Abstract Background Organizational Health Literacy (OHL) refers to the extent to which organizations facilitate equitable access, comprehension, and use of health information and services for informed decision-making. Objective This study aimed to (1) review and map existing OHL frameworks and (2) propose an innovative OHL framework that addresses gaps identified in current models. Methods A systematic search of academic (Web of Science, Scopus, MEDLINE) and grey literature from the past 15 years was conducted to identify OHL frameworks. This scoping review followed the PRISMA-ScR guidelines and the Arksey and O’Malley model. A new OHL intervention framework was developed to address gaps in existing models, based on the principles of preventive medicine and the public health action cycle. Results A total of 19 records were included (10 from academic databases and 9 from grey literature), covering diverse approaches and contexts related to OHL. Four intervention levels were identified: integrating HL into formal education, implementing HL assessments, developing interventions for vulnerable populations, and enhancing accessibility to health resources. The proposed framework emphasizes intersectoral collaboration and communication pathways between education and healthcare sectors, facilitating information exchange to continuously adapt interventions to population needs. Conclusion OHL development requires intersectoral collaboration; however, interoperability between sectors remains unaddressed in existing frameworks. This study proposes an innovative model that fosters sectoral connections toward a shared goal, creating a truly collaborative framework.

Background: Despite advances in precision medicine, the translation of genetic and genomic technologies into routine practice is hampered by a heterogeneous and limited evidence base and the absence of standardized evaluation methodologies. Health Technology Assessment (HTA) plays a critical role in bridging this gap, yet assessment approaches and comprehensiveness vary widely. This systematic review aims to map the landscape of the assessment reports on genetic and genomics applications, analyze their methodological aspects and identify gaps. Methods: PubMed, Scopus, Web of Science, and the international HTA database, were searched for assessment reports of genetic/genomic technologies. Information on reports general characteristics, assessment domains and their components, consulted sources of evidence and reported gaps was extracted. Findings were synthesized narratively. Results: Out of 27,331 screened records, 41 reports were included, predominantly from Canada, the United Kingdom, and Australia, mainly aimed at informing policy making for single or multiple gene tests for cancer patients. Most reports used a generic HTA methodology and assessment domains varied across reports. Key clinical aspects, such as clinical accuracy and safety, suffered from evidence gaps (39.0% and 22.0%), while personal and societal aspects were the least investigated assessment domain (48.8-78.0%). Overall, lack of evidence and limited generalizability of findings were the most commonly reported gaps across multiple domains. Conclusions: The review highlighted significant fragmentation in current evaluation methodologies of genetic and genomic applications, with underassessment of analytical/clinical accuracy, safety, and non-health outcomes, alongside evidence gaps and limited generalizability. These issues compromise both evaluation and decision-making process, underscoring the urgent need for alternative study designs and standardized, comprehensive assessment frameworks to facilitate the successful implementation of emerging genetic and genomic technologies.

Background: The SARS-CoV-2 pandemic had a major impact on nursing and healthcare as well as on research. The aim of this study was to analyse the characteristics of nursing- and SARS-CoV-2-related research in Germany. Methods: A scoping review was conducted. We systematically searched (06/2023) Medline, CINAHL, the German Register of Clinical Trials, abstract books of conferences and conducted a manual literature search. We included empirical studies addressing aspects of nursing and the pandemic and involving German researchers. Study selection and data extraction were conducted independently by two reviewers. Results were analysed descriptively. Results: We included 131 publications (85 quantitative, 27 qualitative, 6 mixed-/multi-methods studies, 12 systematic reviews, 1 discussion paper); 49 % of the studies were published in 2021. First authors were mostly from medicine, psychology and nursing science, last authors from medicine. Most studies were explorative. Most of the quantitative studies used observational designs, only four were experimental. Nurses and other healthcare professionals were the most common target group; people with care needs or relatives were rarely addressed. The most common topics included health, perceived burden, working conditions, and characteristics of care during the pandemic. A quarter of the studies were not externally funded, 32 % did not provide information on funding. The Federal Ministry of Education and Research (21 %) was the most common funding body. Conclusion: Pandemic-related nursing research was published to a limited extent by nursing scientists; clinical nursing research was particularly underrepresented. Dependable funding and the development of a research infrastructure for nursing research are necessary to ensure evidence-based nursing in times of crisis and to generate findings that are relevant to clinical practice and health policy decision-makers.

