Search Results (4,201)

Background/Objectives: Contemporary health systems continue to face persistent challenges in financing, equity, and governance, particularly under conditions of limited resources, workforce shortages, and demographic pressures. While the World Health Organization calls for strengthening social participation to achieve universal health coverage, evidence suggests that such participation often remains largely symbolic. Existing global examples of social participation in health are limited either by their short duration of implementation or by their limited scope. In contrast, the experience of former Yugoslavia (1945–1991) represents a distinctive case. In the early post-war period, health reforms were directed towards the development of a decentralised, self-managed health system that emphasised universal coverage, participatory governance, social solidarity, and local autonomy. The trajectory of these reforms was further shaped by global economic and political pressures, including neoliberal trends, international debt, and the oil crises, which constrained resources and exposed systemic vulnerabilities. The so-called Yugoslav Experiment may offer an alternative to existing market-oriented and, at times, inefficient health systems. This review aims to synthesise evidence on the governance, financing, organisation, and outcomes of Yugoslavia’s self-managed health system and to evaluate its relevance to contemporary debates on health system resilience, decentralisation, participatory governance, equity, and sustainability. It examines power relations, stakeholder interests, and resource allocation, and assesses the lessons that the Yugoslav experience offers for contemporary debates on participatory governance and the sustainability of healthcare systems, while identifying areas of convergence, debate, and gaps in the existing scholarship. Methods: We conducted a systematic narrative review of peer-reviewed articles, book chapters, conference papers, and commentaries published in English or Bosnian–Croatian–Montenegrin–Serbian that covered the period 1945–1991. Scopus, PubMed, and EBSCOhost (including CINAHL Plus with full text, Medline and PsychInfo) were searched on 19 January 2026. Studies were included if they addressed health system reform, self-management, governance, financing, or institutional continuity. Contextual studies of selected services—primary care, mental health, reproductive health, and vaccination—were included only if they illuminated reform trajectories. Data synthesis focused on reform phases, institutional transformations, financing arrangements, governance mechanisms, and power relations, with particular attention to continuity, path dependence, and critical junctures. Given the heterogeneous and predominantly historical, analytical, and policy-oriented nature of the literature, we did not apply conventional study-design-specific risk-of-bias tools. Instead, we used an overarching framework to classify and contextualise the included evidence according to five dimensions: source type, nature of contribution, evidentiary role, temporal context, and health-system domain. The protocol was not registered. The study was financed by the Provincial Secretariat for Higher Education and Scientific Research, Autonomous Province of Vojvodina, Republic of Serbia. Results: The database searches yielded 265 records, of which 193 were selected for title and abstract screening after removing 72 duplicates. At this stage, 133 publications were excluded because they did not meet the eligibility criteria and 60 publications were selected for full-text review. Application of the predefined inclusion and exclusion criteria resulted in 22 eligible publications. An additional 18 studies were identified through citation chaining and targeted Google Scholar searches. Twenty-two publications were coded as primary studies, directly examining health system reform, governance, or self-management, while 18 were classified as contextual studies addressing specialty areas. The analysis identified key reforms that followed the social participation, i.e., ‘self-management’, approach, which expanded primary care, preventive services, and local participation. It revealed institutional changes, as well as the role of power and health financing in health reforms aimed at strengthening social participation. Nonetheless, challenges—including bureaucratic and managerial elitism, unequal professional authority, resource scarcity, and tensions between market-oriented policies and social solidarity—were amplified by global economic forces and neoliberal trends, ultimately contributing to the system’s collapse by the late 1980s. This review was limited by its search strategy, the exclusion of grey literature, the potential omission or inaccessibility of relevant studies, and its focus on selected aspects of health reform, namely post-war recovery and self-management. Conclusions: The Yugoslav experience illustrates both the promise and the fragility of socially oriented, participatory health systems, demonstrating how international political alignments and global economic pressures can profoundly shape domestic health reform trajectories. Lessons from this case remain relevant to contemporary efforts to strengthen social participation for universal health coverage through designing sustainable, resilient, equitable, and socially accountable health systems under complex global conditions. Full article

