{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T23:19:42Z","timestamp":1786749582150,"version":"build-2736575974"},"reference-count":72,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["201707040096"],"award-info":[{"award-number":["201707040096"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,2,19]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>One major tertiary referral hospital in Henan province, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>11 adults with a diagnosis of CKD with CKD stages G1\u2013G5 and 10 HCPs who worked in the Department of Nephrology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient\u2013HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient\u2013HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044059","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T13:45:52Z","timestamp":1614951952000},"page":"e044059","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Patients\u2019 and healthcare professionals\u2019 beliefs, perceptions and needs towards chronic kidney disease self-management in China: a qualitative study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0601-4708","authenticated-orcid":false,"given":"Hongxia","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China"},{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianne M J J","family":"van der Kleij","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J M","family":"van der Boog","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyue","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"School of Nursing and Health, Zhengzhou University, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Chavannes","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2025120600203643000_11.3.e044059.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32064-5"},{"key":"2025120600203643000_11.3.e044059.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2016-000256"},{"key":"2025120600203643000_11.3.e044059.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30045-3"},{"key":"2025120600203643000_11.3.e044059.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60033-6"},{"key":"2025120600203643000_11.3.e044059.5","article-title":"KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease Foreword","volume":"3","author":"Kasiske","year":"2013","journal-title":"Kidney Int Suppl"},{"key":"2025120600203643000_11.3.e044059.6","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn132"},{"key":"2025120600203643000_11.3.e044059.7","doi-asserted-by":"publisher","DOI":"10.1159\/000338135"},{"key":"2025120600203643000_11.3.e044059.8","first-page":"S163","article-title":"All-Cause costs increase exponentially with increased chronic kidney disease stage","volume":"23","author":"Golestaneh","year":"2017","journal-title":"Am J Manag Care"},{"key":"2025120600203643000_11.3.e044059.9","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ijnurstu.2017.06.008","article-title":"Effects of self-management on chronic kidney disease: a meta-analysis","volume":"74","author":"Lin","year":"2017","journal-title":"Int J Nurs Stud"},{"key":"2025120600203643000_11.3.e044059.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001077"},{"key":"2025120600203643000_11.3.e044059.11","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2601_01"},{"key":"2025120600203643000_11.3.e044059.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0738-3991(02)00032-0"},{"key":"2025120600203643000_11.3.e044059.13","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1111\/jan.13924","article-title":"Effectiveness of self-management programme in people with chronic kidney disease: a pragmatic randomized controlled trial","volume":"75","author":"Nguyen","year":"2019","journal-title":"J Adv Nurs"},{"key":"2025120600203643000_11.3.e044059.14","doi-asserted-by":"publisher","DOI":"10.4040\/jkan.2012.42.7.1070"},{"key":"2025120600203643000_11.3.e044059.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-019-1309-y","article-title":"Self-Management interventions for chronic kidney disease: a systematic review and meta-analysis","volume":"20","author":"Peng","year":"2019","journal-title":"BMC Nephrol"},{"key":"2025120600203643000_11.3.e044059.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-018-0748-z","article-title":"Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis","volume":"7","author":"Zimbudzi","year":"2018","journal-title":"Syst Rev"},{"key":"2025120600203643000_11.3.e044059.17","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1053\/j.ajkd.2016.08.042","article-title":"Sodium restriction in patients with CKD: a randomized controlled trial of self-management support","volume":"69","author":"Meuleman","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"2025120600203643000_11.3.e044059.18","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.anr.2016.04.002","article-title":"Self-Management programs on eGFR, depression, and quality of life among patients with chronic kidney disease: a meta-analysis","volume":"10","author":"Lee","year":"2016","journal-title":"Asian Nurs Res"},{"key":"2025120600203643000_11.3.e044059.19","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.ajkd.2016.01.022","article-title":"Educational Interventions for Patients With CKD: A Systematic Review","volume":"68","author":"Lopez-Vargas","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2025120600203643000_11.3.e044059.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.10057"},{"key":"2025120600203643000_11.3.e044059.21","doi-asserted-by":"publisher","DOI":"10.1111\/jorc.12058"},{"key":"2025120600203643000_11.3.e044059.