Background: Both Health Technology Assessment (HTA) and Performance Management (PM) are clinical governance disciplines that aim to improve the quality, equity, and financial sustainability of health organizations and systems. Although HTA and PM share many features, to the authors' knowledge, few studies have investigated their interplay. This study attempts to fill this gap by analysing how the literature has explored and developed the integration between HTA and PM concepts and tolls within healthcare sector. Methods: To address this gap, this study examines 33 papers selected through a scoping review that explores the inter of HTA and PM within the healthcare sector. In particular, the paper adopted the preferred reporting items for systematic reviews and meta-analysis (PRISMA) methodology to select and analyse articles. Results: The review highlights the dynamic convergence of HTA and PM, emphasizing how combining these frameworks and functions can enhance decision-making in healthcare. This integration ensures that technologies are adopted on the basis of proven effectiveness in pursuing healthcare systems goals and that performance metrics align with evidence-based practices, leading to better resource allocation and improved patient outcomes. The literature review underscores the need for further research to understand the integration between HTA and PM and their combined impact on organizational performance, sustainability, and resilience in the healthcare sector. Conclusion: This study contributes to the literature by providing a comprehensive overview of the current state of research on HTA and PM, offering insights for future studies, and practical recommendations for integrating these disciplines to improve healthcare management and policymaking.

Background Although taxes that raise retail tobacco prices and industry-initiated price increases have been shown to decrease tobacco consumption, the scarcity of studies in Latin America and the Caribbean using household- or individual-level data in existing reviews limits their policy relevance. Objective To conduct a systematic review and meta-analysis to assess the association between prices and taxes and the use of tobacco products in Latin America and the Caribbean. Methods We searched six electronic bibliographic databases, two online search engines, two working paper repositories, and hand-searched seven journals. We included all quantitative studies that used any measures of individual or household tobacco use as an outcome, written in English, Portuguese or Spanish. We used random-effects meta-analyses to pool results across studies. Results We found consistent evidence that in Latin American countries, higher cigarette prices were associated with lower cigarette smoking participation, consumption and initiation and that effect sizes were large enough to be policy meaningful. Pooled own-price elasticities indicate that higher prices were associated with a less than proportional decrease in tobacco use (pooled own-price elasticities, participation: –0.14 [95%CI –0.22, –0.06]; consumption: –0.54 [95%CI –0.75, –0.34]; total: -0.75 [95%CI -1.14, -0.36]). We found no consistent evidence that socioeconomic status, age, sex, rurality, or geographic regions affected price responsiveness. Conclusions Our review confirms that taxes that raise tobacco prices can effectively lower tobacco use. Moreover, raising tobacco prices through increased taxes is anticipated to boost tax revenue due to the inelastic nature of the demand for tobacco.

Background Private equity (PE) investment in U.S. nursing homes has increased significantly over the past two decades. The emergence of this novel ownership model has prompted concerns regarding its effects on nursing home performance, especially quality. Objective This systematic review examined the impact of PE ownership on U.S. nursing homes, focusing on quality of care and financial performance. The review was conceptually informed by agency theory and the structure-process-outcome (SPO) framework. Methods Following PRISMA guidelines, a systematic search across five databases identified 12 studies published between 2000 and 2024. Eligible studies examined the effects of PE ownership on nursing home quality or financial performance. Data were extracted and synthesized across these two dimensions. Results Across studies, PE ownership was linked to higher number of deficiencies, increased hospitalization rates, and higher mortality, although some improvements in care processes were noted. Financial outcomes showed initial financial gains but long-term challenges, primarily due to high debt loads. Conclusions Findings suggest that PE strategies may prioritize short-term profitability, which may compromise quality of care in some instances. These findings highlight the need for financial transparency, and reimbursement models that incentivize long-term quality.

