{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:20:21Z","timestamp":1764890421546,"version":"3.46.0"},"reference-count":75,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,14]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cognitive impairments, such as dementia and Alzheimer\u2019s disease, are considered a significant public health challenge as they affect mental functions like memory, attention, language and decision-making. With the growing number of older individuals, the prevalence of these diseases is also increasing and is projected to reach 152\u2009million worldwide by 2050. These disorders result in difficulties with judgement, communication and daily activities, leading to more hospitalisations and risks such as disorientation in the environment and a higher likelihood of falls. Current hospital safety assessment tools mainly focus on physical aspects and overlook other crucial factors. Therefore, this study aims to clarify the concept of safety challenges for patients with cognitive impairment and to develop and psychometrically validate a multidimensional instrument for use in hospital settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A sequential exploratory study with mixed methods will be conducted. In the first qualitative phase, based on a content analysis approach, the aim is to explain and clarify safety issues in patients with cognitive impairment. Participants will be purposively selected until saturation is reached in educational-therapeutic centres affiliated with the University of Medical Sciences, and unstructured in-depth interviews will be conducted. The data will be analysed simultaneously using MAXQDA V.20 software. Additionally, a literature review on safety issues in patients with cognitive impairment will be conducted to supplement aspects that may not have emerged in the interviews.<\/jats:p>\n                    <jats:p>In the second phase, an instrument based on the inductive\u2013deductive method will be developed. The items will be created based on the participants\u2019 experiences and the literature review. Face, content and construct validity, as well as reliability, will be assessed. Data synthesis will involve a linkage strategy, where the qualitative data will be linked to the quantitative data immediately after the completion of the qualitative phase, once the protocols are developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study is part of a postdoctoral project approved by the Tehran University of Medical Sciences Research Ethics Board (IR.TUMS.FNM.REC.1403.006). Findings will be disseminated at the local, national and international levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102299","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T17:27:39Z","timestamp":1761758859000},"page":"e102299","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development and psychometric evaluation of a safety instrument for patients with cognitive impairment in hospital: an exploratory sequential mixed-methods study protocol in Iran"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2501-8667","authenticated-orcid":false,"given":"Mehraban","family":"Shahmari","sequence":"first","affiliation":[{"name":"Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"},{"name":"Department of Medical-Surgical, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-844X","authenticated-orcid":false,"given":"Alvisa","family":"Palese","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Udine, Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2015-0204","authenticated-orcid":false,"given":"Fatemeh","family":"Bahramnezhad","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahdi","family":"Shafiee Sabet","sequence":"additional","affiliation":[{"name":"Faculty member of the Family Medicine Department, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1594-6790","authenticated-orcid":false,"given":"Nahid","family":"Dehghan Nayeri","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2025120415090868000_15.10.e102299.1","unstructured":"World Health Organization . Patient safety, Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/patient-safety [Accessed 7 Mar 2025]."},{"key":"2025120415090868000_15.10.e102299.2","unstructured":"Dhakal A , Bobrin B . Cognitive deficits-statpearls-ncbi bookshelf. StatPearls Publication; 2023. Available: https:\/\/www. ncbi. nlm. nih. gov\/books\/NBK559052"},{"key":"2025120415090868000_15.10.e102299.3","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1186\/s12877-023-03930-1","article-title":"The impact of a cognitive impairment support program on patients in an acute care setting: a pre-test post-test intervention study","volume":"23","author":"Fox","year":"2023","journal-title":"BMC Geriatr"},{"key":"2025120415090868000_15.10.e102299.4","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1177\/0733464820924211","article-title":"Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization","volume":"40","author":"Fox","year":"2021","journal-title":"J Appl Gerontol"},{"key":"2025120415090868000_15.10.e102299.