Advancing radiology with GPT-4: Innovations in clinical applications, patient engagement, research, and learning.

The rapid evolution of artificial intelligence (AI) in healthcare, particularly in radiology, underscores a transformative era marked by a potential for enhanced diagnostic precision, increased patient engagement, and streamlined clinical workflows. Amongst the key developments at the heart of this transformation are Large Language Models like the Generative Pre-trained Transformer 4 (GPT-4), whose integration into radiological practices could potentially herald a significant leap by assisting in the generation and summarization of radiology reports, aiding in differential diagnoses, and recommending evidence-based treatments. This review delves into the multifaceted potential applications of Large Language Models within radiology, using GPT-4 as an example, from improving diagnostic accuracy and reporting efficiency to translating complex medical findings into patient-friendly summaries. The review acknowledges the ethical, privacy, and technical challenges inherent in deploying AI technologies, emphasizing the importance of careful oversight, validation, and adherence to regulatory standards. Through a balanced discourse on the potential and pitfalls of GPT-4 in radiology, the article aims to provide a comprehensive overview of how these models have the potential to reshape the future of radiological services, fostering improvements in patient care, educational methodologies, and clinical research.

A mixed-methods approach to assessing implementers' readiness to adopt digital health interventions (RADHI).

BACKGROUND: Despite being the primary setting for HIV prevention among men who have sex with men (MSM) since the start of the epidemic, community-based organizations (CBOs) struggle to reach this historically stigmatized and largely hidden population with face-to-face interventions. HIV researchers have readily turned to the internet to deliver critical HIV education to this group, with evidence of high effectiveness and acceptability across studies. However, implementation outside of research contexts has been limited and not well studied. We aimed to assess HIV CBOs' readiness to adopt digital health interventions and identify contextual factors that may contribute to differing levels of readiness. METHODS: We recruited 22 CBOs across the US through a pragmatic request-for-proposals process to deliver Keep It Up! (KIU!), an evidence-based eHealth HIV prevention program. We used mixed methods to examine CBO readiness to adopt digital health interventions (RADHI). Before implementation, CBO staff completed a 5-item RADHI scale (scored 0-4) that demonstrated concurrent and predictive validity. We interviewed CBO staff using semi-structured questions guided by the Consolidated Framework for Implementation Research and compared RADHI score groups on determinants identified from the interviews. RESULTS: Eighty-five staff (range = 1-10 per CBO) completed the RADHI. On average, CBOs reported moderate-to-great readiness (2.74) to adopt KIU!. High RADHI CBOs thought KIU! was a top priority and an innovative program complementary to their existing approaches for their clients. Low RADHI CBOs expressed concerns that KIU! could be a cultural mismatch for their clients, was lower priority than existing programs and services, relied on clients' own motivation, and might not be suitable for clients with disabilities. Value, appeal, and limitations did not differ by RADHI group. CONCLUSIONS: While HIV CBOs are excited for the opportunities and advantages of digital interventions, additional pre-implementation and implementation support may be needed to increase perceived value and usability for different client populations. Addressing these limitations is critical to effective digital prevention interventions for HIV and other domains such as mental health, chronic disease management, and transitions in care. Future research can utilize our novel, validated measure of CBOs' readiness to adopt digital health interventions. TRIAL REGISTRATION: NCT03896776, clinicaltrials.gov, 1 April 2019.

GRADE Guidance 39: Using GRADE-ADOLOPMENT to adopt, adapt or create contextualized recommendations from source guidelines and evidence syntheses.

INTRODUCTION: The GRADE-ADOLOPMENT methodology has been widely used to adopt, adapt or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. This guidance refines the operationalization for applying GRADE-ADOLOPMENT. METHODS: Through iterative discussions, online meetings and email communications, the GRADE-ADOLOPMENT Project Group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned Adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE Working Group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people) and twice in September 2023 (approximately 60 and 90 people) for approval. RESULTS: This GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing EtDs when available or developing new EtDs if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. CONCLUSION: This updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over six years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.

Behavioral intentions of university teachers and students toward the adoption of the hyb-blended learning method: Evidence from Bangladesh.