This study provides a comprehensive overview of wastewater surveillance studies on pathogens, identifies key characteristics of studies that are associated with public health actions, and highlights the actions resulting from these studies. Many studies refer to the value of wastewater surveillance in public health decision-making, but it remains unclear how many studies support public health action and whether this is incorporated into study designs. Therefore, we conducted a scoping review following PRISMA guidelines and used the machine learning tool ASReview to identify wastewater surveillance studies monitoring pathogen circulation in human populations, followed by correlational analyses. A total of 974 studies were included, of which only 84 described public health action. Merely 28 of these incorporated strategies to facilitate action within their study designs. Studies leading to public health action primarily monitored viruses, e.g., SARS-CoV-2 and poliovirus, and since 2024 also influenza A and B virus, respiratory syncytial virus, hepatitis A virus and mpox virus. Furthermore, studies conducted by public health institutes or targeting non-standard locations are more likely to result in action, whereas those with larger population sizes or focusing on residential areas are less likely to result in action. The most common public health actions included informing health authorities and identifying cases. Our findings highlight the value of learning from existing use cases. While wastewater surveillance can support public health actions, evidence of its use is limited. Future studies should improve study designs by, e.g., incorporating strategies for public health actions to maximize their effectiveness and impact on decision-making.

Purpose of review: Early Gestational Diabetes Mellitus (eGDM) is an emerging public health issue in India, characterised by varying prevalence estimates, healthcare access disparities, and inconsistent screening practices. This scoping review aims to map the existing literature on eGDM screening in India, identify evidence gaps, and inform future research, policy formulation, and resource allocation. Recent findings: The review, guided by the Arksey and O'Malley framework, includes studies published between 2000 and 2024 that highlight significant eGDM screening and management disparities across public and private healthcare settings, rural-urban locations, and socioeconomic groups. Several screening initiatives have been introduced, but challenges persist, including a lack of standardised diagnostic criteria, low healthcare provider awareness, limited accessibility of screening, and sociocultural barriers. Economic evaluations suggest that eGDM screening can be cost-effective, yet India-specific assessments remain scarce. The integration of eGDM screening within India's national healthcare programs, including NPCDCS, remains minimal. There is a significant gap in knowledge translation, with limited efforts in adapting research findings into policy and practice. Addressing these challenges requires robust policy and programmatic responses, including standardised diagnostic guidelines, improved healthcare provider training, equitable service access, and culturally sensitive community engagement. Strengthening research-to-policy pathways is critical to improving eGDM screening and outcomes across India.

Background: Healthcare workers (HCWs) are at high risk of acquiring and transmitting infections, including COVID-19. Vaccination is a crucial method for preventing the spread of infectious diseases; however, vaccine non-acceptance can hinder optimal vaccine coverage. This research aims to evaluate the level of COVID-19 vaccine acceptance and the associated factors among HCWs in West Africa. Methods: A structured literature review of quantitative cross-sectional studies was conducted, searching databases including Medical Literature Analysis and Retrieval System Online (MEDLINE), African Journals Online, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Google Scholar. The review focused on studies from April 2021 to February 2023 that examined factors influencing COVID-19 vaccine acceptance among HCWs in West Africa. Data extraction and quality assessment of the included studies were conducted using Joanna Briggs Institute tools. Results: Five articles met the inclusion criteria, and they reported that the acceptance level of the COVID-19 vaccine ranged from 38.3% to 73.6%. Barriers to acceptance included concerns about vaccine safety and effectiveness, side effects, short duration of clinical trials, limited and false information, and lack of social trust. Conclusions: COVID-19 vaccine acceptance among West African HCWs is influenced by sociodemographic factors, vaccine concerns, and accurate information, necessitating health promotion strategies and multisectoral collaboration for improved acceptance.

Objective: This study aims to assess research trends in the association between schizophrenia and autoimmune diseases, systematically review their relationship, and evaluate the credibility of existing evidence. Methods: Bibliometric analysis was conducted using the bibliometrix package in R, along with VOSviewer and CiteSpace. Relevant systematic reviews and meta-analyses were retrieved from six databases: PubMed, Web of Science, Embase, CINAHL, PsycINFO, and the Cochrane Library. Summary risk estimates were recalculated using the DerSimonian and Laird method under a random-effects model, and the credibility of the evidence was assessed. Results: The bibliometric analysis found that "meta-analysis" has become a frequently used keyword and may be a focal point for future research. The umbrella review included 17 articles, containing 24 report data points from 12 quantitative reviews. Results indicated that 9 reports assessed the relationship between schizophrenia and autoimmune diseases. Schizophrenia was significantly associated with autoimmune neurological disorders (RR = 1.42; 95 % CI = 1.18-1.72), providing suggestive evidence. Seven reports evaluated the impact of schizophrenia on autoimmune diseases, showing highly suggestive evidence that schizophrenia patients had a pooled relative risk of 2.22 (95 % CI = 1.95-2.52) for psoriasis. Eight reports assessed the impact of autoimmune diseases on schizophrenia, with bullous pemphigoid patients showing significantly higher schizophrenia prevalence (OR = 2.63; 95 % CI = 2.03-3.39). Conclusions: This study synthesizes evidence of varying levels, highlighting the association between schizophrenia and autoimmune diseases. It offers new insights for future exploration, fosters interdisciplinary collaboration, and provides valuable implications for public health policy development.