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-023-10095-5","article-title":"Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study","volume":"23","author":"Dziegielewski","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2025120415090868000_15.10.e102299.6","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1002\/gps.4919","article-title":"Hospital outcomes of older people with cognitive impairment: An integrative review","volume":"33","author":"Fogg","year":"2018","journal-title":"Int J Geriatr Psychiatry"},{"key":"2025120415090868000_15.10.e102299.7","doi-asserted-by":"crossref","DOI":"10.1111\/opn.12315","article-title":"Health outcomes of patients with dementia in acute care settings\u2014A systematic review","volume":"15","author":"Fox","year":"2020","journal-title":"Int J Older People Nursing"},{"key":"2025120415090868000_15.10.e102299.8","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1186\/s12913-020-05618-3","article-title":"What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature","volume":"20","author":"R\u00f8svik","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2025120415090868000_15.10.e102299.9","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1111\/jonm.12883","article-title":"Integrative review of studies about nurses who have been disciplined by their professional regulatory bodies","volume":"27","author":"Papinaho","year":"2019","journal-title":"J Nurs Manag"},{"key":"2025120415090868000_15.10.e102299.10","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1111\/jan.13979","article-title":"Wrongdoing and whistleblowing in health care","volume":"75","author":"Pohjanoksa","year":"2019","journal-title":"J Adv Nurs"},{"key":"2025120415090868000_15.10.e102299.11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/09697330231184469","article-title":"The nurses\u2019 perception of the factors influencing professional misconduct: A qualitative study","volume":"31","author":"Ghobadi","year":"2024","journal-title":"Nurs Ethics"},{"key":"2025120415090868000_15.10.e102299.12","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30925-9"},{"key":"2025120415090868000_15.10.e102299.13","first-page":"30","article-title":"World alzheimer report 2021: journey through the diagnosis of dementia","volume":"2022","author":"Gauthier","year":"2021","journal-title":"Alzheimer\u2019s Disease International"},{"key":"2025120415090868000_15.10.e102299.14","unstructured":"World Health Organization . Dementia: The number of people affected to triple in the next 30 years, Available: https:\/\/www.who.int\/news\/item\/07-12-2017-dementia-number-of-people-affected-to-triple-in-next-30-years [Accessed 7 Jan 2024]."},{"key":"2025120415090868000_15.10.e102299.15","unstructured":"Pinches E . Worldwide dementia cases to triple by 2050, Available: https:\/\/www.alzheimersresearchuk.org\/worldwide-dementia-cases-to-triple-by-2050 [Accessed 7 Jan 2024]."},{"key":"2025120415090868000_15.10.e102299.16","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00249-8"},{"key":"2025120415090868000_15.10.e102299.17","doi-asserted-by":"crossref","DOI":"10.1186\/s44247-023-00008-1","article-title":"New Opportunities for the Early Detection and Treatment of Cognitive Decline: Adherence Challenges and the Promise of Smart and Person-Centered Technologies","volume":"1","author":"He","year":"2023","journal-title":"BMC Digit Health"},{"key":"2025120415090868000_15.10.e102299.18","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ijnss.2023.11.001","article-title":"Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review","volume":"11","author":"Xiong","year":"2024","journal-title":"International Journal of Nursing Sciences"},{"key":"2025120415090868000_15.10.e102299.19","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.gerinurse.2021.03.006","article-title":"A systematic review of interventions to improve acute hospital care for people with dementia","volume":"42","author":"Karrer","year":"2021","journal-title":"Geriatr Nurs (Lond)"},{"key":"2025120415090868000_15.10.e102299.20","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/ageing\/afw220","article-title":"Patient safety in community dementia services: what can we learn from the experiences of caregivers and healthcare professionals?","volume":"46","author":"Behrman","year":"2017","journal-title":"Age Ageing"},{"key":"2025120415090868000_15.10.e102299.21","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/14713012231168958","article-title":"Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography","volume":"22","author":"Dadich","year":"2023","journal-title":"Dementia (London)"},{"key":"2025120415090868000_15.10.e102299.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4447-9","article-title":"Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study","volume":"19","author":"Scott","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2025120415090868000_15.10.e102299.23","unstructured":"England N , Improvement N . The nhs patient safety strategy. safer culture, safer systems, safer patients. 2019."},{"key":"2025120415090868000_15.10.e102299.24","unstructured":"World Health Organization . Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization; 2021."},{"key":"2025120415090868000_15.10.e102299.25","doi-asserted-by":"crossref","first-page":"e567","DOI":"10.7861\/fhj.2021-0122","article-title":"Patient-completed safety checklists as an empowerment tool for patient involvement in patient safety: concepts, considerations and recommendations","volume":"8","author":"Harris","year":"2021","journal-title":"Future Healthc J"},{"key":"2025120415090868000_15.10.e102299.26","unstructured":"Alzheimer\u2019s Association . Home safety checklist, 2022. Available: https:\/\/www.alz.org [Accessed 7 Jan 2023]."