Hyb-blended learning is a novel method that can serve as a substitute for conventional classroom-based learning activities, demonstrating effectiveness in both pandemics like COVID-19 and other crises, as well as in non-pandemic situations. The successful application of this method in the field of education depends on the users' intentions to adopt it. Therefore, this study aims to understand the behavioral intentions of teachers and students at Bangladeshi universities toward the adoption of the hyb-blended learning method. A correlational, cross-sectional, and sample survey-based research design was employed. Two structured questionnaires, one for teachers and one for students, were used to collect data from 171 teachers and 713 students from 11 public and 8 private universities in Bangladesh. The conceptual model of the study was developed on the theoretical underpinnings of the "Unified Theory of Acceptance and Use of Technology (UTAUT)." The study used a structural equation modeling technique to test the hypotheses. The results of the study revealed that the proposed learning method would increase teaching and learning opportunities for both teachers and students in Bangladeshi universities. They would adopt this method without relying on the experiences of others or what others think or say. Unlike teachers, the study also found that students would use it if they received support and influence from friends, fellow students, university authorities, and other external factors. However, their intentions toward adopting this method depend on the availability of resources and support for adopting it, as well as adequate and necessary understanding and talent to use it effectively. Results also revealed that they would adopt the method if it was found to be simple to use. The study has a notable practical implication, as it has proposed an alternative learning and teaching method that would be effective in Bangladeshi universities during the COVID-19 pandemic or other crises and in non-pandemic situations as well.

A theory of coverage rate differences for hearing aids around the world based on correlational observation and analysis.

OBJECTIVE: Our objective was to ascertain likely reasons for explaining variation in coverage rates for hearing aids (HAs) among various countries around the world. DESIGN: A retrospective analysis of past coverage rates and their association to demographic and economic variables of apriori logical consideration. STUDY SAMPLE: Data was obtained on macroeconomic conditions from 37 countries in the OECD and estimated coverage rates for HAs using recent actual sales data. RESULTS: Two variables were identified with a very strong correlation (R = 0.97, R2 = 0.95) to coverage rates. The first variable was the level of subsidy provided for the citizens to obtain HAs. The second variable was the GNI/capita which reflects the income available to citizens to make the purchase of HAs. CONCLUSION: In countries where subsidy for HAs are made available through either public or private health service/insurance, an increase in coverage rates is likely to occur. The effect of subsidy is likely to surpass any effect of OTC HAs that has been demonstrated to date. Where and when feasible, subsidy presence and encouraging income generation among able citizens of a country should be sought in tandem - a complex interplay of improving coverage rates for HAs with economics.

Determinants of the adoption of climate smart agriculture practices by smallholder wheat farmers in northwestern Ethiopia.

Frequent climate variability and change had the strongest direct influences on the availability and accessibility of food through reducing agricultural productivity and cropping patterns. Despite the Ethiopian government having made substantial efforts to boost production and productivity through the introduction of Climate Smart Agriculture Practices (CSAPs), the implementation of these practices by smallholder wheat farmers has remained low. This study, therefore, tried to investigate the determinants of the adoption of CSAPs in Northwestern Ethiopia. The primary data were gathered from 385 randomly selected wheat producers (including 702 plot-level observations). The CSAPs considered in this investigation were wheat row planting, crop rotation, and improved wheat varieties. The factors that influence the adoption of CSAPs were determined using a multivariate probit (MVP) model. The results revealed that the age of the sampled wheat producer farmers, education level of sampled wheat farmers, livestock holding, contact with development agents, credit access, off-farm activities participation, distance to input supply institution, slope of the plot, and soil fertility status of the plot were the major determinants of the adoption of CSAPs. The study suggested that policy-makers and stakeholders should strengthen farmers' skills by providing sufficient and effective short-term training. Moreover, encouraging mixed crop-livestock production systems, strengthening credit access, development agents, and access to near-input supply institutions are required to scale-up the adoption of CSAPs.

Agricultural extension service, technology adoption, and production risk nexus: Evidence from Bangladesh.

