The protocol describes PRECEDE–PROCEED as a comprehensive framework for designing, implementing and evaluating health promotion and public health programs aimed at improving individual and community health and quality of life. The authors identify a dispersed body of research on its application and set out a systematic process for locating and describing it. The planned scope includes qualitative, quantitative and mixed-methods empirical studies.

Eligibility will be assessed using the Population–Concept–Context framework, which the authors selected to accommodate the descriptive nature of a scoping review. Information will be retrieved from five major electronic databases: PubMed, Scopus, Web of Science, Embase and ProQuest. Two reviewers will independently screen titles, abstracts and full texts to determine which studies meet the eligibility criteria.

Data extraction will focus on the population involved, the PRECEDE–PROCEED phases applied, the context in which the model was used—including the setting and health topic—the study design and any reported outcomes. The research team will also chart the kinds of health promotion programs examined, their target populations and their geographical distribution. The synthesis will describe the specific phases and components of PRECEDE–PROCEED that have been applied across the included studies.

Reporting will adhere to the PRISMA extension for Scoping Reviews, known as PRISMA-ScR, and relevant guidance from the Joanna Briggs Institute. Individual studies will not receive a formal quality appraisal, consistent with the standard approach specified for scoping reviews, although the protocol says the breadth of the evidence will be described. This distinction means that the review is intended to organize and characterize the literature, not rank individual studies or test program effectiveness.

The expected result is a descriptive synthesis showing patterns in how PRECEDE–PROCEED has been used. The authors state that the review may reveal areas of extensive application, areas with limited application and gaps in the literature, with the goal of informing future research and practical applications of the model. It also does not establish whether applications of the framework have improved health or quality of life.

The article instead sets out the methods and intended outputs of a 25-year evidence-mapping exercise designed to clarify the research landscape surrounding a framework used for health promotion and public health programming.

Subject of Research: A planned scoping review of empirical PRECEDE–PROCEED applications in health promotion and public health since 2000

Article Title: Protocol for a scoping review of empirical applications of the PRECEDE–PROCEED model in health promotion and public health since 2000

Article References: Ghaffari, M., Rakhshanderou, S., & Lael-Monfared, E. (2026). Protocol for a scoping review of empirical applications of the PRECEDE–PROCEED model in health promotion and public health since 2000. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01545-7

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DOI: 10.1186/s12961-026-01545-7

Keywords: PRECEDE–PROCEED, health promotion, public health, scoping review, study protocol, evidence mapping, program evaluation, PRISMA-ScR, empirical studies, descriptive synthesis, Protocol, scoping

Nora Tuts, Céline R. Gillebert and Caroline van Heugten searched Web of Science, Scopus, PubMed, CINAHL and APA PsycINFO for English-language, peer-reviewed studies describing mindfulness-based interventions in adults with acquired brain injury. They extracted data on participant characteristics, recruitment criteria, intervention aims and contents, and adaptations. Thirty-four unique studies met the inclusion criteria. As a scoping review, the analysis was designed to describe what was delivered, to whom and how; it did not provide a pooled estimate of treatment effectiveness. The review was not preregistered.

Study populations were skewed toward stroke and traumatic brain injury, with most participants in the chronic phase of acquired brain injury, defined in the review as more than six months after injury. Other acquired brain injury groups and people in earlier recovery phases were represented less often in the included evidence. Recruitment criteria also varied substantially between studies. The review therefore found that the same broad label of mindfulness-based intervention did not necessarily refer to a consistent population, even when study programs appeared otherwise similar.

Most interventions were described as Mindfulness-Based Stress Reduction, or as based on that approach, but their components were highly diverse. Differences extended beyond the program name to the aims, exercises and delivery of mindfulness practices. Most studies mentioned delivery-based or content-based adaptations intended for the acquired brain injury population. However, the added value of these adaptations was typically not evaluated, and their use did not translate into more inclusive recruitment. In other words, studies frequently reported modifying programs for an acquired brain injury population without showing that those modifications expanded access to people who might otherwise have been excluded.

The authors identified reporting gaps in three areas: how participants were recruited, what the interventions actually contained and how programs were adapted. They argued that clearer distinctions and more detailed reporting could help separate programs that are currently conflated, support replication and streamline efforts to make mindfulness-based interventions more accessible to people living with the consequences of acquired brain injury. These conclusions concern the organization and transparency of the research literature, not proof that mindfulness is effective, that any particular adaptation is preferable, or that one program is superior to another. The review also leaves unanswered whether the observed variations affect treatment outcomes, because that question was outside the review’s stated aims and the included evidence did not yield a pooled effectiveness assessment.

Subject of Research: Scope and reporting of mindfulness-based interventions for adults with acquired brain injury

Article Title: A Scoping Review of Mindfulness-Based Interventions After Acquired Brain Injury: What Is Delivered, to Whom, and How?

Article References: Tuts, N., Gillebert, C. R., & van Heugten, C. (2026). A Scoping Review of Mindfulness-Based Interventions After Acquired Brain Injury: What Is Delivered, to Whom, and How?. Mindfulness. https://doi.org/10.1007/s12671-026-03003-5

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DOI: 10.1007/s12671-026-03003-5

Keywords: acquired brain injury, mindfulness, mindfulness-based stress reduction, stroke, traumatic brain injury, scoping review, intervention adaptations, participant recruitment, research transparency, Scoping, Review, Mindfulness-Based

The review, published in Discover Education, examined peer-reviewed articles published from 2020 through 2025 that explicitly addressed education for democracy in initial teacher training, teacher preparation or professional development. Searches were conducted independently in Scopus, Web of Science and ERIC. The researchers followed the PRISMA extension for scoping reviews, and their protocol was registered with the Open Science Framework. Of 92 records identified, 34 met the inclusion criteria. Three reviewers screened the records, and disagreements were resolved by consensus.