},{"key":"2025120415090868000_15.10.e102299.27","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/PTS.0000000000000369","article-title":"A National Study of Patient Safety Culture in Hospitals in Sweden","volume":"15","author":"Danielsson","year":"2019","journal-title":"J Patient Saf"},{"key":"2025120415090868000_15.10.e102299.28","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1111\/jocn.17144","article-title":"Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed\u2010methods systematic review","volume":"33","author":"Ye","year":"2024","journal-title":"J Clin Nurs"},{"key":"2025120415090868000_15.10.e102299.29","unstructured":"ACo S , Qi H . A Better Way to Care: Safe and High-quality Care for Patients with Cognitive Impairment (dementia and Delirium) in Hospital: Actions for Health Service Managers. Australian Commission on Safety and Quality in Health Care 2014."},{"key":"2025120415090868000_15.10.e102299.30","first-page":"213","article-title":"Qualitative interviews in cognitive disorders caused by dementia: Addressing methodological, ethical challenges (Part II)","volume":"30","author":"Bahramnezhad","year":"2024","journal-title":"Hayat"},{"key":"2025120415090868000_15.10.e102299.31","first-page":"343","article-title":"The role of qualitative interviews in cognitive disorders caused by dementia: methodological ethical challenges (part one)","volume":"29","author":"Shafiee","year":"2024","journal-title":"Hayat"},{"key":"2025120415090868000_15.10.e102299.32","unstructured":"Creswell JW , Clark VLP . Designing and Conducting Mixed Methods Research. Sage publications, 2017."},{"key":"2025120415090868000_15.10.e102299.33","doi-asserted-by":"publisher","DOI":"10.1177\/2345678906293042"},{"key":"2025120415090868000_15.10.e102299.34","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1177\/1558689819900585","article-title":"Methodological Rigor in Mixed Methods: An Application in Management Studies","volume":"14","author":"Harrison","year":"2020","journal-title":"J Mix Methods Res"},{"key":"2025120415090868000_15.10.e102299.35","unstructured":"Polit D , Yang F . Measurement and the Measurement of Change. Wolters Kluwer, 2016."},{"key":"2025120415090868000_15.10.e102299.36","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1177\/1049732317753586","article-title":"Two Strategies for Qualitative Content Analysis: An Intramethod Approach to Triangulation","volume":"28","author":"Renz","year":"2018","journal-title":"Qual Health Res"},{"key":"2025120415090868000_15.10.e102299.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2003.10.001"},{"key":"2025120415090868000_15.10.e102299.38","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025120415090868000_15.10.e102299.39","unstructured":"Polit D , Beck C . Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 9th edn. Wolters Kluwer, 2018."},{"key":"2025120415090868000_15.10.e102299.40","unstructured":"American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Available: https:\/\/psychiatryonline.org\/doi\/book\/10.1176\/appi.books.9780890425596 [accessed 22 May 2013]."},{"key":"2025120415090868000_15.10.e102299.41","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0b013e3182420bfe"},{"key":"2025120415090868000_15.10.e102299.42","doi-asserted-by":"publisher","DOI":"10.1188\/14.ONF.545-547"},{"key":"2025120415090868000_15.10.e102299.43","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.3233\/JAD-180857","article-title":"Association Between Proxy- or Self-Reported Cognitive Decline and Cognitive Performance in Memory Clinic Visitors","volume":"70","author":"Gruters","year":"2019","journal-title":"J Alzheimers Dis"},{"key":"2025120415090868000_15.10.e102299.44","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1037\/neu0000842","article-title":"Self- versus informant-report of cognitive decline in mild cognitive impairment: Concordance with cognitive and functional performance","volume":"37","author":"Milanovic","year":"2023","journal-title":"Neuropsychology"},{"key":"2025120415090868000_15.10.e102299.45","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.3233\/JAD-230222","article-title":"Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making","volume":"94","author":"Fenton","year":"2023","journal-title":"J Alzheimers Dis"},{"key":"2025120415090868000_15.10.e102299.46","doi-asserted-by":"crossref","first-page":"355","DOI":"10.3233\/JAD-201110","article-title":"Emotional Safety in the Context of Dementia: A Multiperspective Qualitative Study","volume":"79","author":"Kuske","year":"2021","journal-title":"J Alzheimers Dis"},{"key":"2025120415090868000_15.10.e102299.47","unstructured":"Speziale HS , Streubert HJ , Carpenter DR . Qualitative Research in Nursing: Advancing the Humanistic Imperative. Lippincott Williams & Wilkins, 2011."},{"key":"2025120415090868000_15.10.e102299.48","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.nedt.2017.06.002","article-title":"Methodological challenges in qualitative content analysis: A discussion paper","volume":"56","author":"Graneheim","year":"2017","journal-title":"Nurse Educ Today"},{"key":"2025120415090868000_15.10.e102299.49","unstructured":"Lincoln Y . Lincoln and guba\u2019s evaluative criteria. Robert Wood Johnson Foundation; 1985."