Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. The European Medical Association (EMA), Ocular Wellness & Nutrition Society (OWNS) and Italian Society of Nephrology Nurses (SIAN) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.4 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
Mental Health and Alcohol Consumption Among University Students in the Post-Pandemic Context: An Exploratory Cross-Sectional Study in Portugal
Healthcare 2026, 14(2), 223; https://doi.org/10.3390/healthcare14020223 (registering DOI) - 16 Jan 2026
Abstract
Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration
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Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration on drinking patterns and psychological distress remains relatively unexplored, particularly in countries like Portugal, where student traditions heavily shape consumption habits. This study aimed to describe the prevalence of alcohol consumption, depression, anxiety, and stress in a sample of Portuguese university students during the post-pandemic academic period, and to explore associations with sociodemographic variables. Methods: A cross-sectional study was conducted in November 2021 with 90 students from a private higher education institution in northern Portugal. Data were collected via an online questionnaire including sociodemographic information, the Alcohol Use Disorders Identification Test (AUDIT), and the Depression, Anxiety and Stress Scale (DASS-21). Result: The majority of the participants were not at risk of alcohol addiction (95.3%). In total, 15.1% of students reported anxiety symptoms ranging from severe to extremely severe. A binomial logistic regression was performed to ascertain the effects of being away from home and psychological distress (DASS-42 score), on the likelihood that participants were at risk of alcohol addiction (Level 3 and 4 in the AUDIT scale). The logistic regression model was statistically significant, χ2(2) = 9.20, p = 0.010. Living away from home was associated with a substantially lower likelihood of high-risk status (B = −2.79, p = 0.034), corresponding to an odds ratio of 0.06, indicating a strong protective effect. DASS-42 total score was positively associated with high-risk status (B = 0.04, p = 0.039), such that higher psychological distress increased the odds of being classified as high risk. Conclusions: The findings reveal a low prevalence of alcohol risk but heightened symptoms of anxiety, depression, and stress. Psychological distress notably increases the likelihood of hazardous alcohol use, emphasising the importance of targeted mental health and alcohol-use interventions among university students.
Full article
Open AccessSystematic Review
Does Paying the Same Sustain Telehealth? A Systematic Review of Payment Parity Laws
by
Alina Doina Tanase, Malina Popa, Bogdan Hoinoiu, Raluca-Mioara Cosoroaba and Emanuela-Lidia Petrescu
Healthcare 2026, 14(2), 222; https://doi.org/10.3390/healthcare14020222 (registering DOI) - 16 Jan 2026
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Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct
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Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied.
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Open AccessStudy Protocol
The Socio-Demographic Characteristics of Patients Diagnosed with Prostate Cancer Treated in South Africa’s Only Rural Central Hospital in 2020: A Cross-Sectional Study Protocol
by
Xolelwa Ntlongweni, Sibusiso C. Nomatshila, Wezile W. Chitha and Sikhumbuzo A. Mabunda
Healthcare 2026, 14(2), 221; https://doi.org/10.3390/healthcare14020221 (registering DOI) - 16 Jan 2026
Abstract
Background: Prostate cancer remains a significant public health burden globally, particularly in sub-Saharan Africa, where rising incidence rates are compounded by limited screening, late-stage diagnosis and disparities in healthcare access. In South Africa, the Eastern Cape Province reports high prostate cancer prevalence,
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Background: Prostate cancer remains a significant public health burden globally, particularly in sub-Saharan Africa, where rising incidence rates are compounded by limited screening, late-stage diagnosis and disparities in healthcare access. In South Africa, the Eastern Cape Province reports high prostate cancer prevalence, with many patients presenting at advanced stages. Understanding the epidemiological profile of affected individuals is critical for developing targeted health strategies. Objectives: This sub-study aims to describe the epidemiological characteristics of patients diagnosed with prostate cancer, using secondary data from Nelson Mandela Academic Hospital (NMAH), focusing on patients seen between March 2020 and November 2021. Methods: A quantitative cross-sectional study design is employed. De-identified secondary data extracted from clinical records of male patients diagnosed with prostate cancer and managed at NMAH during the study period. Variables include demographic information, clinical characteristics, health service utilization indicators. Analysis: Data will be captured and coded in Microsoft excel 2013 (Microsoft corporation, Seattle, WA, USA). The data will then be exported to STATA 18 for analyses. Descriptive statistics will be used to summarize the data. Inferential analyses such as logistic regression and chi-square tests will be used to explore associations between variables and treatment outcomes. The study provides insights into the demographic and clinical profiles of prostate cancer patients in a high-burden setting. It is anticipated that findings will highlight the age distribution, stage at diagnosis, and treatment patterns among patients diagnosed with prostate cancer. This will inform future prevention and intervention strategies in the Eastern Cape Province. Conclusions: By mapping out the epidemiological patterns of prostate cancer in the Eastern Cape through this sub-study, the research contributes to evidence-based planning and resource allocation, ultimately supporting efforts to reduce prostate cancer morbidity and mortality in rural South Africa.