Studies were assigned to three theory-derived analytical levels: teacher, classroom and institution. Teacher-level studies addressed beliefs, competence, professional identity and reflective agency. Classroom-level studies concerned instructional practice, curriculum, deliberation and student participation, while institutional-level studies addressed governance, leadership, organizational culture, policy and structural decision-making. When a study covered more than one level, researchers selected the level meeting at least two of three criteria: it was the stated target of the study, most findings addressed it, or the discussion interpreted its implications for it.

Two reviewers independently and blindly coded all 34 studies, with a third adjudicating disagreements. Agreement was almost perfect for the primary analytical level, with a Cohen kappa of 0.96 and observed agreement of 97 per cent. Evidence type also had substantial agreement, with a kappa of 0.89 and 94 per cent observed agreement. Agreement was lower for subtopics, at a kappa of 0.74, and for the parent thematic axis, at a kappa of 0.48. A methodological-strength rating was piloted but excluded because agreement was low, with a kappa of 0.13.

Teacher- and classroom-level findings were predominantly qualitative and consistently described professional agency, democratic competence, participatory pedagogy, deliberation and student engagement. Teacher studies reported outcomes including critical agency, civic argumentation, professional positioning in civic debate and the appropriation of democratic and global citizenship values. Classroom studies examined participatory curriculum design, ideological openness, democratic classroom spaces and structured approaches to teaching democracy. These findings document recurring patterns in professional understanding and instructional practice, but the predominance of qualitative and context-specific designs limits conclusions about durability and transferability.

Institutional evidence was less direct despite numbering 11 studies. Most of these studies diagnosed leadership arrangements, governance culture, political constraints and organizational barriers, or examined contextual and cross-sectional associations. They did not trace sustained governance or policy reform resulting from a teacher-education intervention. The authors therefore found that institutional studies could identify conditions associated with democratization, but could not establish a causal sequence from teacher education to lasting organizational change. Overall, 22 of the 34 studies rested on direct empirical evidence, eight on contextual evidence and four on conceptual argument.

The corpus was dominated by qualitative research, which accounted for 21 studies, or 61.8 per cent. Mixed-methods and review-based work each represented 11.8 per cent, theoretical contributions 8.8 per cent and quantitative studies 5.9 per cent. The scarcity of longitudinal and experimental designs was a principal reason the authors described the synthesis as associative rather than causal. The studies were also geographically concentrated in Nordic and Western European settings, particularly Finland, Sweden, Spain and the Netherlands, although the corpus also included Israel, Australia, the United States, Nigeria, Saudi Arabia, Vietnam, South Africa and Zimbabwe. This concentration limits generalizability to other political and institutional settings.

Based on the mapped evidence, the authors proposed a multilevel mediation framework as a conceptual synthesis. In this model, the translation of professional agency and classroom practice into institutional change is conditional on alignment with leadership, governance, organizational culture and political context. The framework is intended to explain how democratic practices may remain concentrated in individual classrooms rather than becoming embedded in institutional decision-making. It is not an empirically demonstrated causal mechanism, and the review states that it requires testing through longitudinal, comparative and multilevel research with explicit measures of institutional participation and organizational change.

Several limitations qualify the findings. The search covered three databases and only English- and Spanish-language publications, potentially omitting relevant work indexed elsewhere, published in other languages or circulating as grey literature. The review mapped the literature but did not estimate effect sizes or formally appraise methodological quality. Its deliberate inclusion of empirical, theoretical, conceptual and review-based studies also created substantial heterogeneity, requiring the authors to distinguish direct empirical findings from contextual evidence and conceptual arguments. The review’s broader policy implication is normative rather than a demonstrated effect: investment in teacher preparation alone may be insufficient where governance, leadership and organizational culture do not support democratic participation.

Subject of Research: A scoping review of evidence linking democratic teacher education to classroom practice and institutional transformation

Article Title: A scoping review of democratic teacher education finds stronger evidence for classroom practice than for institutional transformation

Article References: Naranjo Navas, A. D., Mendoza Cahuana, M. A., Navas Labanda, A. C., & Naranjo Navas, B. J. (2026). A scoping review of democratic teacher education finds stronger evidence for classroom practice than for institutional transformation. Discover Education, 5(1), Article 887. https://doi.org/10.1007/s44217-026-02099-0

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DOI: 10.1007/s44217-026-02099-0

Keywords: democratic teacher education, teacher agency, classroom practice, institutional transformation, participatory pedagogy, school governance, scoping review, evidence synthesis, scoping, review, democratic, teacher

The analysis focused on communications in which a human decision maker evaluates a claim. In firsthand communication, a human or AI source sends the claim directly to the decision maker. In secondhand communication, an intermediary passes or changes it, creating a triad in which the source and intermediary may each be human or AI. The authors described six role arrangements as minimal motifs for comparison rather than models of complete communication networks.

Published in 2026, the review reported screening 3,810 records, including 3,765 keyword-search records returned by Google Scholar and 45 records identified through exploratory searches. Searches were conducted on February 1 and 2, 2025, and the final corpus covered publications from 1987 through 2024. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews as a guide for reporting study selection.

Eligible material included English-language journal articles, conference papers, institutional publications, and books addressing trust, communication, and human or AI interaction. Preprints, studies of AI performance alone, and embodied or non-text multimodal interactions such as work with physical robots were excluded. The resulting evidence base mainly covered text-based and other largely unimodal settings in which people could question, accept, reject, or rely on information from a messenger.

The first author led screening, study-level extraction, and initial coding, while all three authors discussed unclear cases and integrated the resulting categories. Initial coding identified 31 provisional factors across five provisional dimensions. Collaborative review merged seven overlapping sets, reducing the list to 21 factors, and reassignment of factors in a provisional cognitive-mechanism category reduced the framework to four dimensions: Decision Maker, Messenger, Message Property, and Environment.

Decision Maker covers characteristics of the person evaluating the claim, including disposition, ability, habit, reciprocity, physiological basis, and information processing. Messenger covers cues associated with actors who create or deliver the claim, including ability, benevolence, integrity, source, and temporal dynamics. Message Property addresses the claim and its presentation through quality, quantity, process, framing, and modality, while Environment encompasses context, responsibility, task, and trust distance. The dimensions can overlap, and a single study could receive several codes.

