: We found preliminary evidence of recall bias among OAMM, including overreporting and recency effects of pain and depression symptoms. Given the reliance on recall during primary care visits, more research is needed.
Experiences of healthcare services are an important indicator of quality and health system improvement. In correctional facilities, structural and contextual factors affect experiences of healthcare services and processes for voicing these experiences. This study explores barriers and opportunities for people in custody to voice their experiences of healthcare services in custody. We held four focus groups and one interview with people living in the community who had accessed, or tried to access, healthcare services while incarcerated in a provincial correctional facility in Ontario, Canada in the previous five years. Using template analysis, we developed four interacting themes related to expectations and experiences of healthcare, and of submitting complaints or asking for help: i) the system is not designed for healthcare, ii) gatekeeping and perceptions of 'deserving' healthcare, iii) impact of healthcare on other outcomes, and iv) calling the abyss. These factors affected perceptions of the potential efficacy of a patient feedback process, and how people in custody were likely to engage with it. Participants also identified five key features that should be components of any patient feedback processes. This study highlights challenges to patient-reported experiences of care in quality improvement work in restrictive environments and with incarcerated populations.
OBJECTIVES:Earthquake is a traumatic event with significant physiological and psychological effects, profoundly altering individuals' lives. This study aimed to determine the relationship between death distress and fertility intentions among women who experienced the Kahramanmaras earthquake in Türkiye on February 6, 2023. METHODS:This descriptive, correlational study included 294 married women residing in an earthquake-affected region of Turkey. We collected data using the Participant Information Form and the Brief Death Distress Scale. RESULTS:A total of 294 women participated in this study. The mean death distress score was 25.65 ± 7.46. The death depression dimension had the highest score among the subdimensions of the death distress scale (11.02 ± 3.61). Age, income level, pregnancy, number of children, extent of house damage during the earthquake, and experience of being trapped under debris were factors influencing death-related distress. Women who changed their fertility intentions had higher levels of death distress, anxiety, and obsession than those who did not change their fertility intentions. CONCLUSIONS:This study provides a new perspective for understanding post-earthquake changes in married women's mental health and fertility behavior. Death distress is a key factor that should be considered in planning post-disaster healthcare services for women.
Aim: We aimed to examine advice interactions among family physicians using social network analysis (SNA) by categorizing advice interaction according to the five advice dimensions.Background: Inter-individual interactions for information exchange is a powerful tool for the pursuit of solutions to issues. These interactions may involve advice-seeking.Methods: The whole network approach was adopted and face-to-face research was conducted with 139 family physicians. Data were analysed using social network software, UCINET and visualized using the NETDRAW software. To examine the multidimensional advice networks, the frequency, density, reciprocity (dyad) measures were used. The Quadratic Assignment Procedure was used in UCINET to measure the correlations between the dimensions of advice. The Girvan-Newman algorithm was used to examine clustering in the advice network.Findings: Density values in the advice dimensions were very low. This indicates that the network was sparse, with limited interactions among family physicians in terms of giving and receiving advice. The strength of the ties in the dimensions was realized through validation, solutions, problem reformulation, meta-information, and legitimization, respectively. The results showed that the relationships between the dimensions were moderately, positively and significantly correlated. The advice network exhibited high modularity. Family physicians tended to seek advice from colleagues at the family health centers where they worked. We presented a visual representation of advice networks in primary healthcare settings. Identifying multidimensional advice networks through social network analysis can provide insight into how information is disseminated among family physicians. Our findings could contribute to decision makers in developing solution-oriented processes.
Aim: To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK. Background: Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services. Method: Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0-16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss. Findings: Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3-6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.
