{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:09:16Z","timestamp":1792782556709,"version":"4.5.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"name":"Anhui Medical University College of Nursing Graduate Student Youth Cultivation Program","award":["Hlqm22025047"],"award-info":[{"award-number":["Hlqm22025047"]}],"id":[{"id":"https:\/\/ror.org\/03xb04968","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rheumatol Int"],"DOI":"10.1007\/s00296-026-06279-x","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:03:21Z","timestamp":1786982601000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-reported reproductive concerns and care needs among women with systemic lupus erythematosus: a descriptive qualitative study using patient journey mapping"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9725-2477","authenticated-orcid":false,"given":"Si-Yu","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9820-9324","authenticated-orcid":false,"given":"Zhao-Bin","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8210-1206","authenticated-orcid":false,"given":"Yan","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2688-4349","authenticated-orcid":false,"given":"Wen-Yan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6810-035X","authenticated-orcid":false,"given":"Min","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6589-1826","authenticated-orcid":false,"given":"Wei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"6279_CR1","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1093\/rheumatology\/kex260","volume":"56","author":"F Rees","year":"2017","unstructured":"Rees F, Doherty M, Grainge MJ et al (2017) The worldwide incidence and prevalence of systemic lupus erythematosus: A systematic review of epidemiological studies. Rheumatology (Oxford) 56:1945\u20131961. https:\/\/doi.org\/10.1093\/rheumatology\/kex260","journal-title":"Rheumatology (Oxford)"},{"key":"6279_CR2","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12888-017-1234-1","volume":"17","author":"L Zhang","year":"2017","unstructured":"Zhang L, Fu T, Yin R et al (2017) Prevalence of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. BMC Psychiatry 17:70. https:\/\/doi.org\/10.1186\/s12888-017-1234-1","journal-title":"BMC Psychiatry"},{"key":"6279_CR3","doi-asserted-by":"publisher","first-page":"i55","DOI":"10.1093\/rheumatology\/kew427","volume":"56","author":"O Zharkova","year":"2017","unstructured":"Zharkova O, Celhar T, Cravens PD et al (2017) Pathways leading to an immunological disease: systemic lupus erythematosus. Rheumatology (Oxford) 56:i55\u2013i66. https:\/\/doi.org\/10.1093\/rheumatology\/kew427","journal-title":"Rheumatology (Oxford)"},{"key":"6279_CR4","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1007\/s00404-025-08106-3","volume":"312","author":"C Sun","year":"2025","unstructured":"Sun C, Li X, Li X (2025) Risk factors for adverse pregnancy outcomes in systemic lupus erythematosus: a meta-analysis and systemic review. Arch Gynecol Obstet 312:1025\u20131036. https:\/\/doi.org\/10.1007\/s00404-025-08106-3","journal-title":"Arch Gynecol Obstet"},{"key":"6279_CR5","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1136\/ard-2022-223035","volume":"82","author":"J Tian","year":"2023","unstructured":"Tian J, Zhang D, Yao X et al (2023) Global epidemiology of systemic lupus erythematosus: A comprehensive systematic analysis and modelling study. Ann Rheum Dis 82:351\u2013356. https:\/\/doi.org\/10.1136\/ard-2022-223035","journal-title":"Ann Rheum Dis"},{"key":"6279_CR6","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s11136-023-03516-9","volume":"33","author":"Y-H Wang","year":"2024","unstructured":"Wang Y-H, Sun H-Y, Liu Y-Q et al (2024) Health-related quality of life in Chinese SLE patients: Evidence from 1568 SLE patients and 2610 healthy controls. Qual Life Res 33:207\u2013218. https:\/\/doi.org\/10.1007\/s11136-023-03516-9","journal-title":"Qual Life Res"},{"key":"6279_CR7","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.jaut.2018.07.016","volume":"93","author":"SK