research topics in health services management

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

16 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

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Health Services Management Research

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• Description
• Aims and Scope
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Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.

All papers are expected to be of interest and relevance to an international audience. HSMR aims at enhance communication between academics and practitioners concerned with developing, implementing, and analysing health management issues, reforms and innovations primarily in European health systems and in all countries with developed health systems. Papers can report research undertaken in a single country, but they need to locate and explain their findings in an international context, and in international literature. HSMR also promotes invited or commissioned papers, as well as the submission of a collection of papers that could develop into a “special section” or in special issues. Candidacy as guest editor for special issues are welcome.

To achieve the journal's objectives, authors are encouraged to write in a style understandable to health managers and practitioners from other disciplines and in other countries. Health Services Management Research (HSMR) has been accepted into the ESCI.

This journal is a member of the Committee on Publication Ethics (COPE)

The journal encourages the submission of short, full-length, comparative and review articles from different backgrounds (health management, organizational psychology and sociology, applied economics, and others) and which address:

· Original primary research using qualitative or quantitative methods;

· Theoretical or methodological developments , papers that present developments in theories, concepts or models in health services management research, or developments in research methods applied to health services.

· Evidence syntheses , that present the results of secondary research – reviews of the existing research evidence conducted rigorously using recognised and accepted methods for review including (but not limited to) Cochrane systematic reviews, and realist or metanarrative reviews.

· Theory-to-pratice papers , that present the results of implementation of theoretical advances in managerial practices. They can report case studies, incidents, histories, interviews and all other forms of research that help to investigate heath management practices of organizations and systems, and their impacts and lessons.

· Perspectives papers , that aim at highlighting, framing and discussing emerging health management issues in the agenda of organizations and systems.

· Ph.D breakthroughs, that show rigorous and innovative methodological approaches and new research questions of interest for the academics and practitioners community. Sign up for the latest table of content alerts.

To achieve the journal's objectives, authors are encouraged to write in a style understandable to health managers and practitioners from other disciplines and in other countries.

Health Services Management Research (HSMR) has been accepted into the ESCI.

Sign up for the latest table of content alerts.

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Health Services Management Research

Preview this book.

• Description
• Aims and Scope
• Editorial Board
• Abstracting / Indexing
• Submission Guidelines

Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.

All papers are expected to be of interest and relevance to an international audience. HSMR aims at enhance communication between academics and practitioners concerned with developing, implementing, and analysing health management issues, reforms and innovations primarily in European health systems and in all countries with developed health systems. Papers can report research undertaken in a single country, but they need to locate and explain their findings in an international context, and in international literature. HSMR also promotes invited or commissioned papers, as well as the submission of a collection of papers that could develop into a “special section” or in special issues. Candidacy as guest editor for special issues are welcome.

To achieve the journal's objectives, authors are encouraged to write in a style understandable to health managers and practitioners from other disciplines and in other countries. Health Services Management Research (HSMR) has been accepted into the ESCI.

This journal is a member of the Committee on Publication Ethics (COPE)

The journal encourages the submission of short, full-length, comparative and review articles from different backgrounds (health management, organizational psychology and sociology, applied economics, and others) and which address:

· Original primary research using qualitative or quantitative methods;

· Theoretical or methodological developments , papers that present developments in theories, concepts or models in health services management research, or developments in research methods applied to health services.

· Evidence syntheses , that present the results of secondary research – reviews of the existing research evidence conducted rigorously using recognised and accepted methods for review including (but not limited to) Cochrane systematic reviews, and realist or metanarrative reviews.

· Theory-to-pratice papers , that present the results of implementation of theoretical advances in managerial practices. They can report case studies, incidents, histories, interviews and all other forms of research that help to investigate heath management practices of organizations and systems, and their impacts and lessons.

· Perspectives papers , that aim at highlighting, framing and discussing emerging health management issues in the agenda of organizations and systems.

· Ph.D breakthroughs, that show rigorous and innovative methodological approaches and new research questions of interest for the academics and practitioners community. Sign up for the latest table of content alerts.

To achieve the journal's objectives, authors are encouraged to write in a style understandable to health managers and practitioners from other disciplines and in other countries.

Health Services Management Research (HSMR) has been accepted into the ESCI.

Sign up for the latest table of content alerts.

• ASSIA (Online)
• Abstracts in Anthropology Online
• Applied Social Sciences Index & Abstracts (ASSIA)
• ArticleFirst
• British Nursing Index
• Business Source Premier
• Clarivate Analytics: Emerging Sources Citation Index (ESCI)
• EBSCO: Business Source Alumni Edition
• EBSCO: Business Source Complete
• EBSCO: Business Source Elite
• EBSCO: CINAHL Plus with Full Text
• EBSCO: Sales & Marketing Source
• EBSCOhost: Current Abstracts
• Elsevier BV: EMBASE
• Emerald Management Reviews
• Health Policy Reference Center
• OCLC: Electronic Collections Online
• ProQuest 5000
• ProQuest Central
• ProQuest Health & Medical Complete
• ProQuest Health Management
• ProQuest Medical Library
• ProQuest Nursing & Allied Health Source
• ProQuest: ABI/INFORM Complete
• ProQuest: ABI/INFORM Global
• ProQuest: CSA Advanced Technologies Database
• ProQuest: Professional ProQuest Central
• PubMed: MEDLINE
• Reactions Weekly

Manuscript submission guidelines can be accessed on Sage Journals.

• Read Online
• Sample Issues
• Current Issue
• Email Alert
• Permissions
• Foreign rights
• Reprints and sponsorship
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Research on Health Services Management: The Search for Structure

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• Thomas T. H. Wan Ph.D. 2  

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Health services management research (HSMR) has been described as an iterative process, which compiles data, generates pertinent managerial information, and influences the delivery of health care services. This field of inquiry examines the effects of organization, financing, management, and market forces on the performance of health care organizations in the delivery, quality and cost of, access to, and outcomes of health services. The inquiry encompasses a variety of disciplines: social and behavioral sciences, statistics, economics, sociology, political science, anthropology, psychology, operations research, epidemiology, and biostatistics, as well as medicine and nursing. Responsibilities of HSMR include:

Collection and diffusion of health care information and statistics.

Design, development, and evaluation of new health services systems and processes.

Improvement of health services through quality assessment, improvement and management.

Research and theory building in management.

Policy impact analysis.

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Wan, T.T.H. (2002). Research on Health Services Management: The Search for Structure. In: Evidence-Based Health Care Management. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-0795-6_3

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Human resource management research in healthcare: a big data bibliometric study

Xiaoping qin.

1 School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China

Yu-Ni Huang

2 College of Medical and Health Science, Asia University, Taichung, 41354 Taiwan

Kaiyan Chen

3 Department of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China

4 Department of Innovative Medical Research, Hospital Management Institute, Chinese People’s Liberation Army General Hospital, Beijing, 100853 China

Richard Szewei Wang

5 Affiliation Program of Data Analytics and Business Computing, Stern School of Business, New York University, New York, 10012 United States of America

6 Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, 518055 China

Bing-Long Wang

Associated data.

All data and materials generated or analysed during this study are included in this published article.

Human resource management (HRM) in healthcare is an important component in relation to the quality and efficiency of healthcare delivery. However, a comprehensive overview is lacking to assess and track the current status and trends of HRM research in healthcare. This study aims to describe the current situation and global trends in HRM research in healthcare as well as to indicate the frontiers and future directions of research. The research methodology is based on bibliometric mapping using scientific visualization software (VOSviewer). The data were collected from the Web of Science(WoS) core citation database. After applying the search criteria, we retrieved 833 publications, which have steadily increased over the last 30 years. In addition, 93 countries and regions have published relevant research. The United States and Australia have made significant contributions in this area. Current research articles focus on topics clustered into performance, hospital/COVID-19, job satisfaction, human resource management, occupational/mental health, and quality of care. The most frequently co-occurring keywords are human resource management, job satisfaction, nurses, hospitals, health services, quality of care, COVID-19, and nursing. There is limited research on compensation management and employee relations management, so the current HRM research field still has not been able to present a complete and systematic roadmap. We propose that our colleagues should consider focusing on these research gaps in the future.

Introduction

Among the many management elements, people are the most dynamic and active element, and they are an important asset in organizations [ 1 ]. The term “human resources” was first coined by the academic Peter F. Drucker in 1954 [ 2 ]. The key function of human resources management (HRM) is to “put the right people in the right jobs at the right time” [ 2 ]. HRM refers to the planned allocation of human resources in accordance with the requirements of organizational development through a series of processes, such as recruitment, training, use, assessment, motivation, and adjustment of employees, to mobilize their motivation, bring into play their potential and create value for the organization [ 1 ]. Ensuring the achievement of the organization’s strategic objectives, HRM activities mainly include human resource strategy formulation, staff recruitment and selection, training and development, performance management, compensation management, staff mobility management, staff relationship management, staff safety and health management, etc. Similarly, modern healthcare management has human resources as the core. The HRM level in hospitals is related to the quality and efficiency of medical services provided by hospitals, which is also the core of internal hospital management and the focus of health macro management [ 3 ].

The World Health Organization (WHO) states that health systems can only work with the help of health workers, and that improving the coverage of health services and realizing the right to the highest standard of health depends on the availability, accessibility, acceptability and quality of health workers [ 4 ]. In response to evolving characteristics in socio-economic development and the human resource market, healthcare system personnel reforms are evident in three key areas: first, decentralization and flexible employment practices grant hospital managers greater decision-making autonomy concerning priorities and access to medical resources. However, they also impose quantitative and functional constraints on physicians' working hours, career planning, and medical payment systems. Second, a focal point is the rational allocation of technical staff to achieve efficiency while controlling labor costs. Finally, hospital organization change and restructuring are prevalent. Many European countries have unionized hospital employees, limiting the ability to establish independent incentives and rewards. In contrast, U.S. hospital employees often do not belong to specific organizations, leading cost control efforts to revolve around adjusting the allocation of technical staff and employee numbers to reduce labor expenses [ 5 – 7 ].

The current global trend in the number of publications on HRM in healthcare is rising. However, there are currently several problems in HRM research. The following issues mainly exist: (1) the expertise and professionalism of HRM managers are limited. (2) Theoretical methods and technical applications are weak. (3) Insufficient regulation of regulations, systems and procedures. (4) Management is mainly at the level of operational work, and functions are too fragmented [ 8 , 9 ]. Although hospitals worldwide generally recognize the importance of HRM, they do not pay sufficient attention to it. The management of human resources is also stuck in the previous understanding that its work is carried out only by transferring positions in hospitals, promoting and reducing the salary of employees and a series of other operations [ 10 ]. Most senior management in hospitals have comprehensive medical knowledge; some are experts in a particular field. Still, they lack expertise in HRM, which makes them work in a transactional way in HRM. There is also currently a general health workforce imbalance in countries worldwide. The lack of well-being of healthcare workers is particularly problematic in foreign healthcare institutions [ 11 ], and to reduce costs, some organizations have reduced staffing levels. In turn, because of lower quality of service, the morale of healthcare providers often suffers. Patient satisfaction may decline [ 12 ]. In the process of data gathering, we found that the literature related to HRM in healthcare is still under-reported and that the research topics are scattered, and there is still a lack of generalization and summary of these literatures [ 13 ]. There is no systematic theoretical support in the current research, which defines the perspective that researchers should take when analyzing and interpreting the data to be collected, leading to biased interpretations of the results, and does not allow other researchers to combine the findings with existing research knowledge and then apply them to practice [ 14 ]. Second, data collection was not rigorous, and the downloading strategy was not appropriate to achieve completeness and accuracy of data. There is also a lack of information and incomplete use of features in the presentation of knowledge maps and visualization results [ 15 ].

Therefore, the aims of this study are the following; first, we provide a new way of viewing the field of healthcare HRM and its associations by examining co-occurrence data. Second, we relate our evolutionary analysis to a comprehensive future research agenda which may generate a new research agenda in healthcare hospital HRM. This review, therefore, focuses on illuminating the research frontiers and future roadmap for healthcare HRM research [ 16 , 17 ].

Materials and methods

This study provides a bibliometric analysis of the HRM research literature in health care over a 30-year period to describe the landscape and trajectory of change in the research field. The methodology used for this overview is based on bibliometric mapping [ 18 , 19 ], a visualization technique that quantitatively displays the landscape and dynamic aspects of the knowledge domain [ 20 ]. Data were collected from the Web of Science (WoS) core citation database. Two Java-based scientific visualization software packages (CiteSpace and VOSviewer), developed by Chaomei Chen and Van Eck and Waltman, were used to analyze the data [ 18 , 21 ].

The data for this study were retrieved from the Web of Science on 28 September 2022. Web of Science was chosen as the search engine, because it is the most widely accepted and commonly used database for analyzing scientific publications [ 22 ]. The keywords “human resource management” and “healthcare organization” were used as search topics. First, to get a complete picture of HRM research, we searched all the literature from 1977 to the date of the search.

Eight hundred thirty-three publications on HRM in healthcare organizations were identified (Fig.  1 ). We excluded publications before 1990, because the two documents before 1990 did not include complete information. In addition, articles, review articles, and early access articles were included in the study. To minimize language bias, we excluded literature published in languages other than English. Each publication in WoS contains detailed information, including the year of publication, author, author’s address, title, abstract, source journal, subject category, references, etc. A detailed description of the contents of the database preceded the bibliographic analysis. For example, some authors presented their names in different spellings when submitting articles, so reviewing and integrating the data in detail was necessary. A total of 718 publications were included and exported to VOSviewer and CiteSpace software to analyze the following topics: global publishing trends, countries, journals, authors, research orientations, institutions, and quality of publications.

Research flow chart of the bibliometric analysis

Introduction to CiteSpace and VOSviewer

VOSviewer is a software tool for building and visualizing bibliometric networks. It was developed by Van Eck and Waltman [ 21 ]. In VOSviewer, metric networks can be visualized and analyzed for factors, including journals, researchers, or individual publications. They can be constructed based on citations, bibliographic couplings, co-citations, or co-authorship relationships [ 21 ].