Qualitative synthesis of studies assigned to secondhand routes produced four descriptive patterns. Distorted trust calibration, the most common Decision Maker category in 12 studies, describes situations in which available evidence about a source or changes to a claim is difficult to see, potentially leading people to assign more trust than the evidence supports. Trust transfer, the leading Messenger category in 10 studies, refers to trust in one actor extending to another along a communication route, although studies differed in the direction and strength of that transfer.

Extremity amplification, the most frequent Message Property category in nine studies, describes judgments becoming stronger or more polarized when a claim is summarized, edited, or reframed, even as important detail is lost. Accountability diffusion, the leading Environment category in six studies, describes responsibility or blame becoming harder to locate when multiple actors create, change, deliver, or deploy a claim. These labels summarize recurring ideas in the included literature rather than pooled effects, and the review did not test causal relationships among the patterns.

Based on these patterns, the authors proposed four preliminary topics for direct testing in future AI research: role inversion, linked to distorted trust calibration; cognitive offloading, linked to trust transfer; collective bias, linked to extremity amplification; and psychological accountability, linked to accountability diffusion. They also proposed route legibility as a shared starting point for design, governance, and auditing, involving recording and displaying a claim’s origin, changes, supporting evidence, and handoffs. These proposals and their accompanying hypotheses were not findings of the review and require empirical testing.

Several limitations constrain the synthesis. The six motifs do not represent larger networks with multiple sources, cycles, parallel paths, or changing roles, and the corpus did not distinguish among AI model types or systematically compare user groups and domains. The coverage map reflects study counts without considering sample size, study quality, or importance, while differences in methods prevented the authors from combining effect sizes or testing causality. Screening and coding were led by one author and were not independently repeated, and English-language searches, fixed Google Scholar result limits, and the February 2025 cutoff may have excluded relevant evidence. A sensitivity analysis retaining 115 of the 124 studies preserved all six topologies, four dimensions, and upper-category codes, but it could test only stability within the retrieved corpus rather than the completeness of the search.

Subject of Research: Scoping review of trust factors in human-AI communication routes

Article Title: A scoping review of trust in firsthand and secondhand communication involving humans and artificial intelligence

Article References: Yamamoto, K., Tanikawa, T., & Kuzuoka, H. (2026). A scoping review of trust in firsthand and secondhand communication involving humans and artificial intelligence. Discover Artificial Intelligence, 6(1), Article 1445. https://doi.org/10.1007/s44163-026-02469-5

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DOI: 10.1007/s44163-026-02469-5

Keywords: scoping review, human-AI communication, trust calibration, secondhand communication, trust transfer, message framing, accountability, AI mediation, literature mapping, scoping, review, trust

The review, published in Discover Education in 2026, followed the five-stage framework developed by Arksey and O’Malley. The authors searched 13 electronic databases, including Scopus, ScienceDirect, MEDLINE, JSTOR, Google Scholar and Africa-Wide Information, for research published from January 2014 to October 2024. They also searched Google for grey literature and manually checked reference lists. Two reviewers independently assessed full texts, recorded exclusion reasons and resolved disagreements through discussion. Data were extracted with a standardised spreadsheet and analysed using inductive thematic analysis. Of 85 references initially identified, 20 studies met the inclusion criteria.

The evidence base was concentrated in four countries: 12 studies were from South Africa, four from Ethiopia, three from Zimbabwe and one from Zambia. Ten studies used qualitative methods, six used quantitative methods and four used mixed methods. Sample sizes ranged from 50 to 1,200 participants. Eighteen studies focused on students, while six included faculty and staff perspectives. The review therefore provides evidence primarily about public higher education settings in these countries, rather than a representative assessment of the entire region.

Included studies reported sexual violence, physical violence, emotional and verbal abuse, intimate partner violence, cyber violence and stalking. Women were reported to experience higher rates of victimisation, although the review notes that male students can also be victims and that their experiences may be underreported. Reported perpetrators included male peers, intimate partners, staff, faculty and non-students. The studies described hierarchical relationships between lecturers and students and between older and younger students, gender stereotypes, cultural norms, substance use, weak institutional policies, stigma and fear of reporting as contributing factors. First-year students and younger students were identified in some studies as particularly vulnerable.

Universities used several types of response. These included zero-tolerance policies, awareness and training programmes, social-media campaigns, university websites, campus materials, counselling and psychosocial support, medical and legal referrals, and reporting channels such as online systems, toll-free numbers, walk-in options and third-party reporting. Examples included the “No Excuse” initiative, the “Thuso 1777” abuse hotline and the “#SpeakoutUP” initiative. In South Africa, institutional efforts were also considered alongside the National Policy Framework to Address Gender-Based Violence in the Post-School Education Sector.

Student Representative Councils were involved in launching campaigns, linking students with university management and, in some cases, establishing dedicated portfolios for gender-based violence matters. Student-led initiatives included the Girls Against Sexual Violence and Abuse programme at Durban University of Technology, while some students advocated for first-year courses on femicide and discussion forums about violence against women. The review also described several multi-component programmes, including “Ntombi Vimbela!”, which draws on approaches such as Stepping Stones, Creating Futures, SASA! and EAAA.

Despite these initiatives, the review found that campaigns could be short-term or crisis-driven and that limited funding, inadequate staffing and insufficient management support could reduce their reach. Students and staff were often unfamiliar with policies or reporting procedures, while low attendance and student disengagement limited awareness activities. Reporting was deterred by fear of perpetrators, retaliation and re-victimisation, as well as stigma, shame, disbelief and lack of trust in institutional and legal systems. Some programmes also failed to address male survivors, staff victims or LGBTQI+ students adequately.

One of the review’s central gaps was the limited use of evidence-based interventions and standardised, integrated monitoring and evaluation tools. The absence of such tools makes it difficult to measure success and guide strategic planning, rather than establishing that programme effectiveness cannot be determined. The included studies also had limitations, including small samples in some cases, reliance on self-reported data and limited longitudinal information about long-term outcomes. The review was restricted to English-language publications, and the authors noted that non-English research may have been missed.

