Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.

Purpose: Aboriginal and Torres Strait Islander Peoples (hereafter First Peoples) define health and wellbeing as grounded in Country, yet institutionalised national health systems in Australia rarely recognise or resource cultural medicines. Cultural medicines, such as smoking ceremonies, being on Country, and engagement with traditional healers are central to health sovereignty; however, most research has examined traditional, complementary and integrative medicines without focusing on cultural medicines or equity of access. This study reports the first Australia-wide exploratory survey of cultural medicines utilisation, access and intention to use among First Peoples in Australia. Methods: This exploratory, cross-sectional study formed part of a national co-design project on cultural medicines in healthcare. A co-design research group adapted the I-CAM-Q instrument to reflect cultural medicines using iterative, culturally governed co-design. An online survey of First Peoples aged 18 or more years was disseminated through the co-design research group's networks and social media between December 2023 and January 2024. Demographic characteristics and responses on utilisation, access and desire to use cultural medicines were analysed descriptively, with attention to unmet needs and access barriers, and interpreted as exploratory, given the likely under-representation of older knowledge holders, men and people in remote communities. Main findings: A total of 186 First Peoples adults participated (81.7% female; predominantly aged 30–49 years). Demand for cultural medicines was high but access was limited. Only 9.7 per cent reported easy access to traditional healers, yet over 94 per cent of those without access indicated that they would use healers if available. Use of Country as medicine and smoking ceremonies were most common, while song-based ceremonies, insect-based native foods and traditional healers showed lowest engagement. Respondents preferred accessing cultural medicines through Aboriginal community-controlled health services. Most wanted family members to have access to healing ceremonies for grieving as part of their end-of-life care (i.e. palliative care). Only a small minority did not want access to cultural medicines. Principal conclusions: Cultural medicines remain a critical yet under-supported health practice for First Peoples in Australia. Despite limited access, these findings demonstrate strong intent to use cultural medicines and unmet need linked to structural barriers in the health system. Ensuring health equity requires culturally safe healthcare models that respect and integrate cultural medicines under First Peoples’ governance, supported by policy frameworks that protect Indigenous knowledges and uphold health sovereignty and Indigenous rights.

Purpose First Peoples in Australia tend to have shared holistic understandings of health and wellbeing that emphasise strong interconnections among family, community, culture and Country. Central to this holistic health framework is First Peoples’ cultural medicines, which most First Peoples use or want to use, and have been used for millennia to heal the bodies, minds and spirits of First Peoples. This review aimed to explore and document the inclusion and representation of cultural medicines across national level policies and practice guidelines for health professionals. These policies intend to support effective and appropriate healthcare for all Australians, including First Peoples. Methods Australian national health policies that guide the practice of Australian Health Practitioner Regulation Agency registered health professionals and Aboriginal and Torres Strait Islander health workers/Indigenous liaison officers were systematically reviewed to explore their representation of cultural medicines in these policies. The review was informed by Indigenous critical discourse analysis that was modified to suit the review context. National level health policies from March to June 2023 were mapped and 52 policies eligible for inclusion were identified. Policies were downloaded and imported into NVivo for analysis. NVivo text search queries were conducted and nine policies were found to include any content about cultural medicines. Main findings Three overarching themes were found: 1) Absence of national leadership; 2) Disproportionate onus placed on Aboriginal and/or Torres Strait Islander health practitioners; and 3) Lack of detail and actionable directives. There was a distinct lack of representation of cultural medicines in national health policies, with most of these policies not providing any clear guidance for health professionals. The responsibility was too heavily placed on First Peoples health professionals to lead the healthcare related to cultural medicines. Principal conclusions The significant lack of national leadership and actionable directives around cultural medicines is concerning. To uphold cultural safety and the rights of Australia’s First Peoples, it is critical to have clear policy guidance, resources and training that support all Australian health professionals to engage with cultural medicines and see it as part of their responsibility.