Nahal","year":"2018","unstructured":"Nahal SK, Selmi C, Gershwin ME (2018) Safety issues and recommendations for successful pregnancy outcome in systemic lupus erythematosus. J Autoimmun 93:16\u201323. https:\/\/doi.org\/10.1016\/j.jaut.2018.07.016","journal-title":"J Autoimmun"},{"key":"6279_CR8","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jaut.2016.12.005","volume":"78","author":"ME Munroe","year":"2017","unstructured":"Munroe ME, Vista ES, Merrill JT et al (2017) Pathways of impending disease flare in African-American systemic lupus erythematosus patients. J Autoimmun 78:70\u201378. https:\/\/doi.org\/10.1016\/j.jaut.2016.12.005","journal-title":"J Autoimmun"},{"key":"6279_CR9","doi-asserted-by":"publisher","first-page":"153","DOI":"10.7326\/M14-2235","volume":"163","author":"JP Buyon","year":"2015","unstructured":"Buyon JP, Kim MY, Guerra MM et al (2015) Predictors of pregnancy outcomes in patients with lupus: A cohort study. Ann Intern Med 163:153\u2013163. https:\/\/doi.org\/10.7326\/M14-2235","journal-title":"Ann Intern Med"},{"key":"6279_CR10","doi-asserted-by":"publisher","first-page":"2598","DOI":"10.3390\/jcm9082598","volume":"9","author":"M Saleh","year":"2020","unstructured":"Saleh M, Sj\u00f6wall C, Strevens H et al (2020) Adverse pregnancy outcomes after multi-professional follow-up of women with systemic lupus erythematosus: an observational study from a single centre in Sweden. J Clin Med 9:2598. https:\/\/doi.org\/10.3390\/jcm9082598","journal-title":"J Clin Med"},{"key":"6279_CR11","doi-asserted-by":"publisher","first-page":"e0176457","DOI":"10.1371\/journal.pone.0176457","volume":"12","author":"Z Zhan","year":"2017","unstructured":"Zhan Z, Yang Y, Zhan Y et al (2017) Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus. PLoS ONE 12:e0176457. https:\/\/doi.org\/10.1371\/journal.pone.0176457","journal-title":"PLoS ONE"},{"key":"6279_CR12","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s11764-013-0333-3","volume":"8","author":"JR Gorman","year":"2014","unstructured":"Gorman JR, Su HI, Pierce JP et al (2014) A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors. J Cancer Surviv 8:218\u2013228. https:\/\/doi.org\/10.1007\/s11764-013-0333-3","journal-title":"J Cancer Surviv"},{"key":"6279_CR13","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.2147\/IJWH.S519395","volume":"17","author":"F Alnaimat","year":"2025","unstructured":"Alnaimat F, Hamdan O, Othman L et al (2025) Patient perspectives on reproductive health in systemic lupus erythematosus: exploring disease manifestations, quality of life, and the role of social support. Int J Womens Health 17:1849\u20131862. https:\/\/doi.org\/10.2147\/IJWH.S519395","journal-title":"Int J Womens Health"},{"key":"6279_CR14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12969-025-01056-9","volume":"23","author":"B Huynh","year":"2025","unstructured":"Huynh B, Ott MA, Tarvin SE (2025) Experiences of sexual and reproductive health screening and counseling in the clinical setting among adolescents and young adults with rheumatic disease. Pediatr Rheumatol 23:5. https:\/\/doi.org\/10.1186\/s12969-025-01056-9","journal-title":"Pediatr Rheumatol"},{"key":"6279_CR15","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1177\/0961203320980531","volume":"30","author":"J Chen","year":"2021","unstructured":"Chen J, Xiao Z-Z, Shi Q et al (2021) Risk factors associated with adverse pregnancy outcomes in patients with new-onset systemic lupus erythematosus during pregnancy. Lupus 30:393\u2013402. https:\/\/doi.org\/10.1177\/0961203320980531","journal-title":"Lupus"},{"key":"6279_CR16","doi-asserted-by":"publisher","first-page":"2706","DOI":"10.1093\/rheumatology\/keaa684","volume":"60","author":"BS Blomjous","year":"2021","unstructured":"Blomjous BS, de Vries JIP, Zijlstra E et al (2021) Desire to have children and preferences regarding to pre-pregnancy counselling in women with SLE. Rheumatology 