Search Results (4,869)

Introduction: The increasing use of fluoroscopy-guided procedures raises concerns about occupational radiation exposure, underscoring the need for effective radiation protection (RP) practices among healthcare professionals. The primary objective was to evaluate compliance with the use of personal protective equipment (PPE) and dosimeters, and to identify factors influencing safety behaviors among exposed workers. Methods: A cross-sectional, exploratory quantitative study was conducted at a hospital centre using a self-administered questionnaire in fluoroscopy-guided operating and interventional settings. The questionnaire collected sociodemographic and professional data, information on RP training, compliance with personal and collective protective equipment, and dosimeter use, as well as perceptions of occupational risk. Results: The study included 52 workers. Compliance with PPE use varied across professions, with radiographers reporting significantly higher use of lead aprons/skirt-coats and thyroid shields than other professionals (p < 0.05). The RP training was significantly associated with compliance with PPE and dosimeter use (odds ratios: 4.2–8.9). Older age groups reported lower compliance with PPE use. Overall, risk perception of radiation-related diseases was low (46.2%), and no statistically significant association was found between risk perception and reported PPE use. Regarding protection practices, 67% reported appropriate use of the apron/skirt-coat, 65% of the thyroid shield, and 62% of the dosimeter. The main barriers to PPE use were discomfort, weight, and inadequate cleaning, while forgetfulness was the most reported reason for not using the dosimeter. Conclusions: Inconsistent use of protective equipment and dosimeters may lead to unnecessary exposure and underestimation of occupational radiation doses, whereas RP training is a key determinant of compliance and a strong safety culture. Full article

Construction waste minimisation remains a persistent challenge in developing country contexts, where technical and regulatory deficiencies are often compounded by limited behavioural evidence on how professionals understand and respond to waste generation. This study examines the awareness, attitudes, perceptions, and self-reported waste minimisation practices of construction professionals in Lagos, Nigeria, to clarify how these cognitive factors relate to waste minimisation. Using a quantitative cross-sectional survey design, data were collected from 243 construction professionals through a structured questionnaire and analysed using exploratory factor analysis, such as the relative importance index, the Kruskal–Wallis H test, and Spearman’s rank correlation. The findings indicate a high level of awareness of waste reduction strategies, with organised waste sorting for material reuse ranked the highest (RII = 0.868). However, 54.3% of respondents still perceived waste as an inevitable by-product of construction projects, revealing an important cognitive–behavioural gap. Spearman’s rank correlation showed no statistically significant association between awareness and attitudes (r = 0.113, p = 0.079) and no significant association between awareness and perceptions (r = 0.049, p = 0.452). A statistically significant but weak positive association was found between attitudes and perceptions (r = 0.204, p ≤ 0.001), which is consistent with the Theory of Planned Behaviour (TPB) theoretical expectations but does not constitute a direct test of the full TPB model. The study contributes context-specific behavioural evidence showing that awareness alone may be insufficient to support waste minimisation unless accompanied by more favourable perceptions of feasibility and value. These findings have implications for behaviourally informed policy, professional training, and circular construction strategies in Nigeria and similar contexts. Full article

Background: The use of food supplements (FS) is rapidly increasing, particularly in Italy, which leads the European market. This trend is driven by various factors, including the pursuit of physical well-being, the influence of advertising, and concerns about disease prevention. This exploratory pilot descriptive study aimed to characterize FS use among patients attending general practitioner (GP) offices and examine potential patterns with psychophysical well-being. Methods: Two questionnaires were administered to participants: one on FS use and another on physical and mental health (SF-12 questionnaire). General information and anthropometric characteristics were also collected. Results: 230 questionnaires on FS use and 192 on psychophysical well-being were analyzed. The majority of participants (73.5%) reported using FS, primarily for general well-being (21.0%), immune system support (12.2%), and increased energy (11.4%). The most commonly consumed FS were vitamins (19.4%), minerals (16.9%), and probiotics (15.7%). Only 57.4% of patients reported informing their doctor about FS use, while 66.3% engaged in self-prescription. The SF-12 questionnaire revealed lower mental health scores (mood, energy, anxiety, and depression) in the studied population, while physical health remained unaffected. Importantly, no significant associations were observed between FS use and either physical or mental health scores, suggesting these patterns are independent of supplement consumption. Conclusions: FS use is prevalent among patients attending GP offices. The observed decrease in mental health scores may indicate psychological distress though this pattern was not associated with FS consumption. Given the exploratory nature of this study, findings should be interpreted with caution. This study highlights the need for improved health education and professional training to promote safer and more informed FS use. Further research is required to expand upon these initial findings. Full article

Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma underwent standard automated perimetry. Visual function was assessed using Mean Deviation (MD) and Visual Field Index (VFI) from the better eye. Driving status, driving limitation, and self-reported driving difficulties were assessed using a structured questionnaire. Multivariable logistic regression was performed to determine independent associations between visual field parameters and driving limitation, adjusting for age, sex, cataract status, and systemic comorbidities. Because MD and VFI are closely related indices of visual field loss, separate multivariable models were constructed for each parameter. Receiver operating characteristic (ROC) analysis was used to explore threshold values associated with driving limitation. Results: Driving limitation increased progressively with worsening functional severity, affecting 17% of participants with preserved function, 48% of those with borderline impairment, and 72% of those with definite impairment (p < 0.001). Reduced VFI was independently associated with driving limitation (OR = 0.972, 95% CI: 0.948–0.996; p = 0.021). In a separate model, more negative MD was also independently associated with driving limitation (OR = 0.924, 95% CI: 0.875–0.976; p = 0.004). Male sex was associated with a lower likelihood of driving limitation. ROC analysis identified threshold values of VFI ≤ 71% (AUC = 0.663) and MD ≤ −13.36 dB (AUC = 0.650), both characterized by high specificity but limited sensitivity. Participants who had ceased driving demonstrated worse visual field indices than active drivers, whereas never-drivers showed no consistent association with visual field loss. Conclusions: Glaucomatous visual field loss was significantly associated with self-reported driving limitation and behavioural self-regulation. Objective perimetric parameters, particularly VFI and MD in the better eye, may help identify patients more likely to report driving difficulties. The reported threshold values should be interpreted as exploratory reference points rather than clinically actionable criteria and require further validation before clinical application. Full article

Background: Health-related quality of life (HRQoL) in adolescents reflects their perception of physical, psychological, and social well-being within a specific cultural context, considering developmental stage and individual differences. The KIDSCREEN-27 is a self-report instrument designed to assess HRQoL in children and adolescents, with demonstrated validity and reliability in international samples. Objective: To examine the psychometric properties (i.e., reliability, construct validity, convergent and discriminant validity, and measurement invariance) of the KIDSCREEN-27 questionnaire in a sample of Mexican adolescents. Method: A cross-sectional study was conducted with a sample of 1124 Mexican adolescents aged 10–17 years (M = 13.37, SD = 1.08; 53.5% female; 83.6% secondary education) obtained through non-probabilistic convenience sampling. Reliability (Cronbach’s α, McDonald’s ω), structural validity through exploratory (AFE) and confirmatory factor analyses (CFA), measurement invariance by gender, and convergent and discriminant validity via correlations with self-esteem, well-being, stress, and anxiety–depressive symptoms were evaluated. Results: Analyses showed strong internal consistency (α = 0.912, ω = 0.914). EFA supported a five-dimensional structure. CFA showed an optimal fit after including specific covariances (χ²/df = 3.62, RMSEA = 0.048, CFI = 0.929, TLI = 0.919, SRMR = 0.043). Metric and scalar gender invariance were supported. Positive correlations emerged with well-being (r = 0.76, p < 0.01), self-esteem (r = 0.64, p < 0.01), and satisfaction with life (r = 0.52, p < 0.01), and negative correlations with stress (r = −0.61, p < 0.01), academic stress (r = −0.32, p < 0.01) and anxiety–depressive symptomatology (r = −0.53, p < 0.01), providing evidence of convergent and discriminant validity. Conclusions: The KIDSCREEN-27 demonstrated adequate psychometric properties, supporting its use among Mexican adolescents, enabling the identification of well-being needs, monitoring of interventions, informed decision-making in health and educational practice and supporting cross-cultural comparisons of adolescent well-being. Full article