Global publication trends

Number of global trends.

After applying the search criteria, we retrieved a total of 718 articles. Figure  2 a shows the increase in articles from 1 in 1977 to 108 in 2021. To predict future trends, a linear regression model was used to create a time curve for the number of publications throughout the year, and the model fit curve for the growth trend is shown in Fig.  2 b. The trend in the number of publications fitted the time curve well at R 2  = 0.8802. The R-squared value is a measure of how well the trend line fits. This value reflects the degree of fit between the estimated value of the trend line and the corresponding actual data; the better the fit, the more reliable the trend line is [ 23 , 24 ]. Based on the model’s trends, it is also predicted that the number of articles on HRM in healthcare will increase to approximately 300 by 2030, an almost threefold increase compared to 2021.

a Total number of publications related to HRM research. The bars indicate the number of publications per year. b Model fitting curves of global publication trends. c Top 10 countries of total publications. d Distribution world map of HRM research

Country and regional contributions

Figure  2 c, d shows the number of publications and the world distribution of the top 10 countries in total publication numbers. The USA contributed the most publications (172, 24.2%), followed by Australia (86, 12.0%), the UK (83, 11.6%), and China (78, 10.9%).

Total number of citations

The USA had the highest total number of citations of all included publications (5195) (Table ​ (Table1), 1 ), while the UK ranked second (2661), followed by Australia (1960) and the Netherlands (1271). The detailed rankings and numbers are shown in Fig.  3 a and Table ​ Table1 1 .

Contributions in publications of countries

a Top 10 countries of average citations for each article. b Average number of citations. c Top 10 countries of the H-index

Average citation frequency

Belgium had the highest average number of citations (49.26), followed by the UK (32.06), the USA (30.2), and Canada (27.13), as shown in Fig.  3 b.

Total citations and the h-index reflect the quality of a country’s publications and academic impact[ 25 ]. Figure  3 c shows the ranking of the h-index, where the top country is the USA (h-index = 36), followed by the UK (h-index = 27), Australia (h-index = 23), and Canada (h-index = 22).

Analysis of publications

Table ​ Table2 2 shows the top 10 journals for publications on HRM in healthcare, with 54 articles published in “International Journal of Human Resource Management”, 44 articles published in “BMJ Open”, 30 articles published in “Journal of Nursing Management”, and 24 articles in “BMC Health Services Research”.

Top 10 journals of publications related to HRM research

Table ​ Table3 3 shows the top 10 most published authors with 96 articles/reviews in the last decade, representing 13.4% of all literature in the field. Timothy Bartram from Australia has published 19 papers, followed by Sandra Leggat from Australia, Stanton P from the USA, and Townsend K from the UK with 13, 11, and 10 papers, respectively. All researchers listed as authors were included in this term for analysis, regardless of their relative contribution to the study. Notably, we have included all authors in this analysis regardless of their relative contribution to the study.

Top 20 authors of publications

Research orientation

Figure  4 a shows the top 10 research orientations of the 100 research orientations. The most common research orientations were management (193 articles), nursing (107 articles), health policy services (105 articles), and health care sciences services (201 articles).

a Top 10 research orientations and the number of publications in each orientation. b Top 20 institutions with the most publications

Institutions

Figure  4 shows the top 20 institutions with the most published papers. La Trobe University has the highest number of articles with 24, followed by the University of London (23) and Griffith University (18).

Co-occurrence analysis

In the keyword mapping on HRM research in healthcare, the size of the nodes represents the frequency, while the line between the nodes reflects the co-occurrence relationship. A total of 1914 keywords were included, and 59 met the criteria. All keywords were grouped into six clusters: performance (light blue cluster), job satisfaction (red cluster), quality of care (blue cluster), human resource management (brown cluster), occupational/mental health (purple cluster), and hospital/COVID-19 (green cluster) (Fig.  5 ).

Co-occurrence analysis of HRM research in healthcare

The most prominent themes in HRM research in healthcare are as below. In the “Performance” cluster, the keywords which have the greatest co-occurrence strength were “performance”, “systematic review”, “decentralization health system” and “motivation”. The main keywords in the “Job Satisfaction” cluster are “job satisfaction”, “organizational commitment”, “transformational leadership” and “turn over”. In the “Quality of care” cluster, the keywords that stand out are “quality of care”, “patient safety”, “high-performance work system”, “quality management” and “patient satisfaction”. In the “Human resource management” cluster, the prominent keywords include “human resource management”, “health policy”, “public health”, and “education and training”. In the “Occupational/Mental Health” cluster, the prominent keywords are “Occupational health”, “mental health”, “well-being” and “burnout”. The main keywords in the “Hospital/COVID-19” cluster were “hospitals”, “COVID-19” “workforce” and “qualitative research”.

Global trends in HMR in healthcare

Our study of HMR research in healthcare illustrates current and global trends in publications, contributing countries, institutions, and research orientations. The field of HMR research has evolved over the past three decades. However, as this study shows, the number of publications steadily increases yearly, with 93 countries or regions publishing in the field, suggesting that research focusing on HMR research and providing in-depth knowledge will likely increase.

Quality and status of publications worldwide

We find that most publishing countries are developed countries, but developing countries are catching up. The total citation rate and the h-index reflect the quality and scholarly impact of a country’s publications [ 25 ]. According to our study, the US ranks first among other countries in total publications, citations, and h-index, making the most substantial contribution to global HRM research. The UK and Canada also contribute significantly, with impressive total citation frequencies and h-index, especially the UK, which ranks second in average citation frequency. However, some countries, such as Belgium, Canada and Australia, also play an important role, given their high average citation frequency. In developing countries, HRM research has also served as a guide for hospitals to improve the quality of care. The study will serve as a reference for developing countries to learn from the experience of developed countries as their economic development gradually catches up with that of developed countries.

The impact and prestige of the journals can be seen in the number of articles published in the field and the influential journals in healthcare HRM research, including the BMC Health Services Research, the Journal of Nursing Management, the International Journal of Human Resource Management, the Health Care Management Review, and the Journal of Health Organisation and Management. These high-quality journals are thus the main source of information for researchers in this field on the latest developments in HRM in healthcare.

The study shows that almost all of the top 20 institutions come from the top five countries with the most publications, with the majority coming from the US, Australia and the Netherlands, reflecting the great academic influence of these three countries in the field of HRM in healthcare. These institutions play an important role in raising the academic performance of a country. Furthermore, the top 20 authors represent research leaders who are likely to impact the future direction of research significantly. Therefore, more attention should be paid to their work to stay abreast of the latest developments in the field.

Research Focus on HRM

Keywords play a crucial role in research papers as they contain vital information [ 26 ]. A systematic analysis of keywords within a specific research domain offers valuable insights into trends and focal points across various research areas [ 27 ]. Moreover, co-occurrence analysis relies on the number of joint publications to evaluate relationships among the identified keyword domains. As a result, it serves as an effective method for predicting future trends and focal points within the research areas of interest. These findings are expected to inspire more researchers to contribute to the future of HRM research in healthcare [ 28 ].

In this study, a total of six research domains were eventually summarized. Performance, Hospital/COVID-19, Job Satisfaction, Human resource management, Occupational/Mental Health, and Quality of care. By visualizing the analysis results, we can easily further clarify future trends. As the co-occurrence diagram shows, the keywords “Organizational culture”, “Patient safety”, “Nursing”, “Leadership”, “Quality of care” and “Hospitals” are highlighted as larger icons, so that investment and demand for quality research are necessary for the context of these six research directions.

Six modules and research directions in human resources

This study found that the visual clustering results and the keywords that emerged from the clusters were closely related to the HRM module s described in “Human Resources Management: Gaining a Competitive Advantage” by Noe. R . [ 29 ]. The modules have been cited in HRM research and are used as textbooks in universities [ 30 – 33 ]. Some of the keywords in each cluster correspond to human resource planning, performance management, recruitment and staffing, and training and development, respectively. The explanation of the HRM modules is described in the next paragraph. However, there are no explicit keywords in the modules related to employee relations management and compensation management results. This may be due to the private nature of the compensation structure in healthcare organizations during data collection, making it unavailable.

The explanation of the HRM modules [ 29 ]

• Human resource planning is the starting point of HRM. It helps the organization forecast future personnel needs and their basic qualities, primarily through planning.
• Recruitment and staffing, with HR planning as the input, is equivalent to the organization’s blood, nourishing the organization and solving the problem of staffing and staff matching.
• Training and development, with the “education” theme.
• Performance Management is at the heart of the six dimensions. It is also the primary input to the other dimensions.
• Compensation management aims to motivate employees to solve the company’s problems.
• Employee relations management aims to manage people and help the company form an effective cycle of rational human resource allocation.

Human resource planning

Human Resource Plan (HRP) stands for the implementation of the HR development strategy of the enterprise and the accomplishment of the enterprise’s goals, according to the changes in the internal and external environment and conditions of the enterprise, through the analysis and estimation of the future needs and supply of human resources and the use of scientific methods for organizational design, as well as the acquisition, allocation, utilization and maintenance of HR and other aspects of functional planning. HRP ensures that the organization has a balance of HR supply and demand at a needed time and in a required position, and achieves a reasonable allocation of HR and other resources to effectively motivate and develop of employees [ 34 ].

Decentralization health system, organizational culture/structure are high-frequency words in the clustering results related to “human resource management”. It is important to assess the extent to which decentralization can be used as a policy tool to improve national health systems. For policymakers and managers, based on relevant literature and research as well as country experience analysis, the experience of decentralization in relation to the organization and management of healthcare services is considered a forward-looking and pioneering concept capable of achieving optimal allocation of HR and other resources, in addition to the need to focus more on ex-ante and ex-post incentive development to deliver a 1 + 1 > 2 HRM effect [ 35 ]. HRP is the starting point and basis for all specific HRM activities. It directly affects the efficiency of the overall HRM of the enterprise. It is, therefore, taken as the primary job requirement for HR managers [ 36 ]. Organizational culture/structure significantly impacts the healthcare sector, such as excellence in healthcare delivery, ethical values, engagement, professionalism, cost of care, commitment to quality and strategic thinking, which are key cultural determinants of high-quality care delivery [ 37 ]. Therefore, as with other for-profit organizations, healthcare organizations must ensure that their organizational structure functions effectively to achieve their strategic goals. The organization formulates and implements HRM, an important task to achieve the development strategy goals.

Staff recruitment and allocation

Recruitment and staffing are the first steps in hospital HRM activities. Under the guidance of the organization’s human resources development plan, potential staff who meet the development conditions are attracted. Through the scientific selection of outstanding personnel, a platform with guaranteed treatment and development prospects is provided to ensure that the team of the healthcare organization is built solidly and meets the development needs. From the findings of this study, the keywords “workforce” and “workload” appear as high-frequency keywords in the co-occurrence analysis. Still, keywords related to traditional staff recruitment (e.g., analysis of recruitment needs, job analysis, competency analysis, recruitment procedures, and strategies) do not appear often. Recruitment and staffing are the prerequisites of human resources work. They bring a new dynamic source to healthcare organizations while complementing staff, making the organization full of vitality and vigor, facilitating organizational innovation and management innovation and helping improve the healthcare organization’s competitive advantage [ 38 ]. Recruitment and staffing, as a part of HR, directly impact the successful running of daily activities.

Training and development

Human resource training is an important component of quality and safety in the health care system. The keyword “education and training” shows a high frequency of co-occurrence in the clustering results of analysis, corresponding to the module “training and education”. However, it is connected to the keywords “human resource management” and “health policy”, and is in the same cluster with” public health”, “health care management”, and the distance between the lines and dots indicate that these topics are closely related, proving the importance of education and training in the HRM of health systems. Healthcare organizations (especially for non-professionals and caregivers) can improve the performance of their employees by enhancing their capabilities, knowledge and potential through learning and training, so that they can maximize their qualifications to match the demands of their work and advance their performance [ 39 , 40 ].

Performance management

Performance management, the core of the six modules, is also featured in the clustering results. Although this is an important focus for HR professionals, few studies have explored the link between HRM and health sector performance [ 6 ], the results show “performance” and “motivation”. The effectiveness of performance management is an important component of HRM, which effectively improves the quality of care in healthcare organizations/institutions [ 6 ]. Focusing on the effectiveness of performance management is considered to be crucial. First, as an integral part of HRM within an organization, it can help the organization meet its goals. Second, ineffective approaches can lead to negative attitudes among employees (including clinicians, nursing staff, administrators, etc.) and adversely affect performance due to decreased satisfaction among employees and patients. Third, given the increasing quality and cost reduction pressures on healthcare organizations, conducting further research on performance management and effectiveness is critical [ 41 ]. However, it is clear from our results that healthcare organizations have recognized the importance of performance management and are pursuing “high performance”. Although the topic of performance management in HRM in healthcare is one of the research priorities, the number is lacking and more discussion on performance management should be suggested for future research.

Compensation management

Compensation is an important tool to motivate employees to work hard and to motivate them to work hard. The results of the database's bibliographic analysis show that no keywords directly involved compensation. This indicates that “compensation management” has not been considered a hot topic or a research issue over 30 years of available literature. To clarify the content of this module, we further searched the database of 718 articles with keywords, such as compensation, remuneration, salary, etc., and found that only 35 of them mentioned or discussed compensation, and some years (e.g., 2018, 2009) even had no relevant literature being published. However, issues such as fairness of compensation management and employee compensation satisfaction are still important issues of concern to business management academics [ 42 , 43 ]. The actual situation is that it is difficult to conduct research on compensation management. Most organizations keep their employees’ compensation confidential, and when conducting research, HR managers avoid talking about their employees’ compensation or leave it vague, rendering it impossible for researchers to conduct further research.

Employee compensation is one factor that has the greatest impact on organizational performance. In the future, organizations should be encouraged to scientifically structure their compensation management and empower academic research to establish and implement fair compensation management systems based on empirical research while maintaining the privacy and security of organizational information.

