Yolanda Álvarez-Pérez

Background: Survivors of breast cancer frequently experience anxiety, stress, and depression during the follow-up and survivorship phases, when access to psychosocial support is often limited. Although psychological interventions have demonstrated effectiveness, their implementation in routine clinical practice remains challenging. Digital mental health interventions offer a promising alternative. However, many existing solutions show limited personalization, engagement, and long-term adherence, partly due to insufficient involvement of end users in their design. Objective: This study aims to develop and pilot-test a cocreated digital psychological intervention (SerenApp) aimed at improving psychological well-being among women during breast cancer follow-up and to evaluate its feasibility, usability, and preliminary effectiveness. Methods: This mixed methods study adopts a participatory cocreation approach structured into 3 phases. Phase 1 focuses on identifying unmet psychosocial needs and co-designing the app’s content and functionalities through workshops involving patients and health care professionals, applying design thinking principles and the Cocre-Ar-E (cocreate, assemble, and evaluate) framework. Phase 2 involves the technical development of the intervention using an agile scrum framework methodology, followed by usability and technical validation (alpha testing). Phase 3 consists of a pilot randomized controlled trial (n=90; 45 participants in each of the intervention and control groups) conducted in Andalusia and the Canary Islands, Spain. Outcomes include acceptability, usability, adherence, psychological well-being, and cost-effectiveness. Validated instruments include the Cancer Patients’ Stress Coping Questionnaire (CAEPO), Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS), EQ-5D-5L, System Usability Scale (SUS), Client Satisfaction Questionnaire-8 (CSQ-8), Client Service Receipt Inventory (CSRI), and Mobile App Rating Scale (MARS). Quantitative analyses will include ANOVA, multilevel regression models, and cost-effectiveness analyses (incremental cost-effectiveness ratio and incremental cost-utility ratio), whereas qualitative data will be analyzed using reflexive thematic analysis supported by NVivo software. Results: Funding was awarded by the Instituto de Salud Carlos III (PI24/01193) in 2024. The SerenApp project began in January 2025 with an exploratory phase and a comprehensive literature review. The cocreation phase was conducted between September 2025 and May 2026, involving 24 breast cancer survivors and 15 multidisciplinary health care professionals. Development and alpha testing are ongoing, with recruitment expected to begin in 2027. Data analysis has not yet started, and the main study findings are expected to be published in 2028. Conclusions: This protocol describes the development and pilot evaluation of SerenApp. By integrating the perspectives of survivors, health care professionals, researchers, and technology developers, the study seeks to develop an intervention that is relevant, acceptable, and feasible within real-world health care settings. The findings generated through the cocreation process, usability evaluation, and pilot randomized controlled trial are expected to contribute to the evidence base on participatory approaches in digital mental health and inform the future refinement, implementation, and large-scale evaluation of SerenApp. Trial Registration: ClinicalTrials.gov NCT07169539; https://clinicaltrials.gov/study/NCT07169539 International Registered Report Identifier (IRRID): DERR1-10.2196/87151

Introduction Adolescence is a critical period marked by physiological and psychological changes that influence long-term health. Establishing healthy behaviours, particularly regular physical activity, is essential during this stage; however, around 80% of young people do not meet the WHO’s physical activity recommendations. Digital technologies offer promising opportunities to promote health among youth, yet most physical activity mobile applications (apps) lack scientific validation and usability. Unlike psychology, which has validated repositories to guide users in selecting mental health apps, physical activity lacks validated repository platforms, especially for adolescents. The project has a twofold aim: (1) to co-design a website, named the TeenFit website, that facilitates the selection of physical activity apps tailored to each adolescent’s individual needs and preferences and (2) to investigate the barriers and facilitators for the implementation of the TeenFit website in real-world settings. Methods and analysis Adolescents and other stakeholders (ie, caregivers, educators, and health professionals) will be engaged in the development of the TeenFit website app finder through a participatory design approach that involves three workshops, encompassing both a development phase and an implementation phase. Approximately 10–12 participants per group will take part in smaller working groups to collaboratively contribute to the co-design of the TeenFit website. TeenFit will include physical activity apps available in the Spanish market, developed in both English and Spanish. These applications are currently being identified through two ongoing systematic reviews. In addition to qualitative data gathered during the audio- and video-recorded workshops, quantitative data will be collected on participants’ co-design experiences and the acceptability of the TeenFit website. Data analysis will involve descriptive statistics, qualitative content analysis for describing participants’ perspectives on what aspects (ie, content, features and layout) are important for the design of the website and reflexive thematic analysis to identify barriers and facilitators to implementation. Ethics and dissemination The study was approved by the Research Ethics Committee in the province of Málaga (Spain) (REC ref: SICEIA-2024-003172). Research findings will be disseminated primarily via national and international conferences and publication in peer-reviewed journals. Patient and public involvement will inform further dissemination activities.