Background: Health-related quality of life (HRQoL) and job satisfaction are important indicators of nurses and physicians’ wellbeing and system sustainability, particularly under conditions of high clinical demand. Although organizational determinants of nurses and physicians’ wellbeing have received increasing attention, evidence regarding protocol-based work as a specific organizational characteristic remains limited. Methods: A multicenter cross-sectional study was conducted in 11 Greek public hospitals between September 2022 and March 2023. The study included 405 nurses and physicians (214 nurses and 191 physicians). HRQoL was assessed with the SF-36 and job satisfaction with the MSQ-Short Form. Protocol-based work was assessed using a single self-reported dichotomous item referring to the use of standardized clinical protocols during the pandemic. Associations between workplace characteristics and outcomes were examined using multivariable linear regression models. Results: Vitality (57.24 ± 17.61 among nurses and 53.92 ± 16.93 among physicians) and general health (56.58 ± 19.81 and 53.42 ± 16.32, respectively) were the lowest-scoring HRQoL dimensions in both professional groups. Compared with physicians, nurses reported higher mental health (62.52 vs. 58.11, p < 0.05), social functioning (67.17 vs. 58.96, p < 0.05), and overall job satisfaction (3.23 vs. 2.98, p < 0.01), whereas physicians scored higher in physical functioning (83.47, p < 0.05) and bodily pain (72.87, p < 0.05). Conclusions: Several organizational characteristics were associated with wellbeing among nurses and physicians. Protocol-based work showed consistent associations with better HRQoL and job satisfaction across multiple outcomes. However, longitudinal studies are needed to determine whether these associations reflect causal relationships. Full article

Background/Objectives: Records through early 2026 mark 2025 as the warmest year in over 170 years. Pregnant women are among the populations most vulnerable to climate change. The objective of this study was to conduct a review that synthesizes existing knowledge on how the different dimensions of climate change are affecting the vulnerable population of pregnant women. Methods: A scoping review of reviews (PROSPERO: CRD420261400815) was conducted in the Health Sciences databases: PubMed, SCOPUS, PsycInfo, CINAHL and WOS, with no time or language restriction until February 2026. A qualitative synthesis was carried out on data extracted from the different reviews, and a frequency mapping of reported maternal and perinatal outcomes was performed. The methodological quality of the individual reviews included in this review was evaluated using the CASPe tool. Results: Air pollution primarily links to developmental issues and gestational hypertension (four reviews), while extreme heat was most frequently reported in relation to preterm birth (eight reviews). Natural disasters mostly compromise maternal mental health (five reviews), vector-borne diseases were most frequently associated with perinatal complications like low birth weight and preterm delivery (three reviews), and chemical exposure is chiefly associated with gestational diabetes (two reviews). Conclusions: Given all the maternal and perinatal outcomes reported in relation to climate change, healthcare professionals play a key role in advising pregnant women on their actual and perceived knowledge, risk perception, affective evaluation, self-efficacy, intention to adopt protective behaviors, and subsequent information-seeking behavior. Full article

Introduction: Mobile phone text messaging (Short Message Service; SMS) interventions are digital health strategies that may support mental health care. This scoping review examined related study designs, outcomes, and gaps across the literature. Methods: Systematic searches identified 38 eligible studies from 1542 abstracts. Data were extracted and thematically analyzed to identify trends and outcomes. Texting interventions were categorized as cognitive, motivational, instrumental/practical, or combined approaches. Results: Study design included randomized controlled trials (RCTs), quasi-experimental pilots and systematic reviews, with RCTs providing the strongest evidence for improvements in adherence and relapse prevention. Outcomes included behavioral measures (e.g., medication adherence, therapy homework completion, and reduced non-attendance) alongside clinical measures (e.g., symptom reduction and relapse prevention). Cognitive reminders that were most common reduced non-attendance and improved adherence, particularly for medication and appointments, although they were less effective in severe depression. Motivational and combined interventions demonstrated higher acceptability and engagement, particularly in adolescents and high-risk individuals. Success was influenced by diagnosis, age, gender, and social status, including adherence at baseline. Conclusions: Overall, text-based interventions were generally acceptable, accessible, and cost-effective for improving mental health engagement. Limitations included lack of long-term evaluations, technological barriers, and lack of personalization. Future research should address these gaps and include underrepresented populations. Full article