Employee relations management

The connotation of employee relations management involves organizational culture and employee relations, as well as the coordination of the relationship between employers and employees. Healthcare organizations have complex structures with employees with varying skills, tasks or responsibilities, and such conflicts are often managed through the communication skills of administrative staff [ 44 ]. Although the keywords related to “employee relations management” did not occur in this study's analysis results, the six HRM modules are closely related. Therefore, this does not mean that no description of employee relations management was completely absent in the retrieved articles. It is clear that there is currently a lack of research on employee relations management in the healthcare field. Still, with the continuous development of the healthcare industry, it faces multiple challenges. If employee relations are not handled properly, healthcare organizations with social responsibility will face great public pressure, which will even affect the quality of healthcare services and performance, so it is especially important to strengthen the research on employee relations management.

This study inevitably has some limitations, the first of which arises from using quantitative methods to review documents in the field of HRM. The review relied on an analysis of the bibliographic data associated with the documents rather than a review of the research findings. The impact of the study was, therefore, limited to the general direction of developments in the field, rather than a synthesis of research findings. As a result, we may have missed some publications due to database bias. Second, most of the publications identified were in English and some articles relevant to other languages have not been included. Third, Since HRM exists in a wide range of industries and research areas, although researchers have set the screening criteria as detailed as possible, there may still be some literature that has not been detected.

This study describes the current state and global trends in HRM research in healthcare. The United States has made significant contributions in this field, establishing itself as a global leader. It is foreseeable that more and more publications will be published in the coming years, which indicates that HRM research in healthcare is booming. The analysis results of this study echoed the modules of HRM. It can be seen that in the current HRM research, many topics have been of interest. However, the focus and hotspots of the research are scattered, and there is presently no systematic research on the content of HRM in healthcare.

Acknowledgements

The authors thank the Editor-in-Chief and the referees for their helpful comments which help to improve our manuscript significantly.

Author contributions

BW, ZH and LLconceived of the presented idea. BW, developed the theory. BW, YH, RW, KC and XQ collected the data and discussed the results. BW and YH encouraged XQ to investigate the hospital management field and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

This research was supported by Chinese Academy of Medical Sciences and Peking Union Medical College, China (Grant number: 2021-RC630-001).

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There are no human or animal studies in this manuscript, and no potentially identifiable human images or data are presented in this study.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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• Engaging and Empowering Patients

Engaging and empowering patients in their own healthcare leads to improvements in safety, quality, and satisfaction of care. Use of digital healthcare tools, like patient portals, smartphones, or mobile apps—often that allow patients to report and monitor their symptoms—can facilitate patient engagement and empower patients and their caregivers to participate more actively in their own health self-management, chronic care management, and wellness at the many points of interaction with the healthcare system.

In 2023, DHR invested $76.3 million in grants and contracts across the lifetime of the projects to help patients, families, and health professionals work together as partners in promoting care improvements over the duration of the projects.

Research Stories by Subtheme

Below are research stories told in the investigator’s own words that focus on engaging and empowering patients.

Technology Solutions to Engage Patients and Their Families in Care

Studying the Accuracy of Symptom-Checker App in Diagnosing Strokes in a Real World Setting

Connecting NICU Parents with Mental Health Support via a Mobile App

Informing the Future Direction of Patient-Centered Clinical Decision Support Research

Advancing Patient-Centered Clinical Decision Support

Using Patient-Reported Outcomes for Chronic Disease Management

ASTHMAXcel Voice Mobile Application to Improve Chronic Disease Management and Patient Outcomes

Additional Research by Subtheme

Creating a mobile application to support care transitions for older adults after surgery has the potential to provide timely post-discharge information and allow for caregiver preparedness, better health outcomes, and improved communications between providers and patients and their care partner.

The use of a cloud-based, multidisciplinary care plan for children with medical complexity is feasible to implement and may improve care coordination for children with medical complexity, providing the foundation for a future digital health intervention to address gaps in care.

Using the BREASTChoice clinical decision support tool improves a patient’s understanding of breast reconstruction options, timing, and possible complications, with the potential to significantly enhance their ability to make informed decisions about their reconstruction surgery based on their preference and risk factors.

Sharing inpatient notes during pediatric oncology hospitalization between parents and clinicians has the potential to enhance parents’ understanding of and empowerment in their child’s care, and may contribute to a safer and more transparent care environment.

By identifying and addressing patient-reported outcomes that matter most to patients, this research has the potential to maximize clinic time spent with patients with HIV and chronic conditions to tailor and improve their care.

An integrated mobile health (mHealth) application for remote monitoring of asthma symptoms enables primary care clinicians and clinical staff to effectively monitor asthma patient-reported outcomes between visits, enhancing patient quality of life by supporting symptom tracking and self-reporting.

A technology-based patient-reported outcome system that uses text messaging to capture these data in real time and delivers motivational messages based on responses decreased frequency of smoking.

Implementing an artificial intelligence–supported tool to collect patient-reported outcomes for patients with diabetes is expected to enable efficient delivery of high-quality patient-centered care and improve clinical outcomes.

Using Digital Healthcare Technology to Support People with Substance Use Disorder

Participating in an immersive virtual reality experience may increase willingness of emergency department patients with opioid use disorder to engage in medication treatments, including buprenorphine and methadone.

The use of the Peer PLUS (People Leveraging Urgent Support) platform is expected to enhance the connection between those with substance use disorder and peer recovery coaches, assisting in the goal of long-term recovery for these individuals so that they may progress along the four dimensions of recovery (i.e., home, health, community, and purpose).

• Optimizing Care Delivery for Clinicians

The DHR program funds research to support clinicians and other healthcare professionals in maximizing their ability to provide high-quality and safe healthcare to patients. This includes research to optimize clinical decision making by delivering the right information to the right people at the right times, so that clinicians can make the best treatment decisions, while also ensuring that technology is designed in a way that supports cognitive work and does not introduce or increase provider burden.

In 2023, the DHR program invested $46.0 million in grants and contracts across the lifetime of the projects to optimize care delivery for clinicians, including research on using effective clinical decision support (CDS) interventions to improve care, using real-time digital healthcare data to improve timely treatment or diagnosis, and technology solutions to improve medication safety.

Below are research stories told in the investigator’s own words that focus on optimizing care delivery for clinicians.

Using Digital Healthcare Solution to Improve Patient Safety

Improving Safety in Postoperative Handoff Communication with Telemedicine and Machine Learning

Improving Emergency Care Through Innovative Digital Healthcare Solutions

An App to Help Rural Paramedics Improve Timeliness to Deliver Life-Saving Care for Patients Experiencing Heart Attacks

Leveraging Technology for Personalized, Evidence-Based Care and Decision Support

Use of EHR-Embedded Tools To Improve Screening for Intimate Partner Violence

Optimizing Patient Safety Using Digital Healthcare Solutions

Creating Meaningful Decision Support to Reduce Drug–Drug Interactions

Using Digital Tools to Support Shared Decision Making and Personalized Care

App Assists Patients Decide if In-Home Hospital-Level Care is Right for Them

Leveraging Machine Learning to Assess Risk

Using Machine Learning for Military Service Members and Veterans at Risk for Suicide

Using Patient-Reported Outcomes to Improve Care Delivery

Integrating the Patient Voice in Patient-Reported Health Outcomes

The development of a research agenda for precision emergency medicine holds promise to promote needed research in using precision medicine in the emergency setting to improve patient outcomes by considering a patient’s genomic, biologic, environmental, and public health data.

The augmented reality cardiopulmonary resuscitation headset has the potential to improve the quality of pediatric chest compressions, save lives, and improve care equity in lower-resource settings.

Using deep learning and predictive analytics, this research has the potential to activate full capacity protocols in emergency departments before overcrowding occurs, thus avoiding overcrowding and its resultant impacts such as poor patient outcomes including morbidity and mortality.

Implementing an electronic STI risk assessment program in pediatric practices increases STI testing.

Clinical decision support may support providers and patients in making personalized decisions regarding diet goal setting among underinsured patients, with the potential to address dietary behavior change and reduce the rate of obesity.

Successful development and implementation of a clinical decision support strategy to promote uptake of influenza vaccine in pediatric acute care settings may lead to improved influenza vaccine rates as well as provide general considerations to guide clinical decision support for pediatric health maintenance interventions in acute care settings.

Digital nursing surveillance tools can enhance meaningful bedside interactions and improve patient care by leveraging the data to optimize nursing workflow, reduce nonnursing tasks, and boost nurse efficiency.

A point-of-care decision support tool for discontinuing disease-modifying therapies in those with multiple sclerosis has the potential to reduce the risk incurred and the financial burden of those patients using these medications.

The use of an evidence-based clinical decision support tool that uses patient data, including patient values and goals, has the potential to shorten the time between a failing treatment and the use of a more efficacious treatment for children with juvenile idiopathic arthritis, ultimately improving patient outcomes.

The COVID-19 ED return screening tool has the potential to improve morbidity and mortality from COVID-19 infection by identifying, through machine learning algorithms, patients at highest risk of ED return and associated severe disease and decompensation, prompting earlier hospital admission and higher levels of care in the disease course.

Enhancing electronic health records with screening and needs assessment for oncology patients has the potential to answer unmet needs and improve health status using patient reported outcomes.

The ability to remotely collect and review signs and symptoms of lung cancer recurrence using patient-reported outcomes and results of surveillance imaging, coupled with telehealth visits, may improve surveillance guidelines adherence and reduce barriers and disparities in care.

• Supporting Health Systems in Advancing Care Delivery

DHR-funded research focuses on advancing care delivery at the health systems or organizational level. Efforts to scale effective interventions across different platforms, promote interoperability, and leverage data and technologies can strengthen healthcare systems and the care they deliver.

In 2023, the DHR program invested $39.4 million across the lifetime of projects on research to advance care delivery and to scale effective digital healthcare intervention across healthcare systems.

Below are research stories told in the investigator’s own words that focus on advancing care delivery at the health systems level.

Advancing Health Equity

Machine Learning to Improve Patient Triage in the Emergency Department

Leveraging Telehealthcare to Improve Healthcare Delivery

Improving Access to Care with Telehealth Physiatry Visits for Children with Special Healthcare Needs

Optimizing Data Exchange Through Health Information Exchange

Advancing Public Health with Interoperable Data Exchange

Scaling Effective Digital Healthcare Tools Across Health Systems

Scaling and Dissemination of an Effective Clinical Decision Support Tool for Pneumonia

Displaying Patient Photos in Medical Records Reduces Errors, Improves Patient Safety

A Digital Healthcare Equity Framework supports users and other stakeholders assess whether their healthcare solutions that involve digital technologies are equitable at every phase of the digital healthcare lifecycle, including planning, development, acquisition, implementation, and monitoring.

By developing and disseminating recommendations around evidence based telehealth guidelines, policies for reimbursement, equitable access, licensure, and practical solutions, this grant may improve telehealth access and quality in Michigan and can serve as an adaptable roadmap for other states seeking to improve telehealth delivery.

Using a nationwide information system of telehealth services and insurance claims to analyze the response and impact of the COVID-19 pandemic may help to improve the healthcare system’s readiness for future public health emergencies.

Evaluation of the rapid transition to telehealth due to the COVID-19 pandemic will inform patient care post–COVID-19 to ensure equal access and high-quality care.

Asynchronous telepsychiatry has the potential to provide quality psychiatric care for elderly patients in skilled nursing facilities by leveraging nursing facility staff and using telemedicine.

Enhancements in matching patient data across disparate health data sources will expand the integration of data, better research data, and give those caring for patients more comprehensive patient health information improving the quality and safety of patient care.

Improving interoperability of electronic health records through health information exchange has the potential to facilitate care coordination throughout the transfer process and improve patient outcomes.

Routine capture of PROMs in surgical patients is feasible and can be effectively scaled across the American College of Surgeons National Surgical Quality Improvement Program.

This research has the potential to reduce drug–drug interactions involving anticoagulants through a novel shared decision making tool that visually displays, to patients and providers, information on the potential interaction risks from anticoagulants, taking into account a patient’s unique attributes and current medication list.

By making evidence repositories more FAIR—findable, accessible, interoperable, and reusable—through technologies such as application programming interfaces, CEDAR helped health information technology developers design new and exciting ways to make the information available where, when, and how stakeholders need it most.

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Home > USC Columbia > Public Health, Arnold School of > SPH_HEALTH_SERVICES_POLICY_MANAGEMENT > Health Services Policy and Management Theses and Dissertations

Health Services Policy and Management Theses and Dissertations

Theses/dissertations from 2023 2023.

