Background Despite Australia’s universal health insurance scheme, Medicare, out-of-pocket costs (OOPC) for health care comprises 14 % of total health expenditure. People with chronic conditions spend a greater proportion of their incomes on health care than people without a chronic condition. Objective To review the qualitative literature examining experiences of OOPC of out-of-hospital care by people with chronic conditions and to discuss this in relation to current Australian health policy. Methods Systematic review and narrative synthesis of the qualitative literature examining OOPC for people with chronic conditions in Australia. Search: Pubmed, CINAHL Complete, Cochrane Library, PsycINFO and EconLit databases from 1999 to 10th April 2025. Results 37 studies met the inclusion criteria. Reduced or lost employment due to ill-health led to income loss, aggravating the financial burden of health management. While many people were able to access bulk-billing general practitioners, challenges in affording upfront and copayments for medical and allied health consultations, and medication costs were reported. Cost was the greatest barrier to accessing dental care. Trade-offs were described between health management and meeting basic living needs, particularly for people who earned too much to qualify for government welfare payments. Conclusion While Australian health policies effectively reduce the financial burden of health care for many people, distinct challenges exist for groups ineligible for concessional thresholds. Future research to identify the priorities and preferences of people with chronic conditions can further inform policy to improve the equity of health financing in Australia.

Background: The oral health status of older people living in residential aged care facilities (RACFs) is found to be very poor. Many oral health promotion interventions have been tested in RACF settings around the world with varying degrees of success. Aim: The aim of this systematic review is to analyse the health promotion strategies used in oral health promotion interventions in RACF settings and map the behaviour change techniques (BCTs) used in interventions to the Behaviour Change Techniques Taxonomy Version 1 (BCTTV1). This will help us identify the BCTs that are used and how effective they are in improving oral health outcomes for residents and the knowledge, attitudes and skills of caregivers in providing mouth care assistance to residents of RACFs. Methods: A database search was conducted in MEDLINE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews (CDSR), EMBASE, PsycINFO, CINAHL and Web of Sciences databases to screen for articles relevant to the topic of the review; after full-text review a total of 31 articles comprising both randomised controlled trials and non-randomised intervention studies were included in this review. Risks of bias in randomised studies were assessed using the ROB2 tool and ROBINS-I was used to evaluate non-randomised studies. The description of intervention content in each study was coded for the presence of BCTs by two independent review authors trained in coding BCTs according to BCTTv1. Results: The most commonly used BCTs were 'demonstration of behaviour', 'instruction on how to perform behaviour' and 'credible source'. These BCTs were effective in improving oral health outcomes and knowledge of caregivers on short-term follow-up. A higher number of BCTs were coded in studies that showed significant improvement in oral health outcomes of residents on long-term follow-up with rarely used BCTs related to 'monitoring and feedback' being coded in majority of studies that showed consistent improvement in oral health outcomes of residents. Conclusion: This review identified the most commonly used BCTs used in health promotion interventions to improve oral health among older people in RACFs and found that majority of interventions were targeted towards 'knowledge transfer' and were inconsistent in improving oral health outcomes for residents over long-term. Well conducted studies with use of theoretical behaviour change frameworks to develop oral health promotion interventions are needed as majority of strategies used currently do not demonstrate consistent effectiveness in improving oral health outcomes for residents of RACFs.

Background: Essential services ensure the health, safety, and well-being of individuals and their communities. However, there is currently a lack of consensus on what constitutes an essential service in Australia. This gap hinders a detailed spatial understanding of essential service provision, access, and influence on populations. This systematic review critically assessed the literature on essential services and their impact on quality of life to understand service definitions and their relative contributions to quality of life. Methods: A systematic search of ten databases was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Five criteria were established for the inclusion of studies: (i) major developed economies, (ii) defined essential service and focus on spatial access, (iii) quality of life outcome, (iv) peer-reviewed, and (v) published between 2000 and 2024. Results: From 1,473 unique records, seven studies met the inclusion criteria, with studies from Europe, Asia-Pacific, and North America. Across the studies, services were characterised based on their primary function and contributions to quality of life. Service categories included food, retail, personal services, health, education, culture and recreation, and faith-based services. Despite demographic and scale variations, services that fostered social connection and a sense of place showed the highest positive impact on quality of life. Conclusions: Findings indicate limited and inconsistent evidence on essential service measures and their relationship with quality of life. The persistent lack of justification for classifying services as essential in research hinders definitive conclusions about which services most effectively enhance quality of life. Future research should adopt standardised, validated measures, and address representation gaps across diverse populations and regions. This work is fundamental for developing a validated set of essential services, to improve national modelling of geographic access and inform policy, decision-making, and understanding of how access to services influences quality of life.