Background: New psychoactive substances (NPS) represent an evolving component of global substance use patterns and may contribute to HIV transmission through both injection-related and sexual risk behaviors. In Kazakhstan, where HIV incidence has increasingly shifted toward sexual transmission, evidence on HIV testing among NPS users remains limited. This study examined behavioral, social, and structural factors associated with HIV testing in this population. Methods: A cross-sectional study was conducted among 1500 adults reporting NPS use across six regions of Kazakhstan. Data were collected using structured interviewer-administered questionnaires. The primary outcome was self-reported HIV testing (ever tested: yes/no). Independent variables included sociodemographic characteristics, substance use behaviors, sexual practices, peer communication about HIV, and structural access to prevention services. Univariable logistic regression with Bonferroni correction (p < 0.001) was used for variable screening. Multivariable logistic regression models estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Overall, 86.7% of participants reported prior lifetime HIV testing. In the multivariable model (n = 1482), older age was associated with higher odds of testing (AOR 1.06 per year; 95% CI 1.04–1.08; p < 0.001). Compared with participants holding a bachelor’s degree or higher, those without a high school diploma had lower odds of testing (AOR 0.50; 95% CI 0.28–0.89). Injectable psychostimulant use was also associated with testing (AOR 1.40; 95% CI 1.21–2.01). Participants who never discussed HIV within peer networks were less likely to have been tested (AOR 0.69; 95% CI 0.49–0.97). Engagement with HIV prevention services (AOR 0.54; 95% CI 0.39–0.75) and use of prevention centers (AOR 0.63; 95% CI 0.45–0.87) were significantly associated with testing. The model demonstrated acceptable discrimination (AUC = 0.725). Conclusions: Lifetime HIV testing uptake among NPS users in Kazakhstan is high but influenced by educational attainment, peer communication, injection practices, and engagement with prevention services. Strengthening integration of prevention services and expanding peer-based outreach may improve equitable access to HIV testing in this population. Full article

Background/Objectives: Nursing informatics competency is critical for nursing students entering clinical practice in the digital era. Current undergraduate nursing informatics courses prioritize theoretical instruction but lack sufficient integration with clinical applications, which restricts the depth of content delivery. This study aimed to design, implement, and conduct a preliminary evaluation of an undergraduate nursing informatics literacy course. Methods: This was a single-arm mixed-methods study. We implemented five sequential steps aligned with the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model: (1) needs assessment, (2) design of a systematic, progressive course spanning theoretical foundation, technical skills, and clinical application; (3) development of teaching materials and environment; (4) implementation through nine weekly 90 min sessions incorporating teach–practice–feedback; and (5) evaluation via a customized questionnaire and nursing informatics system project reports. Quantitative data were analyzed using the mean, standard deviation, and paired t tests; qualitative data were collected through post-course semi-structured interviews. Results: A total of 120 participants were enrolled from a provincial public medical school, of which 119 (99.2%) completed the course. Statistically significant pre–post improvements were observed in participants’ nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior after course completion (p < 0.001). Participants completed 12 group projects, which received two C grades, nine B grades, and one A grade. Overall course satisfaction averaged 89.03 ± 14.62. Qualitative interviews yielded three themes: (a) cognitive reconstruction and improvement in the ability to apply nursing informatics competencies, (b) dilemmas and breakthroughs in the integration of technology and knowledge in nursing informatics design, and (c) optimization direction of course content, design, and evaluation. Conclusions: An ADDIE-based nursing informatics literacy course may be associated with improvements in nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior among nursing undergraduates. This study provides preliminary evidence supporting the feasibility and potential educational value of such a curriculum. Full article