Future research should examine the barriers to policy implementation, develop strategies for enforcement and monitoring, and expand attention to distance education, administrative staff and other underrepresented groups. The review’s recommendations also call for accessible and confidential reporting systems, sustained funding, gender-inclusive interventions, engagement of men and boys in prevention, and stronger focus on perpetrators and cultural norms. These recommendations respond to the review’s finding that formal policies alone have not consistently translated into effective, trusted and inclusive institutional responses.

Subject of Research: Scoping review of gender-based violence prevention and management in public higher education institutions in Sub-Saharan Africa

Article Title: A scoping review of gender-based violence prevention and management strategies implemented within public higher education institutions in Sub-Saharan Africa

Article References: Mabena, K. M. E., & Gumede, D. (2026). A scoping review of gender-based violence prevention and management strategies implemented within public higher education institutions in Sub-Saharan Africa. Discover Education, 5(1), Article 941. https://doi.org/10.1007/s44217-026-01844-9

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DOI: 10.1007/s44217-026-01844-9

Keywords: gender-based violence, higher education, Sub-Saharan Africa, scoping review, university policy, student support, reporting mechanisms, intervention evaluation, scoping, review, gender-based, violence

Lean methodology originated in the Toyota Production System, where engineers developed a disciplined approach to eliminating muda, the Japanese term for waste. Its core logic is deceptively simple: any step that consumes resources without adding value from the customer’s perspective should be removed, reduced, or redesigned. In manufacturing, this translated into tools such as value stream mapping, which diagrams every step of a process to expose bottlenecks; 5S, a workplace organization method; kanban systems for just-in-time inventory; and continuous improvement cycles known as kaizen. When transplanted into hospitals, the customer becomes the patient, and the product becomes the flow of care itself.

The preoperative phase is a natural target for this kind of thinking because it is where surgical systems leak the most time and money. Before a patient ever reaches the operating room, they typically pass through referral, outpatient consultation, anesthesia assessment, laboratory and imaging workup, and scheduling. Each handoff is an opportunity for redundancy: tests repeated because results cannot be located, appointments rescheduled because information arrived incomplete, and cancellations on the day of surgery because preassessment was never finished. These failures are not merely administrative annoyances. Redundant testing exposes patients to unnecessary venipuncture and radiation, and day-of-surgery cancellations carry measurable psychological and financial costs.

To capture this landscape, the reviewers searched PubMed, Web of Science, and Scopus for English-language studies published between 2010 and 2024, applying the Joanna Briggs Institute framework for scoping reviews. They included studies of surgical patients in which Lean principles were applied to improve efficiency in any phase of the surgical process, and they excluded non-surgical and purely administrative studies. Data were extracted and analyzed according to the JBI methodology, allowing the team to chart where Lean had been deployed, in which surgical specialties, and with what reported effects.

The 27 included studies revealed a consistent catalog of inefficiencies that Lean teams set out to attack. Redundant testing emerged as a recurring theme, with patients undergoing duplicate laboratory work or imaging because results were unavailable at the point of care. Scheduling delays appeared across many settings, driven by poor coordination between preassessment clinics and operating theaters. Communication gaps between departments—surgeons, anesthesiologists, ward nurses, and administrative staff—surfaced as a third major source of waste, often manifesting as incomplete handoffs and last-minute cancellations. Lean interventions addressed these problems through redesigned workflows, standardized checklists, and restructured preassessment pathways.

Most studies in the review reported improvements in process efficiency and resource utilization after Lean implementation. Operating theaters ran with fewer delays, preassessment visits were consolidated, and staff time was used more productively. Some studies went further and documented enhanced patient outcomes, suggesting that smoother preoperative processes can ripple forward into the surgical experience itself. The reviewers also observed notable variation in how Lean was applied across different surgical specialties, reflecting the fact that orthopedics, general surgery, oncology, and other fields each face distinct logistical constraints and patient flows.

The technical appeal of Lean in the preoperative setting lies in its emphasis on value stream mapping applied to the patient rather than the product. When a hospital maps the surgical patient journey, it traces every step from referral to operating room entry, annotating where value is added and where time stagnates. This exposes what Lean practitioners call the eight wastes: defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, and extra processing. In a preassessment clinic, waiting might dominate; in a laboratory pathway, extra processing in the form of duplicate tests; in scheduling, defects in the form of incomplete information. The discipline of mapping forces teams to quantify these losses rather than argue about them anecdotally.

Standardization is another pillar that Lean brings to surgical care. By creating consistent preoperative protocols—uniform checklists, standardized preassessment forms, agreed criteria for when tests are actually needed—hospitals reduce the variability that breeds error. The review’s findings align with broader evidence that standardized pathways reduce day-of-surgery cancellations and improve first-case on-time starts. Yet the reviewers caution that the field lacks consistent metrics. Key performance indicators, or KPIs, varied widely across the included studies, making it difficult to compare results across specialties or to build a unified evidence base for what works best.

This heterogeneity is the review’s central limitation and its most important finding. Because Lean interventions were tailored to local contexts, and because the studies measured different outcomes with different tools, the reviewers could not pool results quantitatively. A scoping review maps the terrain rather than measuring the altitude, and this one reveals a landscape rich with activity but sparse with standardization. The authors conclude that Lean methodology has proven effective in reducing inefficiencies in surgical care, particularly in the preoperative phase, but they call for further research to standardize interventions and develop consistent metrics across surgical specialties to improve evaluation and outcomes.

For hospital administrators and clinicians watching this space, the message is pragmatic. Lean is not a magic bullet, and its success depends on sustained leadership commitment, frontline engagement, and a willingness to measure honestly. But the evidence assembled in this review suggests that when hospitals apply Lean thinking to the preoperative journey—eliminating redundant tests, tightening scheduling, and closing communication gaps—they can reclaim time and resources that would otherwise be lost to waste. As health systems worldwide grapple with surgical backlogs and constrained budgets, the factory floor’s most famous export may prove one of surgery’s most valuable imports.