Background: Mobile health (mHealth) interventions promoting healthy lifestyle changes offer an adaptable and inexpensive method for accessing health information but require cultural appropriateness and suitability for acceptance and effectiveness in Indigenous populations. No systematic review on effective mHealth interventions for Indigenous women during pregnancy and the early childhood years has been conducted. Objective: This review evaluated the effectiveness of mHealth interventions promoting healthy behaviors for Indigenous mothers and children from conception to 5 years post partum. It also aimed to explore the observed effectiveness differences based on participant engagement, intervention design, and provision of context. Further, the review explored if the interventions were co-designed. Methods: A systematic search of 5 databases was conducted: SCOPUS, MEDLINE, CINAHL, PsycINFO, and ProQuest (Dissertation or Thesis). Studies were included if they were either a randomized controlled trial, pre-post comparison, or a cohort study using mHealth with Indigenous women for maternal and child health following a preregistered PROSPERO protocol (CRD42023395710). HealthInfoNet was searched for gray literature and the reference lists of included studies were hand searched. The initial title and abstract screen for eligibility were performed by 1 reviewer. A full-text screen of eligible studies and a quality appraisal of included studies was performed by 2 reviewers independently. The appraisal tools used were the Mixed Methods Quality Appraisal Tool and the Centre of Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). A descriptive synthesis of the extracted data was performed. Results: Of the 663 articles screened, only 3 met the eligibility criteria. Each paper evaluated a different mHealth intervention: Remote Prenatal Education; the SMS Parent Action Intervention (two-way text messaging); and the Screening, Brief Intervention and Referral to Treatment (SBIRT) eCHECKUP To Go (web-based screening and intervention). Statistically significant changes were reported in some outcomes, including an increase in the parental participation rate in face-to-face prenatal education; increased rate of breastfeeding initiation and exclusive breastfeeding (2-12 months); improved overall children's behavior related to sleep, diet, physical activity, screen time, and intake of sugary beverages; improved individual children's behavior related to physical activity and sleep; and decrease in alcohol drinks per week and binge drinking episodes per 2 weeks due to time effect. However, no study provided a sample size calculation for the reported significant outcomes. Also, due to the small number of included studies and each study evaluating a different intervention, it was not possible to combine results to ascertain if the participant engagement, intervention design, or community context had any impact on the effectiveness. Conclusions: Due to the lack of sample size calculation, it was not possible to establish whether differences in the effectiveness were due to the interventions or a type I statistical error. Therefore, caution is required in the interpretation of these findings. Trial registration: PROSPERO CRD42023395710; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395710.