},{"key":"2025120415090868000_15.10.e102299.50","doi-asserted-by":"crossref","unstructured":"Irvine SH , Kyllonen PC . Item Generation for Test Development. Routledge, 2013.","DOI":"10.4324\/9781410602145"},{"key":"2025120415090868000_15.10.e102299.51","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2018.00149","article-title":"Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer","volume":"6","author":"Boateng","year":"2018","journal-title":"Front Public Health"},{"key":"2025120415090868000_15.10.e102299.52","unstructured":"Uo Y . Systematic Reviews: a Practical Guide, Available: https:\/\/subjectguides.york.ac.uk\/systematic-review [Accessed 3 Sep 2025]."},{"key":"2025120415090868000_15.10.e102299.53","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5224"},{"key":"2025120415090868000_15.10.e102299.54","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-015-1561-6","article-title":"A critical review of scoring options for clinical measurement tools","volume":"8","author":"Avila","year":"2015","journal-title":"BMC Res Notes"},{"key":"2025120415090868000_15.10.e102299.55","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9965-9"},{"key":"2025120415090868000_15.10.e102299.56","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/00006199-198507000-00011","article-title":"Types and sources of social support for managing job stress in critical care nursing","volume":"34","author":"Norbeck","year":"1985","journal-title":"Nurs Res"},{"key":"2025120415090868000_15.10.e102299.57","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-010-9606-8"},{"key":"2025120415090868000_15.10.e102299.58","doi-asserted-by":"publisher","DOI":"10.15171\/jcs.2015.017"},{"key":"2025120415090868000_15.10.e102299.59","unstructured":"Colton D , Covert RW . Designing and Constructing Instruments for Social Research and Evaluation. John Wiley & Sons, 2007."},{"key":"2025120415090868000_15.10.e102299.60","doi-asserted-by":"publisher","DOI":"10.1037\/\/1040-3590.7.3.238"},{"key":"2025120415090868000_15.10.e102299.61","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-6570.1975.tb01393.x"},{"key":"2025120415090868000_15.10.e102299.62","unstructured":"Fleiss JL , Levin B , Paik MC . Statistical Methods for Rates and Proportions. john wiley & sons, 2013."},{"key":"2025120415090868000_15.10.e102299.63","first-page":"5","article-title":"Content validity: Definition and procedure of content validation in psychological research","volume":"30","author":"Roebianto","year":"2023","journal-title":"TPM Test Psychom Methodol Appl Psychol"},{"key":"2025120415090868000_15.10.e102299.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"2025120415090868000_15.10.e102299.65","unstructured":"Munro BH . Statistical Methods for Health Care Research. 1. lippincott williams & wilkins, 2005."},{"key":"2025120415090868000_15.10.e102299.66","doi-asserted-by":"crossref","unstructured":"Singh K . Quantitative Social Research Methods. Sage, 2007.","DOI":"10.4135\/9789351507741"},{"key":"2025120415090868000_15.10.e102299.67","doi-asserted-by":"publisher","DOI":"10.1007\/BF02291575"},{"key":"2025120415090868000_15.10.e102299.68","unstructured":"Kazemnejad A , Heydari M , Norouzadeh R . Statistical Methods for Healthcare Research and Application of SPSS in Data Analysis. Tehran: Jame-e Negar publication house, 2010."},{"key":"2025120415090868000_15.10.e102299.69","first-page":"324","volume-title":"The Process of Testing in Health Sciences, Design and Psychometrics","volume":"2023","author":"aZ","year":"2023"},{"key":"2025120415090868000_15.10.e102299.70","first-page":"349","article-title":"Psychometric Properties of the Patient Self-Advocacy Scale: The Persian Version","volume":"40","author":"Vahdat","year":"2015","journal-title":"Iran J Med Sci"},{"key":"2025120415090868000_15.10.e102299.71","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s11165-016-9602-2","article-title":"The Use of Cronbach\u2019s Alpha When Developing and Reporting Research Instruments in Science Education","volume":"48","author":"Taber","year":"2018","journal-title":"Res Sci Educ"},{"key":"2025120415090868000_15.10.e102299.72","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.03.012"},{"key":"2025120415090868000_15.10.e102299.73","unstructured":"Waltz CF , Strickland OL , Lenz ER . Measurement in Nursing and Health Research. Springer Publishing Company, 2010."},{"key":"2025120415090868000_15.10.e102299.74","first-page":"445","article-title":"Translation, development and psychometric properties of health-related measures-Part 2: construct validity, reliability, and responsiveness","volume":"16","author":"Ebadi","year":"2017","journal-title":"Payesh (Health Monitor)"},{"key":"2025120415090868000_15.10.e102299.75","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-432","article-title":"The challenges in monitoring and preventing patient safety incidents for people with intellectual disabilities in NHS acute hospitals: evidence from a mixed-methods study","volume":"14","author":"Tuffrey-Wijne","year":"2014","journal-title":"BMC Health Serv Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-102299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:16:33Z","timestamp":1764890193000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-102299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":75,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,29]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/bmjopen-2025-102299"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-102299","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}