Background: Psychological flourishing is a key indicator of optimal mental health and professional well-being, particularly among psychologists who are routinely exposed to emotionally demanding clinical environments. Although self-compassion has consistently been associated with positive psychological outcomes, few studies have integrated traditional statistical methods with machine learning approaches to predict psychological flourishing among psychologists. Objective: This study aimed to examine the relationship between self-compassion and psychological flourishing among psychologists in Saudi Arabia, identify the unique contribution of self-compassion dimensions, evaluate the predictive performance of supervised machine learning models, and compare their performance with traditional multiple linear regression. Methods: A cross-sectional correlational design was employed, involving 224 psychologists practicing in Saudi Arabia. Participants completed the Self-Compassion Scale and the Flourishing Scale. Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were performed using IBM SPSS Statistics version 29.0. In addition, Random Forest Regression and Support Vector Regression (SVR) models were implemented in Python using scikit-learn version 1.8.0 to predict psychological flourishing based on self-compassion dimensions together with demographic and professional characteristics. Model performance was evaluated using the coefficient of determination (R²), root mean square error (RMSE), and mean absolute error (MAE). Results: Overall, self-compassion was positively associated with psychological flourishing (r = 0.627, p < 0.001). Multiple linear regression showed that self-kindness had a significant positive independent association with psychological flourishing (β = 0.292, p = 0.001), whereas over-identification had a significant negative independent association (β = −0.206, p = 0.009). The regression model explained 40.5% of the variance in psychological flourishing (R² = 0.405, p < 0.001). In the held-out test-set comparison using the same predictor set, predictive performance was similar across multiple linear regression (R² = 0.273; RMSE = 3.583; MAE = 2.849), Random Forest Regression (R² = 0.282; RMSE = 3.562; MAE = 2.771), and Support Vector Regression (R² = 0.272; RMSE = 3.587; MAE = 2.768), with no substantial predictive advantage of the machine-learning models over the linear benchmark. Conclusions: Self-compassion, particularly self-kindness and over-identification, was significantly correlated with psychological flourishing among psychologists. Machine-learning models demonstrated predictive performance comparable to traditional regression, with no substantial predictive advantage over the linear benchmark, indicating that increased model complexity did not improve out-of-sample prediction in the present sample. Full article

Background: Loneliness, psychological stress, and low self-esteem are important mental health concerns among community-dwelling older adults and may negatively affect healthy ageing and quality of life. This study examined psychosocial outcomes associated with participation in a 4-week Hybrid Happy Reminiscence Program among community-dwelling older adults. Methods: A quasi-experimental pretest–posttest control group study was conducted between September and November 2025 among community-dwelling older adults in Don Tako Subdistrict, Ratchaburi Province, Thailand. Participants were recruited using purposive sampling based on predefined eligibility criteria and were subsequently assigned to either an experimental group (n = 30), which received the Hybrid Happy Reminiscence Program combining bi-weekly face-to-face group sessions with a digital intervention delivered through the LINE application, or a control group (n = 30), which received routine community care. No statistically significant between-group differences were detected in the measured baseline demographic characteristics (all p > 0.05). Primary outcomes included self-esteem, loneliness, and psychological stress. Results: Within the experimental group, self-esteem increased from baseline to posttest (t(29) = −8.07, p < 0.001), while loneliness (t(29) = 5.11, p < 0.001, Cohen’s d = 0.93) and psychological stress (t(29) = 6.59, p < 0.001, Cohen’s d = 1.20) decreased. At posttest, the experimental group had higher self-esteem than the control group (mean difference = 4.73, 95% CI: 3.23–6.23, t(58) = 6.32, p < 0.001) and lower loneliness scores (mean difference = −2.13, 95% CI: −3.27 to −1.00, t(58) = −3.78, p < 0.001). For psychological stress, the experimental group also had a lower mean score than the control group at posttest, although the confidence interval included zero (mean difference = −0.73, 95% CI: −1.51 to 0.04, t(58) = −1.89, p = 0.063). Conclusions: Participants receiving the Hybrid Happy Reminiscence Program showed greater post-intervention self-esteem and lower loneliness scores than those receiving routine community care. Although psychological stress decreased within the intervention group, the post-intervention between-group difference was not statistically significant. Given the quasi-experimental design and the non-random allocation procedure, these findings should be interpreted as group differences consistent with a possible beneficial effect of the program rather than definitive evidence of causality. Larger randomized controlled studies with longer follow-up periods are needed to confirm these findings and to distinguish intervention-specific effects from non-specific influences. Full article