The Intersectionality of Rurality and Race on COVID-19 Vaccination Among Adults in the United States , Shiba Simon Bailey

Examining the Associations of the Kidney Allocation System With Patient Sensitivity, Wait Time to Transplant, and Donor Distance , Shamika Danielle Jones

Female Infertility and Maternal and Infant Outcomes in South Carolina – The Role of Insurance Type , Chelsea Mencio Norregaard

Beyond Vaccination Coverage: A Critical Look At Zero-Dose Children in Sub-Saharan Africa , Chamberline Ekene Ozigbu

Complementary and Integrative Health (CIH) And Opioid Use Among Adults With Chronic Noncancer Pain in the US , Yi-Wen Shih

Correlates of Immunization Timeliness in Three South Asian Countries: Secondary Analysis of Demographic and Health Surveys , Tanzir Ahmed Shuvo

Patient Experiences and Disparities in Telehealth HIV Care During the COVID-19 Pandemic: Study Results From the Southern United States , Valerie Yelverton

Theses/Dissertations from 2022 2022

Association of Prior Periodontal Disease With Cancer – Exploring Epidemiologic Evidence of Periodontal Exudate-Exposed Site Cancer Risk Versus Remote Gastrointestinal Sites , Asma Alzahrani

Gonorrhea: Core Areas and State Policies , Jessica Purser

Subject Cognitive Decline in Informal Caregivers , Eunika Simons

Identifying Racial Differences in Colorectal Polyp Profile at Screening Colonoscopy Using Traditional Regression and Machine Learning Approaches , Yuqi Wu

Theses/Dissertations from 2021 2021

Examining the Cost and Quality Relationship in Medicare , Alexandria Fleming Delage

Evaluating the Health Impact of CenteringPregnancy Program Versus Traditional Prenatal Care in Midland Obstetric Clinics and Validating Selected Item On Birth Certificate , Oluwatosin A. Momodu

Hear My Voice: Qualitative Studies to Explore What Empowers Patients to Talk With Their Doctor and Participate in Making Health Care Decisions , Alicia Marie Oostdyk

A Cost Effectiveness Analysis Of The Nutritious Eating With Soul Study , Mary Jones Wilson

Theses/Dissertations from 2020 2020

Magnet Recognition (Mr) and Hospital Quality Outcomes in the U.S.A– Analysis Based on 2017 Hospital Data , Abdulmalik Alhammad

Effect of Lifestyle, Medical School Culture and Income on Medical Students' Decision to Pursue a Primary Care Career in Saudi Arabia , Ahmed Abdullah Alhussain

Package Warning Labels for Communicating Relative Risks of Cigarettes, Heated Tobacco Products, and E-Cigarettes , Yoo Jin Cho

Correlates of Maternal Health Service Use and Women’s Experiences Using Antenatal Care in Ghana: A Mixed-Methods Study , Anna Cofie

Examining Parental Perceptions and Decisions to Uptake Child Influenza Immunizations: Assessing Pandemic and Policy Impacts on Vaccination Rates Following the H1N1 Pandemic, and the ACIP LAIV Preferential Recommendation Revocation , Amir H. Mehrabi

The Impact of Financial Incentives on Urban-Rural Disparities in Dental Supply: Evidence From Thailand , Rakchanok Noochpoung

Effectiveness and Experience of an Integrated Maternal Mental Healthcare Intervention in Private Clinics and Public Health Facilities in Pakistan , Syeda Somyyah Owais

Aging With HIV in the United States: Trends and Impact of Hospital Stays on Inpatient Resource Utilization, and Costs of Care, 2003-2015 , Khairul Alam Siddiqi

Maternal Preventive Dental Services Utilization: The Role of Preconception Oral Health Counseling in and the Association With Birth Outcomes: Evidence From South Carolina Prams , Monique Johnette Williams

Effectiveness Among Community Health Center Governing Boards: An Assessment of the Different Governing Board Members’ Perspectives , Brandi L. Wright

Theses/Dissertations from 2019 2019

Factors Associated with Advance Care Plans and End-Of-Life Care Choices Among Elderly Americans: An Analysis of Health and Retirement Study Data , Agha Ajmal

The Association of Reimbursement Methods With the Tendency of Primary Care Physicians to Apply the American Diabetic Association’s Recommendations and Make Referrals to Specialists Among Ambulatory Care Patients in Us Outpatient Settings. , Abdullah Alharbi

Examining Women’s Perceptions of Maternity Care in Public and Private Sectors of National Guard Hospitals in Saudi Arabia: A Qualitative Study , Hanin M. Almahmoud

Effect of Severe Economic Recession on the Psychological Distress: Evidence of Modifying Effect of Risky Behaviors and Insurance Status , Lumi Bakos

Clinically Integrated Networks: The ‘Magic Pill’ for Improving the Quality of Health Care? , Kaitlyn Ann Crosby

Did Medicaid Expansion Under the Affordable Care Act Reduce the Likelihood That People Report Employment Status Changes Due to Health, U.S., 2009-2017 , Songyuan Deng

The Relationship Between the Electronic Health Record Patient Portal and Shared Decision Making , Gloria Esoimeme

HIV Care Location: An Evaluation of Single Versus Multi Facility Utilization of HIV/Aids Care Services and Patient Health Outcomes and Clinical Indicators in South Carolina , Melanie Gwynn

The Intergenerational Effects of Adverse Childhood Experiences on Children’s Emergency Department Utilization and Depression and Anxiety in South Carolina , Eboni E. Haynes

Assessing the Impact of South Carolina’s Medicaid Adult Dental Policy on Dental Emergency Department Visits , Victor Kirksey

The Association of Rural Hospital Closures with In-Hospital and 30-Day Post Hospital Discharge Mortality from Emergency Care Sensitive Conditions , Melinda A. Merrell

Health Insurance Program for the Poor, Out-Of-Pocket Costs, and Catastrophic Health Expenditures in India , Shyamkumar Sriram

The Prescribing Patterns of Gabapentin and Pregabalin in a Medicaid Population Amid the Opioid Epidemic , Sarah Sullivan

The Association of Health Insurance and Prescription Drug Coverage on Cost-Related Non-Adherence and Hospitalization Across Age-Related Groups of Individuals With COPD , Shamika Martin Walls

Theses/Dissertations from 2018 2018

Investigating Drug-Related Violence in Indian Country: The Lumbee Tribe of North Carolina , Asa Alena Revels

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests , Abeer Alharbi

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes , Duaa I. Aljabri

How Do Health System Employees with Established Musculoskeletal Complaints Decide on Their Treatment Pathway? A Qualitative Approach , Noor Alshareef

Patient Characteristics, Discharge Disposition, and Hospital Factors Associated with All cause 30-day Hospital Readmission for Total Joint Arthroplasty in 2014 , Hamad Yahya Alzamanan

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey , Serdar Aydin

The Association of Hospital Practices to Breastfeeding Behaviors in South Carolina: Analysis of 2013-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) Data , Larisa Donnette Bruner

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes , Metria Harris

Residential Mobility And Enrollment Churn In A Medicaid Population , John E. Stewart

Theses/Dissertations from 2017 2017

Association of Freestanding Dialysis Facility Size, Quality Incentive Program Scores and Patient Survival , Fozia Ajmal

Racism Across The American South: The Association Between Racism On Twitter, Rurality, & Black Mortality , Jarrod Bullard

Association of Provider Communication and Inpatient Hospital Readmissions , Jeremy Dean Faulkenburg

Economic Burden of Tuberculosis among Bangladeshi Population and Economic Evaluation of the Current Approaches of Tuberculosis Control in Bangladesh , Mohammad Rifat Haider

The Association between Clinical Recognition of Depression and Unplanned Hospital Readmission among Older Adults , Karen M. Jones

Association between Job Satisfaction and Pay: The Case of the Wage Payment System of Dental Clinics in Korea , Eui Jeong Kim

Feasibility of Introducing Investor-Owned Hospitals in Korea , HongSeok Seo

A Study on Satisfaction of Dental Implant Patients , Jung Su O

Depressive Symptoms Association With Health Outcomes And Treatment In Older Americans With Diabetes , Lashonda Jovon Williams

Internet Speed and the Effect on Health Information Technology Adoption , Matthew W. Yuen

Theses/Dissertations from 2016 2016

Contextualizing Multilayered Sexual Subjectivities of Heterosexual Black Female Undergraduate Students at a Predominantly White Institution in the South , Amarachi Rossana Anakaraonye

Molecular Cues Of Pattern-Recognition-Receptor Pathways In Redox-Toxicity-Driven Environmental NAFLD , Suvarthi Das

Effectiveness Of Community-Based EIBI Treatment: A Longitudinal Analysis Of Adaptive Behavior And Language Outcomes , John Kuntz

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions , Yueyao Li

Smoking-Related Stigma: A Public Health Tool Or A Damaging Force ? , Paula A. Lozano

Novel Methods for Analyzing Longitudinal Data with Measurement Error in the Time Variable , Caroline Munindi Mulatya

Practice Characteristics That Matter In the Provision of Health Education Services By Primary Care Physicians , George Paul Newby Jr.

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria , Dumbiri Joy Powell

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline , Ashley Shields Robertson

Frequency of Colonoscopy Surveillance in Average-Risk Adults Relative to Guideline Recommendations , Meng-Han Tsai

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’s Perception Of Quality Of Care In The General U.S. Adult Population , Jumee Wang

The Undiagnosed Patient and The Diagnostic Odyssey: Current Genetic Counseling Practices and Perspectives , Amelia Cordell Wardyn

Job Satisfaction And Intent To Quit Outcomes Among Home Health Aides In Home Health Care Industry Of The United States: A Multilevel Study , Seokwon Yoon

Theses/Dissertations from 2015 2015

Relationship Between Job Satisfaction Among Frontline Staff and Patient Satisfaction: Evidence from Community Health Centers in South Carolina , Ashley Lynn Barnes

Association between Electronic Prescribing among Ambulatory Care Providers and Adverse Drug Event Hospitalizations in Older Adults , Grishma Patel Bhavsar

Spatial Analysis and Correlates of Waterpipe Tobacco Smoking among College Students in the United States , Frederick Richard Kates

Community-Level Factors Associated with Health-Related Quality of Life Among Older Adults , Yu-Hsiu Lin

Examination of the Association of Receipt of Opioid Therapy and Lung Cancer Patient Survival Rates among South Carolina Medicaid Recipients , Jametta Sade Magwood

Patient And Provider Characteristics And Practice Patterns of Primary Care Physicians Of Weight-Related Counseling , Kolby T. Redd

Dental Insurance as a Mitigating Factor in Reducing the Risk of Mortality Among Working-Age Adults with Dental Caries and Periodontitis , Naveed Sadiq

Longitudinal Study of the Effectiveness of the South Carolina Medicaid Policy for the Application of Fluoride Varnish for Children Age Three and Under , Christine N. Veschusio

Theses/Dissertations from 2014 2014

Impact of Multi-Hospital System Organizational Structure on Financial Performance and Quality of Care in Rural Hospitals , George Raul Audi

Two Studies of Family-Centered Care Family-Centered Care and Shared Decision Making: Are they the same Construct? and The Association of Family-Centered Care and Shared Decision Making with Receipt of all Needed Prescription Drugs and Emergency Department Visits in Children with Asthma , Barbara Lee Brumbaugh

Women’s HIV Prevention Study (Whips): A Proposal to Pilot Test an HIV Intervention for Older African American Women Living with HIV , Charsey Cherry

Analysis of Risk Factors Contributing to Home–Based Direct Care Workers (DCWS) Occupational Injury in Long–Term Care , Hanadi Y. Hamadi

Mental Disorders, Mental Health Problems, and Treatment Among Army Recruiters and Recruiting Candidates, 2011-2013: An Examination of Current Rates in the Recruiting Population , Chadwick Karl Knight

Theses/Dissertations from 2013 2013

Examining the Role of Electronic Medical Record Generated Provider Reminders On Provider offering of Breast Cancer Screening Services , Charles Beverley, Jr.

An Assessment of Injury Presentation to Determine Elder Abuse Prevalence in South Carolina , Brittani L. Harmon

The Relationship Between Electronic Health Record Implementation and Outcomes of Care For Three Cardiovascular Procedures , Deshia Ann Leonhirth

Assessment of the Effectiveness of an Innovative Screening Colonoscopy Protocol in Producing High Quality Performance and Outcomes by Trained Primary Care Physicians , Yi Jhen Li

Relationship Between the Experience of Perceived and Physician Diagnosed Arthritis and the Presence of DSM-IV Criteria-based Major Depression (MDD) Among Older , Ryan Neil Schmidt

Differential Effects of the Great Recession on Minority Populations , Samuel Towne

Theses/Dissertations from 2012 2012

Assessing Risk Factors, Cost And Mortality Due to Ventilator-Associated Pneumonia (VAP) Using National Inpatient Sample Data , Hasan A. Areabi

Factors Associated With Local Public Health Agency Participation In Obesity Prevention, 2008 , Jeff Hatala

Weathering the Storm Faithfully: African American Women's and Clergy's Perspectives about Natural Disasters and the Role of the Baptist Church In Disaster Preparedness , TaQuesa McClain

A Profile of Diabetes-related Below Knee Amputations Using Nation-wide Patient Discharge Data: Patient, Provider, And Insurance Characteristics , Flora Elisa Melvin

Is Optimum Time to Coronary Artery bypass Surgery Associated With Hospital Teaching Status and Payer Source? A Comparison of Outcomes and Costs Among Non St Segment Elevated Myocardial Infarction Patients and St Segment Elevated Myocardial Infarction Patients , Lamont Andre' Melvin

Association Between Clinical Decision Support System Use and Health Care Disparities in the Treatment and Outcomes of Acute Myocardial Infarction and Pneumonia , Jordan Paul Mitchell

Use of Endoscopic Third Ventriculostomy (ETV) In Treatment of Pediatric Obstructive Hydrocephalus; A Multi-Level Retrospective Analysis of the United States Pediatric Population. , Irene Nancy Okech

Healthcare Cost Implications of Medicaid Managed Care , Margarita Morales Pate

Effectiveness of Medicare's Nonpayment Policy On Hospital-Acquired Conditions , Kristin Schuller

Differences in Interventions for Children With ADHD Their Relationship to Contact with the Juvenile Justice System in SC , Samuel Lee Soltis

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Health Services Management Research Papers/Topics

Attitudes of primary health care (phc) gatekeepers towards patient referral policy, machakos county, kenya.

Abstract Primary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients...

Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

Abstract The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected f...

Patient Perceptions on Primary Health Care (PHC) Nurses and Its Impact on Services Delivery at County Level, Machakos, Kenya

Abstract Background: Patient perceptions on services delivered by nurses are crucial when assessing the quality of health services. These are most attributable to their knowledge, competent skills and other personal characteristics. These can be described in how effective they handle clients when performing their nursing duties and their effectiveness including their ability to utilize a variety of communication skills and their attitudes at their regular work place. Methodology: This is a c...

Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems

Abstract: Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of...

Integrated Review of Management of Hypertension by Lifestyle Changes, Yoga, Exercise, Acupressure, Plant/Herbal and Allopathic Medications and Newer Interventions

Hypertension is a global epidemic with prevalence almost similar in urban and rural populations and it is a significant modifiable risk factor for cardiovascular disease, stroke, and renal diseases. Although many modalities of treatment are available, a large percentage of patients don't have their blood pressure (BP) under control, hence, the management of hypertension has become a vital issue. We do find very few integrative reviews considering all feasible modalities of treatment for h...

