{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:52:34Z","timestamp":1781621554928,"version":"3.54.5"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100014653","name":"NIHR Manchester Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Improving communication between NHS primary and secondary care services should reduce inefficiencies, improve patient care, and provide a source of accurate data for audit and research. Using general practice (primary care) and adult hearing aid services (secondary care) as examples, this study aimed to investigate the: (i) information primary care want from secondary care services during referral processes and what information secondary care can provide, (ii) barriers and facilitators for coding and providing this information, and (iii) targets for interventions to improve communication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Qualitative interview study. Twenty-nine semi-structured interviews were conducted with primary and secondary care staff in North West England, informed by the capabilities, opportunities, and motivations model of behaviour change (COM-B). A thematic analysis with findings mapped to the Theoretical Domains Framework (TDF) was used to identify barriers and facilitators to the recording and communication of hearing health information, as well as behavioural determinants to target in future interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four key TDF domains were identified as potential determinants to target for future interventions: (1) time and resources (e.g., environmental context and resources) are stretched across the two sectors; (2) fatigue, tiredness, and cognitive overload affecting workflow (e.g., memory, attention, and decision processes), particularly adult hearing aid service administration; (3) adult hearing aid services are unaware if their letters are read by general practice, or if the level of information they send is appropriate (e.g., knowledge); and (4) difficulties communicating with general practice and a lack of feedback is causing reduced motivation from adult hearing aid services to make direct contact (e.g., beliefs about consequences).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study identified four theoretically-derived variables that are barriers to communication and record sharing, and highlights how these can be translated into potential interventions (e.g., simplified coding). Further work is required to test interventions developed using behaviour change theory.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13690-025-01756-4","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:35:40Z","timestamp":1764171340000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying targets for interventions to improve communication between primary and secondary care: a qualitative study of referrals to adult NHS hearing aid services"],"prefix":"10.1186","volume":"83","author":[{"given":"Sobia","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Loughran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Armitage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Leverton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishchay","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Oliver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"O\u2019Driscoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Nassar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J.","family":"Sutton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piers","family":"Dawes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Bower","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin J.","family":"Munro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"1756_CR1","unstructured":"Stronger collaboratve working. needed between primary and secondary care | NHS Confederation. www.nhsconfed.org. Available from: https:\/\/www.nhsconfed.org\/articles\/stronger-collaborative-working-needed-between-primary-and-secondary-care."},{"key":"1756_CR2","unstructured":"NHS England \u2013 Data quality improvement. Available from: https:\/\/www.england.nhs.uk\/data-services\/validate\/."},{"key":"1756_CR3","unstructured":"Royal College of Physicians \u2013 Primary care workstream. Available from: https:\/\/www.rcp.ac.uk\/improving-care\/national-clinical-audits\/the-national-respiratory-audit-programme-nrap\/primary-care-workstream\/."},{"issue":"1","key":"1756_CR4","first-page":"63","volume":"37","author":"E Dinsdale","year":"2020","unstructured":"Dinsdale E, Hannigan A, O\u2019Connor R, O\u2019Doherty J, Glynn L, Casey M, Hayes P, Kelly D, Cullen W, O\u2019Regan A. Communication between primary and secondary care: deficits and danger. Fam Pract. 