Subject of Research: Health Services Research

Article Title: The application of lean methodology in the preoperative phase: a scoping review

Article References: Cortes, R., Paulo, M. S., & Sousa, P. (2026). The application of lean methodology in the preoperative phase: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15410-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15410-4

Keywords: application, lean, methodology, preoperative, phase, scoping, review, scientific research

The study, led by Rebecca N. Weston of the University of Maryland School of Nursing together with colleagues including Brian Abery of the University of Minnesota’s Institute on Community Integration, took the form of a scoping review conducted under PRISMA-ScR guidelines. Working with a health sciences librarian, the team searched Medline, CINAHL, Embase, and Scopus for peer-reviewed studies published from 2010 onward that used an identifiable framework, competency set, model, theory, or professional standard to guide disability-focused education within a formal healthcare program. Three independent reviewers screened the results in Covidence, a rigorous process designed to minimize bias in study selection.

Forty-seven studies met the inclusion criteria, spanning twelve countries and an unusually broad range of learner populations: medical, nursing, dental, pharmacy, physical and occupational therapy, and social work students. Medical students were the most frequently studied group, a detail that itself reveals how much of the field’s evidence base rests on a single discipline. The geographic spread was equally telling, with significant gaps in representation from large parts of the world, meaning the conclusions drawn largely reflect high-income, English-speaking educational contexts.

What emerged from the analysis was not a single dominant blueprint but four distinct categories of frameworks guiding disability education. The first comprises formal competency frameworks issued by accrediting bodies or national health authorities, the kind of top-down standards that carry regulatory weight. The second draws on educational theory from the learning sciences, grounding disability content in established principles of how people learn. The third category encompasses disability rights and justice frameworks, which reframe disability not as a deficit to be managed but as a matter of civil rights and social equity, echoing the United Nations Convention on the Rights of Persons with Disabilities. The fourth includes practice-specific or hybrid frameworks that blend elements of the other categories for particular clinical settings.

Technically, the review identified a remarkably diverse array of named frameworks, theories, competency sets, and professional standards, but relatively few recurred across multiple studies. Among those that did were the Core Competencies on Disability for Health Care Education developed by the Alliance for Disability in Health Care Education, competency-based medical education models aligned with the International Classification of Functioning, Disability and Health, and instruments such as the Multidimensional Attitudes Scale Toward Persons with Disabilities used to measure learner attitudes. This fragmentation, the authors suggest, reflects a field still in its formative stages, one where the commitment to structured disability education matters more than allegiance to any particular framework.

The instructional approaches catalogued in the review ranged widely in both creativity and technical sophistication. Simulation and experiential learning formed the backbone of many programs, including encounters with standardized patients with disabilities, actors trained to portray specific conditions in controlled clinical scenarios. Virtual platforms and telehealth-based modules extended reach beyond the classroom, while interprofessional education brought learners from different health disciplines together to practice collaborative disability care. Perhaps most striking were the arts-based methods, from narrative medicine exercises to visual arts encounters, designed to build empathy through modes of engagement that traditional lectures cannot replicate.

Nearly every included study reported at least one positive learner outcome, and most documented statistically significant improvements in self-reported attitudes, knowledge, and confidence. Instruments like the Attitudes and Perspectives Toward Persons with Disabilities scale and the Approach to Disability, Empathy, Practical skills, Training; Clinical Approach to Respectful Encounters framework, known as ADEPT-CARE, appeared repeatedly as outcome measures. But the review also exposed a critical weakness in the evidence base: very few studies assessed whether these gains translated into actual clinical behavior or improved patient experience. Self-reported confidence, the authors caution, is a fragile proxy for competence at the bedside.

The strongest and most durable outcomes emerged from a specific pattern that the review’s findings elevate into a design principle. Studies that incorporated people with disabilities as educators or co-designers of the curriculum, and those that relied on experiential approaches rather than passive instruction, reported outcomes that were not only stronger but more lasting. This aligns with intergroup contact theory, which holds that meaningful, structured interaction between groups reduces prejudice more effectively than information alone. Authentic partnership with disability communities, in other words, is not an optional enhancement but a core mechanism of effective disability education.

No single framework emerged as superior, a conclusion that may disappoint those hoping for a definitive answer but that carries its own practical weight. What mattered, across all twelve countries and every discipline studied, was the intentionality of the educational design: the presence of a structured, deliberate approach to disability content, regardless of which framework anchored it. The authors argue this supports calls for mandatory disability competency requirements embedded in accreditation standards, longitudinal curriculum design that reinforces learning across years rather than confining it to a single module, and genuine co-delivery of programs with disability communities.

The review’s gaps are as instructive as its findings. Evaluation rigor varied widely, few studies tracked outcomes beyond immediate post-training measures, and the durability of measured gains remains largely unknown. Geographic representation was thin, disciplinary coverage uneven, and the near-total reliance on self-reported outcomes leaves the field without solid evidence that better-trained clinicians actually deliver more equitable care. The authors, who completed the project as part of a fellowship through the Golisano Institute for Developmental Disability Nursing, published their work open access so that educators worldwide can act on it. As healthcare systems confront the needs of an aging population with rising disability prevalence, the message from this analysis is unambiguous: structured disability education works, but the field must now prove it works where it matters most, in the clinic, with the patient.

Subject of Research: The impact of disability competency frameworks in guiding curriculum development in healthcare education: a scoping review

Article Title: The impact of disability competency frameworks in guiding curriculum development in healthcare education: a scoping review

Article References: Weston, R. N., Abery, B., Couser, A. H., Fernandez-Dizon, A., & Fu, Y.-T. (2026). The impact of disability competency frameworks in guiding curriculum development in healthcare education: a scoping review. BMC Medical Education. https://doi.org/10.1186/s12909-026-10452-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10452-y

Keywords: impact, disability, competency, frameworks, guiding, curriculum, development, healthcare, education, scoping, review, scientific research

The review, led by Alixe Ménard and colleagues at the University of Ottawa’s Interdisciplinary School of Health Sciences and LIFE Research Institute, with additional contribution from Kanika Sarwal at the University of Waterloo, set out to answer a deceptively simple question: what actually happened to stroke care when COVID-19 swept through hospitals worldwide? The answer, drawn from 107 studies that met rigorous inclusion criteria out of 1,405 initially screened, reveals a story of systemic disruption that touched every link in the stroke care chain—from the moment a patient notices symptoms to long-term rehabilitation and quality of life.