Health Workers Brain Drain - The Ghanaian Perspective

Abstract The emergence of the COVID-19 pandemic has increased the demand for front-line medical staff in Ghanaian hospitals and other developing nations. According to Herzberg's Two Factor Theory, which was applied in the study, the majority of the studies reviewed demonstrate that there is a brain drain of health professionals from Ghana, which was attributed to motivation and hygiene factors. Since the majority of the studies were conducted in developed nations before the COVID-19 pandemic,...

Prevalence of Malaria among Inmates in Medium Security Custodial Center Sokoto

ABSTRACT: Malaria is one of the most severe global public health problems worldwide, particularly in Africa, where Nigeria has the greatest number of malaria cases. Malaria remains a disease of major public health problems in Nigeria especially among the neglected population such as the custodial center environment. This study was designed to investigate the prevalence of malaria among inmates in medium security custodial center Sokoto. this research aims to assess the prevalence of malaria ...

Breast Cancer Awareness and Practice of Breast Self-Examination Among Rural Women in Umuowa, Orlu Local Government Area Imo State

ABSTRACT Breast cancer is said to be the commonest cancer and the most lethal malignancy in women across the world. Most of the cases are brought late to the hospital when the conditions are severe with multiple nodal involvements and poorer clinical pathological prognostic outcome. If braest changes are detected early and treatment commenced early enough, the survival rate of breast cancer wii be increased. The purpose of this study was to investigate the breast cancer awareness and practice...

Caregivers’ Knowledge and Involvement in the Prevention and Management of Relapse in Schizophrenic Patients at Federal Neuropsychiatric Hospital New Haven, Enugu State

ABSTRACT Schizophrenia the most common type of mental illness affecting approximately 1% of the world population is often accompanied by relapse even while on treatment. This study assessed Caregivers’ knowledge and involvement in the prevention and management of relapse in Schizophrenic patients of Federal Neuropsychiatric Hospital Enugu. A descriptive cross sectional design was adopted. A sample of 197 participants was used. 43-item questionnaire developed by the researcher was used for d...

MALNUTRITION AND TREATMENT OUTCOME AMONG CHILDREN ENROLLED IN A NUTRITION PROGRAMME AT NYARUBUYE HC III, KISORO DISTRICT.

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77 interesting medical research topics for 2024

Last updated

25 November 2023

Reviewed by

Brittany Ferri, PhD, OTR/L

Short on time? Get an AI generated summary of this article instead

Medical research is the gateway to improved patient care and expanding our available treatment options. However, finding a relevant and compelling research topic can be challenging.

Use this article as a jumping-off point to select an interesting medical research topic for your next paper or clinical study.

• How to choose a medical research topic

When choosing a research topic , it’s essential to consider a couple of things. What topics interest you? What unanswered questions do you want to address? 

During the decision-making and brainstorming process, here are a few helpful tips to help you pick the right medical research topic:

Focus on a particular field of study

The best medical research is specific to a particular area. Generalized studies are often too broad to produce meaningful results, so we advise picking a specific niche early in the process. 

Maybe a certain topic interests you, or your industry knowledge reveals areas of need.

Look into commonly researched topics

Once you’ve chosen your research field, do some preliminary research. What have other academics done in their papers and projects? 

From this list, you can focus on specific topics that interest you without accidentally creating a copycat project. This groundwork will also help you uncover any literature gaps—those may be beneficial areas for research.

Get curious and ask questions

Now you can get curious. Ask questions that start with why, how, or what. These questions are the starting point of your project design and will act as your guiding light throughout the process. 

For example: 

What impact does pollution have on children’s lung function in inner-city neighborhoods? 

Why is pollution-based asthma on the rise? 

How can we address pollution-induced asthma in young children? 

• 77 medical research topics worth exploring in 2023

Need some research inspiration for your upcoming paper or clinical study? We’ve compiled a list of 77 topical and in-demand medical research ideas. Let’s take a look. 

• Exciting new medical research topics

If you want to study cutting-edge topics, here are some exciting options:

COVID-19 and long COVID symptoms

Since 2020, COVID-19 has been a hot-button topic in medicine, along with the long-term symptoms in those with a history of COVID-19. 

Examples of COVID-19-related research topics worth exploring include:

The long-term impact of COVID-19 on cardiac and respiratory health

COVID-19 vaccination rates

The evolution of COVID-19 symptoms over time

New variants and strains of the COVID-19 virus

Changes in social behavior and public health regulations amid COVID-19

Vaccinations

Finding ways to cure or reduce the disease burden of chronic infectious diseases is a crucial research area. Vaccination is a powerful option and a great topic to research. 

Examples of vaccination-related research topics include:

mRNA vaccines for viral infections

Biomaterial vaccination capabilities

Vaccination rates based on location, ethnicity, or age

Public opinion about vaccination safety 

Artificial tissues fabrication

With the need for donor organs increasing, finding ways to fabricate artificial bioactive tissues (and possibly organs) is a popular research area. 

Examples of artificial tissue-related research topics you can study include:

The viability of artificially printed tissues

Tissue substrate and building block material studies

The ethics and efficacy of artificial tissue creation

• Medical research topics for medical students

For many medical students, research is a big driver for entering healthcare. If you’re a medical student looking for a research topic, here are some great ideas to work from:

Sleep disorders

Poor sleep quality is a growing problem, and it can significantly impact a person’s overall health. 

Examples of sleep disorder-related research topics include:

How stress affects sleep quality

The prevalence and impact of insomnia on patients with mental health conditions

Possible triggers for sleep disorder development

The impact of poor sleep quality on psychological and physical health

How melatonin supplements impact sleep quality

Alzheimer’s and dementia 

Cognitive conditions like dementia and Alzheimer’s disease are on the rise worldwide. They currently have no cure. As a result, research about these topics is in high demand. 

Examples of dementia-related research topics you could explore include:

The prevalence of Alzheimer’s disease in a chosen population

Early onset symptoms of dementia

Possible triggers or causes of cognitive decline with age

Treatment options for dementia-like conditions

The mental and physical burden of caregiving for patients with dementia

• Lifestyle habits and public health

Modern lifestyles have profoundly impacted the average person’s daily habits, and plenty of interesting topics explore its effects. 

Examples of lifestyle and public health-related research topics include:

The nutritional intake of college students

The impact of chronic work stress on overall health

The rise of upper back and neck pain from laptop use

Prevalence and cause of repetitive strain injuries (RSI)

• Controversial medical research paper topics

Medical research is a hotbed of controversial topics, content, and areas of study. 

If you want to explore a more niche (and attention-grabbing) concept, here are some controversial medical research topics worth looking into:

The benefits and risks of medical cannabis

Depending on where you live, the legalization and use of cannabis for medical conditions is controversial for the general public and healthcare providers.

Examples of medical cannabis-related research topics that might grab your attention include:

The legalization process of medical cannabis

The impact of cannabis use on developmental milestones in youth users

Cannabis and mental health diagnoses

CBD’s impact on chronic pain

Prevalence of cannabis use in young people

The impact of maternal cannabis use on fetal development 

Understanding how THC impacts cognitive function

Human genetics

The Human Genome Project identified, mapped, and sequenced all human DNA genes. Its completion in 2003 opened up a world of exciting and controversial studies in human genetics.

Examples of human genetics-related research topics worth delving into include:

Medical genetics and the incidence of genetic-based health disorders

Behavioral genetics differences between identical twins

Genetic risk factors for neurodegenerative disorders

Machine learning technologies for genetic research

Sexual health studies

Human sexuality and sexual health are important (yet often stigmatized) medical topics that need new research and analysis.

As a diverse field ranging from sexual orientation studies to sexual pathophysiology, examples of sexual health-related research topics include:

The incidence of sexually transmitted infections within a chosen population

Mental health conditions within the LGBTQIA+ community

The impact of untreated sexually transmitted infections

Access to safe sex resources (condoms, dental dams, etc.) in rural areas

• Health and wellness research topics

Human wellness and health are trendy topics in modern medicine as more people are interested in finding natural ways to live healthier lifestyles. 

If this field of study interests you, here are some big topics in the wellness space:

Gluten sensitivity

Gluten allergies and intolerances have risen over the past few decades. If you’re interested in exploring this topic, your options range in severity from mild gastrointestinal symptoms to full-blown anaphylaxis. 

Some examples of gluten sensitivity-related research topics include:

The pathophysiology and incidence of Celiac disease

Early onset symptoms of gluten intolerance

The prevalence of gluten allergies within a set population

Gluten allergies and the incidence of other gastrointestinal health conditions

Pollution and lung health

Living in large urban cities means regular exposure to high levels of pollutants. 

As more people become interested in protecting their lung health, examples of impactful lung health and pollution-related research topics include:

The extent of pollution in densely packed urban areas

The prevalence of pollution-based asthma in a set population

Lung capacity and function in young people

The benefits and risks of steroid therapy for asthma

Pollution risks based on geographical location

Plant-based diets

Plant-based diets like vegan and paleo diets are emerging trends in healthcare due to their limited supporting research. 

If you’re interested in learning more about the potential benefits or risks of holistic, diet-based medicine, examples of plant-based diet research topics to explore include:

Vegan and plant-based diets as part of disease management

Potential risks and benefits of specific plant-based diets

Plant-based diets and their impact on body mass index

The effect of diet and lifestyle on chronic disease management

Health supplements

Supplements are a multi-billion dollar industry. Many health-conscious people take supplements, including vitamins, minerals, herbal medicine, and more. 

Examples of health supplement-related research topics worth investigating include:

Omega-3 fish oil safety and efficacy for cardiac patients

The benefits and risks of regular vitamin D supplementation

Health supplementation regulation and product quality

The impact of social influencer marketing on consumer supplement practices

Analyzing added ingredients in protein powders

• Healthcare research topics

Working within the healthcare industry means you have insider knowledge and opportunity. Maybe you’d like to research the overall system, administration, and inherent biases that disrupt access to quality care. 

While these topics are essential to explore, it is important to note that these studies usually require approval and oversight from an Institutional Review Board (IRB). This ensures the study is ethical and does not harm any subjects. 

For this reason, the IRB sets protocols that require additional planning, so consider this when mapping out your study’s timeline. 

Here are some examples of trending healthcare research areas worth pursuing:

The pros and cons of electronic health records

The rise of electronic healthcare charting and records has forever changed how medical professionals and patients interact with their health data. 

Examples of electronic health record-related research topics include:

The number of medication errors reported during a software switch

Nurse sentiment analysis of electronic charting practices

Ethical and legal studies into encrypting and storing personal health data

Inequities within healthcare access

Many barriers inhibit people from accessing the quality medical care they need. These issues result in health disparities and injustices. 

Examples of research topics about health inequities include:

The impact of social determinants of health in a set population

Early and late-stage cancer stage diagnosis in urban vs. rural populations

Affordability of life-saving medications

Health insurance limitations and their impact on overall health

Diagnostic and treatment rates across ethnicities

People who belong to an ethnic minority are more likely to experience barriers and restrictions when trying to receive quality medical care. This is due to systemic healthcare racism and bias. 

As a result, diagnostic and treatment rates in minority populations are a hot-button field of research. Examples of ethnicity-based research topics include:

Cancer biopsy rates in BIPOC women

The prevalence of diabetes in Indigenous communities

Access inequalities in women’s health preventative screenings

The prevalence of undiagnosed hypertension in Black populations

• Pharmaceutical research topics

Large pharmaceutical companies are incredibly interested in investing in research to learn more about potential cures and treatments for diseases. 

If you’re interested in building a career in pharmaceutical research, here are a few examples of in-demand research topics:

Cancer treatment options

Clinical research is in high demand as pharmaceutical companies explore novel cancer treatment options outside of chemotherapy and radiation. 

Examples of cancer treatment-related research topics include:

Stem cell therapy for cancer

Oncogenic gene dysregulation and its impact on disease

Cancer-causing viral agents and their risks

Treatment efficacy based on early vs. late-stage cancer diagnosis

Cancer vaccines and targeted therapies

Immunotherapy for cancer

Pain medication alternatives

Historically, opioid medications were the primary treatment for short- and long-term pain. But, with the opioid epidemic getting worse, the need for alternative pain medications has never been more urgent. 

Examples of pain medication-related research topics include:

Opioid withdrawal symptoms and risks

Early signs of pain medication misuse

Anti-inflammatory medications for pain control

• Identify trends in your medical research with Dovetail

Are you interested in contributing life-changing research? Today’s medical research is part of the future of clinical patient care. 

As your go-to resource for speedy and accurate data analysis , we are proud to partner with healthcare researchers to innovate and improve the future of healthcare.

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• Open access
• Published: 21 August 2024

Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation

• Ratna Sohanpal 1 ,
• Kristie-Marie Mammoliti 2 ,
• Amy Barradell 3 ,
• Moira Kelly 1 ,
• Sian Newton 1 ,
• Liz Steed 1 ,
• Vari Wileman 4 ,
• Vickie Rowland 5 ,
• Clarisse Dibao-Dina 6 ,
• Anna Moore 7 ,
• Hilary Pinnock 8 &
• Stephanie J. C. Taylor 1  

BMC Health Services Research volume  24 , Article number:  960 ( 2024 ) Cite this article

Metrics details

Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results.

Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon’s Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically.

The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and ‘home-practice’ were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey.

We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients’ life, may be more beneficial.

Trial registration

ISRCTN Registry 59,537,391. Registration date 20 March 2017.

Peer Review reports

Introduction

Patients with long-term conditions, such as chronic obstructive pulmonary disease (COPD), are two to three times more likely to experience mental health problems compared to the general population [ 1 ]. Patients with COPD suffer from physically disabling symptoms such as breathlessness, chronic cough and sputum production [ 2 ], and typically have one or more comorbidities such as anxiety and depression [ 1 , 3 , 4 , 5 ]. The mean prevalence of anxiety and depression in patients living with COPD are estimated at 36% (range 6%-74%) and 40% (range 8%-80%), respectively [ 6 ]. These comorbidities reduce patients’ ability to manage COPD effectively, affecting physical activity and quality of life and increasing their susceptibility to exacerbations, hospital admissions and readmissions [ 6 , 7 , 8 ] at major cost to health and care services [ 9 ].

