{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:55:50Z","timestamp":1793717750146,"version":"4.6.1"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>People with multiple sclerosis (PwMS) identify emotional well-being as a key unmet care need. Mindfulness-based interventions (MBI) can improve emotional well-being in PwMS; however, there is a lack of information on their implementation in routine care. Healthcare policy influencers may provide critical insight as to the implementation process. The aim of this study was to explore the needs and priorities of healthcare policy influencers for implementing MBIs for PwMS in Canada.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A qualitative descriptive approach was adopted using semi-structured interviews with an inductive thematic analysis. Healthcare policy influencers (e.g., senior clinical leaders, provisional health service commissioners, healthcare policymakers) in various settings across Ontario were recruited.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Twelve individuals with an average age of 51.1\u2009\u00b1\u20098.9 years participated in the semi-structured interviews. Interviews ranged from 12 to 60\u00a0min. Four themes were identified in thematic analysis: (1) Need for evidence with a personal connection is foundational; (2) People Power: Need for Implementation champions; (3) Finding its place: Need for embedding interventions into existing systems; and (4) Sustainability: Need for focus on long-term impact.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Our study provides novel insight into complex factors which affect implementation of new interventions, such as MBIs for PwMS, into the healthcare landscape in Ontario. Six key steps were identified for implementors to consider when seeking to implement a new intervention: (1) identify the problem and the need for intervention, (2) establish evidence highlighting evidence of effectiveness for an intervention, (3) build a team of implementation champions, (4) pilot the novel intervention to establish proof of concept, feasibility, and ecological integration within current landscape, (5) identify decision makers for intervention implementation, and (6) develop an \u2018elevator pitch\u2019 for decision makers. The implementation process is convoluted and can lack clarity. This is a major challenge for implementers. We have identified six key steps for implementers to consider, making this process more transparent and hopefully more successful. Future research should explore, test, and bridge the gaps in the implementation pathway we have identified, as this may be critical in closing the gaps that exist in our healthcare systems.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12913-025-12633-9","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T18:06:49Z","timestamp":1743185209000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implementing a new clinical service \u2013 what\u2019s your elevator pitch?"],"prefix":"10.1186","volume":"25","author":[{"given":"Ashvene","family":"Sureshkumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Scandiffio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Luong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Munce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanette","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bayley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwon","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Kastner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea D.","family":"Furlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhimanyu","family":"Sud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Feinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Simpson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"12633_CR1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","volume":"4","author":"LJ Damschroder","year":"2009","unstructured":"Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.","journal-title":"Implement Sci"},{"key":"12633_CR2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1748-5908-1-1","volume":"1","author":"MP Eccles","year":"2006","unstructured":"Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci. 2006;1:1.","journal-title":"Implement Sci"},{"issue":"3\u20134","key":"12633_CR3","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s10464-008-9165-0","volume":"41","author":"JA Durlak","year":"2008","unstructured":"Durlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3\u20134):327\u20135.","journal-title":"Am J Community Psychol"},{"key":"12633_CR4","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1748-5908-8-117","volume":"8","author":"DA Chambers","year":"2013","unstructured":"Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8:117.","journal-title":"Implement