Purpose Long-term breast cancer survivors experience permanent effects of cancer treatment such as reduced strength, aerobic capacity, and mobility, as well as cognitive, cardiac, or neurotoxic complications. This study aims to characterise the experience and needs of breast cancer survivorship care and to examine its alignment with the person-centred care model, based on the perspectives of long-term breast cancer survivors and the multidisciplinary professionals involved in their care. Methods This study co-created, with long-term breast cancer survivors and healthcare professionals, a patient journey map to visually describe their experiences. Healthcare-related needs were also prioritised, and solutions to improve health services were proposed. Results Person-centred care in breast cancer survivorship is yet to be fully implemented. Five relevant areas of care were identified through independent focus groups and workshops: early recurrence detection, monitoring of potential physical consequences, psychological health, employment-related aspects, and healthy lifestyles. Being involved in the decision-making process and being listened to were identified as priority needs by patients. Meanwhile, healthcare professionals stressed the importance of improving communication with patients. Psychological support and care coordination were among the most important needs for both patients and healthcare professionals. Conclusion Potential solutions to address these needs included improving access to information and communication channels, increasing resources (such as rehabilitation, psychotherapy, case managers, and direct scheduling), and strengthening support for healthy lifestyle and employment, as well as creating specific training for healthcare professionals. Experiences and care needs of long-term breast cancer survivors were visualised in the patient journey map, which can be used for service redesign.

Background: Paediatric palliative care (PPC) is an early, holistic model addressing the physical, psychological, social, and spiritual needs of children with life-limiting or life-threatening conditions and their families. Parents frequently experience high psychological distress, and although psychological support is a core PPC component, empirical evidence on the effectiveness of interventions within this context remains limited, particularly across non-oncological conditions. This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions for parents of children eligible for PPC. Methods: A systematic search of MEDLINE, Embase, CINAHL, APA PsycINFO, and CENTRAL was conducted in July 2024 and updated in Embase in November 2025. Randomized controlled trials evaluating psychological interventions for parents of children under 18 years eligible for PPC were included. Methodological quality was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). The review was conducted in accordance with PRISMA guidelines, and random-effects meta-analyses were performed where appropriate. Results: Thirty-six studies were included. Although the review aimed to capture studies involving parents of children with various life-limiting conditions eligible for PPC, the evidence base was almost exclusively oncology-focused: only one study was conducted within a PPC context, and all studies involved parents of children with cancer. The psychological interventions were heterogeneous and frequently multimodal, with cognitive-behavioural therapy being the most common approach. Meta-analyses showed primarily short-term significant moderate-to-large effect sizes, indicating improvements in anxiety ( g = −1.00; 95% CI: −1.49, −0.52; I ² = 94%), depression (g = −0.77; 95% CI: −1.15, −0.39; I ² = 85%), psychological distress (g = −0.39; 95% CI: −0.75, −0.04; I ² = 0%) and hope ( g = 0.73; 95% CI: 0.20, 1.26; I ² = 0%). Evidence of long-term effects was limited, with improvements observed only for post-traumatic stress symptoms ( g = −0.29; 95% CI: −0.55, −0.03; I ² = 0%). Discussion: The findings suggest that psychological interventions, particularly those based on cognitive behavioural approaches, are effective in reducing psychological distress and enhancing positive psychological outcomes in the short term among parents of children with cancer who are eligible for PPC. However, the scarcity of studies explicitly conducted within PPC settings highlights the need for further high-quality trials across a wider range of life-limiting and life-threatening conditions. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024594171 , CRD42024594171