60:2706\u20132713. https:\/\/doi.org\/10.1093\/rheumatology\/keaa684","journal-title":"Rheumatology"},{"key":"6279_CR17","doi-asserted-by":"publisher","first-page":"171","DOI":"10.3233\/SHTI220689","volume":"295","author":"AL Joseph","year":"2022","unstructured":"Joseph AL, Monkman H, Kushniruk AW (2022) An evaluation guide and decision support tool for journey maps in healthcare and beyond. Stud Health Technol Inf 295:171\u2013174. https:\/\/doi.org\/10.3233\/SHTI220689","journal-title":"Stud Health Technol Inf"},{"key":"6279_CR18","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1186\/s12913-021-06934-y","volume":"21","author":"S Ly","year":"2021","unstructured":"Ly S, Runacres F, Poon P (2021) Journey mapping as a novel approach to healthcare: A qualitative mixed methods study in palliative care. BMC Health Serv Res 21:915. https:\/\/doi.org\/10.1186\/s12913-021-06934-y","journal-title":"BMC Health Serv Res"},{"key":"6279_CR19","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/jan.15479","volume":"79","author":"EL Davies","year":"2023","unstructured":"Davies EL, Bulto LN, Walsh A et al (2023) Reporting and conducting patient journey mapping research in healthcare: A scoping review. J Adv Nurs 79:83\u2013100. https:\/\/doi.org\/10.1111\/jan.15479","journal-title":"J Adv Nurs"},{"key":"6279_CR20","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1093\/eurjcn\/zvae012","volume":"23","author":"LN Bulto","year":"2024","unstructured":"Bulto LN, Davies EL, Kelly J, Hendriks JM (2024) Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs 23:429\u2013433. https:\/\/doi.org\/10.1093\/eurjcn\/zvae012","journal-title":"Eur J Cardiovasc Nurs"},{"key":"6279_CR21","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19:349\u2013357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042","journal-title":"Int J Qual Health Care"},{"key":"6279_CR22","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1002\/art.1780400928","volume":"40","author":"MC Hochberg","year":"1997","unstructured":"Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725. https:\/\/doi.org\/10.1002\/art.1780400928","journal-title":"Arthritis Rheum"},{"key":"6279_CR23","doi-asserted-by":"publisher","first-page":"e20230141","DOI":"10.1590\/1983-1447.2024.20230141.en","volume":"45","author":"RRD Souza","year":"2024","unstructured":"Souza RRD, Barreto MDS, Teston EF et al (2024) Experiencing pregnancy in the context of lupus and antiphospholipid syndrome: A grounded theory. Rev Ga\u00facha Enferm 45:e20230141. https:\/\/doi.org\/10.1590\/1983-1447.2024.20230141.en","journal-title":"Rev Ga\u00facha Enferm"},{"key":"6279_CR24","doi-asserted-by":"publisher","first-page":"2419","DOI":"10.1111\/1756-185X.14927","volume":"26","author":"Q Liang","year":"2023","unstructured":"Liang Q, Wang X, He Q et al (2023) Factors associated with fertility intention among women with systemic lupus erythematosus in China: A cross-sectional study. Int J Rheum Dis 26:2419\u20132429. https:\/\/doi.org\/10.1111\/1756-185X.14927","journal-title":"Int J Rheum Dis"},{"key":"6279_CR25","doi-asserted-by":"publisher","first-page":"3454","DOI":"10.3390\/jcm13123454","volume":"13","author":"A Gamba","year":"2024","unstructured":"Gamba A, Zen M, Depascale R et al (2024) Modern management of pregnancy in systemic lupus erythematosus: From prenatal counseling to postpartum support. J Clin Med 13:3454. https:\/\/doi.org\/10.3390\/jcm13123454","journal-title":"J Clin Med"},{"key":"6279_CR26","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1136\/annrheumdis-2016-209770","volume":"76","author":"L Andreoli","year":"2017","unstructured":"Andreoli L, Bertsias GK, Agmon-Levin N et al (2017) EULAR recommendations for women\u2019s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and\/or antiphospholipid syndrome. Ann Rheum Dis 76:476\u2013485. https:\/\/doi.org\/10.1136\/annrheumdis-2016-209770","journal-title":"Ann Rheum Dis"},{"key":"6279_CR27","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1002\/acr.24130","volume":"72","author":"LR