{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T22:45:34Z","timestamp":1784933134399,"version":"3.55.0"},"reference-count":71,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,6,7]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"\n Objectives<\/jats:title>\n Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023.<\/jats:p>\n <\/jats:sec>\n \n Eligibility criteria<\/jats:title>\n We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction.<\/jats:p>\n <\/jats:sec>\n \n Data extraction and synthesis<\/jats:title>\n Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients\u2019 and healthcare professionals\u2019 views on PA. Most research teams made recommendations for promoting PA in people with HNC.<\/jats:p>\n Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-083852","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T14:16:39Z","timestamp":1721225799000},"page":"e083852","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Factors influencing physical activity in individuals with head and neck cancer: a scoping review"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9159-7536","authenticated-orcid":false,"given":"Martina","family":"Schmocker","sequence":"first","affiliation":[{"name":"Institute for Therapies and Rehabilitation, Cantonal Hospital Winterthur, Winterthur, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1913-1198","authenticated-orcid":false,"given":"Ramona","family":"Engst","sequence":"additional","affiliation":[{"name":"Institute of Nursing Sciences, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6716-8527","authenticated-orcid":false,"given":"Markus","family":"Wirz","sequence":"additional","affiliation":[{"name":"Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9988-6299","authenticated-orcid":false,"given":"Marika","family":"Bana","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,17]]},"reference":[{"key":"2025120518292754000_14.7.e083852.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41415-022-5166-x"},{"key":"2025120518292754000_14.7.e083852.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-020-00224-3","article-title":"Head and neck squamous cell carcinoma","volume":"6","author":"Johnson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2025120518292754000_14.7.e083852.3","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1002\/lary.29795","article-title":"Cancer-related activity limitations among head and neck cancer survivors","volume":"132","author":"Warinner","year":"2022","journal-title":"Laryngoscope"},{"key":"2025120518292754000_14.7.e083852.4","article-title":"Patients with head and neck cancer: are they frailer than patients with other solid malignancies","volume":"29","author":"Bras","year":"2020","journal-title":"Eur J Cancer Care"},{"key":"2025120518292754000_14.7.e083852.5","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s11912-022-01227-x","article-title":"State of rehabilitation research in the head and neck cancer population: functional impact vs","volume":"24","author":"Parke","year":"2022","journal-title":"Curr Oncol Rep"},{"key":"2025120518292754000_14.7.e083852.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-020-07773-6","article-title":"Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population","volume":"21","author":"Hammerm\u00fcller","year":"2021","journal-title":"BMC Cancer"},{"key":"2025120518292754000_14.7.e083852.7","first-page":"126","article-title":"Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research","volume":"100","author":"Caspersen","year":"1974","journal-title":"Public Health Rep"},{"key":"2025120518292754000_14.7.e083852.8","unstructured":"World Health Organization . Physical activity. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity [Accessed 10 Nov 2022]."},{"key":"2025120518292754000_14.7.e083852.9","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxx007"},{"key":"2025120518292754000_14.7.e083852.10","first-page":"468","article-title":"Exercise is medicine in oncology: engaging clinicians to help patients move through cancer","volume":"69","author":"Schmitz","year":"2019","journal-title":"CA Cancer J Clin"},{"key":"2025120518292754000_14.7.e083852.11","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001937"},{"key":"2025120518292754000_14.7.e083852.12","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0000000000002116"},{"key":"2025120518292754000_14.7.e083852.13","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21719"},{"key":"2025120518292754000_14.7.e083852.14","doi-asserted-by":"publisher","DOI":"10.5694\/mja18.00199"},{"key":"2025120518292754000_14.7.e083852.15","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.jsams.2019.05.003","article-title":"The exercise and sports science australia position statement: exercise medicine in cancer management","volume":"22","author":"Hayes","year":"2019","journal-title":"J