Leonardo Rojas-Mezarina

Mobile clinical-support applications can facilitate access to evidence-based information at the point of care, but evidence on their usability and perceived usefulness among newly graduated physicians working in health facilities with limited capacity is scarce. We assessed physicians’ experiences with BMJ Best Practice using a convergent mixed-methods study. All 81 eligible physicians assigned to rural facilities were invited; 32 enrolled and received application access and training. After three months, participants completed an online survey, and 23 reported using the application. Ten physicians reporting the highest consultation frequency were purposively selected for semi-structured interviews. Survey findings showed a predominantly favorable perception of usability: for most items, 70%–90% of participants agreed or strongly agreed with the statements assessed. Among users, 14 of 23 (60.9%) used the mobile application and 9 (39.1%) used the web version. Interviews indicated that participants valued rapid searches, organized and evidence-based information, and support for diagnostic reasoning, referral decisions, learning, and clinical confidence. Barriers included limited connectivity, difficulties searching in Spanish, automatic updates, challenges locating or using some calculators, and treatment information that was sometimes insufficiently specific. Most importantly, participants could not always implement recommendations because suggested medicines, diagnostic tests, or other resources were unavailable in their facilities. Mobile clinical-support applications may complement decision-making and learning among early-career physicians in rural primary care. However, their practical value depends not only on usability and evidence quality, but also on adaptation to users’ language, workflow, connectivity, and local service capacity. AUTHOR SUMMARY: We evaluated whether BMJ Best Practice, a mobile application that provides evidence-based clinical information, was useful to newly graduated physicians completing SERUMS in rural Peru. Thirty-two physicians had access to the application for three months; 23 reported using it and 10 participated in interviews. Users valued its speed, information organization, and support for diagnostic reasoning, referral decisions, and greater confidence during patient care. However, access to a global tool did not resolve constraints in the practice environment. Connectivity, searches in Spanish, automatic updates, and the performance of some calculators hindered use. Moreover, several recommendations required medicines, diagnostic tests, or other resources that were unavailable in rural primary-care facilities. Our findings suggest that these applications may support learning and decision-making among early-career physicians, but their usefulness depends on adaptation to local language, workflow, and service capacity. Studies using objective usage metrics and clinical outcomes are also needed.

Background Several factors affect the presence of mental health problems in university students and teachers. However, in the Andean region, the identification of these factors is rare. Objective This study sought to evaluate the factors associated with depression, anxiety and perceived stress in students and teachers at a university located in the Andean region. Methods A cross-sectional study was conducted in 2023, including students and teachers with at least one academic cycle at a Peruvian public university in the Andean region. Online surveys were used to collect sociodemographic and clinical data, and validated questionnaires for depression (PHQ-9), anxiety (GAD-7) and stress (PSS-10) were applied. Descriptive analyses and adjusted regressions were performed to identify significant associations. Results A total of 1275 individuals with a median age of 22 years participated; 43.6% were women. A total of 69.3% of the participants reported signs of depression, 62.2% reported anxiety, and 78.4% reported stress. Compared with those aged 20–39 years, students younger than 20 years presented a greater prevalence of mental health problems. A personal mental health history was associated with a greater prevalence of depression, anxiety and stress in students and a greater prevalence of anxiety in teachers. Family history was associated with a greater prevalence of depression and anxiety in students and teachers. Conclusions Sociodemographic and clinical factors are associated with mental health problems in students and teachers in the Andean region. It is essential to consider these particularities to develop effective interventions to address mental health in these settings.