Full article
Open AccessArticle
Perceived Effectiveness of Workplace Violence Prevention Strategies Among Bulgarian Healthcare Professionals: A Cross-Sectional Survey
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Nikolina Radeva, Maria Rohova, Anzhela Bakhova, Sirma Draganova and Atanas Zanev
Healthcare 2026, 14(2), 220; https://doi.org/10.3390/healthcare14020220 - 15 Jan 2026
Abstract
Background: Workplace violence (WPV) is a pervasive occupational hazard in healthcare that undermines staff safety and quality of care. In Bulgaria, WPV remains widespread and underreported, despite recent legislative initiatives. This study assessed healthcare professionals’ perceptions of the effectiveness of WPV prevention strategies
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Background: Workplace violence (WPV) is a pervasive occupational hazard in healthcare that undermines staff safety and quality of care. In Bulgaria, WPV remains widespread and underreported, despite recent legislative initiatives. This study assessed healthcare professionals’ perceptions of the effectiveness of WPV prevention strategies and examined how prior exposure shapes these perceptions. Methods: A nationwide cross-sectional online survey was conducted in December 2024 with 944 healthcare professionals from multiple sectors. Participants rated the perceived effectiveness of 11 prevention strategies, including environmental/security measures, organizational, and national-level interventions, on a three-point scale. Friedman ANOVA with Kendall’s W assessed overall strategy rankings, while Mann–Whitney U tests with rank-biserial correlations compared specific effectiveness ratings between subgroups defined by WPV exposure (experienced or witnessed vs. not exposed in the previous 12 months). Results: In the previous 12 months, 34.7% of respondents reported direct WPV, and 43.4% had either experienced or witnessed incidents. Friedman ANOVA indicated significant differences in perceived effectiveness across strategies (Kendall’s W = 0.13), with stronger differentiation among violence-exposed respondents (W = 0.37) than among non-exposed respondents (W = 0.09). National-level interventions and security/response measures were consistently ranked the highest. Mann–Whitney tests showed significantly higher endorsement of most strategies among violence-exposed professionals, with large effect sizes for security measures and enforcement of sanctions. Conclusions: Bulgarian healthcare professionals view WPV prevention as requiring a multicomponent approach that integrates robust national policy with organizational and environmental measures. Direct exposure to violence is associated with stronger support for security-focused and national interventions. These findings inform context-specific, evidence-based WPV prevention programs for Bulgarian healthcare facilities.
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Open AccessFeature PaperArticle
Dental Anxiety and Oral Health-Related Quality of Life Among Adults in the United Arab Emirates: A Cross-Sectional Study
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Nada Tawfig Hashim, Muhammed Mustahsen Rahman, Riham Mohammed, Md Sofiqul Islam, Vivek Padmanabhan, Sharifa Jameel Hossain, Nallan C. S. K. Chaitanya, Noran Osama Mohammed, Asawer Ahmed Saeed and Shahista Parveen Dasnadi
Healthcare 2026, 14(2), 219; https://doi.org/10.3390/healthcare14020219 - 15 Jan 2026
Abstract
Background: Dental anxiety is a common psychological condition that may influence patients’ perceptions of oral health and well-being. Although its association with oral health-related quality of life (OHRQoL) has been widely studied internationally, evidence from the United Arab Emirates (UAE) remains limited.