Using the Joanna Briggs Institute Methodology for Scoping Reviews, the team searched four major electronic databases—APA PsycInfo, Embase, Medline, and CINAHL—for English-language primary research articles published between December 2019 and September 2024. They focused specifically on individuals who experienced a stroke during the pandemic, extracting study characteristics and significant findings to enable a qualitative and narrative synthesis. The review followed PRISMA-ScR reporting guidelines, the preferred reporting standard for scoping reviews, ensuring transparency in how studies were identified and included.

From the 107 included articles, seven sub-themes emerged, painting a picture of stroke care under siege. The first and perhaps most striking theme concerns patient behavior and awareness. Fear of contracting COVID-19 in hospitals became a powerful deterrent, causing many people to ignore or downplay stroke symptoms rather than seek emergency care. This reluctance to present to emergency departments was not a marginal effect—it was a fundamental shift in how patients weighed the risk of staying home against the risk of going to hospital during a respiratory pandemic.

The second theme involves the rapid and often disruptive pivot to telemedicine and remote care. In-person consultations dropped sharply as healthcare systems tried to limit viral transmission, and while telemedicine offered a lifeline for continuity of care, it also introduced new barriers. Stroke assessment relies heavily on physical examination—neurological deficits, facial asymmetry, motor weakness, speech patterns—and remote evaluation cannot fully replicate that hands-on diagnostic precision. For a condition where minutes determine outcomes, the shift to virtual care was a double-edged sword.

Delays in treatment formed the third theme, with the review documenting reduced utilization of critical interventions. Time-sensitive treatments for stroke—particularly thrombolysis with tissue plasminogen activator and mechanical thrombectomy for emergent large vessel occlusion, or ELVO—depend on rapid presentation, rapid imaging such as CT, and rapid intervention. When patients delayed seeking help, or when hospital processes were reconfigured around infection control, the window for these interventions narrowed. The review found that this translated into measurable declines in the use of these treatments, meaning fewer patients received the therapies that could reverse their deficits.

The fourth theme addresses the strain on healthcare resources, which led to fragmented care. Hospitals repurposed beds, redeployed staff, and reorganized workflows around COVID-19 surges. Stroke units—specialized wards with dedicated nursing, neuroimaging access, and rehabilitation expertise—were among the resources diverted. When a stroke unit becomes a COVID ward, or when stroke neurologists are pulled to pandemic duties, the coordinated pathway from emergency department to imaging to intervention to rehabilitation breaks apart. The review describes this fragmentation as a direct consequence of resource strain, not a failure of individual clinicians.

Quality of care metrics declined as a fifth theme, with documented drops in care benchmarks and patient outcomes. Stroke care is measured through specific quality indicators—door-to-needle time for thrombolysis, proportion of patients receiving reperfusion therapy, rates of appropriate imaging, and functional outcomes at discharge. The review found that these metrics deteriorated during the pandemic, reflecting the cumulative effect of delayed presentation, reduced interventions, and fragmented systems. Greater stroke severity at presentation formed the sixth theme: when patients finally did arrive at hospital, they were often sicker, having waited longer at home while their symptoms progressed. This created a vicious cycle—fewer admissions but more severe strokes among those admitted.

The seventh and final theme is perhaps the most alarming: a reduction in stroke admissions overall, driven by both patient reluctance and changes in healthcare practices. Stroke did not become less common during the pandemic. People continued to have ischemic strokes, hemorrhagic strokes, and transient ischemic attacks. But fewer of them reached hospital. This suggests a hidden burden of untreated stroke in communities—people who survived at home with deficits that could have been minimized, or who died without ever receiving a diagnosis. The review underscores that this reduction was not a reflection of reduced disease incidence but of reduced access and willingness to seek care.

The implications of this review extend far beyond historical documentation. The authors conclude that the pandemic significantly impacted stroke care globally, leading to increased patient reluctance to seek medical attention, delays in treatment, and a rise in stroke severity. The shift to telemedicine and the strain on healthcare resources further disrupted stroke care, resulting in declines in quality metrics and reduced stroke admissions. But the review is not simply a catalogue of failures—it is a call to action. The authors emphasize the need for adaptable stroke care systems, improved telemedicine access, and enhanced patient education to address pandemic-related challenges and inform future emergency preparedness.

For clinicians and policymakers, the message is clear: stroke care cannot be paused during a crisis. The systems that deliver thrombolysis and thrombectomy must be designed with surge capacity in mind, with contingency plans that preserve time-critical pathways even when infection control demands reorganization. Telemedicine must be developed not as a stopgap but as a robust complement to in-person care, with protocols that account for the limitations of remote neurological assessment. And public health messaging must evolve to address the dual fear that pandemic conditions create—the fear of the virus and the fear of the hospital—so that patients understand that stroke symptoms warrant immediate emergency attention regardless of circulating pathogens.

As the world moves past the acute phase of COVID-19, the lessons embedded in this review serve as a blueprint for resilience. Stroke will remain a leading cause of death and disability worldwide, and the next pandemic or large-scale emergency will test healthcare systems again. The evidence gathered by Ménard and colleagues shows that when systems are not prepared, the consequences ripple through every stage of stroke care—from prevention and awareness through acute intervention to rehabilitation and quality of life. Building adaptable, resilient stroke systems is not optional; it is the difference between recovery and permanent disability for millions of people who will experience stroke in the years to come.

