Search Results (469)

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

Background/Objectives: Children undergoing cancer treatment experience multiple distressing symptoms that often go undetected in routine care. This study evaluated the potential impact of integrating the Symptom Screening in Pediatrics Tool (SSPedi) into clinical workflows, focusing on symptom detection and implications for service delivery. Methods: Seventy children (aged 4–18 years) receiving active treatment, and/or their caregivers completed SSPedi weekly for eight weeks (n = 479 completions). Medical records were audited for documentation of symptom assessments and symptom prevalence. SSPedi completions were categorized using a clinical algorithm (low, moderate, immediate concerns) and compared with score-only threshold. Results: The most bothersome symptoms were appetite changes (12%), fatigue (11%), nausea/vomiting (9%) and pain (9%). Severe bother detected by SSPedi was more frequent while hospitalized than at home (e.g., appetite changes 17% versus 9%). Documentation rates of severe symptoms in medical records were substantially lower than SSPedi reports—12% when SSPedi was completed at home and 49% when completed in hospital. Applying the clinical algorithm flagged 58% of SSPedi completions as an immediate concern in home and 63% in hospital, compared with score-only thresholds (31% at home and 17% in hospital). Algorithm-based alerts for immediate concerns would have triggered almost twice as many phone calls as score-based thresholds (168 vs. 91). Conclusions: Routine PROM integration could improve symptom detection and timely intervention. Clinical algorithms enhance sensitivity but increase alert burden, highlighting the need to review thresholds and redesign workflows. Full article

Digital cultural heritage platforms face a dual challenge: preserving rich historical information while engaging an audience with declining attention spans. This paper addresses that challenge by proposing a modular information architecture designed to mitigate cognitive overload in cultural heritage tourism applications. We begin by examining evidence of diminishing sustained attention in digital user experience and its specific ramifications for cultural heritage sites, where dense content can overwhelm users. Grounded in cognitive load theory and principles of user-centered design, we outline a theoretical framework linking mental models, findability, and modular information architecture. We then present a user-centric modeling methodology that elicits visitor mental models and tasks (via card sorting, contextual inquiry, etc.), informing the specification of content components and semantic metadata (leveraging standards like Dublin Core and CIDOC-CRM). A visual framework is introduced that maps user tasks to content components, clusters these into UI components with progressive disclosure, and adapts them into screen instances suited to context, illustrated through a step-by-step walkthrough. Using this framework, we comparatively evaluate personalization and information structuring strategies in three platforms—TripAdvisor, Google Arts and Culture, and Airbnb Experiences—against criteria of cognitive load mitigation and user engagement. We also discuss how this modular architecture provides a structural foundation for human-centered, explainable AI–driven personalization and recommender services in cultural heritage contexts. The analysis reveals gaps in current designs (e.g., overwhelming content or passive user roles) and highlights best practices (such as tailored recommendations and progressive reveal of details). We conclude with implications for designing cultural heritage experiences that are cognitively accessible yet richly informative, summarizing contributions and suggesting future research in cultural UX, component-based design, and adaptive content delivery. Full article

Background: Psychological services within hospitals are essential to delivering integrated, patient-centred care, yet in many health systems they remain fragmented, variably organised, or confined to specific medical specialties. The Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), represents one of the few examples of a hospital-wide psychological governance model in Italy, but its organisational structure and longitudinal activity have not previously been systematically described. Objective: This study (I) describes the organisational design and operational components of the Gemelli Unit; (II) compares it with international organisational models using a typological framework; and (III) examines its resilience and adaptive capacity during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A descriptive–narrative approach was adopted, integrating institutional documentation, routinely collected service data (2019–2024), anonymised case vignettes, and a structured comparison with national and international psychological care structures. The analysis was informed by theoretical models of integrated health-care delivery and by Donabedian’s structure–process–outcome framework. Results: Between 2019 and 2024, psychological interventions increased from 28,878 to 47,076 (+63%), with a post-pandemic average of 41,868 annual interventions. In 2024, the Unit supported 2150 patients and 340 healthcare professionals, with psycho-oncology accounting for approximately one-third of all activities. The model integrates clinical activity, staff support, conflict management, research, and training under a centralised governance structure, ensuring hospital-wide coverage and coordinated referral pathways. The comparative analysis identified four international organisational types—department-based, liaison/specialty-based, structured health-system, and academic–clinical hybrid—highlighting the hybrid and transversal nature of the Gemelli Unit and its capacity to maintain and adapt services during the COVID-19 emergency. Conclusions: The Gemelli Unit represents a distinctive hospital-wide organisational model that combines centralised governance, transversal deployment, personalised care, and structured support for healthcare professionals. These characteristics position it as a potentially transferable benchmark for health systems seeking to integrate psychological care into core organisational and clinical processes. Future work should prioritise the development of standardised outcome indicators and national frameworks to support the evaluation and harmonisation of hospital-based psychological services. Full article