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Background: Dental anxiety is a common psychological condition that may influence patients’ perceptions of oral health and well-being. Although its association with oral health-related quality of life (OHRQoL) has been widely studied internationally, evidence from the United Arab Emirates (UAE) remains limited. Objectives: This study aimed to examine the association between dental anxiety and OHRQoL among adult patients attending an academic dental clinic in the UAE. Methods: A cross-sectional study was conducted among adult dental patients using a non-probabilistic sampling approach. Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS), and OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). Descriptive statistics and nonparametric tests were used for bivariate analyses. Multiple linear regression was applied as an exploratory approach to assess adjusted associations between dental anxiety and OHRQoL after accounting for age and gender. Results: Higher dental anxiety scores were independently associated with poorer OHRQoL after adjustment for age and gender. Bivariate analyses showed no statistically significant differences in dental anxiety or OHRQoL scores between men and women; however, subgroup comparisons should be interpreted cautiously given the sample size. The findings indicate a consistent association between higher anxiety levels and greater perceived oral health impact within the study population. Conclusions: Dental anxiety was associated with impaired oral health-related quality of life among adult dental clinic attendees in the UAE. These findings reflect associations observed within a modest, non-probabilistic, cross-sectional sample and should not be interpreted as causal or generalized to the wider population. Further longitudinal and population-based studies incorporating clinical and contextual variables are needed to clarify temporal relationships and strengthen external validity.
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(This article belongs to the Special Issue Oral and Maxillofacial Health Care: Third Edition)
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Open AccessArticle
Evaluating the Feasibility of Electronic Patient-Reported Outcomes for a Population Receiving Specific Health Checkups: A Pilot Study
by
Hiroshi Yano, Naoki Hosogaya, Shotaro Ide, Rina Kawasaki, Tokuma Tadami, Masatoshi Ide and Kenta Murotani
Healthcare 2026, 14(2), 218; https://doi.org/10.3390/healthcare14020218 - 15 Jan 2026
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Background: In recent years, electronic patient-reported outcome (ePRO) systems on electronic devices, such as smartphones, have been employed to collect patients’ self-assessments and symptom reports. However, these studies were limited to younger populations and patients with severe diseases. Objective: This study
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Background: In recent years, electronic patient-reported outcome (ePRO) systems on electronic devices, such as smartphones, have been employed to collect patients’ self-assessments and symptom reports. However, these studies were limited to younger populations and patients with severe diseases. Objective: This study aimed to evaluate the ease of use and response continuity of an ePRO system used by healthy middle-aged and older adults. Methods: This prospective observational study included participants aged 40–74 years undergoing specific health checkups. The System Usability Scale (SUS) was used to assess ePRO usability. Response continuity was evaluated by assessing EuroQol 5-Dimensional 5-Level responses once a month for up to 3 months after the health checkup date. Results: Eleven participants, aged 47–73 years, participated in the study. The mean SUS on the screening date was 59.1 (95% CI: 50.0–68.1; a cut-off of 70 indicated “useful”). However, only one participant failed to complete the ePRO at one and two months post-examination, and responses were obtained from all participants at three months. Conclusions: Due to the small sample size, usability as measured by the SUS should be interpreted descriptively. While initial onboarding appeared to be a major implementation barrier, sustained monthly ePRO reporting over 3 months was achievable among participants who completed registration with support, suggesting the conditional feasibility of response continuity in this preventive health checkup setting.
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Open AccessReview
Ageing and Quality of Life in Older Adults: Updates and Perspectives of Psychosocial and Advanced Technological Interventions
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Dinara Sukenova, Dejan Nikolic, Aigulsum Izekenova, Ardak Nurbakyt, Assel Izekenova and Jurate Macijauskiene
Healthcare 2026, 14(2), 217; https://doi.org/10.3390/healthcare14020217 - 15 Jan 2026
Abstract
Expanding longevity, together with a decrease in mortality, leads to an increase in the older population worldwide. In this review, ageing and older adults, as well as psychosocial and advanced technological interventions, will be discussed. Older adults are associated with an increased incidence
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Expanding longevity, together with a decrease in mortality, leads to an increase in the older population worldwide. In this review, ageing and older adults, as well as psychosocial and advanced technological interventions, will be discussed. Older adults are associated with an increased incidence of multimorbidity and disability; thus, they have a higher demand for health services than younger individuals. Challenges in welfare services and inadequate family and community-based care support negatively impact the psychosocial and economic wellbeing of older people. Active ageing and successful ageing are crucial aspects for a better quality of life in this age group, as there is a complex interplay of different domains and disease types that influence quality of life in older adults. Additionally, promoting the social participation of older adults is vital for improving their quality of life. Furthermore, the use of technology in older adults has a positive impact on their quality of life; however, aside from the promotion and implementation of technological interventions, challenges persist at all levels of acceptance and use. A better understanding of these challenges and implementing measures to overcome them will have a significant impact on the technological acceptance of older adults and their use in daily life activities, resulting in more favourable quality of life outcomes.