Background: Medication adherence is essential for effective management of chronic conditions, particularly among older adults with complex chronic conditions (CCCs). The Simplified Medication Adherence Questionnaire (SMAQ) is a brief self-report instrument widely used to assess adherence; however, its psychometric properties have not been evaluated in Albanian older populations. Objective: To assess the psychometric properties of the SMAQ in Albanian older adults with CCCs. Methods: A multicenter, cross-sectional study was conducted among 727 adults aged ≥65 years with two or more chronic conditions recruited from primary healthcare centers in southern Albania. Internal consistency was assessed using Cronbach’s alpha and McDonald’s ω. Construct validity was evaluated through exploratory and confirmatory factor analyses and correlations with clinical and behavioral variables. Discriminative validity was examined using known-group approach and independent samples t-tests, and criterion validity was assessed using Spearman correlations. Results: The SMAQ demonstrated good internal consistency (α = 0.799, ω = 0.821). Factor analyses supported a unidimensional structure, with all items loading significantly onto a single factor. Model fit indices indicated acceptable fit (CFI = 0.921; SRMR = 0.051), although RMSEA suggested some misfit (0.116). Non-adherent participants had significantly higher SMAQ scores than adherent participants (p < 0.001), indicating strong discriminative validity. Conclusions: The SMAQ is a reliable and valid tool for assessing medication adherence among Albanian older adults with CCCs, supporting its use in primary healthcare and research settings. Full article

Introduction: Asthma is a chronic inflammatory disease that impairs daily functioning and quality of life. Despite effective therapies, asthma control remains suboptimal and may improve through greater engagement of community pharmacists. This study assessed the knowledge, practices, and perceived barriers of community pharmacists regarding asthma management in the Aseer region, Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered online questionnaire covering demographics, asthma-related knowledge, practice, and perceived barriers. Results: A total of 290 community pharmacists participated. Overall, 64.8% showed high asthma-related knowledge, while 51.7% reported high asthma counseling practice. Pharmacists showed strong knowledge of asthma symptoms, triggers, determinants of poor control, and counseling on medication-related adverse effects, but moderate knowledge of asthma control assessment, guideline-based management, and treatment-related side effects. Commonly reported services included patient education on asthma and medications, identification of modifiable risk factors, and discussion of treatment side effects, whereas written asthma action plans, symptom control assessment, and follow-up visits were less common. In multivariable logistic regression, high knowledge (p = 0.002), interest in asthma training (p < 0.001), and greater work experience (p = 0.01) were associated with higher counseling practice, while patient volume showed a borderline association (p = 0.051). Conversely, higher practice (p = 0.002), working in independent community pharmacies (p < 0.001), and pharmacy location (p = 0.034) were associated with higher asthma knowledge. Conclusions: Community pharmacists demonstrated moderate-to-high knowledge of asthma management, but gaps remain in guideline-based practice and follow-up. Strengthening guideline-oriented training and pharmacist integration into asthma care may improve outcomes. Full article

Background/Objectives: This study aimed to assess complications after endoscopic radial artery harvest, evaluate patient satisfaction, and assess the feasibility of a questionnaire interview. The primary aim was to assess neurological damage after endoscopic radial artery harvest (ERAH), and the secondary aim was to assess the feasibility of a newly constructed questionnaire in Danish. Methods: From June 2010 through October 2012, 108 patients underwent endoscopic radial artery harvest for coronary artery bypass grafting (CABG) at our institution. A total of 100 patients were interviewed by phone between one and two years after the operation. The interviews included questions about infection, bleeding, neurological damage, vascular perfusion of the hand, re-intervention, and general satisfaction with the procedure. Results: The described cohort was mainly male (88.9% 95% confidence interval (CI) 90.5–98.4%) with a mean age of 60.8 years (standard deviation (SD) 9.0). The self-reported incidence of postoperative antibiotic treatment was 7.0% (95% CI 3.1–14.4%), sensory deficit 18.0% (95% CI 11.3–27.2%), pain 8.0% (95% CI 3.8–15.6%), motoric deficit 4.0% (95% CI 1.3–10.5%) and cold or pale fingers 9.0% (95% CI 4.5–16.8%). At a follow-up time with a mean of 1.40 years (range 0.97–2.37 years, SD 0.36), all incisions were healed satisfactorily, 12.0% (95% CI 6.6–20.4%) reported sensory deficit, 7.0% (95% CI 3.1–14.4%) reported pain, 2.0% (95% CI 0.3–7.7%) reported motoric deficit, and none had a tendency towards cold fingers. The mean duration of antibiotic treatment was 8.7 days ± 2.3. When asked to rate the endoscopic procedure points of satisfaction from 0 (worst) to 10 (best), the mean was 9.7 ± 0.7. Conclusions: This study reports the occurrence of surgical complications immediately after ERAH, with an occurrence of self-reported neurological deficits of 18%. A questionnaire was feasible in a cohort of postoperative patients receiving radial artery harvest. Full article