Background: Cystic fibrosis (CF) registries capture important information in high-burden health domains to support improvement in health outcomes, although a number of unanswered questions persist, as follows. 1) Do CF registries utilise implementation science strategies to improve patient outcomes? 2) Which implementation strategies have been engaged? 3) Has the engagement of these strategies been effective in improving clinical outcomes? Methods: We undertook a systematic review to exploring the use of implementation science strategies by CF registries for healthcare improvement. We searched MEDLINE, Embase, Scopus, Emcare and Web of Science databases for use of Expert Recommendations for Implementing Change (ERIC) implementations and use of the Knowledge to Action framework for improvement. We used the Risk of Bias in Non-randomised Studies - of Interventions tool for risk-of-bias assessment. Results: 1974 citations were identified and 12 studies included. Included studies described 45 ERIC implementation strategies from nine categories. Strategies included "use evaluative and iterative strategies" (n=9) and "develop stakeholder interrelationships" (n=10). Least-used strategies were "utilise financial strategies" (n=1), "support clinicians" category (n=3) and "provide interactive assistance" (n=2). All 12 studies utilised monitoring of knowledge use, and assessing barriers and facilitators of knowledge use. Only seven studies utilised mechanisms to sustain knowledge use. Discussion: Reported studies describe significant benefits in important CF outcomes for people with CF reported at site-specific and population levels. Studies highlighted the importance of governance, leadership, patient and family engagement, multidisciplinary engagement, quality improvement, data and analytics and research. The ready availability of clinical performance data feedback to clinicians and patients by CF registries is likely to strengthen the effectiveness of CF registries in driving healthcare improvement within a learning health system.

Background: A recent resurgence of bacterial sexually transmitted infections (STIs) is placing a major burden on high-risk populations, physicians, and the healthcare system. Treatment in the form of antibiotic pre-exposure prophylaxis (STI PrEP) is a potential solution. However, little is known about the acceptability and feasibility of this approach in high-risk populations. Methods: A comprehensive search strategy was developed and executed in October 2024 across six databases adhering to PRISMA guidelines. Results: Eight studies met the inclusion criteria. These studies were all conducted in high-income countries, used various methods, and all focussed on sexual minority men. Findings consistently identified moderate to high levels of acceptability among GBMSM (54.3% - 67.5%). Factors such as engagement in perceived 'high risk' sexual encounters, and past diagnosis of STIs strengthened acceptability, while others (e.g., antimicrobial resistance concerns and stigma) act as barriers. Only one study included the perspectives of healthcare workers, indicating a moderate willingness to prescribe, which would increase under governing-body endorsement. Discussion: Overall, while there is some promise of STI PrEP acceptability among GBMSM, vast gaps in knowledge remain. Knowledge transfer and feasibility and, hence, the sustainability and capacity needed for the success of STI PrEP is yet to be examined and understood. However, for STI PrEP to be successfully adopted, it is essential not only to assess its acceptability and feasibility but also to focus on knowledge transfer. Knowledge transfer is a dynamic and iterative process, involving the synthesis, dissemination, exchange, and application of knowledge in an ethically sound manner. This process supports the improvement of health outcomes, strengthens healthcare systems, and ensures that healthcare interventions, such as STI PrEP, are effectively understood and implemented by both healthcare providers and at-risk populations. Similarly, the perspectives of populations beyond GBMSM have been omitted, and there is little understanding of the impact of their differing socio-cultural contexts around sex-related behaviour and Western pharmaceutical healthcare interventions on their acceptance and uptake. Conclusion: Further research into acceptability, feasibility and knowledge transfer among diverse high-risk groups, healthcare professionals, and policymakers is necessary to create a strong foundation for implementing STI PrEP.

Background: In the World Health Organization (WHO) geographical region of South-East Asia, the mental health burden of adolescents appears high. Addressing this burden requires development of mental health policies consistent with international standards to assist governance, resource allocation and delivery of mental healthcare effectively. The aim was to identify current national mental health policies/plans/programs/legislation in South-East Asia, assess compliance with international standards and review inclusion of adolescents in these documents. Methods: Searches were conducted on WHO MiNDbank, official government websites, Google and Google Scholar. Documents were compiled and screened, data were extracted and evaluated following WHO Guidelines on Monitoring and Evaluation of Mental Health Policies and Plans. Frequencies of checklist and sub scores were calculated. Data were narratively synthesised. Findings: Fourteen mental health policies/plans/programs/legislation from 8 countries met inclusion criteria. Maldivian and Bangladeshi documents complied the greatest with WHO guidelines. All 8 countries considered adolescents to some extent in their documents. Only Indian documents consulted child health groups during policy development. Intra/Inter sectoral collaboration with child health divisions was highlighted in documents from Sri Lanka, Bangladesh, India and Maldives. Interpretation: Most South-East Asian nations had developed separate national mental health governance documents. However, their incorporation of adolescent mental health is rare and compliance with international standards were inconsistent. Binding mental health legislation separate from health legislation; inclusion of adolescents; addressing resource constraints; and guidelines for mental health policy development catered to low-and-middle-income countries are all essential to address the complex mental health needs of South-East Asian adolescents.