Rice production is inherently risky and volatile, and farmers in Bangladesh face a wide range of risks, including weather, pest and disease attacks, interruptions to input supply, and market-associated risks. Moreover, poor farm households often perceive risks in adopting new technology, even though it could improve productivity and food security. Such households are thus caught in a "risk-induced trap" that precludes them from realizing the benefits of technological innovation. Extension service is one way to help farmers improve risk management skills and escape risk-induced traps, but there is limited empirical analysis of its impact in Bangladesh. The objective of the study is to measure the nexus between agricultural extension services, technology adoption, and production risks as well as women empowerment in agriculture index. IFPRI utilized stratified random sampling to determine the 5603 households in 2018 (which is nationally called the BIHS-2018 dataset) from rural and pre-urban areas of Bangladesh. Out of these 5603 households, 2663 households were specifically selected for the study related to rice farming to achieve the main objective of the study. Focusing on rice farming, a moment-based Poisson regression model is estimated with 2SLS and identifies risks associated with key technologies and potential productivity and risk-reducing effects. The results revealed that wealthier households are more likely to adopt technology for minimizing production risk and women's empowerment which can positively affect productivity by mitigating risk. The result revealed a positive and significant difference in WEAI between the AES participant and non-participant group. We find that engagement in agricultural extension services was associated with technology adoption and production risk reduction. The agricultural extension services increased, technology adoption by 4.2 % and decreased production risk by 2.4 %. Based on the findings, it is concluded that more comprehensive extension services can enhance rice production and ameliorate farmers' risk in rice production to some extent.

Disentangling the roles of age and knowledge in early language acquisition: A fine-grained analysis of the vocabularies of infant and child language learners.

The words that children learn change over time in predictable ways. The first words that infants acquire are generally ones that are both frequent and highly imageable. Older infants also learn words that are more abstract and some that are less common. It is unclear whether this pattern is attributable to maturational factors (i.e., younger children lack sufficiently developed cognitive faculties needed to learn abstract words) or linguistic factors (i.e., younger children lack sufficient knowledge of their language to use grammatical or contextual cues needed to figure out the meaning of more abstract words). The present study explores this question by comparing vocabulary acquisition in 53 preschool-aged children (M = 51 months, range = 30-76 months) who were adopted from China and Eastern Europe after two and half years of age and 53 vocabulary-matched infant controls born and raised in English speaking families in North America (M = 24 months, range = 16-33 months). Vocabulary was assessed using the MB-CDI Words and Sentences form, word frequency was estimated from the CHILDES database, and imageability was measured using adult ratings of how easily words could be pictured mentally. Both groups were more likely to know words that were both highly frequent and imageable (resulting in an over-additive interaction). Knowledge of a word was also independently affected by the syntactic category that it belongs to. Adopted preschoolers' vocabulary was slightly less affected by imageability. These findings were replicated in a comparison with a larger sample of vocabulary-matched controls drawn from the MB-CDI norming study (M = 22 months, range = 16-30 months; 33 girls). These results suggest that the patterns of acquisition in children's early vocabulary are primarily driven by the accrual of linguistic knowledge, but that vocabulary may also be affected by differences in early life experiences or conceptual knowledge.

Integrating the family stress model within a longitudinal sibling-adoption study of adolescent externalizing behavior.

Using a sample of linked adopted children, adoptive and birth parents (N = 561), and biological siblings residing in the birth parent home (N = 191), we examined the role of genetics within family stress processes. We tested parental hostility (7 years) as a mediator of the associations between socioeconomic strain and rearing parent psychopathology (4 years) and adolescent externalizing behaviors (11 years) in adoptive and biological parent homes. Next, we examined parent social support (4 years) as a moderator of paths from socioeconomic strain and parent psychopathology to parental hostility. Parental hostility significantly mediated effects of socioeconomic strain and parent psychopathology on adolescent externalizing behaviors in biological and adoptive parent homes, respectively. Equivalence testing of the paths to adolescent externalizing behaviors across family types indicated a negligible role of passive gene-environment correlation. Parent social support significantly attenuated the effect of parent psychopathology on parental hostility in biological families. Birth parent externalizing behaviors were not significantly associated with adoptee externalizing behaviors nor adoptive parent hostility, suggesting negligible heritable risk or evocative gene-environment processes. Full- and half-sibling correlations indicated that children's unique rearing contexts contributed to the parenting they received and the externalizing behavior they exhibited. Implications for intervention are discussed.

Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa.

BACKGROUND: The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions. METHODS: Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups. RESULTS: Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care. CONCLUSIONS: The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.

Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care.