Background: The global push to scale up telemedicine services is challenged by complex, multilevel, multifaceted implementation and a lack of consensus on what the evidence-based essential building blocks of implementation are. Objective: We aimed to evaluate the evidence base supporting telemedicine implementation knowledge tools; identify shared conceptual constructs and outliers; and formulate recommendations to guide the design, development, and optimization of telemedicine services. Methods: We conducted implementation research using a rapid umbrella review, that is, an overview of systematic reviews, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In total, we searched 3 databases (PubMed, Web of Science, and Scopus) for studies focusing on telemedicine implementation frameworks, models, and tools, collectively referred to as "knowledge tools." Reviews meeting the operational definition of a systematically undertaken, secondary evidence synthesis, such as systematic and scoping reviews, and those published from January 2018 to May 2024 were considered. A meta-aggregative qualitative analysis was undertaken, comprising inductive thematic synthesis. Results: In total, 18 reviews were selected, encompassing 973 primary studies. Global perspectives were reflected in 61% (n=11) of the reviews, while 33% (n=6) focused on low- and middle-income country contexts. The primary research included in the reviews represented 63 countries, spanning the Americas, Europe, Africa, the Middle East, and Asia and the Pacific. Findings indicated substantial heterogeneity across the identified telemedicine implementation theories, models, and frameworks. However, following evidence synthesis, considerable convergence was observed, highlighting a state-of-the-art understanding of the essential requirements for a national telemedicine implementation ecosystem. These were categorized into "process" and "thematic" dimensions. Process dimensions included readiness and needs assessment, road map and planning, managing change, implementing telemedicine services, and continuous improvement and measuring performance. Thematic dimensions covered human and sociocultural aspects; organization, operations, management, and leadership; communication and coordination; policy, legal, and financial considerations; clinical health condition and quality of care; and the wider context. Conclusions: The findings of this study inform a pressing translational research knowledge gap in telemedicine implementation, hindering the implementation of high-quality, sustainable, and scalable telemedicine systems. The study contributes to building global consensus on the state of the art of key constructs in telemedicine implementation and recommends that future research focus on field-testing the evidence-based implementation tools to evaluate their usability and adaptability across diverse telemedicine contexts.

Context: Organizational leadership is essential for adequate and stable financing, strong governance across jurisdictions and sectors, and a competent public health workforce for effective and resilient public health systems. While there have been some efforts to characterize leadership competencies at the individual level, more focus is needed to understand effective governance of public health organizations and systems through the lens of leadership competencies at the organizational level. Objective: To identify organizational level leadership competencies for effective and equitable public health governance. Design: This scoping review included published academic literature from Scopus, Web of Science, Medline, and ProQuest and grey literature from Google Scholar, Canadian Government websites, Trove, FedSys, and Open Grey, published between 2004 and 2023. The search strategy focused on the concepts of governance, leadership, and pub-lic health organizations. An inductive-deductive approach informed the analysis using reflexive thematic analysis and a framework outlining the six functions of public health governance. Results: A total of 35 records were included for analysis; 22 academic and 13 grey literature records. This review identified 9 themes describing organizational leadership competencies for public health governance: 1) Systems thinking 2) Public policy development, implementation and evaluation, 3) Partnership and collaboration, 4) Equity and justice 5) Organizational learning, 6) Oversight, 7) Resource stewardship, 8) Legal authority, 9) Organizational ethics. Conclusions: This scoping review contributes to our understanding of the leadership competencies needed to enact and sustain effective governance at an organizational level. These identified themes and associated competencies can facilitate the creation of organizational culture and values that align with effective governance tenets in public health. Additional research is needed to further apply and contextualize these competencies in different countries and public health settings.