BACKGROUND Digital health literacy and person-centred care interventions can enhance understanding of online health information and empower patients, optimizing healthcare. Massive Open Online Courses (MOOCs) can provide flexible access and adapted educational resources and are a useful self-care strategy to chronic patients. OBJECTIVE This study aimed to assess the acceptability and preliminary effectiveness of the MOOC “Active: Empower Yourself Against Breast Cancer” (original title in Spanish: “Activas: Empodérate frente al cáncer de mama”). METHODS The MOOC was developed through a co-creation process involving patients, healthcare professionals, and health science researchers and was designed to improve digital health literacy, health literacy, knowledge, self-care, and person-centred care among women at different stages of breast cancer, breast cancer survivors (currently disease-free), and their families/caregivers. Seventy-nine Spanish-speaking participants were recruited using convenience sampling, of whom forty-three completed all MOOC units and assessed its acceptability. RESULTS Primary outcomes included changes in self-perceived digital health literacy and health literacy after completing the MOOC, measured with the eHealth Literacy Scale (eHEALS) and the Health Literacy Survey European Questionnaire–16 items (HLS-EU-Q16). Knowledge gained in each unit and overall acceptability, based on the Technology Acceptance Model, were also evaluated. Significant improvements were observed in HL (HLS-EU-Q16, P=.0027) and DHL (eHEALS, P=.007). The average rating of the MOOC was 8.9 out of 10. Most participants reported high acceptability regarding language, content, relevance, activities, and alignment with the stated objectives. CONCLUSIONS The MOOC appears to be a feasible strategy to improve the digital health literacy, knowledge, self-care, and person-centred care challenges in women with breast cancer, showing high acceptability. Further research with larger and more diverse samples is warranted. CLINICALTRIAL The study was retrospectively registered in Clinical Trials.gov (NCT06635239) on October 4th, 2024. INTERNATIONAL REGISTERED REPORT RR2-10.3390/ijerph20053922

Pediatric palliative care (PPC) provides holistic and family-centered support that extends beyond end-of-life care. Children living with life-limiting or l

The Spanish National Healthcare System is founded on principles of universality, equity, and financial solidarity, providing comprehensive healthcare services to all citizens. The Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), plays a crucial role in promoting evidence-based decision making regarding the inclusion of new technologies in the healthcare system through a robust health technology assessment (HTA) framework. RedETS has collaboratively developed and implemented methodologies to integrate patient involvement into the assessment process. The Patient Involvement Interest Group within RedETS fosters training initiatives and collaborative efforts to strengthen patient participation, emphasising capacity building and knowledge exchange. The methodologies and procedures established by RedETS for patient involvement in HTA prioritise patient-centred evidence assessment, the generation of insights from patients, and the evaluation of participation processes. These initiatives aim to enhance transparency, accountability, and the continuous improvement of patient engagement within the network.

Background Person-centered care (PCC) and shared decision-making (SDM) are key components of high-quality primary care, yet professionals and patients often perceive them differently. Understanding these discrepancies is essential to improve communication and chronic care management. This study examines the agreement between patients’ and healthcare professionals’ assessments of PCC and SDM in routine primary care. Methods We conducted a cross-sectional study in primary care involving healthcare professionals and their patients with chronic conditions. Participants completed validated PCC and SDM questionnaires. Paired comparisons, correlation analyses, and multilevel models were used to assess discrepancies between professionals’ self-ratings and patients’ evaluations. Results Physicians scored significantly higher than patients on both the PACIC (and all of its subscales) and the SDM questionnaires. Patients show very low scores on both instruments. There were no significant correlations between HCPs’ scores and the mean of their attended patients, with most values near to zero. The only significant predictors of greater discrepancy were professional female gender (for the PACIC, only in the univariate analysis), lower education level (for the SDM-Q-9) and older patients’ age (for both). Conclusion There is a significant gap between professionals and patients’ perceptions of PCC and SDM, showing null correlations between them and consistently higher scores for professionals, and this discrepancy is significantly greater for older and less-educated patients. More research is needed to explore the source of these discrepancies and to develop interventions targeting alignment of perspectives. Efforts to improve care should prioritize patient empowerment and equity to align experiences, enhance satisfaction and ensure fair, sustainable chronic care.

