The integration of social media into medical education offers significant opportunities for learning but also introduces distinct challenges for students. This study aimed to explore the strategies employed by undergraduate medical students at a private medical college in Pakistan to develop digital resilience while using social media platforms for educational purposes. A qualitative case study design utilizing individual semi-structured interviews was conducted from September 2024 to February 2025, after obtaining ethical approval and written informed consent. Participants included 25 undergraduate medical students from all five years of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program at ABWA Medical College, a private medical institution in Faisalabad, Pakistan. The interviews were audio-recorded and transcribed, followed by participant verification of transcripts (member checking) to confirm the accuracy of the recorded accounts. Two researchers independently generated initial codes, followed by collaborative theme development, to identify strategies used by medical students to develop digital resilience. The findings revealed distinct cross-sectional patterns in the strategies reported by students from different academic years. First-year students emphasized supplementary use of YouTube and peer resource sharing, while second-year students focused on time and task management. Third- and fourth-year students described device management, selective curation, and strategic integration of digital resources, whereas final-year students emphasized boundary setting, non-digital learning, and well-being practices. These differences represent comparisons between academic-year groups at one point in time and should not be interpreted as developmental progression within individual students. The cross-year patterns informed the proposed Digital Resilience (DR)-Compass exploratory conceptual model. Medical students from different academic-year groups described varied approaches to digital resilience, ranging from basic adaptation and peer-supported learning to self-regulation, selective engagement, boundary setting, and well-being practices. Because the study was cross-sectional, these differences do not establish developmental progression over time. The proposed DR-Compass organizes the case-derived findings as an exploratory conceptual model of personal capacities, behavioral strategies, and available support rather than a validated developmental pathway. Larger multicentre and longitudinal studies are required to examine its transferability, structure, and validity.
Chronic refractory breathlessness is distressing, disabling, and common in advanced disease. Unpaid/family carers provide support for patients, but often lack knowledge and confidence, experiencing anxiety which can lead to crises. The Learning about Breathlessness programme (LaB) sought to address this. Working with carers and clinical experts, the LaB1 Study identified six topics carers of patients with breathlessness due to cancer or chronic obstructive pulmonary disease (COPD) want to learn about breathlessness, and how they want to learn. To accommodate carers’ varied learning preferences a web-based educational intervention was proposed, with four delivery modes: self-accessed, or accessed via peer-led support groups, established clinician-led groups, or in clinician one-to-ones. The 2-stage LaB2 Study sought to co-develop the web-based resource, suitable for these delivery modes and mapped to carers’ learning needs identified in LaB1. Building on LaB1, website content was co-developed iteratively through qualitative interviews, focus groups and workshops with bereaved carers, current carers, and patients living with breathlessness due to cancer or COPD (n=24), and with a Carer Advisory Group and Study Advisory Group (included clinical experts) (Stage 1). User feedback on the prototype website was then collected from carers, patients and clinicians (n=16) using ‘think-aloud’ interviews enabling website refinement through an iterative process (Stage 2). The co-developed web-based resource, “Supporting Someone with Breathlessness”, covers the six topics carers wanted to learn about and is designed to meet cancer/COPD carers preferences in terms of ways of learning. As such it includes words, pictures, film clips of peer carers and clinical experts, links to other resources and downloadable leaflets. Carers, patients and clinicians confirmed content utility and acceptability and suggested enhancements which enabled refinement. User feedback suggested the utility of the four potential delivery modes. To the best of our knowledge, “Supporting Someone with Breathlessness” is the first website dedicated to meeting the needs of unpaid/family carers of people with breathlessness in advanced disease: https://supporting-breathlessness.org.uk/ . The content and format of this nationally endorsed web-based resource were guided by an evidence base of carer educational need and learning preferences. Design features ensure content is accessible for those without digital access.