Full article
(This article belongs to the Special Issue Aging and Older Adults’ Healthcare)
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Open AccessArticle
Enhancing Quality of Life in Ostomized Patients Through Smart-Glasses-Supported Health Education: A Pre-Post Study
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Emilio Rubén Pego Pérez, Tomás Mendoza Caamaño, David Rey-Bretal, Noelia Gerbaudo-González, Nuria Martínez Laranga, Manuel Gandoy Crego and Raquel Rodríguez-González
Healthcare 2026, 14(2), 216; https://doi.org/10.3390/healthcare14020216 - 15 Jan 2026
Abstract
Background: Ostomy care consultations are essential for promoting patient autonomy and quality-of-life. The integration of innovative technologies may enhance health education and support effective self-care among ostomized patients. Objective: To evaluate the impact of a nursing-led health education intervention supported by smart-glasses
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Background: Ostomy care consultations are essential for promoting patient autonomy and quality-of-life. The integration of innovative technologies may enhance health education and support effective self-care among ostomized patients. Objective: To evaluate the impact of a nursing-led health education intervention supported by smart-glasses on the quality of life of ostomized patients. Methods: A pre–post quasi-experimental design was employed with 14 patients who had undergone digestive surgery resulting in an ostomy. The intervention consisted of a single 60-min session comprising three phases: (1) assessment of baseline knowledge on ostomy management, (2) personalized feedback, and (3) a hands-on workshop using Vuzix© smart-glasses to demonstrate ostomy care techniques. Quality of life was assessed using the SF-36 questionnaire before and after the intervention. Results: The intervention significantly improved overall SF-36 scores, with notable advancements in emotional role (78.57 ± 36.06 to 97.44 ± 9.25, d = 10.54), mental health (79.14 ± 20.10 to 87.38 ± 13.94, d = 6.27), and vitality (69.29 ± 20.56 to 71.15 ± 16.98, d = 4.19). Social function remained high throughout the study, while bodily pain showed a slight decline. A strong correlation (ρ = 0.923, p = 0.001) was observed between pre- and post-intervention quality of life scores. Conclusions: The findings suggest that integrating smart-glasses into nursing-led health education may enhance the quality of life and self-care capabilities of ostomized patients. However, the small sample size, lack of a control group, and exploratory nature of the study limit the generalizability of the results. Further research is needed to validate these findings in larger, controlled trials.
Full article
(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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Open AccessReview
Bridging the Language Gap in Healthcare: A Narrative Review of Interpretation Services and Access to Care for Immigrants and Refugees in Greece and Europe
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Athina Pitta, Maria Tzitiridou-Chatzopoulou, Arsenios Tsiotsias and Serafeim Savvidis
Healthcare 2026, 14(2), 215; https://doi.org/10.3390/healthcare14020215 - 15 Jan 2026
Abstract
Background: Language barriers remain a major obstacle to equitable healthcare access for immigrants and refugees across Europe. Greece, as both a transit and host country, faces persistent challenges in providing linguistically and culturally appropriate care. Methods: This study presents a narrative
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Background: Language barriers remain a major obstacle to equitable healthcare access for immigrants and refugees across Europe. Greece, as both a transit and host country, faces persistent challenges in providing linguistically and culturally appropriate care. Methods: This study presents a narrative literature review synthesizing international, European, and Greek evidence on the effects of limited language proficiency, professional interpretation, and intercultural mediation on healthcare access, patient safety, satisfaction, and clinical outcomes. Peer-reviewed studies and selected grey literature were identified through searches of PubMed, Scopus, Web of Science, and CINAHL. Results: The evidence consistently demonstrates that the absence of professional interpretation is associated with substantially higher rates of clinically significant communication errors, longer hospital stays, increased readmissions, and higher healthcare costs. In contrast, the use of trained medical interpreters and intercultural mediators improves comprehension, shared decision-making, patient satisfaction, and clinical outcomes. Comparative European data from Italy, Spain, Germany, and Sweden show that institutionalized interpretation systems outperform Greece’s fragmented, NGO-dependent approach. Greek studies further reveal that limited proficiency in Greek is associated with reduced service utilization, longer waiting times, and lower patient satisfaction. Conclusions: This narrative review highlights the urgent need for Greece to adopt a coordinated, professionally staffed interpretation and intercultural mediation framework. Strengthening linguistic support within the healthcare system is essential for improving patient safety, equity, efficiency, and the integration of migrant and refugee populations.
