Pub Date : 2025-09-01Epub Date: 2025-05-13DOI: 10.1016/j.hlpt.2025.101031
Colene Bentley , Helen McTaggart-Cowan , Diana Kato , Stephen Sundquist , Janet E. Dancey , Stuart Peacock
<div><h3>Objectives</h3><div>Clinical trials provide opportunities for patients to access novel diagnostic screening, treatment, and supportive care options. Trial access is limited for many Canadians due to distribution and distance from cancer centres with clinical trials. In 2021-23, the Canadian Remote Access Framework for Clinical Trials (CRAFT) was implemented as a proof of concept (PoC) pilot to reduce these inequities by bringing trial opportunities to patients living outside metropolitan areas. CRAFT involves a “primary” site that delegates specific trial responsibilities to regional “satellite” centres to form a “trial cluster.” Our objective was to evaluate the CRAFT pilot implemented in three Canadian provinces: British Columbia, Ontario, and Newfoundland.</div></div><div><h3>Methods</h3><div>We recruited healthcare professionals participating in the PoC at primary and satellites locations. Using a framework with deductive and inductive codes, two researchers independently analyzed the interview data applying principles of constant comparison. Disagreements were settled by consensus.</div></div><div><h3>Results</h3><div>Thirteen one-on-one interviews were conducted with participants from British Columbia (n=4), Ontario (n=6), and Newfoundland (n=3). Participants endorsed CRAFT as means to improve equitable access to experimental therapies for underserved populations; upskill regional healthcare teams; integrate satellites with primary sites; and re-envision future trial delivery. Challenges included responsibilities for contract review and approvals at smaller centres and coordinating research services and senior management support across sites.</div></div><div><h3>Conclusions</h3><div>Healthcare teams endorsed CRAFT to improve equitable access to trials and grow research capacity. A follow-up workshop of all relevant parties in March 2025 addressed needed improvements in research, technology, and governance infrastructure to scale CRAFT to new jurisdictions.</div></div><div><h3>Public Interest Summary</h3><div>Clinical trials create opportunities for patients to access new and innovative approaches to treatment, and clinical trial activity has been reported to improve health system performance. However, patients living in rural and remote regions face barriers to trial participation, including financial, time, and health costs to travel to trials in metropolitan centres. Decentralizing clinical trial delivery, where some trial-related activities take place in regional hospitals, can help mitigate these inequities. This study evaluated a pilot demonstration of the Canadian Remote Access Framework for Clinical Trials (CRAFT) in oncology in three Canadian provinces in 2021-2023, from the perspectives of healthcare professionals participating in the pilot. The framework was endorsed by healthcare professionals to help reduce inequities in trial access and grow research capacity. Study findings show better infrastructure support (e.g., co
{"title":"Evaluation of the Canadian Remote Access Framework for Clinical Trials (CRAFT) Pilot: a Qualitative Study","authors":"Colene Bentley , Helen McTaggart-Cowan , Diana Kato , Stephen Sundquist , Janet E. Dancey , Stuart Peacock","doi":"10.1016/j.hlpt.2025.101031","DOIUrl":"10.1016/j.hlpt.2025.101031","url":null,"abstract":"<div><h3>Objectives</h3><div>Clinical trials provide opportunities for patients to access novel diagnostic screening, treatment, and supportive care options. Trial access is limited for many Canadians due to distribution and distance from cancer centres with clinical trials. In 2021-23, the Canadian Remote Access Framework for Clinical Trials (CRAFT) was implemented as a proof of concept (PoC) pilot to reduce these inequities by bringing trial opportunities to patients living outside metropolitan areas. CRAFT involves a “primary” site that delegates specific trial responsibilities to regional “satellite” centres to form a “trial cluster.” Our objective was to evaluate the CRAFT pilot implemented in three Canadian provinces: British Columbia, Ontario, and Newfoundland.</div></div><div><h3>Methods</h3><div>We recruited healthcare professionals participating in the PoC at primary and satellites locations. Using a framework with deductive and inductive codes, two researchers independently analyzed the interview data applying principles of constant comparison. Disagreements were settled by consensus.</div></div><div><h3>Results</h3><div>Thirteen one-on-one interviews were conducted with participants from British Columbia (n=4), Ontario (n=6), and Newfoundland (n=3). Participants endorsed CRAFT as means to improve equitable access to experimental therapies for underserved populations; upskill regional healthcare teams; integrate satellites with primary sites; and re-envision future trial delivery. Challenges included responsibilities for contract review and approvals at smaller centres and coordinating research services and senior management support across sites.</div></div><div><h3>Conclusions</h3><div>Healthcare teams endorsed CRAFT to improve equitable access to trials and grow research capacity. A follow-up workshop of all relevant parties in March 2025 addressed needed improvements in research, technology, and governance infrastructure to scale CRAFT to new jurisdictions.</div></div><div><h3>Public Interest Summary</h3><div>Clinical trials create opportunities for patients to access new and innovative approaches to treatment, and clinical trial activity has been reported to improve health system performance. However, patients living in rural and remote regions face barriers to trial participation, including financial, time, and health costs to travel to trials in metropolitan centres. Decentralizing clinical trial delivery, where some trial-related activities take place in regional hospitals, can help mitigate these inequities. This study evaluated a pilot demonstration of the Canadian Remote Access Framework for Clinical Trials (CRAFT) in oncology in three Canadian provinces in 2021-2023, from the perspectives of healthcare professionals participating in the pilot. The framework was endorsed by healthcare professionals to help reduce inequities in trial access and grow research capacity. Study findings show better infrastructure support (e.g., co","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101031"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-05-27DOI: 10.1016/j.hlpt.2025.101039
Jessica A. Coetzer , Nicole S. Goedhart , Tjerk Jan Schuitmaker-Warnaar , Christine Dedding , Teun Zuiderent-Jerak
Objectives
The digitalisation of care, whilst beneficial for some, also risks exacerbating health inequities if existing health (and social) disparities are not considered. Literature has indicated the broad, systemic causes of digital health inequities could be addressed through policy. This article aims to explore how health inequities are rendered (in)visible in and by digital care policies.