Sci"},{"key":"12633_CR5","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13012-015-0242-0","volume":"10","author":"P Nilsen","year":"2015","unstructured":"Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. https:\/\/doi.org\/10.1186\/s13012-015-0242-0.","journal-title":"Implement Sci"},{"issue":"1","key":"12633_CR6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12888-020-02800-z","volume":"20","author":"J Freund","year":"2020","unstructured":"Freund J, Titzler I, Thielecke J, Braun L, Baumeister H, Berking M, Ebert DD. Implementing internet- and tele-based interventions to prevent mental health disorders in farmers, foresters and gardeners (implementit): study protocol for the multi-level evaluation of a nationwide project. BMC Psychiatry. 2020;20(1):1\u201316.","journal-title":"BMC Psychiatry"},{"key":"12633_CR7","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/1471-2458-12-109","volume":"12","author":"JN Orem","year":"2012","unstructured":"Orem JN, Mafigiri DK, Marchal B, et al. Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda. BMC Public Health. 2012;12:109.","journal-title":"BMC Public Health."},{"key":"12633_CR8","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1186\/s12913-015-1091-x","volume":"15","author":"L Wye","year":"2015","unstructured":"Wye L, Brangan E, Cameron A, et al. Evidence based policy making and the \u2018art\u2019 of commissioning\u2013 how english healthcare commissioners access and use information and academic research in \u2018real life\u2019 decision-making: an empirical qualitative study. BMC Health Serv Res. 2015;15:430.","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"12633_CR9","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1017\/S1744133120000134","volume":"16","author":"E Stewart","year":"2021","unstructured":"Stewart E, Greer SL, Ercia A, Donnelly PD. Transforming health care: the policy and politics of service reconfiguration in the UK\u2019s four health systems [published correction appears in. Health Econ Policy Law. 2021;16(1):111.","journal-title":"Health Econ Policy Law"},{"issue":"3","key":"12633_CR10","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S1474-4422(18)30443-5","volume":"18","author":"GBDMS Collaborators","year":"2019","unstructured":"Collaborators GBDMS. Global, regional, and National burden of multiple sclerosis 1990\u20132016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2019;18(3):269\u201385.","journal-title":"Lancet Neurol"},{"issue":"14","key":"12633_CR11","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","volume":"26","author":"C Walton","year":"2020","unstructured":"Walton C, King R, Rechtman L, et al. Rising prevalence of multiple sclerosis worldwide: insights from the atlas of MS, third edition. Mult Scler. 2020;26(14):1816\u201321.","journal-title":"Mult Scler"},{"key":"12633_CR12","unstructured":"King R. Atlas of MS 3rd edition: mapping multiple sclerosis around the world. Multiple Sclerosis International Federation; 2020."},{"issue":"2","key":"12633_CR13","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/01376517-200704000-00005","volume":"39","author":"CP White","year":"2007","unstructured":"White CP, White M, Russell CS. Multiple sclerosis patients talking with healthcare providers about emotions. J Neurosci Nurs. 2007;39(2):89\u2013101.","journal-title":"J Neurosci Nurs"},{"issue":"9","key":"12633_CR14","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1080\/09638280701400730","volume":"30","author":"KS Malcomson","year":"2008","unstructured":"Malcomson KS, Lowe-Strong AS, Dunwoody L. What can we learn from the personal insights of individuals living and coping with multiple sclerosis? Disabil Rehabil. 2008;30(9):662\u201374.","journal-title":"Disabil Rehabil"},{"issue":"3","key":"12633_CR15","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/1352458514564491","volume":"21","author":"RA Marrie","year":"2015","unstructured":"Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263\u201381.","journal-title":"Mult Scler"},{"key":"12633_CR16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/1471-2377-14-128","volume":"14","author":"RJ Simpson","year":"2014","unstructured":"Simpson RJ, McLean G, Guthrie B, Mair F, Mercer SW. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014;14:128.","journal-title":"BMC Neurol"},{"issue":"9","key":"12633_CR17","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1177\/1352458520963880","volume":"27","author":"RA Marrie","year":"2021","unstructured":"Marrie RA, Walld R, Bolton JM, et al. Effect of mood and anxiety disorders on health care utilization in multiple sclerosis. Mult Scler. 