Sci Med Sport"},{"key":"2025120518292754000_14.7.e083852.16","first-page":"4867","article-title":"Barriers and facilitators to exercise among adult cancer survivors in Singapore","volume":"30","author":"Chan","year":"2022","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.17","first-page":"685","article-title":"Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review","volume":"26","author":"Clifford","year":"2018","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.18","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s12529-021-10014-0","article-title":"Impact and determinants of structural barriers on physical activity in people with cancer","volume":"29","author":"Depenbusch","year":"2022","journal-title":"Int J Behav Med"},{"key":"2025120518292754000_14.7.e083852.19","doi-asserted-by":"crossref","DOI":"10.3390\/nu12113233","article-title":"Exercise and nutrition interventions in patients with head and neck cancer during curative treatment: a systematic review and meta-analysis","volume":"12","author":"Bye","year":"2020","journal-title":"Nutrients"},{"key":"2025120518292754000_14.7.e083852.20","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04750-z"},{"key":"2025120518292754000_14.7.e083852.21","doi-asserted-by":"crossref","first-page":"105253","DOI":"10.1016\/j.oraloncology.2021.105253","article-title":"Effectiveness of physical activity interventions in improving objective and patient- reported outcomes in head and neck cancer survivors: a systematic review","volume":"117","author":"Lynch","year":"2021","journal-title":"Oral Oncol"},{"key":"2025120518292754000_14.7.e083852.22","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1002\/hed.27420","article-title":"Longitudinal associations among physical activity, inflammatory markers, and quality of life in patients with head and neck cancer","volume":"45","author":"Huang","year":"2023","journal-title":"Head Neck"},{"key":"2025120518292754000_14.7.e083852.23","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1080\/0284186X.2019.1675906","article-title":"Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer","volume":"59","author":"Douma","year":"2020","journal-title":"Acta Oncol"},{"key":"2025120518292754000_14.7.e083852.24","first-page":"6807","article-title":"Physical activity and fitness in survivors of head and neck cancer","volume":"29","author":"Fang","year":"2021","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.25","first-page":"4591","article-title":"Barriers and facilitators to physical activity participation in patients with head and neck cancer: a scoping review","volume":"30","author":"Ning","year":"2022","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.26","article-title":"Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies","volume":"31","author":"Doughty","year":"2023","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2020.10.009"},{"key":"2025120518292754000_14.7.e083852.28","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"2025120518292754000_14.7.e083852.29","doi-asserted-by":"publisher","DOI":"10.11124\/jbies-21-00242"},{"key":"2025120518292754000_14.7.e083852.30","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2025120518292754000_14.7.e083852.31","unstructured":"Covidence . Covidence - better systematic review management. Available: https:\/\/www.covidence.org\/ [Accessed 24 May 2022]."},{"key":"2025120518292754000_14.7.e083852.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x"},{"key":"2025120518292754000_14.7.e083852.33","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000277"},{"key":"2025120518292754000_14.7.e083852.34","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20665"},{"key":"2025120518292754000_14.7.e083852.35","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-007-0293-0"},{"key":"2025120518292754000_14.7.e083852.36","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21053"},{"key":"2025120518292754000_14.7.e083852.37","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1080\/07347332.2015.1067277","article-title":"Refining measurement of social cognitive theory factors associated with exercise adherence in head and neck cancer patients","volume":"33","author":"Rogers","year":"2015","journal-title":"J Psychosoc Oncol"},{"key":"2025120518292754000_14.7.e083852.38","first-page":"E1086","article-title":"Maintaining physical activity during head and neck cancer treatment: results of a pilot controlled trial","volume":"38 Suppl 1","author":"Zhao","year":"2016","journal-title":"Head Neck"},{"key":"2025120518292754000_14.7.e083852.39","first-page":"1447","article-title":"Demographic, clinical, Lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors","volume":"26","author":"Buffart","year":"2018","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.40","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s00405-017-4760-z","article-title":"Exercise