Objective: Radiography education is uniquely positioned to advance the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 17 (Partnerships for the Goals). This narrative review explores the role of radiography education in supporting the SDGs through curriculum development, interdisciplinary learning, and global partnerships. Key findings: In line with SDG 3, radiography plays a pivotal role in non-communicable disease prevention, early diagnosis, and treatment through advanced imaging technologies such as computed tomography (CT) and mammography. Programs such as BreastScreen Australia exemplify the contribution of radiography in reducing mortality through early detection. SDG 4 is reflected in the continuous evolution of radiography curricula to incorporate sustainable practices, ensuring that graduates are well-prepared for the future of healthcare. SDG 17 emphasizes the importance of international collaboration, and radiography education exemplifies this through partnerships with global institutions. These collaborations enhance knowledge exchange, capacity building, and research efforts, particularly in low- and middle-income countries. Conclusion: Radiography education is integral to achieving the SDGs by equipping healthcare professionals with the necessary skills to promote sustainable healthcare practices. Through interdisciplinary learning, curriculum enhancement, and international partnerships, radiography programs contribute to both local and global health initiatives. To strengthen its impact, radiography education must prioritize the integration of sustainability-focused practices, expand interdisciplinary collaborations, and advocate for equitable access to education and healthcare services. Future efforts should focus on leveraging innovative teaching strategies, such as AI-enhanced learning and remote imaging operation, while addressing global health inequities through targeted initiatives. By fostering these sustainable education practices, radiography can have a lasting global impact on public health and development. Implications for practice: By fostering these sustainable education practices, radiography can have a lasting global impact on public health and development, address critical healthcare challenges and contribute to a more sustainable future.

Background: Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings. Methods: A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate. Results: The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints. Conclusions: The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations.

Introduction: The adolescent diet is high in sugars compared with other age groups. Effective approaches to support sugar reduction by adolescents are needed as part of caries prevention. Objective: To systematically review peer-reviewed evidence (1990 to 2023) to identify effective behavior change techniques (BCTs) for sugars reduction in adolescents aged 10 to 16 y. Methods: Nine databases (CINAHL, Cochrane, Dental and Oral Sciences Source, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus, and Web of Science) were searched. Identified articles were screened independently in duplicate for eligibility. Interventions were eligible if they aimed to change adolescent dietary behavior(s) and reported pre- and postsugar-relevant outcome measures. Interventions from included studies were coded using a 93-item BCT Taxonomy (Michie Taxonomy v1). Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Evidence synthesis by vote counting (number of studies showing positive versus null or negative effects) was applied to BCTs that were present in more than 5 interventions. Results: Of 16,271 articles identified, 764 were screened in full, yielding 35 studies (in 43 papers), of which 3 were uncodeable. BCTs coded in interventions covered 11 of 16 BCT clusters and 25 of 93 individual BCTs in the BCT taxonomy. The median number of BCTs applied per study was 3 (interquartile range 2-6). Evidence synthesis indicated that the BCTs most positively associated with a positive reduction in sugars were (with the percentage of strong-/moderate-quality studies applying these techniques that successfully reduced sugars intake in brackets) feedback on behavior (100%), information on social and environmental consequences (100%), problem solving (75%), and social comparison (75%). Conclusion: Notwithstanding limitations in available data, the current evidence most strongly supports the use of BCTs relating to feedback on behavior, providing information on the social and environmental consequences, include problem solving and making social comparisons, to lower sugars intake in adolescents. Knowledge transfer statement: The results of this study will enable clinicians to provide more effective dietary advice when supporting dietary behavior change to reduce sugars intake in adolescents. The results may also be used by researchers to guide future directions for research into effective sugars reduction in adolescents.