Subject of Research: Stroke care during the COVID-19 pandemic: a scoping review of healthcare disruption, telemedicine, and emergency preparedness

Article Title: Navigating stroke care during the COVID-19 pandemic: a scoping review

Article References: Ménard, A., McLean, M., Oostlander, S., Sarwal, K., Manji, I., O’sullivan, T., & Fraser, S. (2026). Navigating stroke care during the COVID-19 pandemic: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15676-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15676-8

Keywords: Navigating, stroke, care, during, COVID-19, pandemic, scoping, review, scientific research

The research team, led by Shaffi Mdala of the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine, together with colleagues from Kamuzu University of Health Sciences in Malawi and partner institutions, analysed 129 reports from 58 countries. Using the Arksey and O’Malley scoping review framework and reporting according to PRISMA-ScR guidelines, they searched MEDLINE, Embase, Global Health and CENTRAL for studies published between 2000 and December 2025, supplementing their search with targeted grey literature. Their goal was to describe operational service delivery models across the entire continuum of diabetic retinopathy care — screening, referral and treatment — and to assess the nature and scope of evidence on their effectiveness in resource-limited settings.

The burden driving this work is projected to increase disproportionately in low- and middle-income countries, precisely where health systems are least equipped to respond. Blindness from diabetic retinopathy is preventable through organised screening and prompt treatment, yet most of these nations lack structured service delivery models because of resource constraints. The review reveals that most of the documented programmes were conducted in lower-middle-income countries, which accounted for 50.4 percent of reports, and upper-middle-income countries, which accounted for 42.6 percent — a distribution that itself highlights how thin the evidence base remains for the poorest nations.

Perhaps the most striking technical finding concerns how screening is actually delivered. In the majority of programmes, screening was opportunistic, meaning patients were examined when they happened to come into contact with the health system rather than through systematic recall, and this approach accounted for 61.1 percent of reports. Screening was most commonly delivered at the primary level of care, representing 50.9 percent of reports. In most programmes, screening was offered alongside routine diabetes services at various levels of the health system, documented in 77 of 94 reports, or 81.9 percent. Physically, screening was delivered within diabetes or non-communicable disease clinic settings in 36 of 109 reports, or 33.0 percent — a decentralisation strategy that embeds eye care directly into the clinics patients already visit.

The review also documents a profound restructuring of the workforce delivering these services. Task-sharing with non-eye health cadres was documented in 28.6 percent of reports, while task-shifting models appeared in 16.1 percent. These approaches delegate retinal examination and grading to nurses, general practitioners, or community health workers rather than relying solely on ophthalmologists, who remain scarce across much of the developing world. This workforce redesign is supported by a technological backbone: digital retinal imaging was used in 75.5 percent of reports, telemedicine in 42.9 percent, and artificial intelligence-assisted grading in 9.8 percent. Together, these tools allow fundus photographs to be captured by minimally trained personnel, transmitted to remote reading centres, and graded either by human graders working at a distance or, increasingly, by algorithms trained to detect retinopathy.

Yet the review exposes a critical asymmetry at the heart of diabetic retinopathy care in poorer nations. While screening has become increasingly decentralised, treatment services remain largely centralised, concentrated in tertiary hospitals and specialised eye centres that many patients cannot easily reach. Referral pathways were described in the literature, but the evidence on whether those pathways actually function is startlingly thin. Only five studies reported referral adherence, seven reported treatment uptake, and nine reported post-treatment visual outcomes. This means that for the vast majority of documented programmes, researchers simply do not know whether patients identified with sight-threatening retinopathy ever received the laser treatment, injections, or surgery they needed — or whether that treatment preserved their vision.

The economic evidence offers a brighter thread. Organised screening and combined screening and treatment programmes were reported as cost-effective in the reviewed literature, suggesting that systematic approaches can deliver value for money even in severely constrained budgets. This finding matters enormously for policy makers weighing whether to invest scarce resources in structured programmes rather than continuing with opportunistic, ad hoc responses. However, the review notes that evidence on the performance of referral pathways or treatment outcomes remains limited, tempering the confidence with which any single model can be recommended.

What emerges from this review is a portrait of health systems adapting under pressure, using whatever cadres, technologies and integration points are available. The convergence of decentralised screening, workforce task-sharing and technology-assisted approaches represents a coherent response to the fundamental constraint: too few eye health specialists for too many people living with diabetes. The integration of screening within routine diabetes care, documented in over 80 percent of programmes, reflects a pragmatic recognition that patients are already in the system — the challenge is to add retinal examination without adding separate infrastructure.

The implications for the coming decade are significant. As diabetes prevalence continues to climb in low- and middle-income countries, the number of people at risk of retinopathy will grow in tandem, and the window for building organised services before the epidemic overwhelms available capacity is narrowing. The review’s mapping of existing models — from primary-level opportunistic screening supported by digital imaging to telemedicine-linked grading networks — provides policy makers and programme designers with a technical catalogue of what has actually been implemented, rather than what might theoretically work. The researchers, funded by the National Institute for Health and Care Research as part of a Global Health project, with Matthew Burton supported by the Wellcome Trust, emphasise that their synthesis is intended to inform policy and programme design in resource-limited settings.

The gaps the review identifies may prove as consequential as the models it documents. Without better evidence on referral adherence, treatment uptake and post-treatment visual outcomes, health systems cannot know whether their screening investments translate into saved vision. The researchers suggest that future work must close this evidence loop, tracking patients from identification through treatment and beyond. For now, the review stands as the most comprehensive technical map of how the world’s poorer nations are confronting a preventable cause of blindness — revealing both the ingenuity of their adaptations and the distance still to travel.

Subject of Research: Delivery models of diabetic retinopathy services in low- and middle-income countries: a scoping review

Article Title: Delivery models of diabetic retinopathy services in low- and middle-income countries: a scoping review

Article References: Mdala, S., Kayange, P., Zungu, T., Heatley, A. C., Maluwa-Yairo, C., Siwinda, S., Puddu, M., Gordon, I., Evans, J. R., Marques, A. P., Burton, M., & Bascaran, C. (2026). Delivery models of diabetic retinopathy services in low- and middle-income countries: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15711-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15711-8

Keywords: Delivery, models, diabetic, retinopathy, services, low-, middle-income, countries, scoping, review, scientific research

The review, conducted according to the Joanna Briggs Institute scoping review methodology and reported following the PRISMA-ScR checklist, searched ten databases, including PubMed, Embase, Scopus, CINAHL, Web of Science, the Cochrane Library, and four Chinese databases, from their inception to 9 August 2026. Two reviewers independently screened records and charted data using a standardized coding manual, achieving an agreement coefficient of κ = 0.91, a level that indicates near-perfect consistency between the two coders. From this exhaustive search, sixteen studies met the inclusion criteria. The team then classified each intervention by the point in the causal chain at which it primarily acts, using the Driving forces–Pressures–State–Exposure–Effect–Action framework, known as DPSEEA, which environmental health researchers use to organize the pathway from societal drivers of pollution all the way to health effects and back to corrective action.