Background/Objectives: The clinical decision between preserving periodontally compromised teeth and replacing them with dental implants represents a complex clinical dilemma influenced by biological, prosthetic, economic, and professional factors. The aim of this pilot study was to develop and preliminarily validate a questionnaire designed to assess dentists’ attitudes and therapeutic preferences regarding the use of periodontally compromised teeth as prosthetic abutments versus extraction and implant-supported rehabilitation. Methods: An observational cross-sectional study was conducted, among Romanian dentists, using a structured self-administered questionnaire consisting of 43 items organized into seven sections addressing clinical attitudes, decision-making factors, professional competence, prosthetic treatment preferences, and implant-related clinical practices. A total of 111 Romanian dentists completed the questionnaire. Responses were recorded using a five-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics software. Internal consistency was evaluated using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC). Construct validity was assessed using exploratory factor analysis based on Principal Component Analysis with Varimax rotation. Results: The questionnaire demonstrated good internal consistency across most sections, with Cronbach’s alpha values ranging between 0.795 and 0.859 after scale optimization. Item–total correlations indicated adequate contribution of individual items to overall scale reliability. Intraclass correlation coefficients confirmed moderate reliability for individual items and good reliability for average section scores. Exploratory factor analysis showed satisfactory sampling adequacy (KMO = 0.709) and statistically significant Bartlett’s test of sphericity (p < 0.001), supporting the suitability of the data for factor analysis. The sample population was predominantly composed of early-career dentists with limited clinical experience, which should be considered when interpreting the findings. Conclusions: The developed questionnaire demonstrated satisfactory psychometric properties, including good internal consistency and acceptable construct validity, supporting its use as a research instrument for assessing Romanian dentists’ self-reported attitudes, therapeutic preferences, and perception-based decision patterns regarding the preservation of periodontally compromised teeth and implant-supported prosthetic rehabilitation. Full article

Background: Wrist pain is frequently reported among housewives and linked to repetitive household tasks, yet the drivers of pain-related disability remain unclear. Beyond physical load, psychosocial factors such as catastrophizing, mood symptoms, and self-efficacy may shape severity and functional impact. Purpose: To evaluate the severity of wrist pain and wrist-related disability in Turkish housewives and to identify the psychosocial and symptom-related factors associated with these outcomes. Methods: This cross-sectional study was conducted with 92 Turkish housewives reporting wrist pain ≥ 3/10 on the Numeric Pain Rating Scale (NPRS) and who have been married for at least 1 year and performing at least 1 h of housework, via Google Forms. Fatigue and wrist pain were measured using the Numeric Rating Scale (NRS), as well as the Patient-Rated Wrist Evaluation–Turkish version (PRWE-T), Pain Self-Efficacy Questionnaire (PSEQ), Patient Health Questionnaire-4 (PHQ-4), and Pain Catastrophizing Scale (PCS). Sociodemographic data were also collected. Associations were analyzed with Spearman’s correlation, and simple linear regression identified factors explaining wrist pain severity and disability. Results: PRWE-T total scores showed strong positive correlations with pain catastrophizing (p < 0.001), PHQ-4 depression (p < 0.001), and PHQ-4 anxiety (p < 0.001), while correlating negatively with pain self-efficacy (p < 0.05). PCS was also strongly correlated with PHQ-4 anxiety (p < 0.001) and PHQ-4 total (p < 0.001), but negatively with PSEQ (p < 0.001). Multivariable regression analyses have shown that PCS and fatigue may be predictory of wrist pain and disability. Additional factors included fatigue severity (p = 0.002), PHQ-4 depression (p < 0.001), and PHQ-4 anxiety (p = 0.001). Conclusions: These findings highlight the multidimensional nature of wrist symptoms in this population. Full article