Abstract Background Inappropriate prescribing in primary care is a major cause of morbidity, hospitalizations, and mortality worldwide. While Clinical Decision Support Systems (CDSS) have been developed to assist general practitioners (GPs) in optimizing medication management and improving patient safety, evidence on the health economic impact of medication-related CDSS remains limited and inconclusive. Therefore, this health economic evaluation alongside a stepped-wedge cluster-randomized controlled trial assessed the costs and cost-effectiveness of a CDSS-supported medication review implemented in German GP practices compared to standard care over up to 14 quarters. Results Overall, from a payer’s perspective, the intervention was associated with non-significant mean cost savings of -7.2 € per patient per quarter in total healthcare costs (95% CI: -109.7 to 95.3; p = 0.891). Whereas outpatient costs with 9.3 € (95% CI: 1.9 to 16.6; p = 0.014) were significantly higher in the intervention group (IG), inpatient costs and pharmaceutical costs were non-significantly lower in the IG, resulting in cost differences of -19.9 € (95% CI: -90.6 to 50.8; p = 0.581), and − 15.8 € (95% CI: -42.1 to 10.5; p = 0.238), respectively. The cost-effectiveness analysis, reporting incremental cost per 1% point reduction in the risk ratio, indicated substantial uncertainty, with the probability of cost-effectiveness not exceeding 62% at the highest willingness-to-pay threshold tested. Conclusions These findings are consistent with recent evidence showing uncertain economic benefits of CDSS interventions. Limited uptake of the CDSS in this trial likely constrained its effectiveness. Future research should therefore adopt more comprehensive evaluations integrating clinical, economic, and implementation perspectives to better understand the contextual factors and mechanisms under which CDSS interventions can generate its full impact. A better understanding of these factors will inform strategies to enhance adoption, effectiveness, and economic efficiency of CDSS in medication management. Trial registration ClinicalTrials.gov NCT03430336. Registered on 2018/02/06.
Primary health care (PHC) in rural Sub-Saharan Africa (SSA) faces persistent challenges, including workforce shortages, inadequate infrastructure, and geographic isolation. Digital health technologies offer opportunities to strengthen PHC delivery; however, evidence on their implementation remains fragmented. This systematic review synthesized evidence on digital health technologies for rural PHC in SSA, examining the technologies implemented, their benefits, and implementation challenges. Following PRISMA 2020 guidelines, PubMed, Scopus, and Google Scholar were systematically searched for studies published between 2015 and 2025. Studies evaluating mobile health, telemedicine, electronic health records, DHIS2, and artificial intelligence in rural PHC settings were included. Two independent reviewers screened 967 records, and methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklists. Data from 35 studies were synthesized using a structured narrative synthesis. Thirty-five studies from 18 SSA countries were included. Mobile health and DHIS2 were the most frequently implemented technologies. Digital health interventions improved healthcare access, treatment adherence, maternal and child health services, and health information management. Three implementation patterns emerged: differential adoption according to health system readiness, a persistent gap between successful pilot implementation and sustainable scale-up, and the interdependence of infrastructure, workforce, governance, and financing challenges. Benefits were greatest where enabling health system conditions were already in place. Digital health technologies can strengthen rural PHC in SSA but are not a standalone solution. Their effectiveness and sustainability depend on health system readiness, including adequate infrastructure, workforce capacity, governance, and sustainable financing. However, evidence on long-term sustainability, cost-effectiveness, equity impacts and pathways to scale remains limited. Addressing these evidence gaps will support equitable and sustainable digital health implementation.
While cloud-based Electronic Health Records (EHRs) are crucial to improving service quality and operational efficiency, uptake is still variable across low-income and middle-income countries (LMICs). There is a significant research gap in Nigeria in terms of empirical evidence on the actual maturity of the implemented systems and the specific performance constraints affecting the effective use of the system. This study aimed to assess the adoption status and operational maturity of EHR systems in Nigerian healthcare facilities. An exploratory sequential mixed methods design was used for this study to diagnose the EHR landscape in Nigeria. Primary data were collected through a structured survey of 26 healthcare facilities in 11 states and secondary institutional data were obtained from 130 facilities to serve as a national baseline. The analysis included descriptive statistics, Chi-square tests (χ²) and systems-engineering tools, such as Pareto analysis, Fishbone (Ishikawa) diagrams and the Technology Acceptance Model (TAM) framework, for prioritizing bottlenecks and assessing user acceptance. A substantial ‘socio-technical gap’ was found: though 75