Telemedicine uses digital technologies to provide healthcare services remotely, greatly improving patient access, especially during crises like the COVID-19 pandemic. This systematic review investigates telemedicine's effects on patient outcomes, access to care, and its role in the evolving healthcare landscape. Relevant studies were identified using MeSH terms and keywords through electronic databases and manual reference list screenings. The selected empirical studies, both quantitative and qualitative, examined telemedicine across various patient populations. The review categorized findings into themes related to patient outcomes and access to care. Telemedicine was found to be a transformative tool in chronic disease management, particularly in diabetes care. Significant improvements in patient health outcomes and cost savings were reported with telemedicine interventions. For example, telehealth platforms enhance diabetes management by increasing patient engagement and improving clinical metrics such as HbA1c levels. Additionally, telehealth services for diabetes-related foot disease (DFD) overcome geographical barriers, providing specialized care and improving patient access and satisfaction. In conclusion, telemedicine significantly improves patient outcomes, access, and satisfaction in chronic disease management, especially diabetes care. By overcoming geographical barriers and enhancing patient engagement, telehealth platforms have the potential to transform global healthcare delivery. Implementing these insights into practice can improve the accessibility and effectiveness of diabetes care worldwide, ensuring equitable and patient-centered healthcare solutions.

Information literacy and intention to adopt e-pharmacy: a study based on trust and the theory of reasoned action.

BACKGROUND: E-pharmacy has gained popularity as an increasingly utilized platform for accessing healthcare services online. However, its adoption exhibits regional variations and necessitates improvement in certain aspects. Guided by the Theory of Reasoned Action (TRA) and Trust theory, this research explores the pivotal role of information literacy in influencing attitudes, perceived control, word of mouth, and trust. The overarching aim is to understand how these factors collectively impact the adoption of E-pharmacy services. METHODS: The study employed Structural Equation Modeling to assess data collected from 473 participants in Nigeria. This methodology allowed for a comprehensive evaluation of the intricate relationships between information literacy, attitudes, perceived control, word of mouth, trust, and E-pharmacy adoption. By utilizing statistical tests within this framework, the research sought to provide a robust analysis of the data and derive meaningful insights. RESULTS: The findings of the research underscore the significance of information literacy in shaping individuals' attitudes towards E-pharmacy. Higher information literacy levels were associated with more positive attitudes, an enhanced sense of perceived control, and increased positive word-of-mouth regarding the use of E-pharmacy services. Additionally, the study revealed that trust plays a crucial intermediary role between word-of-mouth communication and the actual adoption of E-pharmacy. CONCLUSIONS: In summary, this research offers a novel and comprehensive explanation of the relationship between information literacy and the adoption of E-pharmacy services. The study's outcomes contribute valuable insights to the ongoing discourse on E-pharmacy adoption, emphasizing its potential to enhance healthcare accessibility and efficiency within the evolving landscape of digital healthcare. The implications of the findings extend to policymakers, healthcare providers, and other stakeholders interested in optimizing the adoption and integration of E-pharmacy services.

Perceptions of Stakeholders and the Way Forward to Implementing the Family Adoption Programme in Medical Education: A Study From Assam, India.

Background The Family Adoption Programme (FAP) has been introduced under the competency-based medical education curriculum wherein each medical student adopts families. The objective of this study was to determine the stakeholders' perspective and to suggest measures to make it relevant for Indian medical graduates. Methodology A mixed-method study was conducted among the faculty, undergraduate students, and community using prestructured, validated instruments. The quantitative data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA) and analysed, while the qualitative data were coded and analysed thematically. Results All faculty members (12, 100%), the majority of students (49, 44.30%), and the community members strongly agreed that the policy decision to introduce the FAP was 'right'. The benefits mentioned were that FAP helps improve knowledge, psychomotor skills, attitudes and communication, attitude and behaviour skills, understanding of the social structures, health status of the community, and health-seeking behaviour of the families and provides an appropriate early clinical exposure. The challenges mentioned were selecting a site, gaining cooperation from family, communication, arrangement of logistics and transportation, getting support from teachers, difficulties in managing students in the community and coordinating among faculty, staff and students. Most faculty members recommended that the FAP should be started later in the curriculum and there should be restrictions on the number of families to be adopted. The students suggested that adequate logistics be provided as well as a reduction in the number of family visits. Conclusion The programme has been welcomed by most stakeholders. It requires the necessary support from the institution authorities, prior planning of visits, judicious utilization of social media, and coordination with government field-level health workers e.g. Accreditated Social Health Activists (ASHA). A comprehensive program evaluation and formulation of a standard operating module will further strengthen the programme.

What Determines the Adoption of Conservation Agriculture? Evidence from Quebec.