Objective: This scoping review investigates the potential of 6G technology in healthcare, particularly in smart city settings, focusing on its enhanced data capabilities, AI's role in healthcare optimization, infrastructure support, interoperability, quality standards, and privacy and security concerns. Patients and methods: The scoping review followed the Arksey and O'Malley framework, with Levac et al.'s methodological advancements. The review team searched academic databases like PubMed/Medline, SCOPUS, Embase, Web of Sciences, and IEEE Xplore. They also explored grey literature sources like Google Scholar, OpenGrey, and Web of Science Conference Proceedings. A search strategy was developed, and 145 studies were selected from an initial pool of 9835 records from 2010 to 2025. The review categorized 145 studies into three phases, focusing on deploying 6G technology in healthcare, the infrastructure required, and ethical considerations related to the technology's ethical implications. Result: Phase one focused on advancements like real-time imaging, performing medical procedures remotely, using predictive tools to analyze data, and providing care tailored to individual patients. Phase two examined how the next generation of wireless technology (6G) could interact with communication systems, including techniques to handle large amounts of data (massive MIMO) and using extremely high-frequency signals (terahertz communications) to transfer information faster. Phase three explored ethical concerns about applying 6G technology, such as systems that make decisions based on user intentions (intent-driven management) and organizing information around data-based designs (data-driven architecture). The review highlights how 6G technology could revolutionize patient care and medical services by enabling faster data transfers, reducing delays, increasing system capacity, and incorporating artificial intelligence. Conclusion: The scoping review shows the capability of the transformative potential of 6G technology, particularly in healthcare and urban development, emphasizing its enhanced data transfer speeds, reduced latency, and increased capacity that can significantly improve patient care through better remote monitoring, security, and telemedicine services. It stresses the vital role of policymakers in guiding the development of 6G infrastructure, ensuring effective spectrum allocation, and implementing robust security measures while addressing health and electromagnetic exposure concerns. Policymakers are urged to adopt security-by-design principles, adhere to international standards, and foster collaboration among academia, industry, and government to drive innovation and ensure the responsible deployment of 6G technology. By stimulating research and establishing clear performance metrics, they can facilitate continuous improvement and adaptation, ultimately benefiting society as a whole. The review concludes that strategic policy formulation is essential for maximizing the advantages of 6G technology, leading to more intelligent, productive, and sustainable societal frameworks.

Background: Given trends towards greater life expectancy, there is an increasing need to promote healthy ageing and add quality and value to older adults' lives, however the evidence regarding the effects on overall health and wellbeing has not been synthesised. Active lifestyles may provide diverse health and wellbeing benefits for older adults in terms of maintaining or improving their physical, psychological, and social functions. This systematic review evaluates whether and how different types of interventions within community-based settings could benefit specific aspects of older adults' health and wellbeing. Methods: PubMed, PsycINFO, Scopus and Web of Science were systematically searched in January 2022 for experimental studies (including randomised controlled trials, non-randomised controlled trials, and quasi-experimental studies) exploring health and wellbeing benefits of community-based activities in older adults. A total of 12,707 sources were identified through database searches with 183 retained for full screening. Final inclusion was based on the following eligibility criteria: (1) participants were generally healthy and predominantly independent community-dwelling older adults aged 60 and above; (2) interventions were based in real-world settings, e.g., dance, art and technology classes, etc. held in publicly-accessible facilities; (3) pre-/post-interventions assessed at least one outcome in physical health, psychological wellbeing or social connections; (4) control groups were used, including passive and active control groups or groups that received a different type of intervention; (5) experimental studies followed a quantitative research design. Study quality was systematically assessed, and a comprehensive narrative synthesis of the findings was conducted. Results: Of the 183 studies screened, 56 were included in the final review. Among the 33 predominantly physical interventions, 31 demonstrated positive effects. Of the 16 predominantly mental interventions, 14 reported benefits. All seven predominantly social interventions reported positive effects. Discussion: The benefits of real-world interventions were reported across a range of outcomes, particularly in terms of reducing depression or anxiety, or improving physical functioning, sleep quality and social participation. However, heterogeneity in interventions, sample design, duration and dosage suggest that more research is needed to support the effects of duration and dosage of intervention exposure. As real-world interventions more closely resemble the way in which older people engage in activities, evidence of their effectiveness in promoting health and wellbeing should inform preventative healthcare provision and policymaking.