program design considerations for head and neck cancer survivors","volume":"275","author":"Midgley","year":"2018","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2025120518292754000_14.7.e083852.41","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.bjoms.2018.10.001","article-title":"Importance of activity and recreation for the quality of life of patients treated for cancer of the head and neck","volume":"57","author":"Rogers","year":"2019","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2025120518292754000_14.7.e083852.42","doi-asserted-by":"crossref","DOI":"10.1177\/1534735420918935","article-title":"Feasibility and effects of a supervised exercise program suitable for independent training at home on physical function and quality of life in head and neck cancer patients: a pilot study","volume":"19","author":"Felser","year":"2020","journal-title":"Integr Cancer Ther"},{"key":"2025120518292754000_14.7.e083852.43","article-title":"Feasibility of a supervised and home-based tailored exercise intervention in head and neck cancer patients during chemoradiotherapy","volume":"31","author":"Kok","year":"2022","journal-title":"European J Cancer Care"},{"key":"2025120518292754000_14.7.e083852.44","article-title":"Feasibility and safety of heavy lifting strength training in head and neck cancer survivors post-surgical neck dissection (the LIFTING trial)","volume":"31","author":"Ntoukas","year":"2023","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2007.09.003"},{"key":"2025120518292754000_14.7.e083852.46","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1017\/S1478951515001005","article-title":"Recovering function and surviving treatments are primary Motivators for health behavior change in patients with head and neck cancer: qualitative focus group study","volume":"14","author":"Henry","year":"2016","journal-title":"Palliat Support Care"},{"key":"2025120518292754000_14.7.e083852.47","doi-asserted-by":"crossref","first-page":"5942","DOI":"10.3390\/curroncol29080469","article-title":"A qualitative study of patient and healthcare provider perspectives on building multiphasic exercise prehabilitation into the surgical care pathway for head and neck cancer","volume":"29","author":"Daun","year":"2022","journal-title":"Curr Oncol"},{"key":"2025120518292754000_14.7.e083852.48","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/02601060221106624","article-title":"Lifestyle choices following head and neck cancer treatment: a qualitative study","volume":"30","author":"Hanika","year":"2024","journal-title":"Nutr Health"},{"key":"2025120518292754000_14.7.e083852.49","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.ijom.2021.05.006","article-title":"Patients\u2019 views of physical activity whilst living with and beyond head and neck cancer","volume":"51","author":"Rogers","year":"2022","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2025120518292754000_14.7.e083852.50","doi-asserted-by":"crossref","first-page":"885","DOI":"10.3390\/curroncol31020066","article-title":"Expectations and experiences of participating in a supervised and home-based physical exercise intervention in patients with head and neck cancer during chemoradiotherapy: a qualitative study","volume":"31","author":"Kok","year":"2024","journal-title":"Curr Oncol"},{"key":"2025120518292754000_14.7.e083852.51","article-title":"A turning point: head and neck cancer patients\u2019 exercise preferences and barriers before and after participation in an exercise intervention","volume":"27","author":"Jackson","year":"2018","journal-title":"Eur J Cancer Care"},{"key":"2025120518292754000_14.7.e083852.52","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19010287","article-title":"Perception and performance of physical activity behavior after head and neck cancer treatment: exploration and integration of qualitative and quantitative findings","volume":"19","author":"Sealy","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025120518292754000_14.7.e083852.53","doi-asserted-by":"crossref","DOI":"10.1016\/j.pmedr.2023.102255","article-title":"Barriers, facilitators, perceptions and preferences influencing physical activity participation, and the similarities and differences between cancer types and treatment stages - a systematic rapid review","volume":"34","author":"Gildea","year":"2023","journal-title":"Prev Med Rep"},{"key":"2025120518292754000_14.7.e083852.54","article-title":"Exercise for the management of cancer\u2010related fatigue in adults","volume":"11","author":"Cramp","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120518292754000_14.7.e083852.55","doi-asserted-by":"crossref","DOI":"10.3390\/cancers15194864","article-title":"Cancer-related fatigue in head and neck cancer survivors: longitudinal findings from the head and neck 5000 prospective clinical cohort","volume":"15","author":"Sharp","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2025120518292754000_14.7.e083852.56","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.annonc.2020.02.016","article-title":"Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment","volume":"31","author":"Fabi","year":"2020","journal-title":"Ann Oncol"},{"key":"2025120518292754000_14.7.e083852.57","unstructured":"National Comprehensive Cancer Network . NCCN clinical practice guidelines in oncology - cancer-related fatigue. 