Methods
We inductively analysed sixteen Dutch health policy documents focusing on digital care. Employing a constructivist grounded theory approach, we analysed documents to determine how health equity is addressed in relation to digital care.
Results
Although Dutch health policies do consider health inequities, it is not always shown in policies as a concept related to digital care. Health policies portray digital care as progressive and innovative, being able to shape healthcare in several positive ways. The risks of digital care are attended to less, with focus being placed mostly on privacy and data-security rather than also paying attention to digital health inequities.
Conclusions
Policies either ignore digital health equity entirely or present digital health equity in ways that risk overlooking how digital care may subtly aggravate health inequities. This creates a blind spot in which technological deterministic narratives can be disguised. Current policies could unintentionally perpetuate exclusion by not highlighting the role of digital health inequities as a part of the health equity landscape. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future.
Lay Summary
Digital care is increasing in popularity, but risks excluding a significant number of people who usually already experience health inequities. Although Dutch health policy does consider health inequities, it is not shown in policies as a concept related to digital care. As a result, health equity risks being forgotten in the development of digital care. Policies portray digital care as being able to shape healthcare in a number of positive ways but do not address the risks it may pose in widening health inequities. Instead, issues like ensuring privacy receive more attention. By being overly optimistic about technology without being cautious about its other social consequences, achieving aims such as affordable and accessible care could be negatively impacted. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future.
{"title":"Health equity in the digital age: Exploring health policy and inclusive digital care","authors":"Jessica A. Coetzer , Nicole S. Goedhart , Tjerk Jan Schuitmaker-Warnaar , Christine Dedding , Teun Zuiderent-Jerak","doi":"10.1016/j.hlpt.2025.101039","DOIUrl":"10.1016/j.hlpt.2025.101039","url":null,"abstract":"<div><h3>Objectives</h3><div>The digitalisation of care, whilst beneficial for some, also risks exacerbating health inequities if existing health (and social) disparities are not considered. Literature has indicated the broad, systemic causes of digital health inequities could be addressed through policy. This article aims to explore how health inequities are rendered (in)visible in and by digital care policies.</div></div><div><h3>Methods</h3><div>We inductively analysed sixteen Dutch health policy documents focusing on digital care. Employing a constructivist grounded theory approach, we analysed documents to determine how health equity is addressed in relation to digital care.</div></div><div><h3>Results</h3><div>Although Dutch health policies do consider health inequities, it is not always shown in policies as a concept related to digital care. Health policies portray digital care as progressive and innovative, being able to shape healthcare in several positive ways. The risks of digital care are attended to less, with focus being placed mostly on privacy and data-security rather than also paying attention to digital health inequities.</div></div><div><h3>Conclusions</h3><div>Policies either ignore digital health equity entirely or present digital health equity in ways that risk overlooking how digital care may subtly aggravate health inequities. This creates a blind spot in which technological deterministic narratives can be disguised. Current policies could unintentionally perpetuate exclusion by not highlighting the role of digital health inequities as a part of the health equity landscape. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future.</div></div><div><h3>Lay Summary</h3><div>Digital care is increasing in popularity, but risks excluding a significant number of people who usually already experience health inequities. Although Dutch health policy does consider health inequities, it is not shown in policies as a concept related to digital care. As a result, health equity risks being forgotten in the development of digital care. Policies portray digital care as being able to shape healthcare in a number of positive ways but do not address the risks it may pose in widening health inequities. Instead, issues like ensuring privacy receive more attention. By being overly optimistic about technology without being cautious about its other social consequences, achieving aims such as affordable and accessible care could be negatively impacted. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101039"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-06-11DOI: 10.1016/j.hlpt.2025.101056
Ms Rebecca Bosward, Annette Braunack-Mayer, Ms Emma Frost, Stacy Carter