The growing demand for personalized healthcare is driving the development of Wireless Body Area Networks (WBANs). These networks enable continuous monitoring of physiological parameters. In WBANs, routing protocols are essential for ensuring reliable data delivery. However, designing efficient protocols is challenging due to the specific environment of the human body. Key issues include limited energy, frequent topology changes caused by movement, and diverse Quality of Service needs. In this review, we investigate, summarize, and analyze state-of-the-art WBAN routing protocols. Specifically, we outline the architecture of WBAN-based eHealth systems and review major design challenges. We then present a categorized survey of recent protocols. Subsequently, we examine the distribution across protocol categories and compare their performance. Finally, we identify open challenges and discuss future research directions. Full article

Population-level evidence on how different phases of assistive technology service delivery contribute to user satisfaction with assistive products remains limited, despite its importance for strengthening provision systems. This study investigates how different aspects of assistive technology service delivery influence user satisfaction with assistive products and their perceived usefulness. Drawing on data from 992 Italian respondents to the WHO rapid Assistive Technology Assessment (rATA) survey, hierarchical regression and mediation analyses were conducted to examine the relative contribution of pre- and post-delivery services (i.e., assessment and training, and maintenance and follow-up) to overall product satisfaction. Results showed that satisfaction with pre-delivery services (β = 0.571, p < 0.001) was the strongest predictor of product satisfaction, followed by post-delivery services (β = 0.280, p < 0.001). Together, both service dimensions explained nearly 60% of the variance in product satisfaction (R² = 0.595). Mediation analysis further revealed that satisfaction with pre-delivery services partially mediated the relationship between product satisfaction and perceived usefulness (β = 0.147, p < 0.001), accounting for 29% of the total effect. These findings suggest a complementary pattern, in which pre-delivery services may provide a foundation for positive user experiences, while post-delivery services contribute meaningfully to sustaining satisfaction and perceived usefulness. The results provide population-level insights that may support national reflections on how to strengthen assistive technology service delivery, while recognizing that both early- and later-stage service components play important and interdependent roles. Full article

Digital transformation in government services represents a strategic shift that leverages digital technologies to enhance efficiency, accessibility, convenience, and user-centricity. In the wake of the COVID-19 pandemic, many governments accelerated the digitisation of services to support remote access and social distancing. Governments typically progress from digitisation (converting physical processes into digital formats) to digitalisation (automating service delivery and improving process efficiency), and ultimately to full digital transformation, where services are completed instantly and entirely online. However, varying levels of maturity across countries influence service outcomes differently, and indicators related to service quality, convenience, and security remain underexamined, particularly in developing contexts. This study addresses these gaps by examining Kuwait’s progress along the digitalisation–digital transformation continuum. It investigates current trends and user preferences in the use of digital government services based on empirical quantitative data collected from users in Kuwait. Specifically, the research objectives are fourfold: (i) to identify crucial outcome metrics for the success of digital government services, (ii) to assess user evaluations of these services according to these metrics, (iii) to examine significant differences between digital transformation and digitalisation services, and (iv) to develop and empirically test a model for evaluating digital transformation success. Drawing on established Information Systems’ (ISs’) success perspectives, a customised conceptual model incorporating six outcome metrics in three domains—service-related (user satisfaction, service quality), convenience-related (accessibility, ease of use), and security-related (perceived security, perceived trust)—was developed. A survey of 378 users of digital government services in Kuwait was conducted to compare perceptions across service types using independent-samples t-tests and linear regression analyses. The study found that users primarily accessed government services through smartphones and dedicated applications, highlighting the importance of mobile optimisation, and showed a clear preference for real-time, fully automated services over those requiring extended approval processes. The results indicate that digital transformation services significantly outperform digitalisation services across five outcome metrics—satisfaction, service quality, accessibility, ease of use, and perceived security—while trust remains consistent across both. These findings underscore the importance of advancing comprehensive digital transformation to enhance public service delivery. Practical recommendations are provided to support Kuwait’s digital government strategy. Given the purposive sampling and cross-sectional, comparative design, the findings should be interpreted with caution, and future studies are encouraged to apply probability-based sampling and more advanced multivariate techniques (e.g., structural equation modelling) to validate and extend the proposed model. Full article

