Hsun-Yu Chan

Context: Doping and inadvertent exposure to prohibited substances are major concerns in sport because of their implications for athlete health, medication safety, and fair competition. The growing use of prescription medications, over-the-counter products, and dietary supplements has complicated anti-doping practice, particularly among athletes who manage their own medications or rely on nonprofessional sources of information. Pharmacists are well positioned to support athletes through medication counseling, supplement evaluation, and anti-doping education; however, their role in anti-doping systems remains incompletely understood. Objective: To explore the evolving role of pharmacists in anti-doping practice by reviewing pharmacist-led interventions related to athlete medication management and identifying barriers to their implementation and utilization. Data Sources: PubMed, Scopus, and Web of Science were searched for studies published from January 2016 onward. Study Selection: Studies describing pharmacist-led anti-doping interventions, services, or programs related to medication or supplement use among athletes were included. Study Design: Scoping review. Level of Evidence: Level 4. Data Extraction: Data on intervention type, service delivery, implementation barriers, and reported outcomes were extracted and synthesized descriptively. Results: A total of 16 studies were included. Pharmacist-led anti-doping interventions were categorized into 3 areas: (1) anti-doping education, (2) individualized medication and supplement review, and (3) drug information and policy support within sports medicine settings. Pharmacists contributed to identifying prohibited substances, evaluating supplement contamination risks, supporting Therapeutic Use Exemption applications, and counseling athletes. Educational interventions improved athlete knowledge and reduced favorable attitudes toward doping. However, implementation in routine practice remained inconsistent. Doping-related consultations in community pharmacies were infrequent, and simulated-patient studies demonstrated variability in counseling quality. Common barriers included insufficient anti-doping education, lack of confidence, limited access to reliable resources, inadequate multidisciplinary integration, and absence of remuneration for time-intensive consultations. Athletes frequently relied on coaches, peers, or online sources rather than pharmacists for anti-doping information. Conclusion: Pharmacists represent an underutilized resource within anti-doping systems. Expanding pharmacist involvement through structured education, reliable resources, and stronger integration into multidisciplinary sports medicine teams may improve medication safety, reduce the risk of inadvertent doping, and strengthen athlete support. Future implementation-focused research is needed to evaluate sustainable models of sports pharmacy practice across elite and community settings.

Background: Medication adherence is a key determinant of treatment effectiveness, yet few brief, freely available, and culturally appropriate adherence assessment tools are available in Traditional Chinese for use in routine community pharmacy practice. The 15-item Screening Tool for AdheRence to medicineS (15-STARS) is a pharmacy-based questionnaire designed to identify medication non-adherence and its underlying barriers. Objective: To translate, culturally adapt, and validate the 15-STARS in Traditional Chinese and evaluate its utility for screening medication non-adherence and identifying barriers to adherence among patients with type 2 diabetes (T2D) in Taiwanese community pharmacies. Methods: This cross-sectional study comprised two sequential phases: translation and cross-cultural adaptation, followed by field testing. Translation involved forward-backward translation and cognitive debriefing with pharmacists and patients. The Traditional Chinese 15-STARS was administered to adults with T2D recruited from six community pharmacies in Taiwan. Psychometric evaluation included content validity, item-level criterion validity against the Traditional Chinese Adherence to Refills and Medications Scale (ChARMS-T), and internal consistency assessed using McDonald’s omega (ω). Associations among adherence, medication-related factors, and glycemic control were examined. Results: Ten pharmacists and ten patients participated in cognitive debriefing, and 215 patients completed field testing. Content validity was excellent, with item-level and scale-level content validity indices of 1.00 after revision. Items 6– 9 demonstrated good internal consistency (ω = 0.831), and selected 15-STARS items were significantly correlated with corresponding ChARMS-T measures. Among the participants, 53.0% of participants reported no missed medication doses during the previous two weeks, whereas 47.0% reported missing at least one dose. The most common reasons for non-adherence were forgetfulness (33.0%), concerns about taking too many medications (18.6%), and concerns about side effects (15.3%). Greater regimen complexity and higher dosing frequency were associated with lower adherence and poorer glycemic control. Conclusion: The Traditional Chinese 15-STARS demonstrated satisfactory content validity, evidence of criterion validity for selected items, and internal consistency among conceptually related belief-based items in Taiwanese community pharmacies. The instrument may serve as a practical screening tool for identifying patients at risk of non-adherence and exploring adherence-related barriers, thereby supporting targeted pharmacist-led interventions.