<div><h3>Objectives</h3><div>Rapid uptake of big data and technologies in healthcare are transforming methodological capabilities in medicine and public health, giving rise to new fields such as precision public health. We conceptualised precision public health as an emerging technology to understand the emergence of this term and its associated characteristics.</div></div><div><h3>Methods</h3><div>We undertook a scoping review to collate and analyse existing literature on precision public health. Documents in English that mentioned the exact phrase “precision public health” were searched for in CINAHL, Medline, PubMed, Scopus, Web of Science and Google Scholar. A descriptive statistical analysis was performed on resulting documents to generate an account of precision public health terminology and definitions as well as author and funder characteristics of articles. Data were analysed through a sociotechnical lens, which is an approach for understanding how technologies emerge and disrupt existing systems.</div></div><div><h3>Results</h3><div>Precision public health was ill-defined at first but is now stabilising. Using an emerging technology conceptual framework, we identified characteristics of precision public health including rapid growth, incoherence, uncertainty about future impacts and outcomes, and ambiguity about use of terminology. Novelty was contested.</div></div><div><h3>Conclusions</h3><div>Definitions of precision public health are continuously changing, and terms have different meanings and uses. Lack of consensus on definitions and terms for precision public health may impact progress of resarch. A single definitions of precision public health is not achievable; however, definitions should be negotiable among stakeholders, acknowledge similarities and differences between stakeholder values and expectations, and reflect research and policy objectives.</div></div><div><h3>Public interest summary</h3><div>Precision public health is an emerging field which often relies on data-centric approaches, including artificial intelligence and machine learning, to improve population health outcomes, which potentially disrupt traditional evidence-based research methods and practice. We conducted a scoping review of current literature, and conceptualised precision public health as an emerging technology to understand how it impacts evidence-based practice and how terms and definitions of precision public health have changed over time.</div><div>There is currently no consensus around terms and definitions most appropriate for the field and the absence of empirical evidence makes it difficult to evaluate potential future impacts. If precision public health is going to deliver on its promises, researchers and practitioners must be transparent about reporting potential uncertainties, benefits and harms. Definitions should also be open and negotiable among stakeholders in precision public health, and reflect research and policy objectives.</div></div
目的大数据和技术在医疗保健领域的快速应用正在改变医学和公共卫生的方法论能力，催生出精准公共卫生等新领域。我们将精确公共卫生概念化为一种新兴技术，以理解这一术语的出现及其相关特征。方法对现有的精准公共卫生文献进行整理和分析。在CINAHL、Medline、PubMed、Scopus、Web of Science和b谷歌Scholar中搜索了提到“精准公共卫生”这个短语的英文文档。对结果文件进行了描述性统计分析，以生成精确的公共卫生术语和定义以及文章的作者和资助者特征。数据通过社会技术视角进行分析，这是一种理解技术如何出现并破坏现有系统的方法。结果精密度公共卫生最初定义不清，但目前已趋于稳定。使用新兴的技术概念框架，我们确定了精准公共卫生的特征，包括快速增长、不连贯、未来影响和结果的不确定性以及术语使用的模糊性。新颖性受到了质疑。结论精准公共卫生的定义在不断变化，术语的含义和用途也不尽相同。对精确公共卫生的定义和术语缺乏共识可能会影响研究进展。精确公共卫生的单一定义是无法实现的；然而，定义应该在利益相关者之间进行协商，承认利益相关者价值观和期望之间的异同，并反映研究和政策目标。精准公共卫生是一个新兴领域，通常依赖于以数据为中心的方法，包括人工智能和机器学习，来改善人口健康结果，这可能会破坏传统的循证研究方法和实践。我们对现有文献进行了范围审查，并将精确公共卫生概念化为一种新兴技术，以了解它如何影响循证实践以及精确公共卫生的术语和定义如何随时间变化。目前还没有就最适合该领域的术语和定义达成共识，而且由于缺乏经验证据，因此难以评价未来的潜在影响。如果精准公共卫生要实现其承诺，研究人员和从业人员必须在报告潜在的不确定性、利益和危害方面保持透明。定义还应在精准公共卫生的利益攸关方之间公开和可协商，并反映研究和政策目标。
{"title":"The emergence and future of precision public health: a scoping review","authors":"Ms Rebecca Bosward, Annette Braunack-Mayer, Ms Emma Frost, Stacy Carter","doi":"10.1016/j.hlpt.2025.101056","DOIUrl":"10.1016/j.hlpt.2025.101056","url":null,"abstract":"<div><h3>Objectives</h3><div>Rapid uptake of big data and technologies in healthcare are transforming methodological capabilities in medicine and public health, giving rise to new fields such as precision public health. We conceptualised precision public health as an emerging technology to understand the emergence of this term and its associated characteristics.</div></div><div><h3>Methods</h3><div>We undertook a scoping review to collate and analyse existing literature on precision public health. Documents in English that mentioned the exact phrase “precision public health” were searched for in CINAHL, Medline, PubMed, Scopus, Web of Science and Google Scholar. A descriptive statistical analysis was performed on resulting documents to generate an account of precision public health terminology and definitions as well as author and funder characteristics of articles. Data were analysed through a sociotechnical lens, which is an approach for understanding how technologies emerge and disrupt existing systems.</div></div><div><h3>Results</h3><div>Precision public health was ill-defined at first but is now stabilising. Using an emerging technology conceptual framework, we identified characteristics of precision public health including rapid growth, incoherence, uncertainty about future impacts and outcomes, and ambiguity about use of terminology. Novelty was contested.</div></div><div><h3>Conclusions</h3><div>Definitions of precision public health are continuously changing, and terms have different meanings and uses. Lack of consensus on definitions and terms for precision public health may impact progress of resarch. A single definitions of precision public health is not achievable; however, definitions should be negotiable among stakeholders, acknowledge similarities and differences between stakeholder values and expectations, and reflect research and policy objectives.