The role of last-mile delivery professionals is becoming increasingly vital in modern urban logistics, driven by the rapid expansion of e-commerce and rising consumer expectations for fast and reliable services. This study aimed to analyse the decision-making patterns of last-mile delivery professionals through stated preference data. To achieve this, a stated-preference questionnaire was conducted with 333 riders aged 18–65 from Croatia, Cyprus, Greece, Italy and Slovenia. A random parameter logit (RPL) model was applied to evaluate the influence of factors such as driving behaviour, delivery time and salary type on decision-making in hypothetical scenarios. Results showed that driving behaviour, trip duration and salary type significantly affected respondents’ preferences. Participants displayed a strong preference for flat salaries, indicating the importance of income stability over performance-based pay. Driving behaviour was also crucial, as respondents favoured legal and safe practices. Interestingly, while shorter delivery times were generally preferred, several scenarios revealed a tolerance for longer durations, possibly reflecting perceived benefits such as safer routes or reduced stress. Comparative analyses also revealed regional differences in vehicle use, work patterns and safety perceptions. The study highlights the need for tailored training programs on safety compliance, route optimization and time management, alongside hybrid salary structures balancing stability and productivity. Full article

The integration of artificial intelligence (AI) into e-government promises to transform public service delivery, efficiency, and transparency. This study investigates the required critical implementation capacities in e-government/AI integration in developing countries. Although there is a general understanding of e-government/AI integration issues, in-depth knowledge of this phenomenon is limited, especially in developing countries, where both AI and its integration into various technologies are relatively new aspects of digital transformation, highlighting a need for continuing research in this area. In response, we conducted a systematic review in accordance with PRISMA guidelines, employing thematic content analysis on conference papers and peer-reviewed studies published between 2020 and 2025. Findings indicate that e-government/AI integration remains largely in a potential state, with benefits theorised but not yet fully realised. The progression to an actual or desired state is contingent upon building strengths across seven domains: governance, regulation and ethics; strategic and implementation planning; technology and infrastructure development; organisational capacity development; human capital and expertise; AI adoption, implementation, and impact; and citizen engagement and participation. To realise the benefits of AI in e-government, developing countries need to invest in these capacities. In addition to identifying and detailing the above capacities, the study provides a framework for transforming this phenomenon from a theoretical reality into practice. Full article

Background: Telemedicine expanded dramatically during the COVID-19 pandemic, transforming healthcare delivery worldwide. However, implementation faced challenges, and the impact on clinical outcomes, access, and quality remains under investigation. Objective: To systematically review the literature from 2020 to 2025 on telemedicine adoption, identifying key barriers and facilitators, and to evaluate clinical outcomes associated with telehealth use during this period. Methods: We followed PRISMA 2020 guidelines in conducting this review. Multiple databases were searched for studies on the implementation or evaluation of telemedicine/telehealth. Eligible studies included randomized trials and observational studies reporting telehealth-related outcomes, barriers, or facilitators. Two reviewers screened studies and extracted data on study characteristics, telemedicine interventions, barriers/facilitators, and clinical outcomes. Risk of bias was assessed using RoB2 for randomized controlled trials (RCTs) for qualitative or cross-sectional studies. Meta-analyses were performed where data were comparable, and qualitative synthesis was used to summarize barriers and facilitators. Results: Thirty-two studies (17 RCTs and 15 observational) were included. Telemedicine use surged in 2020 and remained elevated compared to baseline through August 2025. Reported barriers included insufficient broadband access, limited digital literacy, uncertain reimbursement policies, and workflow disruptions. Facilitators encompassed supportive policy waivers, the integration of telehealth into established care pathways, and strong acceptance from patients and providers. Clinical outcomes were generally comparable to in-person care. Telehealth enhanced chronic disease management (e.g., hypertension, diabetes) and decreased hospitalizations for heart failure, while ensuring safety in surgical follow-up and prenatal care. However, higher revisit rates were observed in some acute follow-up settings. Patient satisfaction consistently remained high, especially among rural and underserved populations reporting benefits, though disparities in digital access continued to exist. Conclusions: Telemedicine has become a sustainable component of healthcare, delivering clinical outcomes comparable to traditional care while offering convenience and resilience. Overcoming technology gaps, regulatory uncertainties, and equity issues is crucial for ongoing progress. Hybrid care models that combine telemedicine with in-person services, supported by strong policy frameworks, are recommended to maximize benefits and promote fair access in the post-pandemic era. Full article

This study examines the critical success factors for digital transformation in South Africa’s public services, where systemic inefficiency, corruption, and limited transparency have eroded public trust. Using a PRISMA-guided systematic literature review of 64 studies, this study synthesises evidence on digital governance challenges and opportunities through the lenses of New Public Management and Digital-Era Governance, complemented by value co-creation and a citizen-centred design. The analysis shows that transformation efforts often falter because of infrastructure deficits, bureaucratic resistance, and policy misalignment. Successful initiatives rest on five mutually reinforcing pillars: (1) coherent policy and regulatory frameworks; (2) equitable and reliable digital infrastructure; (3) committed leadership with sustained institutional capacity-building; (4) meaningful citizen engagement via co-design and co-production; and (5) data-enabled accountability and process efficiency. Persistent barriers include disparities in access and digital skills across municipalities, cybersecurity vulnerabilities, and legacy–system incompatibilities that impede end-to-end integration. This study proposes an implementation framework that aligns technical solutions with governance reforms, such as depoliticised administration, performance-based accountability, and localised service customization to enhance operational efficiency and rebuild trust. It concludes that bridging the digital divide and embedding context-sensitive, participatory, and ethically grounded approaches are essential for sustainable digital transformation in South Africa’s unequal socioeconomic landscape. Full article