There is a clear relationship between breathlessness and anxiety and/or depression, where one can negatively influence the other and a vicious cycle can develop [ 5 , 6 , 10 , 11 , 12 ] resulting in poorer health outcomes. This emphasises the importance of individually-targeted holistic treatments rather than purely focusing on the disease [ 13 ].

Unmet physical and psychological well-being needs [ 14 ], could be a result of patient and professional barriers [ 15 ]. Patients’ reluctance to ask for – or accept—support offered by health services may be due to stigma, reluctance to talk about emotional problems, physical symptoms masking mood symptoms [ 15 ], or having already adapted to the progressive and fluctuating nature of their COPD and comorbidities; [ 16 , 17 , 18 ] conversely, they may want to seek support but lack knowledge of mental health issues, treatment options, where to seek help, or have difficulty in accessing the support they need [ 14 , 15 , 19 ] further increasing the burden of disease/s [ 1 , 2 , 20 ].

The goals of non-pharmacological self-management interventions in COPD include reducing physical symptoms and functional impairments in daily life and improving emotional well-being [ 21 ]. Completion of evidence-based supervised exercise and self-management support programmes such as pulmonary rehabilitation (PR) is known to improve both physical and emotional well-being among patients with COPD [ 22 ]. However, anxiety or depression being associated with reduced uptake and completion of PR, remain [ 6 ]. Evidence of effective strategies to improve referral to, or uptake and completion of, PR treatment is limited [ 23 ]. Psychological treatment using cognitive-behavioural therapy (CBT) is an effective treatment for anxiety and depression but there is less evidence of benefit in COPD-related depression [ 24 , 25 ] and anxiety [ 25 , 26 ]. A systematic review by Coventry [ 27 ] found some improvement in anxiety and depression from interventions combining exercise with psychological and lifestyle interventions in COPD, and there have been calls for more high quality research into this [ 24 , 26 ].

In response to calls for further research, we developed a tailored, psychological cognitive behavioural approach intervention for patients with moderate to very severe COPD and mild to moderate anxiety and/or depression, to be delivered prior to patient attendance in PR, for evaluation in the TANDEM (Tailored intervention for Anxiety and Depression Management in COPD) randomised controlled trial [ 28 ]. We hypothesised that the intervention (referred to as the TANDEM intervention) delivered by trained respiratory health care professionals (referred to as TANDEM ‘Facilitators’) prior to patient’s attendance in PR would improve anxiety and/or depression (intervention aim and primary trial outcome) which in turn would improve patients’ uptake and completion of PR which would further improve both their physical and mental health (included in the secondary trial outcomes). The respiratory professionals involved in delivery of the TANDEM sessions were not involved in PR sessions delivery. Table 1 shows the patient inclusion/exclusion criteria in the TANDEM trial.

Table 2 describes the content of the TANDEM intervention. The intervention delivery comprised 6–8 weekly individual, face-to-face sessions with practice of skills between sessions to embed them in everyday life. Weekly or fortnightly telephone support calls to patients prior to patients starting PR and then weekly/fortnightly over the course of PR and for two weeks after completion of PR ensured continuity of support until the end of PR. The TANDEM intervention was designed as a precursor to PR but it was also developed to function as a stand-alone intervention in recognition of the fact that not all participants would want to or be able to take up the opportunity to attend PR. Patients who did not take up previous offers of PR, or who had previously dropped out of PR, were eligible for inclusion in the study. Addressing PR-related barriers was just one of the topic covered in the TANDEM intervention. In the UK, following patient referral to PR, the timeline of patients attending the PR assessment appointment following referral can take 4–9 weeks and from assessment to first attendance at a PR session can take a further 1–8 weeks. We worked with PR study sites that could accommodate our recruitment and intervention delivery timeline. In addition, to ensure patients had sufficient time to receive the intervention prior to starting PR, we included patients who had at least 4 weeks before starting the PR exercise class.

The TANDEM trial comprised a parallel health economic evaluation and a process evaluation using qualitative and quantitative methods to inform the implementation of the TANDEM intervention if the trial is positive, or assist interpretation of the findings if it was negative [ 28 , 31 ]. The intervention did not reduce anxiety and/or depression and there was no improvement in uptake/completion of PR [ 29 ].

Specific to this qualitative evaluation, the objectives of the study, developed a priori, were to explore from a patient perspective: [ 31 ].

The acceptability of the intervention among patients, considering intervention content (in session, home practice); therapeutic alliance; and practicalities (location, timing).

Experiences of the intervention, including: its impact on health, quality of care and post-trial implementation.

Any unintended consequences of the intervention.

The qualitative study was conducted between September 2019 and April 2020.

Sampling and participant recruitment

As part of trial recruitment, consent from patients to be approached for an interview was obtained. Those with scores suggestions severe anxiety/depression were ineligible and were referred to their general practitioner for more intensive mental health support. We planned to conduct 20 interviews with patients in the intervention group to meet sampling requirements to help address the research aim and to meet the trial timelines [ 31 , 32 ]. We reviewed the sampling during data collection to help decide if saturation was reached and whether there was need to conduct more interviews or stop data collection. Purposive sampling [ 33 ], using a sampling frame (Table  3 ), was used to identify patients who completed/dropped out of the TANDEM intervention and/or PR. The interviews were planned after the 6-month (i.e., after intervention delivery)) or 12-month (i.e., after PR delivery) follow up assessment during the trial. Patients were contacted by telephone to request an interview.

Data collection

Semi-structured interviews were conducted to explore patients’ perceptions of the intervention and its potential usefulness for future service development. It was led by a topic guide (Table  4 ) informed by the conceptual framework for the TANDEM process evaluation [ 31 ] and Sekhon’s theoretical framework of acceptability [ 34 ]. See Supplementary file 1 for the interview topic guide used in the interviews.

The interviews were conducted face-to-face, in the patients’ home or by telephone, at a date, location and time that suited the patient or in accordance with COVID regulations (mid-March 2020-April 2020). Interviews were audio-recorded using a digital encrypted recorder. They were conducted by three mixed-method researchers, KMM (Global Health Development, MSc), AB (Health Psychology, MSc), RS (Health Services Researcher, PhD). The researchers were involved in trial recruitment and data collection and were experienced in conducting qualitative interviews and were part of the patient working group within the wider process evaluation team and were involved in the discussions that informed the methods of the study. The researchers were not known to the interviewees. The interview planning was coordinated between the researchers in line with the trial milestones.

Data analysis

Audio-recordings of interviews were transcribed verbatim. Nvivo (version 12) data management software was used to support data analysis. Thematic analysis was conducted [ 35 , 36 ]. Researchers (KMM, AB, RS) independently used inductive, semantic, and latent coding to analyse two transcripts and prepare an initial coding framework. The researchers discussed this to reach consensus on the coding framework. The remaining transcripts were individually coded in line with the coding framework and new codes were added to the framework as required, with consensus. Once all transcripts were coded, the researchers jointly reviewed patterns and relationship within the data to generate potential themes and sub-themes. These were discussed with the wider process evaluation team [ 31 ] with the correct experience and expertise [ 37 ] to finalise the content and themes (Table  5 ).

Public involvement

Public involvement was incorporated in the design and delivery of the TANDEM trial [ 31 ]. Specific to this qualitative enquiry, patient and public involvement (PPI) colleagues (people with COPD, carers of people with COPD) provided comments and feedback to support the clarity, readability, and acceptability of the interview process specified in the participant documents. PPI colleagues reviewed the findings in relation to the main trial results and provided feedback, which supported our interpretations of the results.

Patient characteristics

Of the 29 patients invited for interview, 19 agreed to participate. Data collection occurred between September 2019 to April 2020. Due to the Covid-19 pandemic (19 March 2020—1 April 2020), eight interviews were conducted by telephone. The interview duration was between 30–60 min.

Table 6 presents the patient characteristics. Eleven were male. Two were in the 35–55-year age-group, five in 56–65 year age-group, seven in 66–75 year age-group and two in 76–85 year age group. Three interviewees did not provide their age. Thirteen patients had moderate COPD, six had severe/very severe COPD. Ten had both symptoms of anxiety and depression, five had symptoms of depression only and four had symptoms of anxiety only. Regarding other comorbidities, fifteen patients mentioned other comorbidities namely Heart disease, Stroke, High blood pressure, Parkinson’s, Diabetes, Kidney disease, Fatigue, Epilepsy, Diabetes, Pain and Cancer. Interview participants were comparable to main trial participants in terms of age, gender, COPD severity and other comorbidities, although as a group fewer of the interviewees reported comorbidities (79%) than amongst all the trial participants (90%).

Reasons for non-participation were family bereavement ( n  = 1), difficulty with hearing on the telephone ( n  = 1), uncontactable ( n  = 4), not interested ( n  = 3) and busy ( n  = 1). Those who declined taking part in the interview were mostly from the TANDEM intervention completion group ( n  = 7).

Over-arching findings

The findings generated four themes and nine subthemes, three themes related to intervention acceptability in line with Sekhon’s [ 34 ] theoretical framework of acceptability (TFA). The findings are exemplified with quotes. Theme 1 ‘Patient lives are complex’ encompasses patients living with and managing their COPD alongside other comorbidities and ongoing life/social situations, the challenging interplay of external situations, their own needs, and the adoption-refinement of self-coping strategies over time. Theme 2 ‘Relationship with the TANDEM Facilitator and engagement in the intervention sessions’ highlights the building of rapport and partnership between the patient and Facilitator to deliver the TANDEM intervention sessions and patient engagement with the intervention. This theme links with the Affective attitude TFA construct where patients spoke about how they felt about the intervention and with the Intervention coherence TFA construct where patients understood the purpose of the intervention, what was expected of them to engage in the intervention and spoke about their experience of engagement with the intervention materials [ 34 ]. Theme 3 ‘Impact of the TANDEM intervention sessions’ explores the perceived benefits (or lack of sustained benefit), from the intervention in relation to patients’ physical, mental, and social health. In this theme, patients, through their understanding of the intervention (Intervention coherence TFA construct); how they felt about the intervention (Affective attitude TFA construct); and whether they were able to apply the learnt skills following receipt of the intervention (Self-efficacy TFA construct) clearly stated whether they benefitted or not from the intervention (Perceived effectiveness TFA construct) [ 34 ]. Theme 4 ‘Distinguishing TANDEM in COPD care’ discusses lack of previous provision of psychological support and that TANDEM type of care should be offered to patients earlier in their illness journey. This theme links with the Burden TFA construct where patients spoke about their ease of being able to participate in the intervention. We have not presented the themes under the TFA constructs as these constructs are interlinked and overlapped in how patients spoke about their experience of the intervention.

Core themes and subthemes

Patient lives are complex, impact of copd and competing comorbidities/other external stressors.

Patients described how the fluctuation of COPD symptoms, suffering from exacerbations, several other health conditions and negative life events could have a cumulative effect on their physical, psychological, and social health. Many patients had previous experience of bad days, “frightening” breathlessness, and chest infections. Several mentioned the combination of COPD symptoms, along with symptoms of other comorbidities, resulted in low mood. Getting a new diagnosis (e.g., cancer), experiencing a sudden injury (e.g., a fall), an exacerbation of COPD symptoms, or other long-term comorbidities (e.g., stroke, diabetes, sepsis, dementia) made patients feel they could not fully recover physically and mentally.

“The thing that gets me down is I’ve got Parkinson’s as well, which is making walking difficult at the moment. It’s got much worse recently. And I get out of breath when I’m… Although I’m walking slowly it takes a lot of effort. So I get out of breath as well.” (Male, 66–75, Depressed, Moderate COPD, PAT5)

They described the adjustments/adaptations (e.g., sitting and resting) they made to manage their condition. Others described having become resigned to what they could or could not do (e.g., avoiding going out of the house).

“I used to go out a lot. And now I just don’t go out. I even used to do my own shopping with a relative or something. But I don’t even do that now. It’s just too much even with the help of a trolley. Walking around supermarkets, it’s just too much.” (Male, 56–65, Anxious and depressed, Severe COPD, PAT1)

Some patients felt that their COPD or its limitations were not always visible or well understood by others and this caused embarrassment and frustration. A few patients prioritised needs of others over their own health needs.

“….Well, I was outside trying to jet wash, and of course it takes it out of you. Always having a job breathing. Of course, I stopped to get my breath back. And it started to rain. Come on, get inside [partner said]. Hang on [I said], let me bloody breathe will you. Just let me try and breathe, and then I might be able to do something. But yeah. Don’t you realise I have difficulty breathing? …” (Male, 76–85, Anxious and depressed, Moderate COPD, PAT15)

Stoicism and self management

Patients described living with COPD and/or other comorbidities or life events as “I live with it and put up with it” . Several patients had learnt to adapt and developed coping strategies either alone or with the help of family and friends to overcome their physical limitations and anxiety, panic state or mood.

“…it was one of the guys, he lives across the road from me,… He said to me, … the way to look at your breathing is smell the roses and blow out the candles. And that’s always stuck. So when I do feel a bit anxious or panicky I think smell the roses and blow out the candles.” (Female, Age unknown, Anxious and depressed, Moderate COPD, PAT12)

Relationship with the TANDEM facilitator and engagement in the intervention sessions

Knowledge, skills and open communicative partnership.

The patients developed a good rapport and a positive relationship with their Facilitator over the course of the TANDEM intervention sessions. The positive relationship was nurtured by the Facilitator’s knowledge and skills, delivery of weekly sessions and the Facilitator’s ability to tailor content to the patient. Their adaptability to modify home practice to suit the patient’s level of health literacy and providing practical examples to enhance understanding of a topic was valued.

“Anything to do with writing, I’d just wait until she came and we did it. I didn’t do that bit.” (Female, 35–55, Anxious, Severe COPD, PAT2)

Patients praised the Facilitator’s knowledge of both COPD and mental health and their strong communication and counselling skills. Patients felt that their Facilitator was friendly, empathetic, supportive, and genuinely interested in them. They felt listened to and gently encouraged to speaking openly about their mood which for some was related to their social situations and not COPD.