</div></div><div><h3>Public interest summary</h3><div>Precision public health is an emerging field which often relies on data-centric approaches, including artificial intelligence and machine learning, to improve population health outcomes, which potentially disrupt traditional evidence-based research methods and practice. We conducted a scoping review of current literature, and conceptualised precision public health as an emerging technology to understand how it impacts evidence-based practice and how terms and definitions of precision public health have changed over time.</div><div>There is currently no consensus around terms and definitions most appropriate for the field and the absence of empirical evidence makes it difficult to evaluate potential future impacts. If precision public health is going to deliver on its promises, researchers and practitioners must be transparent about reporting potential uncertainties, benefits and harms. Definitions should also be open and negotiable among stakeholders in precision public health, and reflect research and policy objectives.</div></div","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101056"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-05-30DOI: 10.1016/j.hlpt.2025.101041
Orna Tal , Yaron Connelly
Background and Objective
Artificial intelligence (AI) algorithms using language models have emerged as valuable tools in medicine. While AI has demonstrated its ability to address clinical questions, its application in ethical dilemmas remains debated. Some argue that AI can synthesize diverse information to form a comprehensive perspective, while others caution against premature reliance. This study explored the potential of AI in addressing ethical medical dilemmas faced by physicians, transitioning from theoretical discussions to practical solutions.
Methods
ChatGPT-3.5 was presented with three socio-ethical dilemmas relevant to national health policy decisions, and its responses were compared to those of physicians and real-world decisions. The dilemmas included questions on (1) criteria for allocation of technologies when resources are limited (2) personalized treatment, and (3) conflicts between patient requests and health organizations' strategy.
Results
ChatGPT-3.5 aligned with physicians' views on budget allocation but diverged on age-related criteria. It struggled to resolve conflicts between patient preferences and organizational strategies. Its responses reflected physician paternalism and a private market perspective, emphasizing system-wide benefit (utilitarian approach), likely due to familiarity with private healthcare systems.
Conclusions
ChatGPT-3.5 demonstrated an evolving capacity to engage with complex medico-ethical dilemmas but also revealed biases and limitations. Policymakers must carefully integrate AI tools, incorporating broader economic and social insights while ensuring adaptability to diverse scenarios. The academic community and clinicians must remain vigilant and regulate the rapid implementation of AI in the increasingly uncertain and evolving healthcare landscape.
{"title":"Using ChatGPT in ethical dilemmas and policy-related complex decision making: Are we ready yet?","authors":"Orna Tal , Yaron Connelly","doi":"10.1016/j.hlpt.2025.101041","DOIUrl":"10.1016/j.hlpt.2025.101041","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Artificial intelligence (AI) algorithms using language models have emerged as valuable tools in medicine. While AI has demonstrated its ability to address clinical questions, its application in ethical dilemmas remains debated. Some argue that AI can synthesize diverse information to form a comprehensive perspective, while others caution against premature reliance. This study explored the potential of AI in addressing ethical medical dilemmas faced by physicians, transitioning from theoretical discussions to practical solutions.</div></div><div><h3>Methods</h3><div>ChatGPT-3.5 was presented with three socio-ethical dilemmas relevant to national health policy decisions, and its responses were compared to those of physicians and real-world decisions. The dilemmas included questions on (1) criteria for allocation of technologies when resources are limited (2) personalized treatment, and (3) conflicts between patient requests and health organizations' strategy.</div></div><div><h3>Results</h3><div>ChatGPT-3.5 aligned with physicians' views on budget allocation but diverged on age-related criteria. It struggled to resolve conflicts between patient preferences and organizational strategies. Its responses reflected physician paternalism and a private market perspective, emphasizing system-wide benefit (utilitarian approach), likely due to familiarity with private healthcare systems.</div></div><div><h3>Conclusions</h3><div>ChatGPT-3.5 demonstrated an evolving capacity to engage with complex medico-ethical dilemmas but also revealed biases and limitations. Policymakers must carefully integrate AI tools, incorporating broader economic and social insights while ensuring adaptability to diverse scenarios. The academic community and clinicians must remain vigilant and regulate the rapid implementation of AI in the increasingly uncertain and evolving healthcare landscape.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101041"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-06-16DOI: 10.1016/j.hlpt.2025.101058
Muhammad Iqhrammullah , Naufal Gusti , Asyraf Muzaffar , Yousef Khader , Sidik Maulana , Marius Rademaker , Asnawi Abdullah
Background
The COVID-19 pandemic exposed how infodemics undermine public health efforts, which subsequently led to the promotion of harmful behaviors. This review aimed to examine major sources of misinformation and explore how demographic and socioeconomic factors affect digital and health literacy, shaping vulnerability to infodemics.