A significant challenge in e-commerce is the inability of consumers to physically inspect products, forcing them to rely on perceived quality derived from other consumers’ experiences. However, gaps remain in understanding which dimensions of perceived quality are most frequently mentioned and influential for customer satisfaction, particularly in emerging markets like Indonesia. This study investigates these gaps by identifying key perceived quality aspects and examining their impact on satisfaction, with a specific focus on the moderating role of logistics delivery services. Using a large language model (LLM), specifically Google’s Gemma 2, we performed aspect-based sentiment analysis on 5000 smartphone reviews from Indonesian e-commerce. Logistic regression models incorporating interaction variables were employed to evaluate the relationships. The results identify the most frequently mentioned aspects of perceived quality: Logistics delivery services, Functionality, Originality, Responsiveness, and Packaging. While Logistics delivery services was the most mentioned aspect, Packaging had the most significant direct influence on satisfaction. Notably, Logistics delivery services also play a significant moderating role, enhancing the positive effect of other perceived quality aspects on satisfaction. These findings suggest that Logistics delivery services contribute directly to satisfaction and amplify other aspects, resulting in greater customer satisfaction. The study contributes to the literature by demonstrating LLM-driven aspect-based sentiment analysis methods and expanding the concept of perceived quality to include service aspects, thus promoting a more complete consideration of perceived quality in e-commerce. Full article

Background: Endoscopic Electroporation (EE) is an innovative minimally invasive therapy that utilises short electrical pulses combined with intratumoural (IT) calcium or IT/intravenous (IV) chemotherapy to induce tumour cell death in colorectal cancer (CRC). Based on electrochemotherapy protocols developed for the treatment of skin cancers, EE has shown promising results in salvage therapy, local tumour control, and symptom palliation, particularly in patients who are unsuitable for surgery or standard treatments. Objective: To establish, for the first time, a comprehensive and standardised protocol for setting up a Salvage Endoscopic Electroporation (SEE) service in CRC clinical practice, covering multidisciplinary patient selection, procedural steps, equipment needs, and follow-up care. Methods: Drawing from the European Standard Operating Procedures of Electrochemotherapy (ESOPE) and emerging clinical evidence on EE from King’s College London, we detail infrastructure, treatment delivery, and monitoring for CRC. Key procedural elements, safety considerations, and patient management strategies are outlined. Electroporation pulses were delivered using the Conformité Européenne (CE) approved ePORE^® electroporation generator and single-use CE-marked EndoVE^® probe (Mirai Medical, Galway, Ireland). Results: Tumour assessment involves both clinical evaluation and endoscopic imaging, with radiological correlation. EE treatment has been safely carried out under sedation using specialised endoscopic probes, leading to effective local tumour response, symptomatic relief, and improved quality of life. Follow-up schedules allow for timely assessment of treatment response and enable repeat treatments if needed. Conclusions: This novel protocol provides a practical framework for centres aiming to implement SEE services, promoting consistency, safety, and better patient outcomes. Future prospective studies will refine indications and improve integration of this approach into colorectal cancer management pathways. Full article

Online shopping is widely believed to reduce demand for retail stores and presumably decrease energy consumption in the retail sector, yet this relationship has not been studied empirically. We address this gap by first developing a regression model that empirically links historical retail building space needs to in-store shopping time. The historical online shopping time is taken from the 2003–2023 American Time Use Survey, which is then extrapolated to 2030 under two scenarios: a slower growth scenario based on 2003–2023 trends, and a faster growth scenario based on 2015–2023, reflecting a more recent acceleration of online shopping. Future energy use in retail buildings is estimated by combining predicted building space demand with extrapolated trends in energy intensity. Monte Carlo analysis is used to quantify uncertainty. Results show that by 2030, retail building energy demand will decline by 6–12% under the slower growth scenario and by 11–20% under the faster growth scenario, relative to 2018. These changes correspond to reductions in total U.S. commercial building energy demand of 0.7–1.3% and 1.3–2.2%, respectively. While potential increases in warehouse space, delivery services, and residential energy use are not analyzed here, the findings have significant implications regarding e-commerce for retail space and urban energy demand. Full article