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.
Effective referral systems are essential for timely and equitable access to preventive and health promotion services. However, limited evidence exists on how referral flows are perceived to be appropriate and functional across sectors. This study aims to investigate how referral practices from general practitioners (GPs), hospitals, and municipal staff to municipal preventive and health promotion services are perceived and experienced in municipalities, with a focus on actor-specific challenges and municipal strategies to address them. This nationwide sequential mixed-methods study combined a survey of municipal health directors (response rate 98
This study aims to examine differences in disease burden between informal caregivers and non-caregivers using claims data, with a particular focus on mental disorders and on characteristics related to high morbidity. The study applied a retrospective observational design using claims data from two major German statutory health insurance funds. We identified 139,002 informal caregivers based on caregiving-related insurance records and compared them to 272,716 insured individuals without official caregiving responsibilities. The analysis assessed morbidity based on documented diagnoses coded according to the International Classification of Diseases. Disease categories included mental and behavioral disorders, musculoskeletal disorders, cardiovascular diseases, and other major diagnostic groups. We calculated odds ratios with 95