Methods
A narrative review was conducted to synthesize evidence on the pathways, sources, and social determinants of health misinformation. Additionally, a bibliometric analysis was performed using Scopus data from 1997 to 2024, analyzed via Bibliometrix and VOSviewer. The analysis focused on publications related to infodemics and health misinformation on digital platforms, mapping thematic clusters, trends, and keyword co-occurrences.
Results
Mainstream news media, social media, and scientific journals each play a role in disseminating misinformation, exacerbated by time pressure, algorithmic amplification, and inadequate validation processes. Factors attributable to low digital and health literacy include age, education, income, and internet access, which increase vulnerability to misinformation. The bibliometric analysis revealed exponential growth in related research, peaking during the COVID-19 pandemic. Eight dominant research clusters were identified: Health communication and social media; Infodemiology and data analysis; COVID-19 and misinformation; Public and digital health; Vaccine hesitancy; Risk and infodemic management; Conspiracy theories in social media; and Crisis communication.
Conclusion
Infodemics are driven by multi-source digital misinformation and disproportionately affect those with limited literacy. Fact-checking as a mitigation effort can be developed by leveraging artificial intelligence, machine learning, and natural language processing, yet strengthening digital and health literacy remains critical.
{"title":"Narrative review and bibliometric analysis on infodemics and health misinformation: A trending global issue","authors":"Muhammad Iqhrammullah , Naufal Gusti , Asyraf Muzaffar , Yousef Khader , Sidik Maulana , Marius Rademaker , Asnawi Abdullah","doi":"10.1016/j.hlpt.2025.101058","DOIUrl":"10.1016/j.hlpt.2025.101058","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic exposed how infodemics undermine public health efforts, which subsequently led to the promotion of harmful behaviors. This review aimed to examine major sources of misinformation and explore how demographic and socioeconomic factors affect digital and health literacy, shaping vulnerability to infodemics.</div></div><div><h3>Methods</h3><div>A narrative review was conducted to synthesize evidence on the pathways, sources, and social determinants of health misinformation. Additionally, a bibliometric analysis was performed using Scopus data from 1997 to 2024, analyzed via Bibliometrix and VOSviewer. The analysis focused on publications related to infodemics and health misinformation on digital platforms, mapping thematic clusters, trends, and keyword co-occurrences.</div></div><div><h3>Results</h3><div>Mainstream news media, social media, and scientific journals each play a role in disseminating misinformation, exacerbated by time pressure, algorithmic amplification, and inadequate validation processes. Factors attributable to low digital and health literacy include age, education, income, and internet access, which increase vulnerability to misinformation. The bibliometric analysis revealed exponential growth in related research, peaking during the COVID-19 pandemic. Eight dominant research clusters were identified: Health communication and social media; Infodemiology and data analysis; COVID-19 and misinformation; Public and digital health; Vaccine hesitancy; Risk and infodemic management; Conspiracy theories in social media; and Crisis communication.</div></div><div><h3>Conclusion</h3><div>Infodemics are driven by multi-source digital misinformation and disproportionately affect those with limited literacy. Fact-checking as a mitigation effort can be developed by leveraging artificial intelligence, machine learning, and natural language processing, yet strengthening digital and health literacy remains critical.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101058"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-06-18DOI: 10.1016/j.hlpt.2025.101061
Amrit Kirpalani
Objectives
The rapid adoption of AI tools like ChatGPT has transformed information access, particularly in healthcare. However, engagement with AI may be influenced by factors such as healthcare accessibility and educational resources, with potential implications for misinformation in low-resource settings. This study investigates the relationship between physician density, tertiary education enrollment, and national interest in ChatGPT.
Methods
A cross-sectional analysis was conducted using global datasets. Physician density, tertiary education enrollment, GDP, and internet penetration were sourced from WHO, UNESCO, and the World Bank, respectively. The primary outcome, ChatGPT interest scores, was derived from Google Trends. Pearson correlation and multiple linear regression analyses were used to explore associations, controlling for GDP and internet penetration. Logistic regression was employed as a sensitivity analysis, categorizing variables into high and low groups.
Results
Data from 100 countries were analyzed. A significant negative correlation was observed between physician density and ChatGPT interest (r = -0.32, p = 0.012). Multiple linear regression confirmed that lower physician density was significantly associated with higher ChatGPT interest (β = -0.2857, p = 0.045). Tertiary education enrollment showed no significant association with ChatGPT interest. Logistic regression supported these findings, with higher physician density significantly reducing the likelihood of high ChatGPT interest (OR = 0.214, p = 0.001).