Aim: The aim of our study was to understand how routine pharmacy practice was impacted during the COVID-19 pandemic and the consequences for patient access.Background: Community pharmacists are among the most accessible primary care providers, playing a vital role in primary care access for patients. During the COVID-19 pandemic, community pharmacists took on numerous additional roles to support safe primary care access. As health systems are in the latter stages of recovery from the pandemic, understanding how the pandemic impacted routine community pharmacy practice and the repercussions for post-pandemic practice is important.Methods: Between September 2020 and January 2021, we interviewed 11 pharmacists working in community pharmacies in Nova Scotia, Canada. We thematically analyzed qualitative data pertaining to pharmacists' perceptions of pandemic impacts on providers, patients, and pharmacy practice.Findings: The COVID-19 pandemic greatly impacted community pharmacy practice, patients, and community pharmacists. Participants recommended maintaining some of the community pharmacy practice changes and suggested that continuing to expand the scope of practice for pharmacists is essential to meeting population health needs moving forward. Pharmacists recognize and are willing to maintain the essential roles they have assumed in facilitating patient access to primary care. Decision-makers should consider providing the necessary supports (e.g., communication software) and funding support to enable the full scope of community pharmacist practice.
AIM:This study aimed to develop a European definition of Community Health Centres (CHCs) as a model of primary care, assess the acceptability and feasibility of this model among experts, and propose a common framework to guide CHC implementation across European countries. BACKGROUND:CHCs have existed in Europe for more than five decades and are increasingly recognized as effective models for delivering comprehensive, equitable and integrated primary care. Despite their established global presence, there remains a need to contextualize and define CHCs within Europe's diverse healthcare systems. METHODS:Building on the International Federation of Community Health Centres (IFCHC) definition, a refined version comprising 35 key statements was developed through expert consultations. A two-round Delphi study was conducted with 31 experts from 16 countries, using five-point Likert-scale questionnaires to evaluate the acceptability and feasibility of each statement. FINDINGS:All 35 statements were rated as acceptable and feasible (average value >3 on the five-point Likert scale). The most highly rated elements included respect for human rights, accessibility irrespective of socioeconomic status, interprofessional collaboration, and integrated, people-centred care. Although feasibility ratings were slightly lower than acceptability ratings, they improved in the second round, indicating increased consensus. Statements concerning governance, community participation, and responsibility for specific population subgroups received lower feasibility ratings. Overall, the findings demonstrate broad expert consensus on the relevance and adaptability of the CHC model within Europe. While some implementation challenges persist, particularly regarding governance, interprofessional collaboration, and intersectoral coordination, the proposed definition offers a robust foundation for strengthening primary care across diverse European contexts.
AIM:To assess the acceptability and appropriateness of remote patient monitoring and self-administered pulse oximetry among high-risk COVID-19 patients, triage centre staff, and study personnel in Tegucigalpa and Comayagüela, Honduras. INTRODUCTION:During the COVID-19 pandemic, the Honduras Secretariat of Health and partners conducted a randomized trial to assess the impact of remote patient monitoring with versus without self-administered pulse oximetry in high-risk populations in urban Honduras. Acceptability and appropriateness were examined to inform future intervention adaptation. METHODS:This mixed-methods study included trial participants, study and triage centre staff. Data sources include trial data, computer-aided self-interviews, and in-depth interviews. The trial ran from March 2022 to January 2023. FINDINGS:1767 participants completed a disenrollment questionnaire. Thirty-four providers completed a self-interview, and 16 participated in an in-depth interview. Respondents understood interventions and expressed positive attitudes; SESAL staff attitudes were less positive. 94.9% of participants reported willingness to participate again. Some staff expressed concern over participant comprehension and pulse oximeter self-administration, but participants reported successful use. Providers were confident implementing the intervention, but some questioned its appropriateness given competing priorities. Overall, study participants and healthcare providers believed interventions were an acceptable way to monitor for deterioration during the acute phase of a COVID-19 infection. Findings showed that an intervention can be acceptable, but appropriateness may be less clear-cut due to competing priorities. The approach shows promise for adaptation to other settings experiencing health emergencies where technology penetration is high and healthcare availability does not align with demand; appropriateness considerations should be explored prior to implementation.