Background/Objectives: University students are particularly vulnerable to unhealthy lifestyle behaviours, including poor dietary habits, insufficient physical activity, and prolonged sedentary time. While these three behaviours have each been extensively studied individually, the extent to which they have been jointly investigated as distinct constructs in the same undergraduate populations remains unclear. This scoping review aimed to map the available evidence jointly addressing dietary habits, sedentary behaviour, and physical activity among undergraduate university students. Methods: Following the PRISMA-ScR guidelines, a systematic search was conducted on PubMed and Scopus (search date: 27 June 2026), covering records published between 2014 and 2026 in English. Studies were eligible if they measured all three constructs (diet, sedentary behaviour, and physical activity) as distinct outcomes in undergraduate populations aged 18 years or older. Results: Of 1910 records identified, 70 studies met the eligibility criteria, comprising 62 primary studies and 8 ongoing study protocols. The primary studies spanned 26 countries across five continents, and most used cross-sectional designs; only one intervention study was identified. Across studies, inadequate diet, low physical activity, and elevated sedentary time were common and frequently co-occurred within individuals, with associations reported for mental health, body image, and weight-related outcomes. Sedentary behaviour was the construct most often absent from otherwise relevant studies and was consistently elevated when measured. Conclusions: Across the 62 primary studies spanning 26 countries, a broadly consistent pattern of suboptimal diet, insufficient physical activity, and elevated sedentary time was observed among undergraduate students. Full article

Frailty represents a significant challenge for aging populations, as population age and the prevalence of functional decline, chronic conditions, and complex health needs increase. This study examines the role of the built environment in the prevention and management of pre-frailty and frailty, with the aim of identifying and synthesizing evidence on environmental elements that influence physical, mental, and social health. The review also explores different interventions and planning approaches that may help reduce the risk of frailty or delay its onset. This study used an umbrella review approach based on existing systematic reviews and meta-analyses focusing on adults aged 45 years and older. Eligible reviews focused on built environment characteristics in relation to frailty, healthy aging, or related health outcomes; reviews of institutionalized populations or those without relevant built-environment or health outcomes were excluded. PubMed, Scopus, ScienceDirect, the Cochrane Library, and COBISS were searched, with final searches conducted on 1–2 July 2025. Methodological quality was assessed using the JBI Critical Appraisal Checklist, and findings were synthesized narratively. A total of 26 reviews were included. The findings suggest that built environments that support and promote physical activity, social interaction, accessibility of services, and community engagement are consistently associated with a lower risk of (pre-)frailty and improved quality of life. In particular, high-quality green and blue spaces, safe and walkable neighborhoods with good connectivity, and accessible housing play an important role in maintaining functional independence. Furthermore, the review highlights the importance of subjective perceptions of safety, social cohesion, and neighborhood quality. The evidence is limited by methodological heterogeneity and by the frequent use of indirect frailty-related outcomes. These results provide a basis for the development of evidence-informed recommendations, planning guidelines, and spatial measures to support active and healthy aging in the community. The review was co-financed by the European Union and by the Republic of Slovenia’s State Budget under the European Cohesion Policy Programme 2021–2027 in Slovenia. The review was not registered. Full article

Background: Artificial Light at Night (ALAN) is a growing public health concern, associated with circadian disruption, sleep disturbances, mental health issues, and increased risk for chronic conditions such as cancer and cardiovascular diseases. Despite a rapidly expanding epidemiological literature on ALAN-related health outcomes, there is limited consensus on standardized and comparable tools for assessing both how individuals perceive ALAN and their objective exposure at the individual and population levels. Methods: A scoping review was conducted using Scopus, PubMed, and Web of Science to identify studies published between 2010 and 2025. The aim was to systematically map the methods, tools, and frameworks used to evaluate both the perception of ALAN and objective ALAN exposure, and to examine their implications for public health. Eligibility was restricted to studies explicitly describing approaches to assess ALAN perception or exposure applied to human health research. Results: Most studies adopted cross-sectional designs and focused on urban contexts. Satellite-derived nighttime light data (62%) and GIS-based indicators (46%) were the most frequently used exposure proxies, while surveys and self-reported measures were commonly used to capture individual behaviors, health impacts and perceptions. Only 23% of studies employed wearable sensors or mobile applications, and architectural or building-level data were included in a single study (8%), highlighting a substantial gap in indoor exposure characterization. Conclusions: By critically reviewing current methods, tools, and frameworks, this work highlights the urgent need for harmonized, validated approaches that integrate objective environmental light measurements with human-centered data on how ALAN is perceived and experienced, thereby strengthening the evidence base for public health research and policy. Full article