Conclusion
Our study suggests that regions with fewer healthcare professionals may engage more with AI tools like ChatGPT, highlighting the need for careful integration of AI into healthcare systems to prevent misinformation and support equitable access to reliable health information.
Public Interest Summary
It is well known that people who have difficulty in accessing healthcare may turn to the internet for medical advice, but it is not yet known if artificial intelligence, like ChatGPT, is being adopted by users for this same purpose. Given the widespread use of ChatGPT, this study explored whether ChatGPT interest in different countries was related to the number of physicians in those countries. We found that in countries with fewer doctors per capita, public interest in ChatGPT tends to be higher. While this does not confirm that people are using ChatGPT specifically for medical advice, it raises important questions about how AI may be filling gaps in access to healthcare. Given the potential for AI to spread inaccurate information, these findings highlight the need for careful regulation to ensure AI tools are used responsibly and do not contribute to misinformation in healthcare.
ChatGPT等人工智能工具的迅速采用改变了信息访问方式，特别是在医疗保健领域。然而，与人工智能的接触可能会受到医疗保健可及性和教育资源等因素的影响，在资源匮乏的环境中可能会产生错误信息。本研究调查了医师密度、高等教育入学率和国家对ChatGPT的兴趣之间的关系。方法采用全球数据集进行横断面分析。医生密度、高等教育入学率、GDP和互联网普及率分别来自世卫组织、联合国教科文组织和世界银行。主要结果ChatGPT兴趣评分来源于谷歌Trends。使用Pearson相关和多元线性回归分析来探索关联，控制GDP和互联网普及率。采用Logistic回归作为敏感性分析，将变量分为高组和低组。结果分析了来自100个国家的数据。医师密度与ChatGPT兴趣呈显著负相关（r = -0.32, p = 0.012）。多元线性回归证实，较低的医师密度与较高的ChatGPT兴趣显著相关（β = -0.2857, p = 0.045）。高等教育入学率与ChatGPT兴趣无显著关联。Logistic回归支持这些发现，较高的医生密度显著降低了ChatGPT高兴趣的可能性（OR = 0.214, p = 0.001）。我们的研究表明，医疗保健专业人员较少的地区可能会更多地使用ChatGPT等人工智能工具，这突出了将人工智能仔细整合到医疗保健系统中以防止错误信息并支持公平获取可靠卫生信息的必要性。公共利益摘要众所周知，难以获得医疗服务的人可能会转向互联网寻求医疗建议，但目前尚不清楚用户是否正在采用人工智能（如ChatGPT）来实现同样的目的。鉴于ChatGPT的广泛使用，本研究探讨了不同国家对ChatGPT的兴趣是否与这些国家的医生数量有关。我们发现，在人均医生人数较少的国家，公众对ChatGPT的兴趣往往更高。虽然这并不能证实人们使用ChatGPT是专门为了获得医疗建议，但它提出了一个重要的问题，即人工智能将如何填补获得医疗保健的空白。鉴于人工智能有可能传播不准确的信息，这些发现强调了谨慎监管的必要性，以确保人工智能工具得到负责任的使用，不会导致医疗保健领域的错误信息。
{"title":"Global ChatGPT interest across healthcare and education access","authors":"Amrit Kirpalani","doi":"10.1016/j.hlpt.2025.101061","DOIUrl":"10.1016/j.hlpt.2025.101061","url":null,"abstract":"<div><h3>Objectives</h3><div>The rapid adoption of AI tools like ChatGPT has transformed information access, particularly in healthcare. However, engagement with AI may be influenced by factors such as healthcare accessibility and educational resources, with potential implications for misinformation in low-resource settings. This study investigates the relationship between physician density, tertiary education enrollment, and national interest in ChatGPT.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted using global datasets. Physician density, tertiary education enrollment, GDP, and internet penetration were sourced from WHO, UNESCO, and the World Bank, respectively. The primary outcome, ChatGPT interest scores, was derived from Google Trends. Pearson correlation and multiple linear regression analyses were used to explore associations, controlling for GDP and internet penetration. Logistic regression was employed as a sensitivity analysis, categorizing variables into high and low groups.</div></div><div><h3>Results</h3><div>Data from 100 countries were analyzed. A significant negative correlation was observed between physician density and ChatGPT interest (<em>r</em> = -0.32, <em>p</em> = 0.012). Multiple linear regression confirmed that lower physician density was significantly associated with higher ChatGPT interest (β = -0.2857, <em>p</em> = 0.045). Tertiary education enrollment showed no significant association with ChatGPT interest. Logistic regression supported these findings, with higher physician density significantly reducing the likelihood of high ChatGPT interest (OR = 0.214, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Our study suggests that regions with fewer healthcare professionals may engage more with AI tools like ChatGPT, highlighting the need for careful integration of AI into healthcare systems to prevent misinformation and support equitable access to reliable health information.</div></div><div><h3>Public Interest Summary</h3><div>It is well known that people who have difficulty in accessing healthcare may turn to the internet for medical advice, but it is not yet known if artificial intelligence, like ChatGPT, is being adopted by users for this same purpose. Given the widespread use of ChatGPT, this study explored whether ChatGPT interest in different countries was related to the number of physicians in those countries. We found that in countries with fewer doctors per capita, public interest in ChatGPT tends to be higher. While this does not confirm that people are using ChatGPT specifically for medical advice, it raises important questions about how AI may be filling gaps in access to healthcare. Given the potential for AI to spread inaccurate information, these findings highlight the need for careful regulation to ensure AI tools are used responsibly and do not contribute to misinformation in healthcare.