Sustainable financing of community pharmacy services requires reimbursement models that accurately reflect resource use. However, empirical cost data for dispensing services remain limited in many health systems, including Taiwan's single-payer National Health Insurance (NHI) program. This study estimated the cost of dispensing services in community pharmacies and assessed the extent to which current reimbursement reflects underlying resource utilization. A cost analysis was conducted from the healthcare provider perspective using a time-driven activity-based costing approach. Eight community pharmacies in Taiwan were included. Dispensing workflows were systematically mapped into six sequential steps, and time-and-motion data were collected across six simulated standardized dispensing scenarios designed to capture variation in medication number and type. Resource use included direct, indirect, and personnel-related cost components. Indirect costs were allocated using both space-based and revenue-based approaches. Personnel costs were calculated using capacity cost rates based on pharmacist salaries and practical working capacity. All costs were expressed in New Taiwan Dollars (NT$), and sensitivity analyses assessed robustness under alternative allocation assumptions. Mean dispensing time ranged from 195 to 303 s per prescription and increased with prescription complexity. Total dispensing costs ranged from NT$30.82 to NT$61.21 per prescription. Each additional medication increased costs by NT$13-17, while controlled substances added NT$18-23 due to additional regulatory procedures. Personnel-related costs were the primary cost driver, and cognitive verification activities accounted for the largest share of workload. Compared with current NHI dispensing reimbursement of approximately NT$49-68 per prescription, reimbursement may inadequately reflect the resources required for more complex prescriptions. Cost patterns were consistent across allocation methods. Dispensing services are resource-intensive and vary with prescription complexity, yet current flat-fee reimbursement under Taiwan's NHI does not adequately reflect this variation. Complexity-adjusted reimbursement mechanisms, such as per-medication or controlled-substance modifiers, may better align payment with actual resource utilization and support sustainable community pharmacy services.

Background: Online health information seeking (OHIS) has become a central component of chronic disease management within an increasingly interactive, algorithm-mediated digital ecosystem. For individuals with diabetes, ongoing self-management demands create sustained needs for accessible, actionable health information. Although prior reviews have described general information-seeking behaviors, few have integrated technological evolution, multilevel determinants, and equity considerations specific to diabetes. Objective: This scoping review maps patterns of OHIS among individuals with diabetes, identifies the types of information sought, synthesizes the multilevel determinants of OHIS, and explores temporal shifts across major phases of digital health development. Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension (PRISMA-S) reporting guidelines and was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework. Five electronic databases (PubMed, Scopus, Web of Science, CINAHL, and Embase) were systematically searched for English-language empirical studies from inception to May 4, 2026. Eligible studies included empirical research investigating OHIS behaviors among individuals with type 1 diabetes, type 2 diabetes, or gestational diabetes. Data were extracted using a standardized charting form and synthesized descriptively. Determinants were organized according to the Social Ecological Model, and qualitative findings were analyzed using content analysis. Studies were stratified into 3 periods reflecting shifts in digital infrastructure: early web environments (2002-2010), expansion of social media and mobile technologies (2011-2018), and integrated digital and artificial intelligence (AI)–enabled ecosystems (2019-2025). Results: Eighty-one studies from 32 countries met the inclusion criteria. The use of digital sources diversified over time. Early studies emphasized search engines and institutional websites, whereas later studies increasingly reported engagement with social media platforms and online communities. Mobile health apps and generative AI chatbots appeared in recent publications, although evidence on AI use remained limited. The most frequently sought content included self-management and lifestyle guidance, general diabetes knowledge, and treatment-related information. Determinants of OHIS operated across multiple levels. At the individual level, younger age, greater educational attainment, higher income, and better eHealth literacy were associated with increased engagement, while psychological factors such as perceived knowledge gaps and a desire for autonomy motivated searching. Interpersonal influences included peer support and clinician communication. Organizational and environmental factors encompassed health care access, digital infrastructure, information quality, and platform characteristics. Persistent disparities were observed among older adults and socioeconomically disadvantaged groups. Conclusions: This review synthesizes OHIS among individuals with diabetes through the lenses of technological evolution, multilevel determinants, and digital health equity. Unlike previous reviews that focused on specific platforms or general information-seeking behaviors, it maps the transition from web-based resources to social media and emerging AI-enabled ecosystems. This temporally informed synthesis advances understanding of digital engagement in diabetes self-management, identifies key evidence gaps, and informs clinical, organizational, and policy strategies to promote equitable access to trustworthy online health information.