Background: Telehealth has expanded rapidly, yet its sustained use beyond emergency responses remains uneven. Facility and organizational conditions are modifiable determinants of healthcare intervention implementation, and readiness assessments are key steps in the early adoption and further uptake process. However, many telemedicine readiness assessment instruments lack psychometric evidence, limiting their value for benchmarking, prioritizing investments, and monitoring progress at scale. Objective: To adapt and psychometrically validate the Telemedicine Readiness Inventory at the Facility Level (TRI-F). Methods: We conducted a cross-sectional analysis using data from an online assessment of a large sample of primary care facilities (PCFs) in Peru, held between December 2023 and March 2024. The analytic sample included 774 PCFs, with one designated respondent per facility completing the survey. Internal structure was evaluated using exploratory factor analysis and confirmatory factor analysis. Internal consistency was estimated using Cronbach’s alpha and McDonald’s omega. Measurement invariance was evaluated across the facility complexity and the respondant’ time working at the PCF. Criterion validity was examined using Spearman correlations between the five domain scores (Organizational readiness, Processes, Digital environment, Human resources, and Regulatory issues) and proportion of telemedicine modality among overall outpatient encounters. Results: Confirmatory factor models showed adequate fit across domains, with CFI values ranging from 0.959 to 0.999, TLI from 0.952 to 0.997, RMSEA from 0.028 to 0.065, and SRMR from 0.016 to 0.057, for the five domains assessed. Internal consistency was acceptable to high across all domains (α = 0.75-0.87; ω = 0.76-0.88). Measurement invariance was supported across the facility category and time working at the PCF, with ΔCFI values below 0.010. Criterion validity analyses showed positive but small correlations between all five domains and proportional telemedicine use (r _s = 0.15–0.23; p < 0.001). Conclusions: The adapted tool showed satisfactory structural validity, internal consistency, and measurement invariance for assessing telemedicine readiness in PCFs. The availability of percentile-based norms supports interpretation and benchmarking. The instrument can support implementation planning, monitoring, and prioritization of technical assistance in primary care settings.

Background Inborn errors of immunity (IEIs) include more than 500 genetic disorders that cause recurrent infections, autoimmunity, and inflammatory complications. Although classified as rare diseases, their prevalence is increasing, making IEI an emerging public health problem. However, reliable national epidemiological data and coordinated follow-up data of IEI patients are lacking, which potentially affects up to 20,000 people in Peru. Objective In this study, we aim to describe the protocol of a three-phase mixed-method study that will design, build, and evaluate the usability and feasibility of the first Peruvian National IEI Registry. Methods Guided by the Exploration-Preparation-Implementation-Sustainment (EPIS) framework, Phase I (qualitative) will map stakeholder needs through in-depth interviews and focus groups; the data will undergo hybrid thematic analysis in ATLAS.ti. Phase II (pre-experimental) will enroll ≥20 clinical immunology consultants and residents to complete standardized tasks on the REDCap-based prototype; efficiency (task time), effectiveness (error rate), and satisfaction will be compared pre/post-iteration. Phase III (observational) will assess feasibility by enrolling ≥126 IEI cases across six national reference hospitals; the primary outcomes are clinical profile, data completeness, and accuracy. Results The study protocol received institutional review board approval in February 2025 from the UNMSM-Research Ethics Committee. Phase I enrollment started in March 2025. We expect our REDCap-based prototype to incorporate key needs and preferences gathered from focus groups and interviews to develop the platform. By the completion of the study phase II, we will have assessed the usability of the prototype platform. Study phase III will begin in April 2026. The final results are expected by November 2026 and will be published thereafter. Conclusions By evaluating usability and feasibility in real-world conditions, this protocol lays the groundwork for a national IEI registry. The resulting evidence will inform scale-up decisions and facilitate its incorporation into Peruvian health policy. Contributions to the literature - Shows how the EPIS framework can steer real-world adoption of a REDCap-based registry and prospectively measure usability and feasibility across six public hospitals involved in rare-disease surveillance. - Provides a mixed-methods protocol that designs, iterates and field-tests Peru’s first national registry for inborn errors of immunity, tackling persistent barriers to rare-disease data capture in low- and middle-income countries and offering a scalable blueprint for other resource-constrained settings. - Outlines a FAIR-aligned governance and data-sharing strategy that can be adapted by future programmes planning registries for rare and orphan diseases in similar contexts.

Background: In Peru, the Universidad Nacional Mayor de San Marcos involved teachers and students in the creation of management cases in the Rural Urban Marginal Health Service (SERUMS). However, their perception of the implementation of this methodology is not known. Objective: To evaluate the perception of students and teachers on the implementation of a case-creation methodology in the Health Management course at UNMSM. Methods: Mixed methods design. Questionnaires (quantitative phase) and focus groups (qualitative phase) were used to explore the perceptions of students and teachers on the implementation of a case-creation methodology in the Health Management course at UNMSM during 2019. Results: Of the 182 surveyed students, 61% found the created cases interesting and 63% stated that the methodology encourages the use of critical thinking. Qualitatively, the possibility to learn about real SERUMS cases and work collaboratively to find innovative solutions was highlighted. However, several mentioned that this led to an academic overload and emphasized a lack of information on the topic. Teachers mentioned that the methodology promoted learning in management, though they recognized challenges in its implementation due to the limited experience and training of teachers and students. Conclusions: The case-creation methodology is perceived as an innovative and beneficial and educational strategy for teaching managerial aspects in SERUMS. However, an adequate process of training, planning, and organization is suggested for its effective implementation.