Full article
(This article belongs to the Special Issue Healthcare for Migrants and Minorities)
Open AccessArticle
Chronic Pain and Biopsychosocial Correlates in Rural Filipino Adults: A Cross-Sectional Secondary Analysis
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James Mangohig, Jennifer Kawi, Andrew Thomas Reyes, Reimund Serafica, Marysol C. Cacciata, Carol Manilay-Robles and Lorraine S. Evangelista
Healthcare 2026, 14(2), 214; https://doi.org/10.3390/healthcare14020214 - 15 Jan 2026
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Background: Chronic pain is a leading contributor to disability worldwide, yet population-based data from rural and medically underserved settings remain limited. Evidence describing the biopsychosocial correlates of chronic pain in rural Filipino communities is particularly scarce. Methods: We conducted a secondary
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Background: Chronic pain is a leading contributor to disability worldwide, yet population-based data from rural and medically underserved settings remain limited. Evidence describing the biopsychosocial correlates of chronic pain in rural Filipino communities is particularly scarce. Methods: We conducted a secondary analysis of cross-sectional data from the I-HELP-FILIPINO community cohort, collected between January and June 2017. Participants included 909 adults aged 18–93 years who voluntarily attended barangay clinic days in rural Philippine communities. Pain severity was assessed with standardized self-report tools. Sociodemographic, psychosocial, sleep, and functional health factors were examined using bivariate analysis and hierarchical linear regression. Results are shown with 95% confidence intervals. Results: Chronic pain was very common, affecting 83.8% of participants, with 5.6% experiencing severe pain. In multivariable models, psychosocial distress, sleep issues, and reduced physical functioning were significantly linked to increased pain severity, while demographic factors contributed minimally to the variance. Most of the explained variance in pain outcomes was accounted for by psychosocial and clinical variables. Conclusions: In this rural Filipino cohort, chronic pain was strongly associated with modifiable psychosocial, sleep, and functional health factors. Focusing on community-based and culturally tailored interventions can inspire hope and empower healthcare professionals and policymakers to tackle these issues more effectively.
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Open AccessArticle
Supporting Young Carers in Early Childhood: Mapping Power, Threat, Meaning, and Strengths: A PTMF-Informed Qualitative Study
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Carly Ellicott, Ali Bidaran, Felicity Dewsbery, Alyson Norman and Helen Lloyd
Healthcare 2026, 14(2), 213; https://doi.org/10.3390/healthcare14020213 - 14 Jan 2026
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Background/Objectives: This qualitative study examines strengths and strains faced by professionals working with young carers throughout the United Kingdom (UK) in the context of society’s youngest carers; young carers in early childhood (YCEC) (0–8 years). Methods: The Power Threat Meaning Framework (PTMF) was
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Background/Objectives: This qualitative study examines strengths and strains faced by professionals working with young carers throughout the United Kingdom (UK) in the context of society’s youngest carers; young carers in early childhood (YCEC) (0–8 years). Methods: The Power Threat Meaning Framework (PTMF) was utilised to map key findings of three focus groups. This conceptual lens offers a narrative-based understanding of ways in which power operates in society. Increasingly applied to explore experiences of individuals, communities, and groups, the PTMF proposes that concepts of distress are founded in broader contexts of injustice and social inequalities. Twenty-four participants were recruited from throughout the UK via the Carers Trust Young Carers Alliance. Results: Findings highlight the strength of legal, ideological, and economic power shaping societal beliefs and policy concerning YCEC. This informs constructs of perceived social norms regarding who young carers are most likely to be, and where they may be found. This power threatens the health and well-being of YCEC, impacting the ability of professionals to provide optimal support. Inappropriate policy formed from these assumptions disempowers those providing services to young carers at the frontline of service delivery. Professionals and adults with living experience of caring in their early childhoods reflect upon silent tensions that exist within society, suggesting that YCEC remain the ‘elephant in the room’. Conclusions: We make recommendations to review the efficacy of statutory mandates concerning the needs assessment of young carers in England, and to align policy concerning early childhood and young carers to embed young carers’ rights consistently, starting in early childhood.