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101061"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing faculty shortages received less attention in the literature and media outlets compared to registered clinical nursing staff shortages. One may question whether we do not have enough nursing faculty to teach and train students, who will take that responsibility? This critical question should be addressed by nursing leaders, researchers, and key system partners to develop innovative and sustainable policies that reduce nursing faculty shortages. Otherwise, the nursing faculty shortage would negatively affect the quality of nursing education and lead to a declining number of nursing seats, which should be avoided as we need more nurses in the upcoming years. This paper suggested developing a new policy for nursing regulators, titled “Non-clinical Academic Registration Category”, to support internationally educated nurses (IENs) with master's or doctoral degrees who wish to contribute to the nursing faculty workforce. To better understand the context of this policy and its benefits, the paper described the challenges of the registration process experienced by three IENs and the implications of integrating them into the workforce. Through collective and innovative policies, we can empower the future nursing faculty workforce and rationally respond to the ongoing crisis.
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Pub Date : 2025-09-01Epub Date: 2025-07-03DOI: 10.1016/j.hlpt.2025.101051
Jorn Ockerman , Anke Van Bladel , Jelle Saldien , Hilde Van Waelvelde , Lynn Bar-On
Objectives
The aim of this study was to investigate the current levels of use and attitudes towards standardised measurement instruments and (rehabilitation) technology among physiotherapists in Flanders, Belgium.
Methods
This cross-sectional study used an open, online survey, accessible to physiotherapists working in Flanders.
Results
305 completed records were retrieved. Most respondents were female (73,8 %), had >11 years of clinical experience (54,1 %), and treated >10 patients per day (82,6 %). Less than half of the respondents (47,5 %) reported frequent use of standardised measurement instruments. Treating <15 patients per day and working in a rehabilitation centre were significantly associated with frequent use of measurement instruments. Lack of time and added value were most often reported as perceived barriers for systematic implementation. Regarding technology, respondents reported to lack sufficient knowledge (40,7 %), with 36,7 % using no technology in their clinical practice. Having between 3–10 years of clinical experience and frequently treating neurological disorders were significantly associated with an increased use of technology. Lack of finances, knowledge, time and skills were the most frequently perceived barriers to the use of (rehabilitation) technology.
Conclusion
Frequent use of measurement instruments among Flemish physiotherapists appears to be relatively low and one in ten frequently alters the standardised administration. Though attitudes toward (rehabilitation) technology are positive, its adoption in clinical practice appears to be relatively low. Identified barriers include financial constraints, lack of knowledge, time and skills.
Public interest summary
This study investigated how frequently physiotherapists in Flanders, Belgium use standardized measurement instruments (which assess a patient’s health status) and technology during their patients’ treatment. We surveyed 305 physiotherapists and found that fewer than half regularly use measurement instruments. Those who treated fewer patients and worked in rehabilitation centres used these tools more often. Lack of time was most often reported as a barrier for frequent use of measurement instruments.
Concerning (rehabilitation) technology, many physiotherapists felt they didn't have enough knowledge about such devices and more than one in three used no technology in their clinical practice. Those with 3–10 years of professional experience and those who often treated neurological disorders were more likely to use technology. The biggest barriers to using technology were lack of money, knowledge, time, and skills.
Stimulating the use of both standardised measurement instruments and rehabilitation technology could yield benefits for both therapist and patient.