ObjectiveThis scoping review aimed to synthesise research on the relationships between health literacy and adherence to physical activity guidelines in adults.Data SourceA search of MEDLINE, ProQuest, Scopus, CINAHL, Web of Science (Core Collection), PubMed, and PsycINFO was conducted using keywords. Observational and intervention studies written in English were reviewed.Inclusion and Exclusion CriteriaEligible research studies used a validated, objective measure of health literacy. Physical activity needed to be reported as either a primary or secondary outcome, and groups needed to be dichotomised as physically active, inactive, or similar.ExtractionOut of 2098 articles identified, 19 met the inclusion criteria.SynthesisA numerical analysis of the studies was performed. A narrative summary supplemented the analysis to synthesise the main themes and patterns.ResultsFifteen studies examined the association between total health literacy scores and achieving >150 minutes of moderate-to-vigorous physical activity weekly. Nine studies reported a positive association, while others found no significant association. In particular, studies using self-reported physical activity more frequently found an association, whereas no association was found when using objective physical activity measures.ConclusionThe findings of this review were inconclusive. The lack of a standardised health literacy instrument presents a barrier to progress in the field of physical activity and health literacy research. Moreover, longitudinal relationships between health literacy, mediators and physical activity must be investigated.

The success of a public health response to an infectious disease outbreak depends on the public perception and attitude towards its risks and the significance of preventive approaches. Understanding public perceptions and attitudes is critical, especially for the migrant population. Our study explored African migrants’ perceptions and attitudes towards the COVID-19 pandemic and its public health response in New South Wales (NSW), Australia. We employed an inductive, qualitative research design. We conducted semi-structured, in-depth interviews with 21 African migrants across New South Wales. We analysed our data thematically. Our findings suggest that African migrants were sceptical about the severity of COVID-19 and Australia’s public health response. Such scepticism was enhanced by conspiracy theories, mixed messaging, poor community engagement, and perceived racial and cultural hyper-policing of African migrants during the pandemic, which affected the uptake of the COVID-19 response intervention. Vaccine hesitancy was also seen to be underpinned by apprehensions about efficacy and safety, and the need for boosters. Such concerns were deepened by mistrust of government authorities and initiatives. African migrants in NSW interpreted COVID-19 and its response through an Afrocentric lens. Misinformation and distrust hindered vaccine uptake, highlighting the importance of community engagement in public health initiatives to build trust and counter misinformation.

Background: Since 1978, the World Health Organization (WHO) has repeatedly called on Member States to recognize the role of traditional and complementary medicine (T&CM) in primary healthcare, improve safety, and accessibility by governing T&CM. In the 2019 Global Report on T&CM, the WHO reported that 40 out of 47 (85%) Member States from African Region had enacted governance policies, and 20 out of 47 (43%) had regulatory policies on herbal medicines. The primary barriers to implementing T&CM policy were identified as an absence of data and inadequate financial support for research. The objective of this protocol was to detail how to perform a scoping review that will examine the policy, legislative, and regulatory landscape for T&CM practitioners and products in sub-Saharan Africa.Methods: Databases will be searched (AMED, CINAHL Plus with Full Text, MEDLINE Plus with Full text, Web of Science, Scopus, PubMed, Google Scholar) for relevant articles. Searches will be limited to English, French, Portuguese, and Spanish language studies in peer-reviewed journals (1963-2023) that substantively report on legislation, bills, policies, governance approaches and regulations on T&CM (including successes and/or challenges in their design and implementation). Actual legislation, policies, and regulatory documents on T&CM and peer-reviewed studies with emphasis on integrating T&CM and biomedicine into healthcare systems will be excluded.Expected Outcomes: This protocol has formulated the objectives for a scoping review to identify, map, and synthesize evidence on the governance of T&CM in sub-Saharan Africa.

Objective: To examine the relationship between health literacy and adherence to physical activity guidelines. Methods: In line with the Joanna Briggs Institute framework, we conducted a scoping review of the literature. Results: Out of 2,098 articles identified, 20 met the inclusion criteria. The studies utilised various health literacy measurement tools, with the European Health Literacy Survey being used the most. Fifteen studies examined the association between total health literacy scores and achieving >150 minutes of moderate-to-vigorous physical activity weekly. Nine studies reported a positive association, while others found no significant association. In particular, studies using self-reported physical activity more frequently found an association, whereas no association was found when using objective physical activity measures. Conclusions: The findings of this review were inconclusive. The lack of standard health literacy instruments and reporting presents a barrier to the field of knowledge progressing. Moreover, longitudinal relationships between health literacy, mediators and physical activity need to be investigated. Implications for public health: Policymakers should be cautious about using health literacy as the main focus of programs that aim to increase population physical activity ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