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Introduction: In 2019 the World Health Organisation published a report which concluded microplastics in drinking water did not present a threat to human health. Since this time a plethora of research has emerged demonstrating the presence of plastic in various organ systems and their deleterious pathophysiological effects. Methods: A scoping review was undertaken in line with recommendations from the Johanna Briggs Institute. Five databases (PubMed, SCOPUS, CINAHL, Web of Science and EMBASE) were systematically searched in addition to a further grey literature search. Results: Eighteen articles were identified, six of which investigated and characterised the presence of microplastics and nanoplastics (MNPs) in the human urinary tract. Microplastics were found to be present in kidney, urine and bladder cancer samples. Twelve articles investigated the effect of MNPs on human cell lines associated with the human urinary tract. These articles suggest MNPs have a cytotoxic effect, increase inflammation, decrease cell viability and alter mitogen-activated protein kinases (MAPK) signalling pathways. Conclusion: Given the reported presence MNPs in human tissues and organs, these plastics may have potential health implications in bladder disease and dysfunction. As a result, institutions such as the World Health Organisation need to urgently re-evaluate their position on the threat of microplastics to public health. Impact statement: This scoping review highlights the rapidly emerging threat of microplastic contamination within the human urinary tract, challenging the World Health Organisation's assertion that microplastics pose no risk to public health. The documented cytotoxic effects of microplastics, alongside their ability to induce inflammation, reduce cell viability and disrupt signalling pathways, raise significant public health concerns relating to bladder cancer, chronic kidney disease, chronic urinary tract infections and incontinence. As a result, this study emphasises the pressing need for further research and policy development to address the challenges surrounding microplastic contamination.

Aims: The aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses. Design: The scoping review was conducted and reported following the JBI methodology for scoping reviews. Data sources: Searches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023. Review methods: A total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Results: When compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice. Conclusion: Policy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges. Impact: The advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation. Patient or public contribution: No patient or public contribution.

Objective The aims of this systematic review were to (1) synthesize the available qualitative evidence on the barriers and facilitators influencing implementation of the electronic collection and use of patient-reported measures (PRMs) in older adults' care from various stakeholder perspectives and (2) map these factors to the digital technology implementation framework Non-adoption, Abandonment, challenges to the Scale-up, Spread, Sustainability (NASSS) and behavior change framework Capability, Opportunity, Motivation, Behaviour (COM-B).Materials and Methods A search of MEDLINE, CINAHL Plus, and Web of Science databases from 1 January 2001 to 27 October 2021 was conducted and included English language qualitative studies exploring stakeholder perspectives on the electronic collection and use of PRMs in older adults' care. Two authors independently screened studies, conducted data extraction, quality appraisal using the Critical Appraisal Skills Programme (CASP), data coding, assessed confidence in review findings using Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual), and mapped the findings to NASSS and COM-B. An inductive approach was used to synthesize findings describing the stakeholder perspectives of barriers and facilitators.Results Twenty-two studies were included from the 3368 records identified. Studies explored older adult, caregiver, healthcare professional, and administrative staff perspectives. Twenty nine of 34 review findings (85%) were graded as having high or moderate confidence. Key factors salient to older adults related to clinical conditions and socio-cultural factors, digital literacy, access to digital technology, and user interface. Factors salient to healthcare professionals related to resource availability to collect and use PRMs, and value of PRMs collection and use.Conclusion Future efforts to implement electronic collection and use of PRMs in older adults' care should consider addressing the barriers, facilitators, and key theoretical domains identified in this review. Older adults are more likely to adopt electronic completion of PRMs when barriers associated with digital technology access, digital literacy, and user interface are addressed. Future research should explore the perspectives of other stakeholders, including those of organizational leaders, digital technology developers and implementation specialists, in various healthcare settings and explore factors influencing implementation of PREMs.PROSPERO registration number CRD42022295894 Older adults are likely to have high care needs. Health outcomes and experiences can inform these care needs. Surveys can be used to collect health outcomes and experiences. Health care services have used paper surveys. It might be better to use electronic surveys. It saves time and cost for health care services. This study reviewed factors affecting use of electronic surveys. We included research findings from qualitative studies. These studies gathered views of older adults, carers, and health care staff. Many factors affect older adults' use of electronic surveys. Older adults need access to technology. Knowledge on how to use technology was important. Technology should be easy to use. Future work should research use of electronic surveys in different health care settings.