“Yeah, and maybe asked questions that I would’ve not fancied talking about possibly. So she did probe. But it wasn’t putting me on the spot. Then it made me think, oh yeah, I don’t mind talking about that.” (Female, 56–65, Anxious and depressed, Very severe COPD, PAT18)

However, some patients did find it difficult to talk about their anxiety or mood with the Facilitator and preferred to discuss other things in the sessions.

“We discussed a little bit of anxiety, because the anxiety, I don’t really like to discuss my anxiety, because it just gets to me after a while when I’m talking about it.” (Male, 66–75, Anxious and depressed, Moderate COPD, PAT7)

Some patients who lived alone described enjoying the Facilitator’s company and the continued opportunity to discuss their illness. A few said that it was like conversing with a friend.

“…And like I say, people are probably the same as me, more benefits with just having that person coming for the company as well as talking about a specific illness.” (Male, 56–65, Anxious and depressed, Severe COPD, PAT1)

Engagement with the TANDEM intervention materials and sessions

Most patients understood that the TANDEM study was about education and discussions around their physical and/or emotional health with a focus on improving it. Patients recalled receiving various study-related materials such as leaflet/s, handouts, DVDs, and worksheets for home-practice and setting goals. Some patients had difficulty remembering the home-practice requirements. A few patients chose not to watch the DVD due to lack of interest or lost interest shortly after starting because it felt too repetitive and replicated the handouts/leaflets provided or the exercises shown were not deemed suitable to them.

“The CD was pretty boring. It was very repetitive and I lost interest quite quickly I’m afraid.” (Male, 66–75, Depressed, Moderate COPD, PAT5)

Two patients stopped receiving the intervention after two and three sessions because they described not being affected by their mood and were already familiar with the information provided. The third patient chose to discontinue after receiving two sessions because their sessions began to overlap with PR and they wanted to prioritise PR instead.

“Yeah, it was sort of a joint decision. If I had any problems I could give her a ring. But then I more or less carried on with the breathing thing [PR programme], so I did see people over at this breathing session. So any questions and the information you got from that at the beginning was very good Interviewer: And how soon did you join that exercise class after your one-to-one sessions? More or less straightaway.” (Male, Age unknown, Anxious, Severe COPD, PAT11)

Two patients did not complete any sessions and had no recollection of the intervention.

Impact of the TANDEM intervention sessions

Perceived benefits and the lack of perceived benefits.

The effects of the TANDEM intervention sessions on thoughts, feelings, behaviours and/or symptom management were varied and wide-ranging. Several patients described improvements to their mental health and had adopted positive coping strategies. They described the intervention having helped to shift negative thoughts to positive ones, feel more at ease and able to take control of their anxiety.

“I’ve got to be honest, when I had this chest infection I thought I was suffocating. My ribs, I thought they were breaking with this cough. And so it [TANDEM sessions] helped me a sense up here [thoughts], keep the anxiety [under control]. Because I was struggling to breathe at one stage.” (Female, 56–65, Anxious and depressed, Very severe COPD, PAT18)

Patients felt they made connections between their physical and mental health by acknowledging the presence of depression or anxiety. Patients realised the value of self-reflection. Some adopted a resilient mindset, refusing to let breathlessness, anxiety and/or depression stop them. Instead, they emphasised the importance of not giving up, setting goals, accepting help, and being kind to themselves. This realisation gave them confidence to move forward and see the value of life again.

“I didn’t realise I was depressed at the time because I was going to the bed most days in the afternoon, and that was more because I was… I retired last year, so I think it’s because I’d recently retired. I was just bored. So I was going to bed in the afternoons just to kill time. And then I realised through talking to [Facilitator] that that was more me being depressed….I’m going to say it [the TANDEM project] changed my outlook on life. … helped me realise if I get a little bit fitter I’ll be a lot happier and I’ll probably increase my…not going to say I’m going to live longer, but the years I’ve got to live I’ll be fitter, happier…” (Male, age group unknown, Anxious, Moderate COPD, PAT6)

Many patients described learning skills, techniques and adopting healthy behaviours to enhance their daily management of COPD/COPD-related breathlessness and COPD-related anxiety such as relaxation techniques (e.g., mindfulness, distraction, breathing techniques). These techniques were successfully applied during daily activities, such as walking, climbing stairs, gardening, getting to the car, and shopping. The perceived benefits varied for different individuals and comprised, an increase in knowledge, confidence, acceptance of condition and improvements to social life.

“Well I slow down a bit. I have a lady, [facilitator], from your research team come down last year. And she took me out for little walks, and she discovered that I was taking in too much air. So she did me little techniques of when I go out for a little walk, like doing things in your head, like counting odd numbers or counting from 100 backwards. Little bits like that to get your breathing under control.” (Female, 56–65, Depressed, Severe COPD, PAT8)

For a few patients, the sessions did not provide any new material but helped to reaffirm their existing knowledge about their condition and its management or reminded them of techniques/behaviours that could help them to effectively manage their condition. Others did not perceive any benefits from the intervention. One patient did not expect to learn anything new whilst another patient explained they knew most of what was being covered and that they were used to doing things on their own.

“Interviewer: Do you think your confidence levels have changed? “No, I don’t think so. No.” Interviewer: … Are there any other changes in your social life? No, not really…. I see my friends, at least once a week, sometimes twice. So yeah, I mean I don’t want to stay indoors, or watch TV. I do go out and see my friends.” (Male, 56–65, Anxious, Moderate COPD, PAT4)

Attendance and completion of pulmonary rehabilitation

Patients recalled discussions with their Facilitator regarding PR, specifically focusing on how PR could potentially benefit them and what they could anticipate from attending the programme. Some patients mentioned they always planned to attend PR despite the TANDEM sessions, whilst others were encouraged to attend PR following receipt of the TANDEM sessions. The reasons given by those who did not attend/complete PR were competing comorbidities which needed prioritisation, and health service-related reasons.

“I’ve done the pulmonary rehab before and I did go to an appointment but they wanted…because I was waiting for an ECG. They wanted to wait for the results for that, and that kept getting pushed back and pushed back…” (Female, 35–55, Anxious and depressed, Moderate COPD, PAT9)

Difficulties keeping up learnt skills or new activity due to personal or external factors

The application of learnt skills/techniques by patients varied over time with the perceived benefits not viewed as sustainable by some patients. Whereas others stated their learnings from the intervention had become in-built and they now knew what to do to manage their condition.

“Emotionally I was quite low, no self-esteem before I saw [facilitator], but afterwards I felt quite a lot better and I’ve still kept feeling more positive and more confident in those quite a few months since I saw her. I’ve not slipped back into my old way of thinking and everything.” (Female, 66–75, Anxious and depressed, Moderate COPD, PAT13)

For various reasons, some patients were unable to maintain changes they had adopted due to internal or external factors. (e.g., injury, new diagnosis with poor prognosis, new disabling symptoms from COPD, disabling comorbidities affected patient mood negatively; reduced motivation to be physically active, increased gym costs or changes made to the gym made it unsuitable to attend led patients unable to start or keep up with their physical activity; and Covid-19 restrictions affected both mood and physical activity negatively). Some patients attributed their worsening physical and mental health specifically to the Covid-19 lockdown and reduced access to services, whilst others described coping well and trying to continue activities at home, albeit on a much smaller scale to their usual routine.

“I think my breathing’s actually got worse …because now we can’t go out. So it’s…yeah, it’s… I’m definitely wheezing a lot more than I was before and get breathless. …if I sit still it’s fine. It’s when I start moving around. So I think it’s probably because I was going out literally every day. I was going out for a half hour walk, I was doing exercises. And of course now you’re stuck in the house and you can’t get out. So yeah…” (Female, Age unknown, Anxious and depressed, Moderate COPD, PAT12)

Distinguishing TANDEM in COPD care

Tandem is different to current care.

Patients described the intervention as incomparable to other currently available COPD services. Most interviewees had never previously received any psychological therapy for anxiety/depression. Some had undergone counselling (e.g., for grief, stress) but felt the counselling was not specific to their COPD. One patient who had previously received CBT felt the TANDEM sessions were more helpful.

“I’ve spoken to my GP just about general depression, not to do with my COPD. And I’ve had a couple of CBT appointments. But I didn’t really find those too helpful. They just seemed to give me one of these assessment sheets every time and I had to write down in the boxes how I felt about each situation. And then they were just adding my score up, oh, this week you’ve scored a bit higher than last week. They didn’t really offer me any advice as to how to improve the situation.” Interviewer: And what was different from the one-to-one sessions you had with [Facilitator]? I was able to talk through all sorts of problems that I’ve had over the last couple of years to do with my COPD and to do with personal stuff as well.” (Female, 66–75, Anxious and depressed, Moderate COPD, PAT13)

Having flexibility in the location (e.g., patient’s home, GP practice or local hospital) for intervention delivery was highly valued. This flexibility recognised the physical limitations experienced by people living with COPD and was conducive in creating a safe, comfortable, and private environment. Some patients expressed appreciation for not being excluded from receiving the intervention just because they were unable to leave their home. Others preferred the sessions at a GP practice or a public space to avoid distractions at home.

“…Because I said I don’t drive, I can’t afford the taxi fare. I can’t use public transport…So having the opportunity to have her [facilitator] come to the house was a god send, because otherwise I don’t think I would’ve done it. I couldn’t have done. I couldn’t have got anywhere to do it.” (Female, Age unknown, Anxious and depressed, Moderate COPD, PAT12)

Need for psychological support at different time points of the illness journey

Several patients suggested that the sessions would be helpful at diagnosis because some felt they were given insufficient information or support at this time point. Whilst others recommended the sessions at differing stages of their illness because symptoms can evolve over time or be influenced by external life events.

“I think it’s the whole package that matters. The cognitive therapy, you might just need that, mightn’t you? … So I just embraced it. It’s obviously valuable, and I suppose they’ll roll it out one day if you have got COPD or have an operation, it’ll be offered to you. It’s down to the individual.” The same participant continued “See generally it’s going to be older people doing this thing, I think. I mean younger people there might be more benefit. So a lot of them brought up to keep it…they can’t express their emotions. So I wonder…this might be for future generations. But older people are a bit reluctant to talk about themselves. It’s like get on with it.” (Female, 56–65, Anxious and depressed, Very severe COPD, PAT18)

Despite the overall acceptability for TANDEM, a few patients were considerate of the cost and the time impact upon NHS services. However, it was made very clear that the flexibility of intervention delivery (e.g., at home) should not be compromised.

“I think [home visits] should never be dropped and it should be moved to a place where it’s set for you to save money. Because that’s when everything starts going down hill then. And people trying to cut corners and then we have a meeting maybe every six months. And they say well, this never used to happen when we used to do one-on-ones at home. And now it is happening. So I think you should carry on exactly the way you are doing.” (Male, 56–65, Anxious and depressed, Severe COPD, PAT1)

As part of an integrated process evaluation of the TANDEM intervention, we explored patients’, experience of intervention receipt and acceptability to help us understand the trial findings. We found the fluctuation of patients’ COPD symptoms combined with comorbidities, and challenging social circumstances meant many patients had already developed coping strategies, including stoicism. Positive experiences of the intervention were attributed to the Facilitator’s knowledge in COPD and mental health, their supportive, empathetic, and person-centred communication skills. This enabled many patients to talk freely about their mental health, acknowledge the connection between their physical and mental health, and disclose interacting social circumstances. Some, but not all, patients found the intervention materials and home practice helpful. Most completers of the intervention perceived improvements in their mood/mental health, physical and social benefits. Sustaining these benefits was challenging for many due to personal, health-related, and external factors (including Covid-19). Patients described the intervention as novel, they valued the flexibility in how it could be delivered. Some patients suggested making the intervention sessions available ‘on demand’ throughout the illness trajectory so the patient could take them up when needed.

Comparison with other literature

We found only one qualitative study [ 38 ] exploring experiences of a home-based psychoeducation intervention within a trial, however, the structure and delivery were different to TANDEM. The intervention targeted symptoms related to breathlessness and anxiety [ 39 ] among patients with advanced COPD who reported perceived benefits such as anxiety becoming more manageable and taking control of cognitions [ 38 ]. TANDEM intervention completers also perceived improvements such as coping better with anxiety, feeling more content and at ease with oneself, and experiencing a shift from negative thoughts to a more positive outlook. Additionally, patients cited increase in knowledge, confidence, acceptance of condition and improvements to social life/daily activities.

However, the perceived improvements were not sustained and may therefore explain the trial outcomes. In Bove’s trial [ 39 ], the timing of the outcome assessment was one month and three-month post intervention delivery. Bove explained that this duration was a period for new knowledge and skills to be integrated into everyday life and was the right time for qualitative exploration. In contrast, the outcome assessments for TANDEM were at six- and twelve-months post intervention, [ 28 ], recommended for COPD self-management interventions [ 40 ]. Our findings show that several personal factors and external events prevented patients from long-term application or adherence of their TANDEM learnings. Non-adherence to learnt self-management skills is known to result in worse health outcomes [ 41 ]. Part of our intervention delivery occurred during the Covid-19 pandemic meaning some patients were unable to attend PR or continue their planned physical/social activities and this may have impacted the trial outcomes. The negative impact of Covid-19 on physical activity, social isolation and mental health has been shown in advanced respiratory disease [ 42 ]. A recent COPD study [ 43 ] reported initial gains made by an intervention were lost without content teaching about how to maintain health behaviours even in times of stress. Although we included problem solving as a topic, for future iterations of TANDEM, it may be useful to include a session involving specific discussions about the likelihood of setbacks/external stressors and practical strategies for dealing with them, possibly as a ‘booster’ session or ‘on demand’ during times of stress. It may also have been possible to deliver TANDEM alongside PR rather than as a precursor, however this would have increased patient burden and was not in line with our programme theory that reduction in depression and/or anxiety would be helpful to increased uptake and completion of PR.