Sammaritano","year":"2020","unstructured":"Sammaritano LR, Bermas BL, Chakravarty EE et al (2020) 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Care Res (Hoboken) 72:461\u2013488. https:\/\/doi.org\/10.1002\/acr.24130","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"6279_CR28","first-page":"288","volume":"29","author":"DD Gladman","year":"2002","unstructured":"Gladman DD, Iba\u00f1ez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29:288\u2013291","journal-title":"J Rheumatol"},{"key":"6279_CR29","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1186\/s12905-026-04342-0","volume":"26","author":"J Pu","year":"2026","unstructured":"Pu J, Huang L, Li Y, Zhong Q (2026) Latent profile analysis of reproductive concern among women of childbearing age with systemic lupus erythematosus in China: a cross-sectional study. BMC Womens Health 26:176. https:\/\/doi.org\/10.1186\/s12905-026-04342-0","journal-title":"BMC Womens Health"},{"key":"6279_CR30","doi-asserted-by":"publisher","first-page":"e001867","DOI":"10.1136\/lupus-2025-001867","volume":"13","author":"M Delgado","year":"2026","unstructured":"Delgado M, Montes De Oca A, Ramirez A et al (2026) Getting comfortable with the uncomfortable\u2019: barriers, facilitators and influences on reproductive health discussions from Hispanic women with systemic lupus erythematosus in the USA\u2014a qualitative study. Lupus Sci Med 13:e001867. https:\/\/doi.org\/10.1136\/lupus-2025-001867","journal-title":"Lupus Sci Med"},{"key":"6279_CR31","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1177\/09612033251324493","volume":"34","author":"SB Lieber","year":"2025","unstructured":"Lieber SB, Stamm BC, Young SR et al (2025) Infant feeding experiences of women with systemic lupus erythematosus: A qualitative study. Lupus 34:365\u2013373. https:\/\/doi.org\/10.1177\/09612033251324493","journal-title":"Lupus"},{"key":"6279_CR32","doi-asserted-by":"publisher","DOI":"10.1177\/09612033261465938","author":"A Sood","year":"2026","unstructured":"Sood A, Wise LM, Sediqi S et al (2026) Diagnosis to dialogue: reproductive health conversations and guideline adherence in women with lupus. Lupus. https:\/\/doi.org\/10.1177\/09612033261465938","journal-title":"Lupus"},{"key":"6279_CR33","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1080\/03009742.2019.1657492","volume":"49","author":"A Phuti","year":"2020","unstructured":"Phuti A, Hodkinson B, Tikly M, Schneider M (2020) The feeling of not being entitled to something\u2019: fertility, pregnancy, and sexuality among women with systemic lupus erythematosus in South Africa. Scand J Rheumatol 49:214\u2013220. https:\/\/doi.org\/10.1080\/03009742.2019.1657492","journal-title":"Scand J Rheumatol"},{"key":"6279_CR34","doi-asserted-by":"publisher","first-page":"120","DOI":"10.46497\/ArchRheumatol.2021.7989","volume":"36","author":"Z Behboodi Moghadam","year":"2021","unstructured":"Behboodi Moghadam Z, Faezi ST, Zareian A, Rezaei E (2021) Experiences of Iranian female patients with systemic lupus erythematosus: a qualitative study. Arch Rheumatol 36:120\u2013128. https:\/\/doi.org\/10.46497\/ArchRheumatol.2021.7989","journal-title":"Arch Rheumatol"},{"key":"6279_CR35","doi-asserted-by":"publisher","first-page":"e70751","DOI":"10.1111\/1756-185x.70751","volume":"29","author":"V Ravindran","year":"2026","unstructured":"Ravindran V, Radhakrishna MH, Kayidhi S et al (2026) The Asia Pacific League of Associations for Rheumatology (APLAR) consensus statements for the management of reproductive issues in autoimmune rheumatic diseases. Int J Rheum Dis 29:e70751. https:\/\/doi.org\/10.1111\/1756-185x.70751","journal-title":"Int J Rheum Dis"},{"key":"6279_CR36","doi-asserted-by":"publisher","first-page":"e001793","DOI":"10.1136\/lupus-2025-001793","volume":"13","author":"Y Chen","year":"2026","unstructured":"Chen Y, Lin S, Wang M et al (2026) Balancing stringency and feasibility: Comparative value of disease-activity measures to predict pregnancy outcomes in systemic lupus erythematosus. Lupus Sci Med 