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019814"},{"key":"2025120600203643000_11.3.e044059.23","doi-asserted-by":"crossref","first-page":"205031211454449","DOI":"10.1177\/2050312114544493","article-title":"Lay and health care professional understandings of self-management: a systematic review and narrative synthesis","volume":"2","author":"Sadler","year":"2014","journal-title":"SAGE Open Med"},{"key":"2025120600203643000_11.3.e044059.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-016-0416-2","article-title":"Person-Centred care in chronic kidney disease: a cross-sectional study of patients' desires for self-management support","volume":"18","author":"Havas","year":"2017","journal-title":"BMC Nephrol"},{"key":"2025120600203643000_11.3.e044059.25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jorc.12140","article-title":"Self-Management support for people with chronic kidney disease: patient perspectives","volume":"42","author":"Havas","year":"2016","journal-title":"J Ren Care"},{"key":"2025120600203643000_11.3.e044059.26","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2015.230"},{"key":"2025120600203643000_11.3.e044059.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0221325","article-title":"Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: a mixed methods study","volume":"14","author":"Sperati","year":"2019","journal-title":"PLoS One"},{"key":"2025120600203643000_11.3.e044059.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0214454","article-title":"The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma","volume":"14","author":"Daivadanam","year":"2019","journal-title":"PLoS One"},{"key":"2025120600203643000_11.3.e044059.29","unstructured":"Merriam SB . Qualitative research: a guide to design and implementation. John Wiley & Sons, 2009."},{"key":"2025120600203643000_11.3.e044059.30","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.10.012"},{"key":"2025120600203643000_11.3.e044059.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-020-02160-6","article-title":"Development and evaluation of an eHealth self-management intervention for patients with chronic kidney disease in China: protocol for a mixed-method hybrid type 2 trial","volume":"21","author":"Shen","year":"2020","journal-title":"BMC Nephrol"},{"key":"2025120600203643000_11.3.e044059.32","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025120600203643000_11.3.e044059.33","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-46857-7","article-title":"Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in Chinese rural residents: a cross-sectional survey","volume":"9","author":"Duan","year":"2019","journal-title":"Sci Rep"},{"key":"2025120600203643000_11.3.e044059.34","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1093\/ckj\/sfx057","article-title":"Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy","volume":"10","author":"Brown","year":"2017","journal-title":"Clin Kidney J"},{"key":"2025120600203643000_11.3.e044059.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-017-0638-y","article-title":"Symptom burden in chronic kidney disease; a population based cross sectional study","volume":"18","author":"Senanayake","year":"2017","journal-title":"BMC Nephrol"},{"key":"2025120600203643000_11.3.e044059.36","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"2025120600203643000_11.3.e044059.37","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1214\/aoms\/1177705148","article-title":"Snowball sampling","volume":"32","author":"LA","year":"1961","journal-title":"Ann Math Stat"},{"key":"2025120600203643000_11.3.e044059.38","doi-asserted-by":"crossref","first-page":"16035","DOI":"10.1038\/npjpcrm.2016.35","article-title":"Fresh air: an implementation research project funded through horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings","volume":"26","author":"Cragg","year":"2016","journal-title":"NPJ Prim Care Respir Med"},{"key":"2025120600203643000_11.3.e044059.39","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.sapharm.2018.04.004","article-title":"Beliefs influencing community pharmacists' interventions with chronic kidney disease patients: a theory-based qualitative study","volume":"15","author":"Quintana-B\u00e1rcena","year":"2019","journal-title":"Res Social Adm Pharm"},{"key":"2025120600203643000_11.3.e044059.40","unstructured":"Spradley JP . Participant observation. New York: Holt, Rinehart and Winston, 1980."},{"key":"2025120600203643000_11.3.e044059.41","first-page":"245","article-title":"Data saturation: the mysterious step in Grounded theory method","volume":"23","author":"Aldiabat","year":"2018","journal-title":"The Qualitative Report"},{"key":"2025120600203643000_11.3.e044059.42","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-117"},{"key":"2025120600203643000_11.3.e044059.43","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-0597.2008.00341.x"},{"key":"2025120600203643000_11.3.e044059.44","unstructured":"Miles MB HA . Qualitative data analysis: an expanded sourcebook. Thoasand Oakes: Sage Publications, 1994."},{"key":"2025120600203643000_11.3.e044059.45","doi-asserted-by":"publisher","DOI":"10.1188\/14.ONF.89-91"},{"key":"2025120600203643000_11.3.e044059.46","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.pec.2018.08.034","article-title":"The taxonomy of everyday self-management strategies (TEDSS): a framework derived from the literature and refined using empirical data","volume":"102","author":"Audulv","year":"2019","journal-title":"Patient Educ Couns"},{"key":"2025120600203643000_11.3.e044059.47","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-027775","article-title":"Delineating the concept of self-management in chronic conditions: a concept analysis","volume":"9","author":"Van de Velde","year":"2019","journal-title":"BMJ Open"},{"key":"2025120600203643000_11.3.e044059.48","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01860-2015"},{"key":"2025120600203643000_11.3.e044059.49","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-017-1022-0","article-title":"An