INTRODUCTION:Active duty military personnel and veterans have unique and complex health needs, with the high demands of military life often leading to chronic physical and mental health conditions. Complementary and integrative medicine (CIM) could be a possible solution to this problem. Some military health systems have started integrating CIM into health care delivery. However, there has been no systematic evaluation of the prevalence and utilization of CIM in military and veteran populations globally. MATERIALS AND METHODS:A Preferred Reporting Items For Systematic Reviews and Meta-Analysis Protocols protocol was used to systematically search for original research assessing the prevalence and utilization of CIM among active serving military or veterans. CINAHL, MEDLINE, Scopus, and AMED databases were searched up to February 3, 2023. RESULTS:A total of 27 studies met the inclusion criteria and were included in this review. The overall quality of evidence was high with a low risk of bias. Utilization of CIM varied. The lowest utilization demonstrated that only 1.9% of services delivered by military health system were CIM. The majority of studies found utilization rates between 30% and 80%, with some studies reporting use as high as 90%. The most commonly used CIM therapies included chiropractic care, massage, mindfulness/meditation, and acupuncture. Utilization of CIM products was high and ranged from 32% to 87%. The most frequently used products were dietary supplements, particularly multivitamins and minerals and protein supplements/amino acids. The use of herbal products was high among veterans ranging from 10% to 79%. CONCLUSIONS:The high demand for CIM by military personnel and veterans has important implications for policy, funding allocation, and integration of these services into clinical practice, particularly by countries not currently doing so. Further research is needed to assess the implementation of CIM into real-world settings to explore barriers and facilitators for their use in clinical practice and, by extension, their integration into the wider health care system.

Background: The 2018 Declaration of Astana acknowledges the need to include traditional, complementary and integrative health care (TCIH) knowledge and technologies within primary health care. The World Health Assembly has also called member states to integrate TCIH into national healthcare systems. However, little attention has been given to developing supportive resources for this process in practice, policy, research and education. Methods: This study employed Delphi methodology to refine a framework for the evaluation and implementation of text-based traditional knowledge in contemporary health contexts. An international sample was recruited of expert participants with experience in a diversity of settings and disciplines. Framework items were retained, removed or modified based on participant consensus agreement on the importance of each item (consensus set at ≥75 per cent agreement), and mapped for comprehensiveness against an implementation framework. Findings: The initial survey round was completed by 19 participants and the second round by 15 participants. Most participants (n=15) held TCIH qualifications, representing six TCIH professions in total (naturopathy, Western herbal medicine, osteopathy, traditional Chinese and Oriental medicine, Ayurveda, and homeopathy). Participants typically had experience in multiple contexts across clinical practice, research, education and policy development. Consensus was achieved after two rounds and the resulting framework included three sections comprising guiding principles (five items), critical appraisal criteria (three items) and application criteria (eight items). Conclusions: As the international health community increasingly recognised the potential value and importance of TCIH knowledge and technologies, this Contemporary Implementation of Traditional knowledge and Evidence (CITE) Framework provides a timely and much-needed practical guide to rigorous and respectful traditional knowledge implementation.

Optimal diet and nutrition is vital for military readiness, performance and recovery. Previous research on military diets has primarily focused on the nutritional composition of field/combat rations and dietary intake during deployment. There is accumulating research exploring the usual free-living dietary intake and nutritional status of defence members in garrison (i.e. military bases on which personnel are stationed). However, no comprehensive review has been conducted to assess the overall dietary quality of defence members internationally. Therefore, this review assessed the diets of military populations against national nutritional guidelines and Military Dietary Reference Intakes (MDRI). A systematic literature review of original research was conducted. CINAHL, Medline (EBSCO), Scopus (Elsevier), PubMed and AMED databases were searched up to the 20/02/2023. A total of thirty-six studies met the inclusion criteria. The overall quality of included studies was high, with a low risk of bias. The diet quality scores indicate poor to fair diet quality among defence members. Defence members display low intakes of fruits, vegetables, wholegrains, seafood, plant protein and nuts and high intakes of added sugars, trans fat and processed meat. Results also indicated suboptimal intake of fibre, essential fatty acids, vitamin A, vitamin E, folate, Mg, Zn and iodine. This may lead to reduced performance, increased risk of chronic diseases and mental health disorders. More research is needed to assess the long-term consequences of poor diet quality in defence members. These results require the attention of policymakers to ensure that military education and food environment is supportive of healthy eating.