Background: Addressing healthcare communication skills through a multimedia approach may enrich undergraduate pharmacy students’ medication counseling competence. This study explored the impacts of a blended classroom teaching approach (incorporating newly designed video-based materials into conventional slide-based lectures) on students’ self-efficacy and performance in over-the-counter (OTC) medication counseling services. Methods: Using a sequential explanatory mixed methods approach, two cohorts of undergraduate pharmacy students enrolled in the 16-week Introduction to Community Pharmacy course were investigated. The cohort expected to graduate in 2025 served as the control group and received 4 weeks of conventional instruction using PowerPoint slides to introduce professional communication and counseling skills. In contrast, the intervention cohort expected to graduate in 2026 received 3 weeks of PowerPoint-based instruction, followed by an additional week of video-rich learning in OTC counseling. Pre- and post-course questionnaires were administered to assess students’ self-efficacy in OTC counseling. Moreover, their counseling performance was evaluated through role-playing exercises with standardized patients during the final week of the course. Multivariate regression analyses determined the effectiveness of each teaching approach in enhancing self-efficacy and counseling performance. Semi-structured interviews were conducted and analyzed using inductive thematic analysis to gain insights into students’ perspectives and experiences with the two teaching approaches. Results: Both cohorts exhibited enhanced self-efficacy in medication counseling through the two approaches. However, the group that received the blended multimedia approach showed significantly greater improvement in counseling performance than its counterpart ( p = 0.007). Students in the intervention cohort appreciated how video-based instruction provided visual and auditory cues, helping them grasp the structured flow of OTC counseling. Witnessing real-case scenarios in videos facilitated their understanding and appreciation of counseling techniques in real-life pharmacy settings. Conclusion: The study highlights that integrating multimedia instruction, particularly videos, significantly improved pharmacy students’ OTC counseling performance, while self-efficacy showed improvement without a significant difference compared to traditional slide-based lectures. To better support the development of counseling competence, a blended instructional approach that combines video-based learning with conventional lectures is recommended.

This study examined the effect of a virtual growth mindset intervention in enhancing the perceived flexibility of intelligence and academic outcomes of community college students enrolled in corequisite math courses during the COVID-19 pandemic. Prior research suggests that growth mindset interventions can positively influence students’ beliefs about intelligence and academic performance, but effects may vary based on individual sociodemographic characteristics and college readiness. Employing a randomized pre-posttest design, this investigation assessed the impact of the intervention on students’ perceived intelligence flexibility and course grades for those enrolled in corequisite math courses. Results indicate a significant increase in growth mindset among participants in the intervention group. However, no significant differences in self-report course grades existed between the intervention and control groups. These findings underscore the complex relationship between growth mindset, academic performance, and contextual factors. The results call for further research to elucidate the long-term effects of growth mindset interventions for underprepared college students.

BACKGROUND Online health information seeking (OHIS) has become a central component of chronic disease management within an increasingly interactive, algorithm-mediated digital ecosystem. For individuals with diabetes, ongoing self-management demands create sustained needs for accessible, actionable health information. Although prior reviews have described general information-seeking behaviors, few have integrated technological evolution, multilevel determinants, and equity considerations specific to diabetes. OBJECTIVE This scoping review maps patterns of OHIS among individuals with diabetes, identifies the types of information sought, synthesizes the multilevel determinants of OHIS, and explores temporal shifts across major phases of digital health development. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension (PRISMA-S) reporting guidelines and was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework. Five electronic databases (PubMed, Scopus, Web of Science, CINAHL, and Embase) were systematically searched for English-language empirical studies from inception to May 4, 2026. Eligible studies included empirical research investigating OHIS behaviors among individuals with type 1 diabetes, type 2 diabetes, or gestational diabetes. Data were extracted using a standardized charting form and synthesized descriptively. Determinants were organized according to the Social Ecological Model, and qualitative findings were analyzed using content analysis. Studies were stratified into 3 periods reflecting shifts in digital infrastructure: early web environments (2002-2010), expansion of social media and mobile technologies (2011-2018), and integrated digital and artificial intelligence (AI)–enabled ecosystems (2019-2025). RESULTS Eighty-one studies from 32 countries met the inclusion criteria. The use of digital sources diversified over time. Early studies emphasized search engines and institutional websites, whereas later studies increasingly reported engagement with social media platforms and online communities. Mobile health apps and generative AI chatbots appeared in recent publications, although evidence on AI use remained limited. The most frequently sought content included self-management and lifestyle guidance, general diabetes knowledge, and treatment-related information. Determinants of OHIS operated across multiple levels. At the individual level, younger age, greater educational attainment, higher income, and better eHealth literacy were associated with increased engagement, while psychological factors such as perceived knowledge gaps and a desire for autonomy motivated searching. Interpersonal influences included peer support and clinician communication. Organizational and environmental factors encompassed health care access, digital infrastructure, information quality, and platform characteristics. Persistent disparities were observed among older adults and socioeconomically disadvantaged groups. CONCLUSIONS This review synthesizes OHIS among individuals with diabetes through the lenses of technological evolution, multilevel determinants, and digital health equity. Unlike previous reviews that focused on specific platforms or general information-seeking behaviors, it maps the transition from web-based resources to social media and emerging AI-enabled ecosystems. This temporally informed synthesis advances understanding of digital engagement in diabetes self-management, identifies key evidence gaps, and informs clinical, organizational, and policy strategies to promote equitable access to trustworthy online health information.