Another explanation for the perceived lack of sustained benefits could be the severity of disease and disabling experience of patients from the burden of COPD and interacting comorbidities [ 44 , 45 ]. Many patients in this study talked about the fluctuating and unpredictable nature of COPD symptoms and the negative impact of ongoing comorbidities. Recognising the comorbidities in COPD, a study [ 46 ] discussing future interventions in COPD has suggested inclusion of a ‘feedback loop’ to assess progress of desired outcomes and treatment expectations related to comorbidities among patients. However, before this, further work is required to understand how comorbidities impact on/interact with COPD [ 47 ] and what outcomes are important to this patient group to support intervention development and its assessment in research for better health outcomes. Managing and adapting to the fluctuating nature of ongoing health conditions and its limitations and interactions with the surrounding social environment made achieving ‘normality’ out of reach for some patients. The perceived lack of understanding about COPD among family members and wider society, was felt to affect mood for some patients. One study, with comparable findings to ours, found difficult living situations, other life events and comorbidities negatively influence COPD-related distress [ 48 ]. The Facilitators reported working through problems (social, psychological, physical) with patients that were unrelated to COPD which shifted the focus away from the intervention targeting mood related to COPD symptoms/breathlessness [ 49 ]. The latter was perceived as a challenge during intervention delivery [ 49 ] and could contribute to explaining the trial outcomes, although overall fidelity to the intervention has been reported to be high [ 49 ]. Focusing on the physical/social environment of patients with COPD is important for future interventions in COPD [ 50 ], but will require gaining better understanding of the social environment and its impact on individuals [ 51 ].

Several patients in our study were stoic, and the stance taken was ‘to get on with it’. Stoicism can make patients hold on to strategies they perceive are working for them, they may be reluctant towards the treatment or they may have less realistic expectations of treatment benefits [ 52 ] which could have affected the trial outcomes. Some patients found the intervention unsuitable for their needs or failing to meet their expectations. The lack of perceived benefits amongst some is not surprising as, needs, expectations and preferences will vary among individuals. Some patients felt that they had not learnt anything new, whilst for some the intervention helped to reinforce strategies they were already using to manage their condition which will have reduced the potential for improvement in trial outcomes. A person-centred approach, only offering intervention to those with perceived need to reduce anxiety/depression may be more appropriate.

Although not reflected in the trial outcome analysis, a positive experience of the TANDEM intervention was that the patients particularly valued the therapeutic relationship with the Facilitator (a key element of the TANDEM intervention) [ 30 ]. The intervention sessions gave patients an opportunity to reflect on what COPD meant to them, recognise their actions were a result of anxiety and/or depression, make connections between their physical and mental health, and adopt home-practice activities which helped to improve their physical activity and symptoms. Despite the trial outcomes, the positive experiences of patients suggest that it might be useful to provide opportunities in practice to enable patients to reflect on the relationship between their physical and mental health [ 49 , 53 ]. An explanation for the lack of improvement in outcomes, supported by these findings, is that some patients did not do any independent home-practice between intervention sessions because they did not like to write things down or read. Not doing the home-practice may have made it difficult to embed the learning from the TANDEM sessions. The latter could be attributed to comorbidities or poor health literacy previously reported for this population [ 54 ]. It has been suggested that not doing CBT-related homework can lead to negative health outcomes [ 55 , 56 ]. A recent review [ 57 ] assessing the efficacy of psychosocial interventions on physical and psychological outcomes in COPD highlighted that older age may yield limited effects as they would be less adept to learn skills and techniques taught in a psychosocial intervention. The median age of patients in the TANDEM trial was 69 years and there were high intervention uptake and completion rates [ 29 ], so the offer of psychosocial interventions should continue among this population regardless of their age [ 57 ]. However, assessment of health literacy needs should be considered for interventions comprising written materials [ 43 , 46 , 50 , 54 ]. Production of intervention materials needs to be more creative than paper-based materials and need to be available in various formats to match patient choice, preferences and literacy levels.

Some patients in our study were reluctant to talk about their mood, which could be due to such discussion being unfamiliar within a healthcare setting. Few had received any psychological support previously for their mental health in relation to their COPD. The new treatment and the lack of familiarity of this psychological approach may have had an impact on trial outcomes. This could be related to the perceived stigmatisation of COPD [ 24 ] and mental health [ 48 ] or that having a one-off, short-term intervention may not be enough. There are reports of limited screening of mental health issues, and limited review of mental health issues as part of routine COPD review appointments, leading to under-diagnosis and consequently under-treatment [ 6 , 15 ]. A recent review [ 57 ] concluded that more research is needed to identify the ideal duration, or regularity of a psychosocial intervention in COPD, as long duration can have small effects due to waning of the effect or becoming dependent on the therapist. The duration of the TANDEM intervention was not a perceived problem for our interviewees, but they suggested offering TANDEM at diagnosis or at different timepoints in line with the illness journey allowing the opportunity for the patient to take it up when needed. The TANDEM Facilitators felt that offering TANDEM earlier on in the illness trajectory might be more suitable for patients with less complex needs [ 49 ]. This highlights the need for more mental health support to be available for patients with COPD.

Strengths and limitations

This study forms one part of the process evaluation work of the TANDEM trial and has provided an insight into why the TANDEM intervention may have not worked. The findings, via Sekhon’s acceptability framework [ 34 ], highlighted that most patients found the intervention acceptable but the acceptability of the intervention and the positive experiences were not translated into improvement in the trial outcome measures relative to controls. The reported positive and negative experiences of the TANDEM intervention might be useful for researchers and clinicians looking to improve mental health comorbidities in COPD and beyond COPD/COPD-related breathlessness.

We only interviewed patients in the intervention arm and conducted more interviews with those who had completed the intervention. We achieved data saturation among our sample of patients that had completed the TANDEM intervention with and without completion of pulmonary rehabilitation. We would have liked to speak to more patients who dropped out of the intervention as two patients did not attend any TANDEM intervention sessions and could not recall the reasons for non-attendance. However, we were unable to invite more patients due to administrative delays. Despite this we were able to show a balance of views among the interviewees to help explain the trial findings. A few trial participants had received the intervention by telephone due to the pandemic, but this was not anticipated and hence they were not interviewed.

Implications

More opportunities need to be created in practice to ask about mental health by professionals trained in person-centred skills, psychological skills, knowledge about COPD and common comorbidities associated with/linked to COPD. This is because patients may not be able to ask for treatment or it might not be the right time to seek treatment due to competing demands resulting from the fluctuating and unpredictable nature of COPD, the influence of individual social contexts and interaction with other conditions. Cognitive behavioural approach treatments may be more suited for patients earlier on in their COPD illness journey with built-in sustained follow up, allowing patients to include the learnt skills into their coping mechanisms for improved outcomes.

There is an increased need for co-production work among patients with COPD and comorbidities to develop intervention materials related to cognitive behaviour approach treatments suitable for patients at varying literacy levels, including those who do not like to read any materials or engage in independent home-practice. There is scope to develop interventions that consider an individual’s primary symptoms and interacting social environment to improve the physical and mental health outcomes of patients living with moderate to very severe COPD and anxiety and depression. Future research could look into the role of assistive technology interventions (e.g. adaptive and telecare equipment) [ 58 ] in COPD [ 29 ] that are relevant to improve function, independence, wellbeing and quality of life, particularly technology (e.g. personal digital assistant device) targeted at people with psychosocial disability including anxiety and depression with some evidence of benefit [ 59 ].

This study provides an insight into why a person-centred psychological intervention, evaluated in a randomised controlled trial, did not improve symptoms of anxiety/depression brought on by COPD symptoms, particularly breathlessness in patients with moderate to very severe COPD and did not improve uptake/completion of PR. Patients in our study were affected by other comorbidities or difficult social situations that caused anxiety/depression not necessarily related to COPD. Patients had learnt to manage their conditions or situations through long-established coping strategies. Patients who had not received any psychological treatment specific to COPD and mental health previously felt the intervention might be more suited to people earlier on in their illness journey or at different time points to gain benefits. There were patients who did not want to talk about mood, did not perceive any benefits from the intervention and did not want to use the intervention materials or do any home practice work independently. Our study further highlights that the time spent with the skilled Facilitator led some patients to talk freely about their mental health and they perceived improvements in their health including mental health through discussions, use of intervention materials and home practice work but the benefits were not sustainable due to personal/external factors. To improve the mental health of patients with advanced COPD, more opportunities need to be created to discuss mental health in routine assessments for COPD/for multimorbidity with availability of a sustained intervention that considers the holistic and dynamic nature of social and clinical complexities in COPD.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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R.S., K.M.M., A.B. were involved in data collection, data analysis and interpretation of data. R.S. was the major contributor in writing the manuscript and K.M.M. and A.B. contributed to the revision of the manuscript. S.J.C., H.P. were chief investigators and S.J.C., H.P., M.K., L.S., V.W., V.R., R.S., A.B., K.M.M., C.D.D., A.M. formed the process evaluation team for the TANDEM trial and designed the study. S.J.C., H.P., M.K., L.S., V.W., V.R., C.D.D. K.M.M. and A.M. contributed to the data analysis, data interpretation and the revision of the manuscript. All authors read and approved the final manuscript.

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Sohanpal, R., Mammoliti, KM., Barradell, A. et al. Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation. BMC Health Serv Res 24 , 960 (2024). https://doi.org/10.1186/s12913-024-11370-9

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The adoption of generative artificial intelligence (AI) by users to perform everyday, work, and academic activities has fostered a global debate about the benefits and threats of AI to human health. There is a growing need to consider and address the potential consequences of widely accessible, improved, and user-friendly AI on mental health globally. Generative artificial intelligence has emerged as a powerful tool with significant potential to transform various aspects of contemporary society. In the field of global public health, its impact is particularly relevant due to the opportunities it offers to improve the efficiency, accuracy, and accessibility of mental health services. Research into the effects of generative AI on mental health from an economic and behavioral perspective is critical to fully exploit its benefits, address its challenges, and ensure that its implementation is equitable and sustainable globally. The rapid advancement of artificial intelligence (AI) presents unprecedented opportunities to address public health challenges, particularly in mental health. This intersection of AI, public health, and economics demands rigorous research to harness its full potential. AI's capacity to process vast amounts of data can revolutionize mental health diagnostics, treatment, and resource allocation. However, its implementation raises critical questions about efficacy, cost-effectiveness, and ethical considerations. The economy of attention, which treats human attention as a scarce resource, is especially relevant in today's digital age where mental health is increasingly affected by information overload and digital distractions. Understanding how AI can be leveraged to optimize attention allocation in health interventions is crucial. Moreover, economic principles can guide the development of sustainable AI-driven health solutions, ensuring equitable access and efficient resource utilization. Research in this field is vital to inform evidence-based policies, improve health outcomes, and navigate the complex landscape of AI in public health. This research topic aims to examine how AI technologies, combined with economic principles, can revolutionize our approach to public health challenges, particularly in the mental health domain. We seek papers that contribute to the following broad themes (but not limited to the themes mentioned below): • AI applications in mental health screening, diagnosis, and intervention; • The role of the economy of attention in designing effective public health interventions; • Economic models for optimizing resource allocation in mental health services; • AI-powered predictive analytics for public health policymaking; • Ethical considerations in AI-driven mental health research; • The impact of digital attention-grabbing technologies on mental well-being; • Cost-effectiveness analysis of AI-based mental health interventions; • AI's potential in addressing health disparities and improving access to care We encourage interdisciplinary approaches that combine insights from public health, computer science, economics, psychology, and related fields. Submissions should highlight the potential of AI and economic concepts to drive innovation in public health research and practice.

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August 20, 2024

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Inhaler misuse leads to mismanagement of COPD symptoms and increased exacerbations, research finds

by COPD Foundation

Inhaler misuse leading to inadequate medication delivery impacts a person's ability to manage symptoms of chronic obstructive pulmonary disease (COPD), and additional education about proper inhaler use is needed to improve health outcomes, according to two new articles. The articles are published in the July 2024 issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation .

COPD comprises several conditions, including chronic bronchitis and emphysema, and can be caused by irritants like smoke or pollution and genetics. The disease affects more than 30 million Americans, yet awareness of the disease's symptoms, methods to reduce risk, and disease management remains poor. Symptoms, which include breathlessness, fatigue, and chronic cough, are primarily treated using inhaled medications.

In a new study , "Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized With COPD in a Department of General Internal Medicine: A Cross-Sectional Study," the authors examined how often inhalers were misused by patients hospitalized with COPD over the course of nine months at Fribourg Hospital in Switzerland.

Inhaler misuse was categorized as either a critical error in inhalation technique or insufficient peak inspiratory flow. These errors result in a lesser dose of medication reaching the person's lungs, which impacts the person's ability to manage their symptoms and can lead to increased exacerbations.

"Misuse of inhalers is common, and in our study, we found that approximately two-thirds of inhalers were misused," said Gaël Grandmaison, M.D., an assistant physician in internal medicine at University and Hospital of Fribourg in Switzerland.

"If an inhaler was misused, a physiotherapist conducted up to three teaching sessions with the patient. These sessions helped reduce the number of critical errors in inhaler use. However, despite this education , more than one in 10 inhalers continued to be used suboptimally, either due to an inability to generate sufficient inspiratory effort or because the inhaler was unsuitable for the patient's characteristics.

"These results highlight the importance of regular therapeutic education, assessing the patient's ability to generate a sufficient inspiratory effort, and selecting an inhaler suited to the patient's characteristics."

In a perspective article , "Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly," the author discusses the decreased effectiveness of inhaled medications as the result of inhaler misuse (often due to intricacies and multiple steps required to use the inhaler) and the high cost of inhaler-based therapies. The author also highlights several advances in inhaler use, including the ability to combine therapies and to choose the right inhaler based on patient-centered decisions.

"Education is key to increasing the effectiveness of inhaled medications, and many clinicians—and often even the patients themselves—are unaware that patients are having difficulty getting enough medication into their lungs," said Valerie G. Press, M.D., MPH, an associate professor of medicine at the University of Chicago.

"Additional inhaler technique education is needed to ensure patients are using the device correctly, especially when multiple inhaled medications are prescribed. Additional education, supported by the necessary resources, would help ensure patients are receiving optimal treatment and avoiding adverse health outcomes."

Valerie G. Press, Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation (2024). DOI: 10.15326/jcopdf.2024.0546

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