Background A nationwide assessment of the link between women’s empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women’s empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. Method We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15–49 years who gave birth in the five years preceding the survey were included. Outcome variable was “home birth of their last child among women in the five years preceding the 2019 SLDHS. Women’s empowerment parameters include women’s knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. Results Three in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43–2.92] and medium [aOR 1.44; 95%CI 1.05–1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51–2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women’s decision-making power and home birth [aOR 1.11; 95% CI 0.86–1.41]. Conclusion Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.

Introduction: The 1978 Alma Ata Declaration initiated international recognition of non-biomedical healing systems and their relevance for primary health. World Health Assembly (WHA) resolutions have called for the study and inclusion of traditional and complementary medicine (T&CM) into national health systems through policy development. The increased public, political, and scholarly attention given to T&CM has focused on clinical efficacy, cost-effectiveness, mechanisms of action, consumer demand, and supply-side regulation. Although >50% of WHO member states have T&CM policies, scant research has focused on these policies and their public health implications. This paper defines a novel term "therapeutic pluralism," and it aims at characterizing related policies in Latin America.Methods: A qualitative content analysis of Latin American therapeutic pluralism policies was performed. Policies' characteristics and the reported social, political, and economic forces that have made possible their development were assessed. Pre-defined policy features were categorized on an MS-Excel; in-depth text analyses were conducted in NVivo. Analyses followed the steps described by Bengtsson: decontextualization, recontextualization, categorization, and compilation.Results: Seventy-four (74) policy documents from 16 of the 20 sovereign Latin American countries were included. Mechanisms for policy enactment included: Constitution, National Law, National Policy, National Healthcare Model, National Program Guideline, Specific Regulatory Norms, and Supporting Legislation, Policies, and Norms. We propose a four-category typology of policy approaches in Latin America: Health Services-centered, Model of Care-based, Participatory, and Indigenous People-focused. Common themes countries used when justifying developing these policies included: benefits to the health system, legal and political mandates, supply and demand, and culture and identity. Social forces these policies referenced as influencing their development included: pluralism, self-determination and autonomy, anticapitalism and decolonization, safeguarding cultural identity, bridging cultural barriers, and sustainability.Conclusion: Policy approaches to therapeutic pluralism in Latin America go beyond integrating non-biomedical interventions into health services; they offer perspectives for transforming health systems. Characterizing these approaches has implications for policy development, implementation, evaluation, international collaboration, the development of technical cooperation tools and frameworks, and research.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Background: The 2018 Declaration of Astana identifies traditional knowledge (TK) as one of the drivers for strengthening primary health care systems through the use of technology (traditional medicines) and knowledge and capacity building (traditional practitioners). While TK underpins both traditional practice and the use of traditional medicines, facilitating the use of TK in contemporary health care systems has been difficult to achieve. The aim of this study was to identify key factors related to the translation of TK into contemporary settings to help establish tools to support the knowledge translation process. Methods: This study used World Café methodology to collect the observations, ideas, and perspectives of experts who use TK in their practice. These experts (n = 9) were from a variety of contexts, including clinical practice, research, education, policy, and consumer advocacy, participated in the 1-day event. Data were collected into NVivo 12 software and analyzed using inductive-deductive thematic analysis. Results: Thematic analysis identified five themes: the need to define the elements required for critical evaluation of sources of TK as evidence, the importance of applying a tradition-centric lens when translating TK for contemporary use, the need to bridge gaps between TK and its contemporary applications, the value of critically evaluating the TK translation process itself, and the recognition of traditions as living systems. Taken together, the themes showed holistic interpretation of the translation process that incorporates critical analysis of the TK itself and accountable, transparent, and ethical processes of translation that consider safety, socioeconomical and intellectual property impacts of TK in contemporary use. Conclusions: Stakeholders identified TK as a valid and important source of evidence that should guide practice in a range of contemporary settings (e.g., policy and clinical practice), and outlined important consideration for critiquing, evaluating, communicating, and using TK within these settings.