In the current labor market, perceived employability is a key resource for university students approaching the transition from university to work, which is often marked by heightened stress, vulnerability, and unhealthy behaviors, particularly in contexts with high youth unemployment rates. Despite prior research documenting the buffering role of perceived employability in the relationships between career-related stressors and well-being, limited evidence exists regarding the roles of faculty support and self-compassion, a fundamental factor for effective emotional regulation, during university years. Consequently, this study aimed to examine the relationships between faculty support, self-compassion, career self-efficacy, career planning, and perceived employability through a self-report questionnaire completed by 186 Italian university students, mainly female, with a mean age of 21.24 (SD = 2.57). Results from a partial least squares model indicated that faculty support was indirectly associated with perceived employability through self-compassion, career self-efficacy, and career planning. These findings could support higher education organizations by suggesting the design of interventions to promote supportive learning environments and to develop training in emotional regulation skills. Such an approach could empower students to effectively cope with career-related stressors and, in turn, engage in adaptive behaviors associated with employability. Full article

Disinformation is a global challenge that affects areas such as politics, health, economics, and science and is spread rapidly by social media (SM), suggesting the necessity of advancing educational proposals to strengthen critical thinking (CT) and digital literacy (DL). This quantitative, non-experimental, descriptive study identified the self-perception that master’s students (n = 72; at three Spanish universities; October 2024–March 2025) have regarding their DL, along with their CT, in post-truth and fake news settings. A self-administered online questionnaire (53 items) was conducted, covering aspects such as the responsible use of information and platforms, algorithmic perceptions, actions taken to verify this information, and concepts of CT, post-truth, and fake news. The results show that Instagram (97%) and WhatsApp (96%) predominated, with a notable proportion of users (86%) reporting that algorithms influenced them ‘highly’ or ‘moderately’. Despite being aware of disinformation they find on social media (65%) as well as its close link to hate speech (90% who ‘strongly’ or ‘somewhat’ agreed), this knowledge does not fully translate into taking measures to counter it. In fact 61% of respondents report sharing news on at least some occasions, while only 25% are able to identify a professional fact-checking organization. In conclusion, these findings suggest the merit of assessing the prevalence of skills such as Critical Thinking (CT) and strategies like fact-checking among students in other postgraduate education systems. Such assessments could inform the potential promotion of media and digital literacy as cross-curricular skills in education. This approach would help bridge the gap between theoretical knowledge and the active verification needed to counter disinformation. Full article

The prevalence of chronic conditions such as hypertension, diabetes, and Human Immunodeficiency Virus (HIV) is rising globally, yet access to continuous care remains limited, particularly in rural low- and middle-income countries. This study evaluated the acceptability and psychosocial predictors of retention in a linkage-to-care (LTC) intervention for patients with chronic conditions in rural South Africa. We conducted a cross-sectional analytical study with a retrospective cohort component among 1673 patients diagnosed with hypertension, diabetes, and/or HIV in Limpopo Province, South Africa. Acceptability and psychosocial factors were assessed cross-sectionally using a theory-informed, interviewer-administered questionnaire between January and June 2024. Retention in care over the preceding six months (July–December 2023) was extracted from routine clinic records and classified as consistent (no gaps > 6 months between visits) or inconsistent (≥1 gap > 6 months. Logistic regression examined associations between psychosocial factors and retention outcomes, adjusting for age, gender, marital status, and diagnostic category. Overall, 25.1% of participants maintained consistent retention over six months, while 74.9% were retained inconsistently. Acceptability of the LTC intervention varied significantly by diagnosis (p < 0.001): 79.5% of participants with multimorbidity rated the intervention as acceptable compared to 54.9% with hypertension, 64.5% with diabetes, and 46.8% with HIV. However, only 12.8% of multimorbid participants agreed that intervention activities fit well with their daily lives. In adjusted analyses, participants who were not happy to participate had 85% lower odds of consistent retention (adjusted odds ratio [AOR] = 0.15, 95% CI: 0.09–0.22) and 7.2 times higher odds of inconsistent retention (AOR = 7.2, 95% CI: 4.8–10.9). Most participants supported de-identified data sharing, though privacy concerns were elevated among those with multimorbidity. Acceptability of LTC interventions differs by diagnosis, with multimorbid patients reporting poorer alignment with daily routines. Retention is strongly associated with emotional engagement and self-efficacy, suggesting that LTC interventions should integrate psychosocial support and be contextually adapted for multimorbid patients in rural settings. Full article