Introduction: Adolescence is a critical period marked by physiological and psychological changes that influence long-term health. Establishing healthy behaviors, particularly regular physical activity, is essential during this stage; however, around 80% of young people do not meet the World Health Organization’s physical activity recommendations. Digital technologies offer promising opportunities to promote health among youth, yet most physical activity apps lack scientific validation and usability. Unlike psychology, which has validated repositories to guide users in selecting mental health apps, physical activity lacks validated repository platforms, especially for adolescents. The project has a twofold aim: (1) to co-design a website, named the TeenFit website, that facilitates the selection of physical activity apps tailored to each adolescent’s individual needs and preferences; and (2) to investigate the barriers and facilitators for the implementation of the TeenFit website in real-world settings. Methods and analysis: Adolescents and other stakeholders (i.e., caregivers, educators, and health professionals) will be engaged in the development of the TeenFit website app finder through a participatory design approach that involves three workshops, encompassing both a development phase and an implementation phase. Approximately 10-12 participants per stakeholder group will take part in smaller working groups (i.e., workshops) to collaboratively contribute to the co-design of the TeenFit website. TeenFit will include mobile applications available in the Spanish market, developed in both English and Spanish. These applications are currently being identified through two ongoing systematic reviews. In addition to qualitative data gathered during the audio- and video-recorded workshops, quantitative data will be collected on participants’ co-design experiences and the acceptability of the TeenFit website. Data analysis will involve descriptive statistics, qualitative content analysis for describing participants’ perspectives on what aspects (i.e., content, features, and layout) are important for the design of the website, and reflexive thematic analysis to identify barriers and facilitators to implementation. Ethics and dissemination: The study was approved by the Research Ethics Committee in the province of Málaga (Spain) (REC ref: SICEIA-2024-003172). Research findings will be disseminated primarily via national and international conferences and publication in peer-reviewed journals. Patient and public involvement will inform further dissemination activities. Strengths and limitations of this study: The major strength of the study is that it draws on both qualitative and quantitative data to generate meaningful insights into the co-design and implementation of the TeenFit website, including participants’ co-design experiences, preferences, sociodemographic characteristics, the website’s acceptability, and the barriers and facilitators to its implementation. Limitations include the use of a convenience sampling approach, which may lead to uneven demographic representation. A transparent reporting of participant characteristics will nevertheless allow readers to assess whether our findings are transferable to other settings. Offering one-to-one online participation alongside in-person workshops may mitigate accessibility barriers, though it could affect the dynamics of group interaction compared with fully in-person sessions.

BACKGROUND Survivors of breast cancer frequently experience anxiety, stress, and depression during the follow-up and survivorship phases, when access to psychosocial support is often limited. Although psychological interventions have demonstrated effectiveness, their implementation in routine clinical practice remains challenging. Digital mental health interventions offer a promising alternative. However, many existing solutions show limited personalization, engagement, and long-term adherence, partly due to insufficient involvement of end users in their design. OBJECTIVE This study aims to develop and pilot-test a cocreated digital psychological intervention (SerenApp) aimed at improving psychological well-being among women during breast cancer follow-up and to evaluate its feasibility, usability, and preliminary effectiveness. METHODS This mixed methods study adopts a participatory cocreation approach structured into 3 phases. Phase 1 focuses on identifying unmet psychosocial needs and co-designing the app’s content and functionalities through workshops involving patients and health care professionals, applying design thinking principles and the Cocre-Ar-E (cocreate, assemble, and evaluate) framework. Phase 2 involves the technical development of the intervention using an agile scrum framework methodology, followed by usability and technical validation (alpha testing). Phase 3 consists of a pilot randomized controlled trial (n=90; 45 participants in each of the intervention and control groups) conducted in Andalusia and the Canary Islands, Spain. Outcomes include acceptability, usability, adherence, psychological well-being, and cost-effectiveness. Validated instruments include the Cancer Patients’ Stress Coping Questionnaire (CAEPO), Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS), EQ-5D-5L, System Usability Scale (SUS), Client Satisfaction Questionnaire-8 (CSQ-8), Client Service Receipt Inventory (CSRI), and Mobile App Rating Scale (MARS). Quantitative analyses will include ANOVA, multilevel regression models, and cost-effectiveness analyses (incremental cost-effectiveness ratio and incremental cost-utility ratio), whereas qualitative data will be analyzed using reflexive thematic analysis supported by NVivo software. RESULTS Funding was awarded by the Instituto de Salud Carlos III (PI24/01193) in 2024. The SerenApp project began in January 2025 with an exploratory phase and a comprehensive literature review. The cocreation phase was conducted between September 2025 and May 2026, involving 24 breast cancer survivors and 15 multidisciplinary health care professionals. Development and alpha testing are ongoing, with recruitment expected to begin in 2027. Data analysis has not yet started, and the main study findings are expected to be published in 2028. CONCLUSIONS This protocol describes the development and pilot evaluation of SerenApp. By integrating the perspectives of survivors, health care professionals, researchers, and technology developers, the study seeks to develop an intervention that is relevant, acceptable, and feasible within real-world health care settings. The findings generated through the cocreation process, usability evaluation, and pilot randomized controlled trial are expected to contribute to the evidence base on participatory approaches in digital mental health and inform the future refinement, implementation, and large-scale evaluation of SerenApp. CLINICALTRIAL ClinicalTrials.gov NCT07169539; https://clinicaltrials.gov/study/NCT07169539 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/87151