Mental health is shaped by multiple psychological, social, cultural, and spiritual factors. This narrative review aimed to synthesize the available evidence on the relationship between spirituality, religiosity, and mental health across the lifespan, with particular emphasis on psychological well-being, coping, resilience, and help-seeking behaviors, while considering both beneficial and potentially adverse associations. A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2000 and 2026 were screened according to predefined eligibility criteria. A total of 52 publications, including quantitative and qualitative studies, systematic reviews, meta-analyses, and narrative reviews, were included. The evidence was synthesized according to three life stages (childhood and adolescence, adulthood, and older adulthood), with an additional section examining help-seeking behaviors and access to mental health care across the lifespan. The reviewed evidence identified both beneficial and adverse mental health outcomes in relation to spirituality and religiosity. Beneficial outcomes included lower levels of depression, anxiety, substance use, and suicidal behaviors, as well as higher levels of resilience, emotional support, and life satisfaction. In contrast, negative religious coping and spiritual struggles were associated with higher levels of depression and anxiety, as well as delayed help-seeking behavior. Overall, the findings varied across study designs, populations, and cultural contexts. Spirituality and religiosity can influence mental health in both positive and negative ways throughout life. Understanding these relationships may help support more sensitive and individualized approaches to mental health care. Full article

Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain. Full article

Background/Objectives: Sleep-related problems are common among university students and are linked to adverse academic and health outcomes. This study evaluated the association between lifestyle medicine adherence and sleep-related problems among first-year Ecuadorian university students. Methods: A cross-sectional study was conducted in Quito, Ecuador, during the 2024–2025 academic year. First-year undergraduate students aged 16–35 years were recruited through a census-based, non-probability strategy (N = 2007). Lifestyle medicine adherence was assessed using the Short Multidimensional Inventory Lifestyle Evaluation for University Students (U-SMILE), and sleep-related problems were defined using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure sleep domain (score ≥ 2), a symptom screen that is conceptually related to, but not identical with, the U-SMILE sleep quality domain. Multivariable binary logistic regression models were used and adjusted for sociodemographic and health-related covariates. A post-hoc sensitivity analysis recomputed the global U-SMILE score after excluding the sleep quality domain. Results: The median age was 18.0 years, and 51.0% were female. Among participants with Level 1 sleep data (n = 1906), 47.8% were classified as having sleep-related problems. In the fully adjusted model (n = 1893), higher overall U-SMILE scores were associated with lower odds of sleep-related problems (odds ratio (OR) per 1 point = 0.93, 95% Confidence Interval (CI): 0.91–0.94; OR per 1 SD = 0.56, 95% CI: 0.50–0.62). In a post-hoc sensitivity analysis, this association persisted after excluding the sleep quality domain from the global score (OR per 1 point = 0.94, 95% CI: 0.93–0.95; OR per 1 SD = 0.66, 95% CI: 0.60–0.73). Among non-sleep domains, the strongest associations were avoidance of substance use (OR = 0.87), social relationships (OR = 0.90), and nutrition (OR = 0.90); physical activity, nature engagement, and stress management were also significant. Conclusions: Higher lifestyle medicine adherence was associated with lower odds of sleep-related problems, including in post-hoc analyses when the sleep domain was omitted from the U-SMILE total. These findings support multidimensional lifestyle medicine approaches for sleep health promotion in university settings. Full article