2021;27(9):1411\u201320.","journal-title":"Mult Scler"},{"issue":"8","key":"12633_CR18","doi-asserted-by":"crossref","first-page":"e71834","DOI":"10.1371\/journal.pone.0071834","volume":"8","author":"SE Lakhan","year":"2013","unstructured":"Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS ONE. 2013;8(8):e71834.","journal-title":"PLoS ONE"},{"issue":"8","key":"12633_CR19","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1177\/1359105314562084","volume":"21","author":"A Senders","year":"2016","unstructured":"Senders A, Sando K, Wahbeh H, Peterson Hiller A, Shinto L. Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs. J Health Psychol. 2016;21(8):1676\u201387.","journal-title":"J Health Psychol"},{"issue":"1","key":"12633_CR20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7224\/1537-2073.2020-026","volume":"23","author":"CD Mayo","year":"2021","unstructured":"Mayo CD, Farzam-Kia N, Ghahari S. Identifying barriers to and facilitators of health service access encountered by individuals with multiple sclerosis. Int J MS Care. 2021;23(1):37\u201344.","journal-title":"Int J MS Care"},{"issue":"3","key":"12633_CR21","first-page":"1","volume":"7","author":"J Petrin","year":"2021","unstructured":"Petrin J, McColl MA, Donnelly C, French S, Finlayson M. Prioritizing the healthcare access concerns of Canadians with MS. Mult Scler J Exp Transl Clin. 2021;7(3):1\u201310.","journal-title":"Mult Scler J Exp Transl Clin"},{"issue":"5","key":"12633_CR22","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1111\/hex.13109","volume":"23","author":"J Petrin","year":"2020","unstructured":"Petrin J, Donnelly C, McColl MA, Finlayson M. Is it worth it? The experiences of persons with multiple sclerosis as they access health care to manage their condition. Health Expect. 2020;23(5):1269\u201379.","journal-title":"Health Expect"},{"issue":"4","key":"12633_CR23","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1080\/17538157.2020.1755975","volume":"45","author":"JM O\u2019Donnell","year":"2020","unstructured":"O\u2019Donnell JM, Jelinek GA, Gray KM, et al. Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum. Inf Health Soc Care. 2020;45(4):374\u201384.","journal-title":"Inf Health Soc Care"},{"key":"12633_CR24","volume-title":"Full catastrophe living: The program of the stress reduction clinic at the University of Massachusetts Medical Center","author":"J Kabat-Zinn","year":"1990","unstructured":"Kabat-Zinn J. Full catastrophe living: The program of the stress reduction clinic at the University of Massachusetts Medical Center. New York: Delta; 1990."},{"key":"12633_CR25","unstructured":"Segal Z, Williams J, Teasdale J. Mindfulness-based cognitive therapy for depression: A new approach to relapse prevention. New York: Guilford 2002."},{"issue":"3","key":"12633_CR26","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1007\/s00415-022-11497-x","volume":"270","author":"R Simpson","year":"2023","unstructured":"Simpson R, Posa S, Bruno T, et al. Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review. J Neurol. 2023;270(3):1300\u201322.","journal-title":"J Neurol"},{"issue":"2","key":"12633_CR27","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1177\/1742395317715504","volume":"14","author":"R Simpson","year":"2018","unstructured":"Simpson R, Byrne S, Wood K, Mair FS, Mercer SW. Optimising mindfulness-based stress reduction for people with multiple sclerosis. Chronic Illn. 2018;14(2):154\u201366.","journal-title":"Chronic Illn"},{"issue":"9","key":"12633_CR28","first-page":"1","volume":"9","author":"J Rycroft-Malone","year":"2019","unstructured":"Rycroft-Malone J, et al. Mind the gaps\u2019: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study. BMJ Open 9 9. 2019;9(9):1\u201310.","journal-title":"BMJ Open 9 9"},{"key":"12633_CR29","doi-asserted-by":"crossref","unstructured":"Braun V, Clarke V, Hayfield N, Jenkinson E, Davey L. Doing Reflexive Thematic Analysis. In Supporting Research in Counselling and Psychotherapy. Qualitative, Quantitative, and Mixed Methods Research, edited by S. Bag.\u00a02022.","DOI":"10.1007\/978-3-031-13942-0_2"},{"issue":"4","key":"12633_CR30","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","volume":"11","author":"V Braun","year":"2019","unstructured":"Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Res Sport Exerc Health. 2019;11(4):589\u201397.","journal-title":"Qualitative Res Sport Exerc Health"},{"issue":"1","key":"12633_CR31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","volume":"24","author":"V Braun","year":"2022","unstructured":"Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. Int J Transgend Health. 2022;24(1):1\u20136.","journal-title":"Int J Transgend Health"},{"issue":"4","key":"12633_CR32","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G","volume":"23","author":"M Sandelowski","year":"2000","unstructured":"Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334\u201340.","journal-title":"Res Nurs Health"},{"issue":"3","key":"12633_CR33","first-page":"3351","volume":"9","author":"M Maguire","year":"2017","unstructured":"Maguire M, Delahunt B. Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. All Irel J High Educ. 2017;9(3):3351\u201333514.","journal-title":"All Irel J High Educ"},{"issue":"1","key":"12633_CR34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13012-017-0700-y","volume":"13","author":"ID Graham","year":"2018","unstructured":"Graham ID, Kothari A, McCutcheon C, Integrated Knowledge Translation Research Network Project Leads. Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation. Implement Sci. 2018;13(1):22.","journal-title":"Implement Sci"},{"issue":"13","key":"12633_CR35","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","volume":"26","author":"K Malterud","year":"2016","unstructured":"Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753\u201360.","journal-title":"Qual Health Res"},{"key":"12633_CR36","volume-title":"Effective evaluation: improving the usefulness of evaluation results through responses and naturalistic approaches","author":"E Guba","year":"1985","unstructured":"Guba E, Lincoln Y. Effective evaluation: improving the usefulness of evaluation results through responses and naturalistic approaches. San Francisco: Jossey Bass; 1985."},{"key":"12633_CR37","volume-title":"Qualitative research for nurses","author":"I Holloway","year":"1996","unstructured":"Holloway I, Wheeler S. Qualitative research for nurses. Malden: Blackwell Science Ltd; 1996."},{"issue":"1","key":"12633_CR38","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12913-020-4935-y","volume":"20","author":"KD Dryden-Palmer","year":"2020","unstructured":"Dryden-Palmer KD, Parshuram CS, Berta WB. Context, complexity and process in the implementation of evidence-based innovation: a realist informed review. BMC Health Serv Res. 2020;20(1):81.","journal-title":"BMC Health Serv Res"},{"key":"12633_CR39","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","volume":"17","author":"LJ Damschroder","year":"2022","unstructured":"Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated consolidated framework for implementation research based on user feedback. Implement Sci. 2022;17:75.","journal-title":"Implement Sci"},{"key":"12633_CR40","first-page":"1","volume":"8","author":"N Shen","year":"2022","unstructured":"Shen N, Kassam I, Chen S, Ma C, Wang W, Boparai N, Jankowicz D, Strudwick G. Canadian perspectives of digital mental health supports: findings from a national survey conducted during the COVID-19 pandemic. Digit Health. 2022;8:1\u201315.","journal-title":"Digit Health"},{"issue":"3","key":"12633_CR41","first-page":"238","volume":"45","author":"A Metz","year":"2021","unstructured":"Metz A, Albers B, Burke K, et al. Implementation practice in human service systems: Understanding the principles and competencies of professionals who support implementation. Hum Service Organizations: Manage Leadersh Gov. 2021;45(3):238\u201359.","journal-title":"Hum Service Organizations: Manage Leadersh Gov"},{"key":"12633_CR42","doi-asserted-by":"crossref","first-page":"216495612110491","DOI":"10.1177\/21649561211049154","volume":"10","author":"M Niemi","year":"2021","unstructured":"Niemi M, Crane R, Sinselmeijer J, Andermo S. The implementation of Mindfulness-Based programs in the Swedish healthcare System - A survey study of service providers. Glob Adv Health Med. 2021;10:21649561211049154.","journal-title":"Glob Adv Health Med"},{"issue":"6","key":"12633_CR43","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1177\/1073191113490790","volume":"20","author":"RS Crane","year":"2013","unstructured":"Crane RS, Eames C, Kuyken W, et al. Development and validation of the mindfulness-based interventions - teaching assessment criteria (MBI:TAC). Assessment. 2013;20(6):681\u20138.","journal-title":"Assessment"},{"key":"12633_CR44","doi-asserted-by":"crossref","unstructured":"Rycroft-Malone J, Gradinger F, Griffiths HO, et al. In: Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study. Southampton (UK): NIHR Journals Library; 2017.","DOI":"10.3310\/hsdr05140"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12633-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12633-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12633-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T13:56:24Z","timestamp":1743256584000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12633-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12633"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12633-9","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]},"assertion":[{"value":"26 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Research Ethics Board at the University Health Network (CAPCR ID: 22-5477). Written informed consent was obtained prior to data collection. Participants were informed about the objectives and content of the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"462"}}