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Pub Date : 2025-09-01Epub Date: 2025-06-06DOI: 10.1016/j.hlpt.2025.101052
Aliasgar Shahiwala
{"title":"AI in personalized medicine: Bridging ethical and regulatory gaps in resource-limited settings","authors":"Aliasgar Shahiwala","doi":"10.1016/j.hlpt.2025.101052","DOIUrl":"10.1016/j.hlpt.2025.101052","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101052"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-07-03DOI: 10.1016/j.hlpt.2025.101067
Digby Simpson , Kabir Ahmad , Md Parvez Mosharaf , Bushra Farah Nasir , Srinivas Kondalsamy-Chennakesavan , Matthew McGrail , Katharine A Wallis , Khorshed Alam
<div><h3>Background</h3><div>Virtual healthcare services are increasingly overcoming geographical barriers and improving access to primary healthcare, especially for rural populations. This systematic review evaluates the economic value of virtual healthcare interventions in rural primary healthcare settings.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol guidelines. The search strategy included databases such as MEDLINE, PubMed, CINAHL, PsycINFO, and ECOLIT, covering studies published between January 31, 2010, and January 31, 2024. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist.</div></div><div><h3>Results</h3><div>Fifteen studies met inclusion criteria. Studies were classified into cost–benefit analyses (<em>n</em> = 2), cost analysis (<em>n</em> = 4), and cost-effectiveness/cost-utility (<em>n</em> = 9) studies. Five studies met over 70 % of CHEERS 2022 reporting criteria. Key findings include significant cost savings and improved cost-effectiveness for interventions targeting elderly populations, Indigenous populations, war veterans, and adults in general.</div></div><div><h3>Discussion</h3><div>The review highlights the economic value of virtual healthcare in rural primary healthcare settings, derived from cost savings and cost-effective service provision. However, inconsistencies in defining ‘virtual healthcare’, limited stakeholder engagement, and incomplete reporting of economic outcomes were identified. Future research should further consider the long-term sustainability, inclusion of younger populations, and wider stakeholder consultation in economic evaluations.</div></div><div><h3>Conclusion</h3><div>Virtual healthcare is a cost-effective and sustainable solution for strengthening rural primary healthcare systems. Policymakers and healthcare providers are encouraged to scale up rural virtual healthcare models to bridge healthcare disparities and enhance equity in access to healthcare in rural settings.</div></div><div><h3>Public Interest Summary</h3><div>This systematic review critically examined the economic value of virtual healthcare interventions within rural primary healthcare settings. Synthesis of evidence reveals the substantial cost savings and cost-effectiveness of rural virtual healthcare services, particularly for interventions targeting older adults, Indigenous communities, war veterans, and the general adult population.</div><div>The findings underscore the major economic advantages of integrating virtual healthcare into rural primary care services. However, it also highlights limitations, such as inconsistent definitions for ‘virtual healthcare’, insufficient engagement with diverse stakeholders, and incomplete reporting of economic outcomes. Future research should prioritise long-term sustainability, include younger
{"title":"The economic value of virtual primary healthcare services for rural populations: A systematic review","authors":"Digby Simpson , Kabir Ahmad , Md Parvez Mosharaf , Bushra Farah Nasir , Srinivas Kondalsamy-Chennakesavan , Matthew McGrail , Katharine A Wallis , Khorshed Alam","doi":"10.1016/j.hlpt.2025.101067","DOIUrl":"10.1016/j.hlpt.2025.101067","url":null,"abstract":"<div><h3>Background</h3><div>Virtual healthcare services are increasingly overcoming geographical barriers and improving access to primary healthcare, especially for rural populations. This systematic review evaluates the economic value of virtual healthcare interventions in rural primary healthcare settings.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol guidelines. The search strategy included databases such as MEDLINE, PubMed, CINAHL, PsycINFO, and ECOLIT, covering studies published between January 31, 2010, and January 31, 2024. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist.</div></div><div><h3>Results</h3><div>Fifteen studies met inclusion criteria. Studies were classified into cost–benefit analyses (<em>n</em> = 2), cost analysis (<em>n</em> = 4), and cost-effectiveness/cost-utility (<em>n</em> = 9) studies. Five studies met over 70 % of CHEERS 2022 reporting criteria. Key findings include significant cost savings and improved cost-effectiveness for interventions targeting elderly populations, Indigenous populations, war veterans, and adults in general.</div></div><div><h3>Discussion</h3><div>The review highlights the economic value of virtual healthcare in rural primary healthcare settings, derived from cost savings and cost-effective service provision. However, inconsistencies in defining ‘virtual healthcare’, limited stakeholder engagement, and incomplete reporting of economic outcomes were identified. Future research should further consider the long-term sustainability, inclusion of younger populations, and wider stakeholder consultation in economic evaluations.</div></div><div><h3>Conclusion</h3><div>Virtual healthcare is a cost-effective and sustainable solution for strengthening rural primary healthcare systems. Policymakers and healthcare providers are encouraged to scale up rural virtual healthcare models to bridge healthcare disparities and enhance equity in access to healthcare in rural settings.</div></div><div><h3>Public Interest Summary</h3><div>This systematic review critically examined the economic value of virtual healthcare interventions within rural primary healthcare settings. Synthesis of evidence reveals the substantial cost savings and cost-effectiveness of rural virtual healthcare services, particularly for interventions targeting older adults, Indigenous communities, war veterans, and the general adult population.</div><div>The findings underscore the major economic advantages of integrating virtual healthcare into rural primary care services. However, it also highlights limitations, such as inconsistent definitions for ‘virtual healthcare’, insufficient engagement with diverse stakeholders, and incomplete reporting of economic outcomes. Future research should prioritise long-term sustainability, include younger ","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101067"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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