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Open AccessArticle
Psychological and Physiological Assessment of Distress Among Public Healthcare Workers During Pandemic Control Efforts
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Dinko Martinovic, Anamarija Jurcev Savicevic, Majda Gotovac, Zeljko Kljucevic, Magda Pletikosa Pavic, Marko Kumric, Zeljka Karin, Slavica Kozina, Daniela Supe Domic, Manuel Colome-Hidalgo and Josko Bozic
Healthcare 2026, 14(2), 212; https://doi.org/10.3390/healthcare14020212 - 14 Jan 2026
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Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the
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Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the sense of coherence among public health workers by integrating psychological assessments with physiological markers of stress to identify protective factors against pandemic-related occupational stress. Methods: This longitudinal study was conducted at the Teaching Public Health Institute of Split and Dalmatia County from July 2021 to February 2022 at two time points: the latency phase (between COVID-19 waves) and hyperarousal phase (during an active wave). Fifty-four public health workers participated in the study. There were three questionnaires assessing psychological distress: Kessler Psychological Distress Scale, Impact of Events Scale—Revised and Sense of Coherence Scale-29. Salivary and blood samples were collected at both time points to measure cortisol levels, cortisol awakening response, and interleukin-6 concentrations. Results: The cortisol area under the curve with respect to ground (AUCg) was significantly elevated during the stress phase compared to the latency phase (234.8 vs. 201.8; p = 0.023), indicating heightened physiological stress responses. Epidemiologists demonstrated significantly lower sense of coherence scores compared to non-epidemiologists (117.9 ± 9.1 vs. 125.6 ± 10.5; p = 0.029). A lower sense of coherence was significantly associated with higher psychological distress and post-traumatic stress symptoms. Multiple linear regression analysis revealed that sense of coherence and interleukin-6 levels were significant independent predictors of cortisol changes. Conclusions: The findings demonstrate that public health workers experience measurable physiological stress responses during pandemic peaks, with sense of coherence emerging as a protective psychological factor. Interventions targeting sense of coherence and organizational support may possibly enhance resilience and reduce mental health morbidity in this vulnerable workforce during crisis situations.
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Open AccessReview
Digital Mental Health Through an Intersectional Lens: A Narrative Review
by
Rose Yesha, Max C. E. Orezzoli, Kimberly Sims and Aviv Y. Landau
Healthcare 2026, 14(2), 211; https://doi.org/10.3390/healthcare14020211 - 14 Jan 2026
Abstract
For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be
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For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be trained to identify specific markers of distress and resilience by incorporating community knowledge in machine learning algorithms. However, DMHAs that use rule-based systems and large language models (LLMs) may generate algorithmic bias. At-risk populations face challenges in accessing culturally and linguistically competent care, often exacerbating existing inequities. Creating equitable solutions in digital mental health requires AI training models that adequately represent the complex realities of marginalized people. This narrative review analyzes the current literature on digital mental health through an intersectional framework. Using an intersectional framework considers the nuanced experiences of individuals whose identities lie at the intersection of multiple stigmatized social groups. By assessing the disproportionate mental health challenges faced by these individuals, we highlight several culturally responsive strategies to improve community outcomes. Culturally responsive strategies include digital mental health technologies that incorporate the lived experience of individuals with intersecting identities while reducing the incidence of bias, harm, and exclusion.
Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
Open AccessArticle
Health Education Modalities and Influencing Factors in Rural Philippine Communities: A Mixed-Methods Study
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Andrew Thomas Reyes, Carol Manilay-Robles, Reimund Serafica, Marysol C. Cacciata, Jennifer Kawi and Lorraine S. Evangelista
Healthcare 2026, 14(2), 210; https://doi.org/10.3390/healthcare14020210 - 14 Jan 2026
Abstract
Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how
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Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how context affects them. Objective: To identify preferred sources of health education among adults in rural Philippine communities and investigate the contextual factors that influence these preferences. Methods: A cross-sectional mixed-methods study included 1203 adults from disadvantaged Luzon and Visayas barangays. Participants completed a self-administered survey on the importance of neighborhood health fairs, native-language instructional tools, and social media. Descriptive statistics (mean ± standard deviation) were used to aggregate importance ratings, and exploratory comparisons were made using paired and independent-samples t-tests. A subsample of 60 semi-structured interviews was analyzed using thematic analysis to interpret qualitative data. Results: Community health fairs were identified as the primary source of health education, with a mean rating of 8.5 ± 1.6, followed by native-language educational materials, which received a mean rating of 5.5 ± 2.4. In contrast, social media was rated the lowest, with a mean of 3.5 ± 2.3. Preference patterns were consistent across regions and sociodemographic groups, with only slight variation in rating magnitudes. Qualitative analysis revealed four themes influencing source preferences: accessibility and proximity, cultural and linguistic relevance, confidence in local health providers, and structural obstacles to digital access. Conclusions: In rural Philippine communities, intimacy, confidence, and cultural congruence influence health education preferences more than online platforms do. Strengthening community-based, locally integrated health education strategies may enhance the reach and contextual relevance of preventive health communication in underserved settings.
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Open AccessArticle
A Qualitative Study on the Experiences of Adult Females with Late Diagnosis of ASD and ADHD in the UK
by
Victoria Wills and Rhyddhi Chakraborty
Healthcare 2026, 14(2), 209; https://doi.org/10.3390/healthcare14020209 - 14 Jan 2026
Abstract
Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for
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Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for further investigation. Accordingly, the aim of this study was to explore the lived experiences of adult females receiving a late diagnosis of ASD and/or ADHD and to identify key barriers within the UK diagnostic pathway. This study addresses a critical knowledge gap by examining the factors contributing to delayed diagnosis within the United Kingdom. Study Design and Method: The study employed a qualitative approach, utilising an anonymous online questionnaire survey comprising nine open-ended questions. Responses were obtained from 52 UK-based females aged 35–65 years who had either received or were awaiting a diagnosis of ASD and/or ADHD. Data were analysed thematically within a constructivist framework. Findings: The analysis revealed three overarching themes: (i) limited understanding and lack of empathy among healthcare professionals, (ii) insufficient post-diagnostic support, with most participants reporting no follow-up care, and (iii) a complex, protracted diagnostic process, often involving waiting periods exceeding three years. Gender bias and frequent misdiagnosis were recurrent issues, contributing to significant psychological distress. These findings underscore the need for systemic reforms and align closely with gaps identified in the existing literature. Conclusions: The findings emphasise the urgent need for gender-sensitive diagnostic frameworks, enhanced professional training, and a person-centred approach to care. Key recommendations include shortening diagnostic waiting times, strengthening healthcare professionals’ knowledge base, and ensuring equitable and consistent post-diagnostic support.
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(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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Open AccessConference Report
Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe
by
Guglielmo M. Trovato, Camille A. Huser, Lynn Wilson and Giovanni S. Leonardi
Healthcare 2026, 14(2), 208; https://doi.org/10.3390/healthcare14020208 - 14 Jan 2026
Abstract
Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European
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Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe.
