Abstract BackgroundThis study presents a novel virtual health-humanities approach to collaborative online international learning, developed and delivered between 2023 and 2025. The approach, which we describe for the purposes of this study as a “Health Humanities Global Classroom” (HHGC), aimed to raise health professions students’ awareness of intercultural perspectives, potentially fostering more interculturally attuned health professionals. In the HHGC, students across 3 international universities participated synchronously in a virtual object-based learning seminar using shared teaching expertise and digitized artworks and museum objects drawn from the universities’ diverse art and cultural collections. ObjectiveThis mixed methods research study aimed to assess the HHGC’s impact on encouraging a deeper awareness of intercultural perspectives in participants. MethodsA mixed methods study was conducted, involving 58 health professions students from universities in Australia, Singapore, and Hong Kong in February 2025 and March 2025. All students participated in a 2-hour online seminar with the theme of global health and well-being, during which they undertook guided exploration of virtual museum objects and artworks. Data on students’ seminar experiences were collected through presurveys and postsurveys, written reflections created during the seminar, and online focus groups conducted immediately afterward. ResultsAll 58 students participated in the focus groups. Among the participants, 84% (49/58) completed the postseminar survey; 96% (47/49) agreed that the seminar increased their awareness of how they communicate and exchange meanings with peers from diverse cultures; 98% (48/49) agreed that engaging with the museum objects in the seminar with peers heightened their awareness of diverse perspectives; and 86% (42/49) agreed that the seminar increased their awareness of local health in interprofessional contexts. Four primary themes were identified through qualitative analysis, including (1) key learning outcomes (intercultural, analytical, and empathic capacities, and knowledge acquired), (2) enabling factors (pedagogy, environment, and peer interaction), (3) barriers to learning (pedagogical approach, learning resources, time factors, and virtual constraints), and (4) novel and distinctive experiences (international, arts-integrated learning). ConclusionsThis study provides early evidence for an innovative and accessible pedagogical approach. The HHGC is promising as a valuable educational activity, with positive student engagement in a safe environment for intercultural dialogue mediated by virtual museum objects and artworks. This approach may be useful to enhance participants’ awareness of cultural humility.
Abstract BackgroundTabletop exercises (TTXs) are commonly used to enhance prehospital readiness for mass casualty incidents (MCIs). However, evidence on their design, facilitation, and evaluation remains scattered. TTXs simulate organized interactions at 3 levels: among individual responders and response protocols, within interdisciplinary teams, and across organizations and systems. While existing reviews cover tabletop simulation generally, they do not specifically focus on the prehospital MCI interface or assess whether evaluation methods match the exercise objectives. ObjectiveThis scoping review aimed to explore how TTXs are designed, facilitated, and evaluated in prehospital MCI preparedness. It classified outcomes using the Kirkpatrick Evaluation Model and analyzed how evaluation methods align with the purpose of each exercise. MethodsWe performed a scoping review following Arksey and O’Malley’s framework, with enhancements from Levac et al, along with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and PRISMA-S (PRISMA Extension for Reporting Literature Searches) guidelines. Searches across PubMed, Embase, Scopus, PsycINFO, CINAHL, the Cochrane Library, ClinicalTrials.gov, Google Scholar, and references were limited to English peer-reviewed and gray literature published from 2015 to May 2026. Eligible studies focused on TTXs related to prehospital disaster or MCI preparedness and reported measurable educational, clinical, or system outcomes. The review protocol was registered beforehand on Protocols.io. Two reviewers (PP and AA) independently screened records, extracted data, and classified outcomes using Kirkpatrick levels, with an added level 2+ (Applied Learning) category for structured performance evaluation during exercises. ResultsThirteen studies from 9 countries were included. They were categorized into a preliminary 3-tier typology called the TTX Design Spectrum, representing increasing levels of interaction: algorithm-rehearsal exercises (n=2) focused on individual responders’ interaction with triage protocols, scenario-based decision-training exercises (n=7) aimed at multidisciplinary team decision-making under realistic conditions, and systems integration exercises (n=4) centered on interagency coordination and system-level preparedness. Facilitation varied by exercise purpose, from standardized assessment-focused approaches to expert-led and multidisciplinary facilitation. Evaluation primarily targeted Kirkpatrick level 1: Reaction (n=10), level 2: Learning (n=10), and level 2+ (Applied Learning) (n=8), with fewer studies examining level 3: Behavior (n=2) or level 4: Results (n=3). Operational frameworks were reported more consistently than formal educational design or assessment frameworks. Additionally, natural disaster scenarios and evidence from resource-limited settings were underrepresented. ConclusionsTTXs for prehospital MCI preparedness should be viewed as a collection of related exercise types rather than a single, uniform intervention. This review introduces an initial typology called the TTX Design Spectrum, along with the level 2+ (Applied Learning) classification, which operationalizes the distinction between in-training performance and behavioral transfer. These tools aim to help align exercise purpose, facilitation, and evaluation strategies. Future research should focus on validating this typology, enhancing follow-up assessments of behavioral transfer, and adapting TTX design for natural disaster and resource-limited settings.
Abstract Background Intervention studies frequently report that fewer than half of adolescent participants complete digital health interventions as intended, yet a systematic synthesis of the factors driving this low adherence across lifestyle domains is lacking. Understanding these factors is essential for informing the design of interventions that can sustain adherence and achieve meaningful behavioral outcomes. Objective This systematic review identified and analyzed factors influencing adherence to digital health interventions targeting key adolescent lifestyle domains: physical activity, dietary habits, obesity management, alcohol consumption, and tobacco use. Methods We systematically searched PubMed, PsycINFO, Embase, and CINAHL in March 2024, with the search updated in June 2026, for studies of digital interventions targeting adolescents (10‐19 years). Studies were included if they reported adherence outcomes. Data on intervention characteristics, user-related factors, and adherence outcomes were extracted and narratively synthesized using a framework distinguishing intervention-related and user-related factors across 3 evidence types (statistical, descriptive, and qualitative). Study-level attrition was additionally pooled in a random-effects meta-analysis. Results A total of 116 studies, comprising 46,029 participants, were included. The average completion rate (binary measure) was 66.9% (SD 26%), while average adherence to individual intervention components was 55.2% (SD 25.5%). A meta-analysis of attrition across 108 comparisons yielded a pooled dropout of 16.9% (95% CI 13.6‐20.9), with very high between-study heterogeneity and no significant moderators. Consistently reported facilitators included personalization, user-friendly design, reminders, goal setting, gamification, and human support (particularly health coaching and parental involvement). The most common barriers were technical difficulties and poor system usability. Evidence regarding the effects of intervention duration and social components on adherence was inconsistent. Conclusions Given that adolescents frequently underuse digital health interventions, completing only about half of intervention components on average, the effectiveness of these interventions is fundamentally constrained by adherence challenges. Adherence is primarily driven by user-centered design features and robust technical performance, while the impact of social and user-related factors varies by health domain and study context. Future research should adopt standardized adherence frameworks and reporting standards to enable meaningful cross-study comparisons and the development of evidence-based engagement strategies.