Background: This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available. Methods: All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners). The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken. Results: A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making. Conclusion: The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

Objective: To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. Design: Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. Results: Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). Conclusions: The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.

Objectives: Public awareness initiatives have attracted growing attention globally, as a strategy to reduce low-value care and disinformation. However, knowledge gap remains in determining their effects. The aim of this systematic review was to summarize existing evidence to date on global effectiveness of public awareness initiatives. Methods: Primary quantitative studies focusing on passive delivery of public awareness initiatives that targeted health professionals were included. Eligible studies were identified through search of MEDLINE, Embase, Emcare, the Cochrane Library, PsycINFO, Business Source Complete, Emerald Insight, and Google (initially on December 19, 2018, followed by updated search between July 8-10, 2019, and then between March 8-9, 2022) and the reference list of relevant studies. Methodological quality of included studies was assessed using modified McMaster critical appraisal tool. A narrative synthesis of the study outcomes was conducted. Results: Twenty studies from United States, United Kingdom, Canada, Australia, and multicountry were included. Nineteen studies focused on Choosing Wisely initiative and one focused on National Institute of Clinical Excellence reminders. Most studies investigated one recommendation of a specialty. The findings showed conflicting evidence on the effectiveness of public awareness initiatives, suggesting passive delivery has limited success in reducing low-value care among health professionals. Conclusions: This review highlights the complexity of change in an established practice pattern in health care. As passive delivery of public awareness initiatives has limited potential to initiate and sustain change, wide-ranging intervention components need to be integrated for a successful implementation.

BACKGROUND: Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings. METHODS: A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool. RESULTS: Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening. CONCLUSIONS: Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.

Background: Currently, there is no systematic review to investigate the effectiveness of digital interventions for healthy ageing and cognitive health of older adults. This study aimed to conduct a systematic review to evaluate the effectiveness of digital intervention studies for facilitating healthy ageing and cognitive health and further identify the considerations of its application to older adults. Methods: A systematic review and meta-analysis of literature were conducted across CINAHL, Medline, ProQuest, Cochrane, Scopus, and PubMed databases following the PRISMA guideline. All included studies were appraised using the Mixed Methods Appraisal Tool Checklist by independent reviewers. Meta-analyses were performed using JBI SUMARI software to compare quantitative studies. Thematic analyses were used for qualitative studies and synthesised into the emerging themes. Results: Thirteen studies were included. Quantitative results showed no statistically significant pooled effect between health knowledge and healthy behaviour (I2 =76, p=0.436, 95% CI [-0.32,0.74]), and between cardiovascular-related health risks and care dependency I2=0, p=0.426, 95% CI [0.90,1.29]). However, a statistically significant cognitive function preservation was found in older adults who had long-term use of laptop/cellphone devices and had engaged in the computer-based physical activity program (I2=0, p<0.001, 95% CI [0.01, 0.21]). Qualitative themes for the considerations of digital application to older adults were digital engagement, communication, independence, human connection, privacy, and cost. Conclusions: Digital interventions used in older adults to facilitate healthy ageing were not always effective. Health knowledge improvement does not necessarily result in health risk reduction in that knowledge translation is key. Factors influencing knowledge translation (i.e., digital engagement, human coaching etc) were identified to determine the intervention effects. However, using digital devices appeared beneficial to maintain older adults' cognitive functions in the longer term. Therefore, the review findings suggest that the expanded meaning of a person-centred concept (i.e., from social, environmental, and healthcare system aspects) should be pursued in future practice. Privacy and cost concerns of technologies need ongoing scrutiny from policy bodies. Future research looking into the respective health benefits can provide more understanding of the current digital intervention applied to older adults. Study registration: PROSPERO record ID: CRD42023400707 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400707 .