Background: A high prevalence of speech, language and communication needs are reported amongst individuals in contact with the criminal justice system. Speech and language therapists are increasingly employed to support people within prisons. As this is a relatively new area of clinical practice, there is limited research evidence to inform service delivery. Case studies are a first step in providing evidence of the effectiveness of speech and language therapy within a custodial environment. This study aims to profile the delivery of speech and language therapy in custodial youth justice settings in England, identifying the facilitators and barriers affecting these services. Method: Speech and language therapists working within two custodial youth justice settings in England described examples of speech and language therapy intervention they delivered in their settings (four case studies from one setting and two case studies from another). Six case studies are presented, profiling speech and language therapy for six male participants, aged 17–21. A case study template included background information, referral information, assessment details, intervention details, and session descriptions. Results: A variety of intervention approaches were used based on the individual’s needs. These were all reported following a framework developed in an earlier study. The intervention duration ranged between 25 and 510 min, consisting of 1–13 sessions. Intervention was provided both in individual and group settings and employed functional and impairment-based approaches. The outcomes of intervention were: an increase in self-awareness of strengths and needs, use of self-advocacy strategies, learning and using strategies to support effective communication, and a self-reported increase in well-being and self-esteem. Discussion: This case series highlights the range of interventions and approaches currently used in custodial youth justice settings in England. Further research is needed to explore speech and language therapy’s role in contributing to functional outcomes and its impact on mental health, well-being, and recidivism rates. Full article

The rapid digital transformation of the sports industry in Saudi Arabia under Vision 2030 has reshaped how football fans engage with sporting events through modern infrastructure, international competitions, and expanding digital media ecosystems. While sport participation and spectatorship have been associated with positive well-being outcomes, limited empirical evidence exists regarding how digitally enabled sports investments relate to football fans’ mental health. This study examines the associations between three dimensions of perceived sports industry investment, hosting international football events (HIFE), football infrastructure investment (FII), and digital platforms and broadcasting investment (DP&BI), and self-reported symptoms of depression, anxiety, and stress among 550 Saudi football fans. Data was analysed using partial least squares structural equation modelling (PLS-SEM). The findings indicate that HIFE was significantly associated with lower levels of depression, anxiety, and stress. FII was significantly associated with lower depression and anxiety, but not with stress. DP&BI was significantly associated with lower depression and anxiety, while its association with stress was non-significant. The results highlight the role of emerging digital sports ecosystems in supporting psychological well-being and demonstrate that different forms of sports investment contribute unequally to mental health outcomes. This study contributes to the literature on digital transformation in sport by illustrating how investments in digital platforms, broadcasting technologies, and digitally enhanced fan experiences are associated with mental health outcomes among football supporters. Practical implications are provided for policymakers and sport organisations seeking to leverage digital and physical sports investments to promote societal well-being within the framework of Saudi Vision 2030. Full article

Patient motivation is fundamental to engagement, rehabilitation, and recovery within forensic psychiatric hospitals, yet it is often interpreted primarily through the lens of psychopathology and the negative symptoms of schizophrenia. This instrumental case study was conducted in a medium-security forensic inpatient unit within a Canadian tertiary mental health hospital and included two patients and four members of the interdisciplinary clinical team. Qualitative findings were interpreted using Self-Determination Theory and situated within contemporary literature on schizophrenia, institutionalization, organizational behaviour, and forensic mental health care. The findings suggest that patient motivation is influenced by the interaction of individual clinical characteristics with organizational, environmental, interpersonal, and institutional conditions. Participants described barriers that may undermine the basic psychological needs for autonomy, relatedness, and competence, contributing to reduced engagement in recovery-oriented behaviours. Rather than supporting a single explanatory mechanism, the findings highlight the importance of understanding motivation as an emergent outcome of both patient factors and the environments in which treatment is delivered. The study introduces a decision-support framework that prioritizes identified barriers according to the degree of organizational control and their systemic reach, together with an integrative conceptual model that synthesizes qualitative findings with contemporary psychiatric and interdisciplinary theory. The findings suggest that patient motivation should be understood not only as a function of individual psychopathology but also as an outcome shaped by the environments and organizational systems in which care is delivered. By identifying modifiable organizational and environmental determinants of motivation, the proposed framework shifts the focus of intervention beyond patient-level approaches toward system-level strategies—including organizational practice, environmental design, and institutional policy—that may better support engagement in recovery-oriented forensic mental health care. Full article