13:e001793. https:\/\/doi.org\/10.1136\/lupus-2025-001793","journal-title":"Lupus Sci Med"},{"key":"6279_CR37","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00296-026-06117-0","volume":"46","author":"D Yerlanova","year":"2026","unstructured":"Yerlanova D, Makhanbetkulova D, Usen A et al (2026) Pregnancy planning in women with rheumatic diseases: an integrated framework for risk stratification and multidisciplinary management. Rheumatol Int 46:81. https:\/\/doi.org\/10.1007\/s00296-026-06117-0","journal-title":"Rheumatol Int"},{"key":"6279_CR38","doi-asserted-by":"publisher","first-page":"e667","DOI":"10.1016\/S2665-9913(24)00160-7","volume":"6","author":"M Wind","year":"2024","unstructured":"Wind M, Fierro JJ, Bloemenkamp KWM et al (2024) Pregnancy outcome predictors in systemic lupus erythematosus: A systematic review and meta-analysis. Lancet Rheumatol 6:e667\u2013e683. https:\/\/doi.org\/10.1016\/S2665-9913(24)00160-7","journal-title":"Lancet Rheumatol"},{"key":"6279_CR39","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1007\/s00296-026-06074-8","volume":"46","author":"MC Gerardi","year":"2026","unstructured":"Gerardi MC, Gagliardi C, Giacobbe E et al (2026) Suboptimal contraceptive counseling and use in women with autoimmune rheumatic diseases of childbearing age: Findings from a cross-sectional survey of patients. Rheumatol Int 46:42. https:\/\/doi.org\/10.1007\/s00296-026-06074-8","journal-title":"Rheumatol Int"},{"key":"6279_CR40","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s00296-023-05398-z","volume":"44","author":"A Gupta","year":"2024","unstructured":"Gupta A, De Vera MA, Rebi\u0107 N, Amiri N (2024) Pre-pregnancy planning for female patients seen at a pregnancy and rheumatic diseases clinic: a retrospective analysis of patients with rheumatic diseases seeking pregnancy-related care. Rheumatol Int 44:283\u2013289. https:\/\/doi.org\/10.1007\/s00296-023-05398-z","journal-title":"Rheumatol Int"}],"container-title":["Rheumatology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06279-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00296-026-06279-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-026-06279-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:09:51Z","timestamp":1790932191000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00296-026-06279-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["6279"],"URL":"https:\/\/doi.org\/10.1007\/s00296-026-06279-x","relation":{},"ISSN":["1437-160X"],"issn-type":[{"value":"1437-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"assertion":[{"value":"24 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Biomedical Ethics Committee of Anhui Medical University (approval date: 9 December 2025; protocol number 81250966). All formal participants included in the final analysis provided written informed consent before the interviews. The study was performed in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. No identifiable personal information, images, or individual-level identifying details are included in this manuscript.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work has not been previously presented or published as a congress abstract.","order":5,"name":"Ethics","label":"Related congress abstract publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors acknowledge the use of ChatGPT by OpenAI (GPT-5.6 Thinking) for language editing, improvement of readability, and refinement of English expression during manuscript preparation and revision. The AI tool was not used for study design, participant recruitment, data collection, qualitative coding, data analysis, interpretation of findings, or generation of scientific conclusions. All AI-assisted text was carefully reviewed, revised, and verified by the authors. The authors take full responsibility for the accuracy, integrity, originality, and scientific content of the manuscript.","order":6,"name":"Ethics","label":"Ethical AI use","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"240"}}