Conservation agriculture (CA) is promoted by various organisations and scholars as alternative to conventional agriculture to meet growing food demand with minimal damage on environment; but its factors of adoption have not been well identified. The study uses the recent composite index of adoption of CA developed by Takam Fongang et al. (2023) to analyse the factors of adoption of conservation agriculture among maize and soybean farmers in Quebec. Using data from 93 maize and soybean producers and a Fractional logit model, the study shows that adoption of CA increases with farmer's favourable perceptions of yield and easiness of implementing CA, off-farm employment and higher education. The study therefore indicates that higher education, technical assistance and popularisation of performance of CA can play a significant role in boosting adoption of CA in Quebec.

Study on socio-economic status and farming practices of fish farmers in Pachrauta Municipality, Bara, Nepal.

An interview-based questionnaire survey was done in 2021 to assess the socio-economic conditions, farming practices adopted, and problems faced by fish farmers and to analyze the cost and benefits of fish farming in the Fish super zone area of Pachrauta Municipality, Bara district. A simple random sampling technique was used to select 60 respondents for the study and the information collected was analyzed and processed by MS-Excel and SPSS. The majority of respondents were male, belonged to the age group of 25-36 years, and had a secondary level of school education. The mean total land holding size was found to be 3.65 ± 2.57 bigha with a total pond area of 1.38 ± 1.08 bigha and a small minority (18 %) practiced contract farming. Most of the farmers were found to have experience of 6-11 years (40 %). The farming system was polyculture and mostly Intensive (60 %). While the use of modern equipment was low (25 %), the majority of farmers (>90 %) practiced regular drying and liming of ponds. Mid-April to Mid-July was the most preferred time of stocking and the big fraction of feed used was locally prepared (70 %). Fertilizer use and Multiple harvesting were also common. Fish farming in the study area was found to fetch an average annual income of 0.95 million NRs. The major problems faced by farmers were Expensive feed (0.67), Lack of quality seeds (0.60), and Lack of proper marketing channels (0.55). Despite the constraints, Economic analysis revealed fish production in the study area as a profitable business with a BC ratio of 2.20 and a high gross margin value (Rs. 1330341.6 per hectare).

Characterizing the Adoption and Experiences of Users of Artificial Intelligence-Generated Health Information in the United States: Cross-Sectional Questionnaire Study.

BACKGROUND: OpenAI's ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals' health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what. OBJECTIVE: This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform. METHODS: In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers. RESULTS: Of 2406 respondents, 21.5% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9% vs 67%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2% vs 22.8%, P<.001). Around 39.3% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4%, n=245) or to explore alternative treatment (46.2%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7%, n=429) and their doctor (81%, n=407). About one-third of respondents requested a referral (35.6%, n=184) or changed medications (31%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9%, n=336), most turned to their physicians (67.5%, n=349). CONCLUSIONS: This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology.

Deimplementation of Ineffective and Harmful Medical Practices: A Data-Driven Commentary.

Deimplementation is the discontinuation or abandonment of medical practices that are ineffective or of unclear effectiveness, ranging from simply unhelpful to harmful. With epidemiology expanding to include more translational sciences, epidemiologists can contribute to deimplementation through defining evidence, establishing causality, and advising on study design. An estimated 10-30% of healthcare practices have minimal to no benefit to patients and should be targeted for deimplementation. The steps in deimplementation are: 1) identify low-value clinical practices, 2) facilitate the deimplementation process, 3) evaluate deimplementation outcomes, and 4) sustain deimplementation, each of which is a complex project. Deimplementation science involves researchers, healthcare and clinical stakeholders, and patient and community partners affected by the medical practice. Increasing collaboration between epidemiologists and implementation scientists is important to optimizing health care delivery.

Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: knowledge and perceptions of health providers from Argentina.

BACKGROUND: The 2021 World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate disease elimination. However, evidence shows that health providers' adherence to screening guidelines is low. We conducted a study in Argentina to analyze health providers' knowledge and perceptions regarding the 2021 WHO Guidelines. METHODS: A qualitative study was conducted based on individual, semi-structured interviews with health providers specializing in gynecology (n = 15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. RESULTS: Although health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, its supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, WHO guidelines should be disseminated through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, and treatment for women aged 30 + with HPV-testing every 5 to 10 years) and perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low-complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30 + every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that did not respond to women's needs, and was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests were the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage. CONCLUSION: WHO guidelines should be widely disseminated among health providers, especially in settings that could benefit from a screen-and-treat approach. Identifying areas of partnership and collaboration with PMAs in implementing WHO guidelines is essential.