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(This article belongs to the Section Healthcare and Sustainability)
Open AccessArticle
Migraine Characteristics Among Smokers and Non-Smokers: A Cross-Sectional Survey in Saudi Arabia
by
Abdullah Alsabaani, Mona Hussain Aldukain, Ali Hussain Aldukain, Roaa Al Murayyi, Shahad Ali Alshehri, Shuruq Abdullah M. Alqahtani, Omair Mohammed O. Alshahrani, Abdulmohsin Mohammed S. Alzuhairi and Syed Esam Mahmood
Healthcare 2026, 14(2), 207; https://doi.org/10.3390/healthcare14020207 - 14 Jan 2026
Abstract
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Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking
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Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking in Saudi Arabia. Methods: A cross-sectional study using an online survey tool had been conducted in Saudi Arabia. The survey assessed migraine characteristics, smoking behaviour, demographics, and comorbidities. Statistical analyzes were performed to investigate the occurrence of migraine, smoking behaviour, and demographic factors. Descriptive statistics summarized the data, with various statistical tests employed to compare variables between groups. Results: A total of 229 participants were included in the study, with a majority being young adults (48.47%), predominantly females (66.81%), and holding a bachelor’s degree (63.32%). The study found that 19.2% of individuals with migraine were current smokers, with an average smoking duration of 9.7 years. While some reported relief from migraine pain, others experienced increased pain intensity or frequency. No significant differences were found in migraine characteristics between smokers and non-smokers, but younger individuals and males with migraine were more likely to smoke. The study highlights the complex relationship between smoking and migraine, with varying effects on individuals. Conclusions: The study underscores the lack of significant differences in migraine characteristics between smokers and non-smokers, suggesting that smoking does not play a pivotal role in the clinical presentation of migraines. This insight prompts a shift in research focus towards other potential contributors to migraines, such as genetic predispositions, environmental factors, and comorbidities. Understanding these associations can inform public health strategies aimed at alleviating migraine-related burdens.
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Open AccessEditorial
New Advances in Palliative Care—State of the Field, Its Challenges and Advances at the End of the Year 2025
by
Georg Bollig and Erika Zelko
Healthcare 2026, 14(2), 206; https://doi.org/10.3390/healthcare14020206 - 14 Jan 2026
Abstract
In recent decades, palliative care has become an essential component of modern healthcare systems [...]
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(This article belongs to the Special Issue New Advances in Palliative Care)
Open AccessArticle
Untold Stories of Black and Racialized Immigrants with Disabilities During COVID-19 in the Greater Toronto and Hamilton Area
by
Chavon Niles, Karen Yoshida, Kelsey Vickers, Jheanelle Anderson, Yahya El-Lahib, Rana Hamdy and Nadeen Al Awamry
Healthcare 2026, 14(2), 205; https://doi.org/10.3390/healthcare14020205 - 14 Jan 2026
Abstract
Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities
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Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies.
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(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)
Open AccessArticle
Patient Activation Among Individuals with Chronic Illness: A Cross-Sectional Study from Jordan
by
Mohammad B. Nusair, Rawand Khasawneh, Fahad H. Baali, Ahmed B. Alkhalil, Samer A. Aldehoun and Sayer Al-Azzam
Healthcare 2026, 14(2), 204; https://doi.org/10.3390/healthcare14020204 - 13 Jan 2026
Abstract
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Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients’ knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients
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Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients’ knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients with chronic conditions. Therefore, this study explores PA and its determinants in individuals with chronic conditions in Jordan. Methods: A cross-sectional study was conducted using a convenience sample of outpatients recruited from a tertiary hospital in Jordan. Participants completed a questionnaire including sociodemographic and clinical data, the Single Item Literacy Screener, and the 13-item Patient Activation Measure (PAM). Bivariate and regression analyses were conducted to explore the factors associated with PAM scores. Results: Among a total of 666 participants, the mean PAM score was 57.1 ± 9.17, indicating a moderate activation level overall. Regression analysis revealed that being female (p = 0.14), adequate health literacy (p = 0.002), and post-secondary education (p = 0.004) were significantly associated with higher PAM scores, and older age (p = 0.004) and polypharmacy (p = 0.010) with lower scores. An additional regression model showed that the negative association between polypharmacy and PA scores did not differ by health literacy level, with no significant interaction between polypharmacy and health literacy (p = 0.555). Conclusions: This study showed that individuals with chronic illnesses in Jordan had moderate to high patient activation levels. Several sociodemographic and clinical factors were significantly associated with patient activation. Polypharmacy was independently associated with lower patient activation scores, regardless of health literacy levels. However, given the study’s exploratory nature, the results should be interpreted as preliminary evidence warranting further research.
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