Background: Health Technology Assessment (HTA) is a crucial tool for evaluating the worth and roles of health technologies, and providing evidence-based guidance for their adoption and use. Artificial intelligence (AI) can enhance HTA processes by improving data collection, analysis, and decision-making. This study aims to explore the opportunities and challenges of utilizing artificial intelligence (AI) in health technology assessment (HTA), with a specific focus on economic dimensions. By leveraging AI's capabilities, this research examines how innovative tools and methods can optimize economic evaluation frameworks and enhance decision-making processes within the HTA context. Methods: This study adopted Arksey and O'Malley's scoping review framework and conducted a systematic search in PubMed, Scopus, and Web of Science databases. It examined the benefits and challenges of AI integration into HTA, with a focus on economic dimensions. Findings: AI significantly enhances HTA outcomes by driving methodological advancements, improving utility, and fostering healthcare innovation. It enables comprehensive assessments through robust data systems and databases. However, ethical considerations such as biases, transparency, and accountability emphasize the need for deliberate planning and policymaking to ensure responsible integration within the HTA framework. Conclusion: AI applications in HTA have significant potential to enhance health outcomes and decision-making processes. However, the development of robust data management strategies and regulatory frameworks is essential to ensure effective and ethical implementation. Future research should prioritize the establishment of comprehensive frameworks for AI integration, fostering collaboration among stakeholders, and improving data quality and accessibility on an ongoing basis.

Background Organizational Health Literacy (OHL) refers to the extent to which organizations facilitate equitable access, comprehension, and use of health information and services for informed decision-making. Objective This study aimed to (1) review and map existing OHL frameworks and (2) propose an innovative OHL framework that addresses gaps identified in current models. Methods A systematic search of academic (Web of Science, Scopus, MEDLINE) and grey literature from the past 15 years was conducted to identify OHL frameworks. This scoping review followed the PRISMA-ScR guidelines and the Arksey and O’Malley model. A new OHL intervention framework was developed to address gaps in existing models, based on the principles of preventive medicine and the public health action cycle. Results A total of 19 records were included (10 from academic databases and 9 from grey literature), covering diverse approaches and contexts related to OHL. Four intervention levels were identified: integrating HL into formal education, implementing HL assessments, developing interventions for vulnerable populations, and enhancing accessibility to health resources. The proposed framework emphasizes intersectoral collaboration and communication pathways between education and healthcare sectors, facilitating information exchange to continuously adapt interventions to population needs. Conclusion OHL development requires intersectoral collaboration; however, interoperability between sectors remains unaddressed in existing frameworks. This study proposes an innovative model that fosters sectoral connections toward a shared goal, creating a truly collaborative framework.

Abstract Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent - and how - subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.

Abstract Background: Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations. Objective: To study the determinants and consequences of the length of consultations in GP care. Method: We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters. Results: We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies. Conclusion: Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.

Objective: This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness. Design: Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data sources: We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature. Eligibility criteria for study selection: We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention. Methods: Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention. Conclusion: Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well. Prospero registration number: PROSPERO (CRD42021296618).

Objective: This study evaluated the effectiveness of health literacy interventions aimed at reducing sugar and sugar-sweetened beverage (SSB) intake among Asian populations and identified the common characteristics of effective interventions through a systematic review of randomised and non-randomised studies. Study design: Systematic review of randomised and non-randomised trials. Methods: A systematic search of five databases identified randomised and non-randomised studies on health literacy interventions aimed at reducing sugar and SSB intake among Asian populations. Screening followed predefined criteria, and data extraction captured the intervention type, delivery, duration, and outcomes. Quality was assessed using the Cochrane Risk of Bias-2 and ROBINS-I tools for bias, and the findings were synthesised to identify effective intervention traits and research gaps. Results: Of the eight included studies, three were face-to-face educational, one behavioural, one online, one mobile text messaging, and two front-of-pack (FOP) labelling interventions. Six out of eight studies measured sugar intake, with four assessing SSB intake. Seven studies reported significant dietary improvements. Overall, bias risk was present, with three rated high. Significant inconsistencies in the two studies were further explored. Conclusion: The effectiveness of health literacy interventions in reducing sugar or sugar-sweetened beverage intake was positive, particularly for face-to-face interventions and FOP labels. Available evidence may inform policymaking for the implementation of health promotion for disease prevention and complement standards of care practices for disease management.