Three intervention types emerged from the sixteen studies. Air purification dominated the field, appearing in eleven studies. These interventions typically deployed high-efficiency particulate air filtration devices or other purifier technologies to remove particulate matter from the indoor environment after it had already been generated. Multi-component behavioral interventions appeared in five studies, combining elements such as education about pollution sources, guidance on ventilation practices, and encouragement of cleaner cooking or heating behaviors. Policy-level interventions, the least common category, appeared in four studies, encompassing measures such as clean fuel subsidies, improved stove programs, and housing-related regulations that operate far upstream of the individual patient’s living room.

When the researchers located these interventions on the DPSEEA framework, a clear pattern crystallized. Air purification and behavioral interventions both addressed the State and Exposure stages, meaning they acted midway along the causal chain, either by altering the concentration of particulate matter already present in the home or by reducing the contact between the patient and that pollution. The four policy-level interventions, by contrast, acted at the Driving forces and Pressures stages, with two studies each, tackling the societal and structural forces that generate indoor pollution in the first place, such as household energy choices and housing conditions. Most notably, no intervention addressed the Effect stage, and, perhaps more consequentially, no study set out to test coordinated action across multiple stages of the framework.

This absence of coordinated, multi-stage action is the review’s most sobering finding. The DPSEEA framework implies that interventions targeting different points in the causal chain could be complementary: upstream policies that shift households toward cleaner fuels reduce the generation of pollution, while downstream air purifiers and behavioral changes reduce whatever exposure remains. If combining these measures adds benefit beyond either alone, patients would gain the most from integrated programs. But because no study tested such coordination, the existing evidence simply cannot show whether combining upstream and downstream measures adds benefit. The sixteen studies, in other words, describe a field of isolated interventions rather than a system of layered protection.

The outcome measures reported across the studies fell into four broad domains: exposure indicators, which quantify the particulate matter concentrations patients actually experience; clinical and physiological measures, such as forced expiratory volume in one second, the COPD Assessment Test, the St. George’s Respiratory Questionnaire, and the modified Medical Research Council dyspnea scale; health-related quality of life; and behavioral indicators, which track changes in cooking, heating, or ventilation practices. The review found that studies defined these outcomes inconsistently, a technical shortcoming that makes it difficult to pool findings or compare the effectiveness of different intervention types. Without a common set of indicators, the field cannot build a cumulative evidence base in which each new study refines what came before.

The technical logic of the causal chain deserves closer attention, because it explains why the review’s authors frame their conclusions as they do. Particulate matter exposure in COPD follows a pathway: societal driving forces, such as energy poverty and reliance on biomass fuels, create pressures, such as indoor combustion for cooking and heating; these pressures determine the state of the indoor environment, the concentration of particulate matter suspended in household air; the state governs exposure, the amount of pollution inhaled by the patient; and exposure drives effects, the exacerbations, lung function decline, and mortality that define the disease burden. Interventions can, in principle, interrupt this chain at any point. Air purifiers interrupt it late, at the state and exposure stages, and can demonstrably reduce particulate concentrations, but they do nothing about the forces that keep generating pollution. Clean fuel policies interrupt it early, at the driving forces and pressures stages, and are the most likely to be equitable because they change conditions for entire communities rather than for individual households that can afford a purifier.

From this analysis, the review articulates two research priorities. First, upstream policy measures on household energy and housing should be evaluated with health outcomes, since they are the least studied of the intervention types and the most likely to deliver benefits equitably across socioeconomic groups. The authors emphasize that equity-focused research is needed most in low-income, biomass-dependent regions, where solid fuel combustion remains a daily reality for hundreds of millions of households and where the burden of COPD intersects with limited access to clean energy. Second, studies need longer follow-up periods and a common set of outcome indicators. Short follow-up windows cannot capture the slower trajectories of lung function decline or the accumulation of exacerbation risk that matter most to COPD patients, and inconsistent outcome definitions prevent the kind of meta-analytic synthesis that could settle questions about comparative effectiveness.

For COPD patients and their clinicians, the practical takeaway is that air purification currently represents the best-evidenced downstream option, with eleven studies supporting its role in reducing indoor particulate matter exposure, while behavioral counseling on ventilation and fuel use offers a complementary approach that addresses exposure through daily practices. But the review’s framework mapping suggests that patients in biomass-dependent, low-income settings may benefit most from structural changes, such as access to cleaner fuels and improved housing, that no purifier can replicate. For researchers, the message is sharper still: the field needs studies that combine interventions across the DPSEEA stages, evaluate them with harmonized outcomes over clinically meaningful timeframes, and prioritize the populations where indoor air pollution and COPD collide with the least protection. Until such coordinated evidence exists, the promise of cleaner indoor air for COPD patients will remain a collection of partial solutions rather than an integrated public health strategy.

Subject of Research: Indoor particulate matter interventions for COPD: a scoping review mapped onto the DPSEEA framework

Article Title: Interventions to reduce indoor particulate matter exposure in patients with chronic obstructive pulmonary disease: a scoping review

Article References: Liu, J., Wang, W., Hu, X., Xu, J., Chen, F., & Zhao, W. (2026). Interventions to reduce indoor particulate matter exposure in patients with chronic obstructive pulmonary disease: a scoping review. BMC Public Health. https://doi.org/10.1186/s12889-026-29940-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29940-3

Keywords: Interventions, reduce, indoor, particulate, matter, exposure, patients, chronic, obstructive, pulmonary, disease, scoping