Background: Medication nonadherence in cardiometabolic syndrome negatively impacts patients’ quality of life, health care systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. SMS text messaging has emerged as a widely accessible and cost-effective intervention, particularly when the intervention is structured using behavioral theories. Objective: This study aimed to review existing literature and identify key factors in the design of SMS text messaging interventions for improving medication adherence among patients with diabetes, hypertension, or hyperlipidemia. Methods: We conducted a scoping review following the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Relevant literature on SMS text messaging interventions was searched in the PubMed and Scopus databases from inception to October 2024. The search terms included “diabetes,” “hypertension,” “hyperlipidemia,” “message,” “text,” “text message,” “app,” “application,” “digital,” “device,” “mobile,” “medical adherence,” and “medication adherence,” combined using logical operators “OR” and “AND.” Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages. Results: A total of 52 studies investigating SMS text messaging interventions to enhance medication adherence were identified. The targeted conditions included diabetes (26/52, 50%), hypertension (16/52, 31%), and various other chronic diseases (10/52, 19%). More than half of the studies (33/52, 64%) incorporated behavioral theories or techniques in their intervention design, using 19 distinct behavioral models. The most frequently used frameworks were the behavior change technique taxonomy (16/52, 31%) and the capability, opportunity, motivation, and behavior model (6/52, 12%). In addition, 33 (64%) studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (21/52, 40%), followed by personalized timing and frequency of messages (14/52, 27%), to enhance interventions’ adaptability and relevance to users’ needs. Conclusions: This review highlights critical factors influencing the design of SMS text messaging interventions for medication adherence in the management of diabetes, hypertension, and hyperlipidemia. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.

Background: Understanding personal beliefs about medications is an effective approach to improving adherence. A validated tool is essential for identifying these beliefs in routine clinical practice. Objective: To validate the factor structure and reliability of the Traditional Chinese version of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) among individuals with type 2 diabetes (T2D) in Taiwan. Methods: The original 10-item BMQ-Specific was translated into Traditional Chinese using a forward-backward translation process and reviewed by four experts in pharmacy practice and educational psychology. A cross-sectional study was conducted among adults with T2D who were using diabetes medications. Participants were recruited from five community pharmacies in Taiwan between June 2023 and May 2024. Internal consistency was assessed using McDonald’s omega (ω). Construct validity was examined through exploratory factor analysis, and criterion validity was determined by exploring associations between concern beliefs, medication adherence, and glycemic control, as measured by A1C levels. Results: Two hundred and seventy-three patients participated in the study. Exploratory factor analysis confirmed a two-factor structure consistent with the original English version, comprising the Specific-Necessity and Specific-Concerns subscales. All items loaded onto their respective subscales. The internal consistency reliability of the instrument was acceptable, with McDonald’s ω values of 0.785 for both the BMQ-Specific Necessity and BMQ-Specific Concerns subscales. These satisfactory properties were further supported by predictive validity data, which demonstrated the impact of treatment beliefs on adherence levels. The BMQ-Specific Concerns subscale showed a positive correlation with higher barriers to medication-taking (r = 0.270, p < 0.001) and poorer glycemic control (r = 0.130, p = 0.032). Conclusion: The Traditional Chinese BMQ-Specific is a reliable and valid tool for assessing medication beliefs among patients with T2D in Taiwan. It can be effectively incorporated into clinical practice to support patient-provider communication and improve medication adherence.