integrative review of e-learning in the delivery of self-management support training for health professionals","volume":"17","author":"Lawn","year":"2017","journal-title":"BMC Med Educ"},{"key":"2025120600203643000_11.3.e044059.50","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/jnu.12377","article-title":"The roles of social support and health literacy in self-management among patients with chronic kidney disease","volume":"50","author":"Chen","year":"2018","journal-title":"J Nurs Scholarsh"},{"key":"2025120600203643000_11.3.e044059.51","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220116","article-title":"Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice","volume":"14","author":"Dineen-Griffin","year":"2019","journal-title":"PLoS One"},{"key":"2025120600203643000_11.3.e044059.52","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0224869","article-title":"The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes","volume":"14","author":"Yao","year":"2019","journal-title":"PLoS One"},{"key":"2025120600203643000_11.3.e044059.53","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7489(03)00095-6"},{"key":"2025120600203643000_11.3.e044059.54","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2008.01.006"},{"key":"2025120600203643000_11.3.e044059.55","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1053\/j.ajkd.2017.05.019","article-title":"Patients' experiences after CKD diagnosis: a Meta-ethnographic study and systematic review","volume":"70","author":"Teasdale","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"2025120600203643000_11.3.e044059.56","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03480160079038"},{"key":"2025120600203643000_11.3.e044059.57","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2516.2002.00636.x"},{"key":"2025120600203643000_11.3.e044059.58","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1080\/10410236.2015.1052871","article-title":"Beyond \"One Size Fits All\": Physician Nonverbal Adaptability to Patients' Need for Paternalism and Its Positive Consultation Outcomes","volume":"31","author":"Carrard","year":"2016","journal-title":"Health Commun"},{"key":"2025120600203643000_11.3.e044059.59","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1177\/1049732318783696","article-title":"Can physicians demonstrate high quality care using Paternalistic practices? A case study of paternalism in Latino physician-patient interactions","volume":"28","author":"Thompson","year":"2018","journal-title":"Qual Health Res"},{"key":"2025120600203643000_11.3.e044059.60","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.5.1442"},{"key":"2025120600203643000_11.3.e044059.61","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1111\/hex.12577","article-title":"The association between patient activation and self-care practices: a cross-sectional study of an Australian population with comorbid diabetes and chronic kidney disease","volume":"20","author":"Zimbudzi","year":"2017","journal-title":"Health Expect"},{"key":"2025120600203643000_11.3.e044059.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2010.07.026"},{"key":"2025120600203643000_11.3.e044059.63","doi-asserted-by":"crossref","first-page":"426","DOI":"10.7475\/kjan.2018.30.4.426","article-title":"An Empowerment program to improve self-management in patients with chronic kidney disease","volume":"30","author":"Lee","year":"2018","journal-title":"Korean Journal of Adult Nursing"},{"key":"2025120600203643000_11.3.e044059.64","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013166"},{"key":"2025120600203643000_11.3.e044059.65","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.puhe.2016.03.030","article-title":"Why is changing health-related behaviour so difficult?","volume":"136","author":"Kelly","year":"2016","journal-title":"Public Health"},{"key":"2025120600203643000_11.3.e044059.66","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.7786","article-title":"The digital divide and health disparities in China: evidence from a national survey and policy implications","volume":"19","author":"Hong","year":"2017","journal-title":"J Med Internet Res"},{"key":"2025120600203643000_11.3.e044059.67","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocv100"},{"key":"2025120600203643000_11.3.e044059.68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/160940690300200201","article-title":"\u2018Clear as Mud\u2019: Toward Greater Clarity in Generic Qualitative Research","volume":"2","author":"Caelli","year":"2003","journal-title":"Int J Qual Methods"},{"key":"2025120600203643000_11.3.e044059.69","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/160940691401300119","article-title":"Generic qualitative approaches: pitfalls and benefits of methodological Mixology","volume":"13","author":"Kahlke","year":"2014","journal-title":"Int J Qual Methods"},{"key":"2025120600203643000_11.3.e044059.70","doi-asserted-by":"publisher","DOI":"10.1177\/1077800410383121"},{"key":"2025120600203643000_11.3.e044059.71","doi-asserted-by":"publisher","DOI":"10.7748\/nr2011.01.18.2.52.c8284"},{"key":"2025120600203643000_11.3.e044059.72","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-648.1992.tb01859.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-044059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:20:48Z","timestamp":1765009248000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-044059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":72,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,4]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bmjopen-2020-044059"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-044059","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}