2020;37(1):63\u20138.","journal-title":"Fam Pract"},{"key":"1756_CR5","doi-asserted-by":"crossref","unstructured":"Boddy N, Barclay S, Bashford T, Clarkson PJ. How can communication to gps at hospital discharge be improved? A systems approach. BJGP Open. 2022;6(1).\u00a0https:\/\/bjgpopen.org\/content\/6\/1\/BJGPO.2021.0148.long","DOI":"10.3399\/BJGPO.2021.0148"},{"key":"1756_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12875-020-01234-6","volume":"21","author":"M Janssen","year":"2020","unstructured":"Janssen M, Sagasser MH, Fluit CR, Assendelft WJ, De Graaf J, Scherpbier ND. Competencies to promote collaboration between primary and secondary care doctors: an integrative review. BMC Fam Pract. 2020;21:1\u20133.","journal-title":"BMC Fam Pract"},{"key":"1756_CR7","unstructured":"Department of Health and Social Care. \u2013 Chief medical officer\u2019s annual report 2023: health in an aging society [internet]: Available from: https:\/\/www.gov.uk\/government\/publications\/chief-medical-officers-annual-report-2023-health-in-an-ageing-society."},{"issue":"10278","key":"1756_CR8","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1016\/S0140-6736(21)00516-X","volume":"397","author":"LM Haile","year":"2021","unstructured":"Haile LM, Kamenov K, Briant PS, Orji AU, Steinmetz JD, Abdoli A, Abdollahi M, Abu-Gharbieh E, Afshin A, Ahmed H, Rashid TA. Hearing loss prevalence and years lived with disability, 1990\u20132019: findings from the global burden of disease study 2019. Lancet. 2021;397(10278):996\u20131009.","journal-title":"Lancet"},{"issue":"4","key":"1756_CR9","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1093\/ageing\/afy061","volume":"47","author":"A Maharani","year":"2018","unstructured":"Maharani A, Dawes P, Nazroo J, Tampubolon G, Pendleton N. Sense-Cog WP1 group. Visual and hearing impairments are associated with cognitive decline in older people. Age Ageing. 2018;47(4):575\u201381.","journal-title":"Age Ageing"},{"issue":"2","key":"1756_CR10","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/AUD.0b013e31803126b6","volume":"28","author":"EM Chia","year":"2007","unstructured":"Chia EM, Wang JJ, Rochtchina E, Cumming RR, Newall P, Mitchell P. Hearing impairment and health-related quality of life: the blue mountains hearing study. Ear Hear. 2007;28(2):187\u201395.","journal-title":"Ear Hear"},{"issue":"3","key":"1756_CR11","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1093\/geront\/40.3.320","volume":"40","author":"WJ Strawbridge","year":"2000","unstructured":"Strawbridge WJ, Wallhagen MI, Shema SJ, Kaplan GA. Negative consequences of hearing impairment in old age: a longitudinal analysis. Gerontologist. 2000;40(3):320\u20136.","journal-title":"Gerontologist"},{"key":"1756_CR12","doi-asserted-by":"crossref","unstructured":"Ferguson MA, Kitterick PT, Chong LY, Edmondson-Jones M, Barker F, Hoare DJ. Hearing aids for mild to moderate hearing loss in adults. Cochrane Database Syst Rev. 2017;(9). https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD012023.pub2\/full?cookies","DOI":"10.1002\/14651858.CD012023.pub2"},{"issue":"2","key":"1756_CR13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1007\/s00127-021-02155-0","volume":"57","author":"D Tsimpida","year":"2022","unstructured":"Tsimpida D, Kontopantelis E, Ashcroft DM, Panagioti M. The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the english longitudinal study of ageing (ELSA). Soc Psychiatry Psychiatr Epidemiol. 2022;57(2):353\u201362.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"5","key":"1756_CR14","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1097\/AUD.0000000000000695","volume":"40","author":"CS Sawyer","year":"2019","unstructured":"Sawyer CS, Armitage CJ, Munro KJ, Singh G, Dawes PD. Correlates of hearing aid use in UK adults: self-reported hearing difficulties, social participation, living situation, health, and demographics. Ear Hear. 2019;40(5):1061\u20138.","journal-title":"Ear Hear"},{"issue":"3","key":"1756_CR15","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1177\/1084713810385712","volume":"14","author":"L Vestergaard Knudsen","year":"2010","unstructured":"Vestergaard Knudsen L, \u00d6berg M, Nielsen C, Naylor G, Kramer SE. Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: A review of the literature. Trends Amplif. 2010;14(3):127\u201354.","journal-title":"Trends Amplif"},{"issue":"5","key":"1756_CR16","doi-asserted-by":"publisher","first-page":"291","DOI":"10.3109\/14992027.2014.966922","volume":"54","author":"JH Ng","year":"2015","unstructured":"Ng JH, Loke AY. Determinants of hearing-aid adoption and use among the elderly: A systematic review. Int J Audiol. 