2023. Available: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/fatigue.pdf [Accessed 22 Nov 2023]."},{"key":"2025120518292754000_14.7.e083852.58","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdm056"},{"key":"2025120518292754000_14.7.e083852.59","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1111\/odi.13701","article-title":"Prevalence of pain in oral cancer: a retrospective study","volume":"27","author":"Khawaja","year":"2021","journal-title":"Oral Dis"},{"key":"2025120518292754000_14.7.e083852.60","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.semradonc.2017.08.008","article-title":"Head and neck cancer survivorship: learning the needs, meeting the needs","volume":"28","author":"Ringash","year":"2018","journal-title":"Semin Radiat Oncol"},{"key":"2025120518292754000_14.7.e083852.61","first-page":"9527","article-title":"The course of swallowing problems in the first 2 years after diagnosis of head and neck cancer","volume":"30","author":"Vermaire","year":"2022","journal-title":"Support Care Cancer"},{"key":"2025120518292754000_14.7.e083852.62","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-021-01116-9","article-title":"Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review","volume":"18","author":"Elshahat","year":"2021","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2025120518292754000_14.7.e083852.63","article-title":"What\u2019s love got to do with it? Marital status and survival of head and neck cancer","volume":"28","author":"Osazuwa\u2010Peters","year":"2019","journal-title":"Eur J Cancer Care"},{"key":"2025120518292754000_14.7.e083852.64","first-page":"E41","article-title":"Family caregivers\u2019 experiences of caring for patients with head and neck cancer","volume":"Publish Ahead of Print","author":"Zeng","year":"2022","journal-title":"Cancer Nurs"},{"key":"2025120518292754000_14.7.e083852.65","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s11764-020-00978-5","article-title":"Health literacy impacts self-management, quality of life and fear of recurrence in head and neck cancer survivors","volume":"15","author":"Clarke","year":"2021","journal-title":"J Cancer Surviv"},{"key":"2025120518292754000_14.7.e083852.66","doi-asserted-by":"crossref","first-page":"873","DOI":"10.6004\/jnccn.2020.0031","article-title":"Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology","volume":"18","author":"Pfister","year":"2020","journal-title":"J Natl Compr Canc Netw"},{"key":"2025120518292754000_14.7.e083852.67","unstructured":"ESMO . Clinical practice guidelines-squamous cell carcinoma of the head and neck, 2020. Available: https:\/\/www.esmo.org\/guidelines\/guidelines-by-topic\/head-and-neck-cancers\/squamous-cell-carcinoma-of-the-head- and-neck [Accessed 22 Nov 2023]."},{"key":"2025120518292754000_14.7.e083852.68","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21343"},{"key":"2025120518292754000_14.7.e083852.69","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1188\/15.ONF.602-609","article-title":"The Teachable moment after cancer diagnosis: perceptions from oncology nurses","volume":"42","author":"Karvinen","year":"2015","journal-title":"ONF"},{"key":"2025120518292754000_14.7.e083852.70","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1002\/pon.3857","article-title":"Grasping the \u2018Teachable moment\u2019: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors","volume":"24","author":"Bluethmann","year":"2015","journal-title":"Psychooncology"},{"key":"2025120518292754000_14.7.e083852.71","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1016\/j.pec.2021.04.019","article-title":"Physical activity counseling to cancer patients: how are patients addressed and who benefits most?","volume":"104","author":"Haussmann","year":"2021","journal-title":"Patient Educ Couns"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-083852","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:29:40Z","timestamp":1764988180000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-083852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":71,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,17]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bmjopen-2023-083852"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-083852","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}