Background: University communities, especially in low-resource settings like Peru’s Andean region, experience high rates of depression, anxiety, and stress, which harm academic performance and well-being. Traditional mental health services often remain inaccessible, necessitating scalable, self-guided solutions. While digital mental health interventions have shown promise broadly, evidence is scarce for fully self-administered platforms in low-resource university environments. Objective: We evaluated the efficacy of a self-administered digital mental health service in members of a public university to reduce symptoms of depression, anxiety, and perceived stress. Methods: We conducted a double-blind, parallel-group randomized controlled trial with 1:1 allocation to the digital mental health self-care service or a 30-day waiting-list control. We recruited 427 participants (students, teachers, and administrative staff) in May-June 2024, reporting mild to moderate symptoms of depression, anxiety, and stress. Participants were randomized via simple randomization and blinded through automated platform assignment. The intervention comprised 6 sequential 5-day modules grounded in acceptance and commitment therapy, mindfulness, and behavioral activation, delivered via videos, daily text prompts, workbooks, and a responsive chatbot. SMS and WhatsApp (Meta) reminders promoted adherence. Depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), and perceived stress (PSS-10) were assessed at baseline and immediately post intervention (day 30). Secondary outcomes in the intervention arm included usability (Computer System Usability Questionnaire), satisfaction (Client Satisfaction Questionnaire-8), and subjective commitment (Twente Engagement with Ehealth Technologies Scales). Analysis of covariance (ANCOVA) adjusted for baseline scores, and multivariate ANCOVA accounted for correlations among outcomes. Effect sizes were quantified using Cohen d and partial epsilon-squared (ε² _p ). Results: Of 427 randomized, 85 (19.9%) completed all assessments (intervention: n=30; control: n=55). Baseline demographic and clinical characteristics were comparable between groups. Post intervention, the digital mental health self-care service group exhibited significantly greater reductions in mean Patient Health Questionnaire-9 scores (mean difference 2.78; Cohen d =0.64; P =.006), Generalized Anxiety Disorder-7 scores (mean difference 2.13; Cohen d =0.56; P =.015), and PSS-10 scores (mean difference 4.08; Cohen d =0.69; P =.003) than controls. ANCOVA confirmed robust group effects for depression ( F ₁,₈₂=9.78; P =.002; ε² _p =0.31) and anxiety ( F ₁,₈₂=8.28; P =.005; ε² _p =0.32), with a trend toward stress reduction ( F ₁,₈₂=3.73; P =.057; ε² _p =0.46). Multivariate ANCOVA demonstrated a significant multivariate effect (F₄,₁₂=7.23; P =.015). Among intervention completers, 100% scored below the Client Satisfaction Questionnaire-8 satisfaction threshold (<24), 60% rated platform usability as low (Computer System Usability Questionnaire<64); yet, 96.7% reported high subjective commitment (Twente Engagement with Ehealth Technologies Scales ≥18), indicating strong engagement despite interface challenges. Conclusions: A self-administered digital self-care service effectively reduced depression, anxiety, and stress symptoms in a Peruvian university community. High user commitment underscores the platform’s relevance, while low satisfaction and usability necessitate interface optimization—streamlined navigation, adaptive personalization, and feedback mechanisms—to enhance user experience and support scalable implementation in low-resource educational settings.

Although home office employment has been happening for several decades, the COVID-19 pandemic has led to an unprecedented surge in telework. Concurrently, the prevalence of sedentary individuals has gradually increased, posing health challenges. In this study, we introduce a mobile app designed to promote healthy lifestyles (HLs) among home office workers (HOWs). Central to this app is an IBM Watson Assistant-powered Chatbot, offering remote workers a near-natural interface to enhance their well-being. Users can establish lifestyle improvement goals, receive activity reminders, earn rewards upon achieving goals, and employ their smartphone’s pedometer to measure their physical activity (PA) levels. Additionally, the app includes questionnaires to gauge the user’s knowledge on sedentarism and HL. The app’s efficacy was assessed via a two-week trial involving 20 participants. The results showed that HL knowledge was improved in 46% of the users. Usability surveys yielded high ratings in terms of usefulness, user-friendliness, and recommendations.