2015;54(5):291\u2013300.","journal-title":"Int J Audiol"},{"issue":"3","key":"1756_CR17","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1093\/geronb\/gbu024","volume":"70","author":"L Benova","year":"2015","unstructured":"Benova L, Grundy E, Ploubidis GB. Socioeconomic position and health-seeking behavior for hearing loss among older adults in England. Journals Gerontol Ser B: Psychol Sci Social Sci. 2015;70(3):443\u201352.","journal-title":"Journals Gerontol Ser B: Psychol Sci Social Sci"},{"issue":"5","key":"1756_CR18","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1097\/AUD.0000000000000839","volume":"41","author":"CS Sawyer","year":"2020","unstructured":"Sawyer CS, Armitage CJ, Munro KJ, Singh G, Dawes PD. Biopsychosocial classification of hearing health seeking in adults aged over 50 years in England. Ear Hear. 2020;41(5):1215\u201325.","journal-title":"Ear Hear"},{"key":"1756_CR19","unstructured":"Davis A, Smith P, Ferguson M, Stephens S, Gianopoulos I. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technol Assess. 2007;11(42).\u00a0https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/HTA11420"},{"key":"1756_CR20","unstructured":"World Health Organization \u2013 hearWHO [internet]. Available from: https:\/\/www.who.int\/teams\/noncommunicable-diseases\/sensory-functions-disability-and-rehabilitation\/hearwho."},{"key":"1756_CR21","unstructured":"Royal National Institute for Deaf People. \u2013 online hearing test [internet]. Available from: https:\/\/rnid.org.uk\/information-and-support\/take-online-hearing-check\/."},{"issue":"42","key":"1756_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta11420","volume":"11","author":"A Davis","year":"2007","unstructured":"Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technol Assess. 2007;11(42):1\u2013294.","journal-title":"Health Technol Assess"},{"key":"1756_CR23","volume-title":"NHS funding and expenditure","author":"R Harker","year":"2012","unstructured":"Harker R. NHS funding and expenditure. London: House of Commons; 2012."},{"issue":"3","key":"1756_CR24","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/AUD.0000000000000641","volume":"40","author":"AN Simpson","year":"2019","unstructured":"Simpson AN, Matthews LJ, Cassarly C, Dubno JR. Time from hearing aid candidacy to hearing aid adoption: A longitudinal cohort study. Ear Hear. 2019;40(3):468\u201376.","journal-title":"Ear Hear"},{"issue":"8","key":"1756_CR25","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1080\/14992027.2020.1773550","volume":"59","author":"H Dillon","year":"2020","unstructured":"Dillon H, Day J, Bant S, Munro KJ. Adoption, use and non-use of hearing aids: a robust estimate based on Welsh National survey statistics. Int J Audiol. 2020;59(8):567\u201373.","journal-title":"Int J Audiol"},{"issue":"2","key":"1756_CR26","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3928\/00989134-20080201-12","volume":"34","author":"MI Wallhagen","year":"2008","unstructured":"Wallhagen MI, Pettengill E. Hearing impairment: significant but underassessed in primary care settings. J Gerontol Nurs. 2008;34(2):36\u201342.","journal-title":"J Gerontol Nurs"},{"issue":"1","key":"1756_CR27","doi-asserted-by":"publisher","first-page":"20","DOI":"10.5694\/j.1326-5377.2010.tb03395.x","volume":"192","author":"JM Schneider","year":"2010","unstructured":"Schneider JM, Gopinath B, McMahon CM, Britt HC, Harrison CM, Usherwood T, Leeder SR, Mitchell P. Role of general practitioners in managing age-related hearing loss. Med J Aust. 2010;192(1):20\u20133.","journal-title":"Med J Aust"},{"key":"1756_CR28","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","volume":"6","author":"S Michie","year":"2011","unstructured":"Michie S, Van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.","journal-title":"Implement Sci"},{"key":"1756_CR29","volume-title":"The behaviour change wheel: a guide to designing interventions","author":"S Michie","year":"2014","unstructured":"Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. 1st ed. London: Silverback Publishing; 2014.","edition":"1"},{"key":"1756_CR30","doi-asserted-by":"publisher","first-page":"a1655","DOI":"10.1136\/bmj.a1655","volume":"337","author":"P Craig","year":"2008","unstructured":"Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new medical research Council guidance. BMJ. 2008;337:a1655.","journal-title":"BMJ"},{"issue":"4","key":"1756_CR31","doi-asserted-by":"publisher","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"},{"key":"1756_CR32","doi-asserted-by":"publisher","first-page":"233121652096947","DOI":"10.1177\/2331216520969472","volume":"25","author":"AH Ismail","year":"2021","unstructured":"Ismail AH, Munro KJ, Armitage CJ, Marsden A, Dawes PD. A quasi-randomized controlled trial of the I-PLAN intervention to promote hearing aid use among first-time adult hearing aid users. Trends Hear. 2021;25:2331216520969472.","journal-title":"Trends Hear"},{"key":"1756_CR33","doi-asserted-by":"crossref","unstructured":"Ismail AH, Armitage CJ, Munro KJ, Marsden A, Dawes PD. Evaluation of the I-PLAN intervention to promote hearing aid use in new adult users: A randomized controlled trial. 2022;43(4):1103\u201313.","DOI":"10.1097\/AUD.0000000000001195"},{"key":"1756_CR34","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1111\/bjhp.12368","volume":"24","author":"C Keyworth","year":"2019","unstructured":"Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. It\u2019s difficult, I think it\u2019s complicated\u2019: health care professionals\u2019 barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. Br J Health Psychol. 2019;24:571\u201392.","journal-title":"Br J Health Psychol"},{"key":"1756_CR35","unstructured":"Taylor D, Bury M, Campling N, Carter S, Garfied S, Newbould J, Rennie T. (2006). A Review of the use of the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM) to study and predict health related behaviour change. London, UK: National Institute for Health and Clinical Excellence, 1\u2013215."},{"key":"1756_CR36","doi-asserted-by":"crossref","unstructured":"Couth S, Loughran MT, Plack CJ, Moore DR, Munro KJ, Ginsborg J, Dawes P, Armitage CJ. Identifying barriers and facilitators of hearing protection use in early-career musicians: A basis for designing interventions to promote uptake and sustained use. Int J Audiol. 2021.","DOI":"10.1080\/14992027.2021.1951852"},{"issue":"24","key":"1756_CR37","doi-asserted-by":"publisher","first-page":"12879","DOI":"10.3390\/ijerph182412879","volume":"18","author":"MT Loughran","year":"2021","unstructured":"Loughran MT, Couth S, Plack CJ, Armitage CJ. Identifying targets for interventions to increase earplug use in noisy recreational settings: a qualitative interview study. Int J Environ Res Public Health. 2021;18(24):12879. https:\/\/doi.org\/10.3390\/ijerph182412879.","journal-title":"Int J Environ Res Public Health"},{"key":"1756_CR38","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1748-5908-7-37","volume":"7","author":"J Cane","year":"2012","unstructured":"Cane J, O\u2019Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.","journal-title":"Implement Sci"},{"key":"1756_CR39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13012-017-0605-9","volume":"12","author":"L Atkins","year":"2017","unstructured":"Atkins L, Francis J, Islam R, O\u2019Connor D, Patey A, Ivers N, Foy R, Duncan EM, Colquhoun H, Grimshaw JM, Lawton R. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:1\u20138.","journal-title":"Implement Sci"},{"key":"1756_CR40","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77\u2013101.","journal-title":"Qual Res Psychol"},{"issue":"1","key":"1756_CR41","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1080\/001401397188396","volume":"40","author":"RA Henning","year":"1997","unstructured":"Henning RA, Jacques P, Kissel GV, Sullivan AB, Alteras-Webb SM. Frequent short rest breaks from computer work: effects on productivity and well-being at two field sites. Ergonomics. 1997;40(1):78\u201391.","journal-title":"Ergonomics"},{"issue":"12","key":"1756_CR42","first-page":"1216","volume":"55","author":"JB Brown","year":"2009","unstructured":"Brown JB, Lewis L, Ellis K, Stewart M, Freeman TR, Kasperski MJ. Mechanisms for communicating within primary health care teams. Can Fam Physician. 2009;55(12):1216\u201322.","journal-title":"Can Fam Physician"},{"key":"1756_CR43","unstructured":"RCGP. GPs Have Seen a 20% Workload Increase and Appointments Growing in complexity, Says College Vice Chair.www.rcgp.org.uk.2023. Available from: https:\/\/www.rcgp.org.uk\/News\/Workload-increase-growing-complexity."}],"container-title":["Archives of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-025-01756-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13690-025-01756-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-025-01756-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T13:57:53Z","timestamp":1781618273000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13690-025-01756-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1756"],"URL":"https:\/\/doi.org\/10.1186\/s13690-025-01756-4","relation":{},"ISSN":["2049-3258"],"issn-type":[{"value":"2049-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]},"assertion":[{"value":"17 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 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":"Ethical review (REC) and approval was granted through Integrated Research Application System (IRAS) (REF: 295139\/1545834\/37\/936).","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":"284"}}