{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:11:02Z","timestamp":1772169062856,"version":"3.50.1"},"reference-count":61,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dementia Trials Ireland Clinical Trials Network","award":["HRB DTICTN-2021-003"],"award-info":[{"award-number":["HRB DTICTN-2021-003"]}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns3:p>\n                    Background Sleep disturbance is common among those with cognitive impairment, potentially contributing to negative outcomes. Furthermore, growing evidence suggests that sleep disturbance is associated with the onset and progression of cognitive decline. There is therefore increasing interest in treating sleep disturbance in people with cognitive impairment. Non-pharmacological treatments for sleep disturbance are unhindered by many of the adverse effects associated with pharmacological treatments, yet evidence supporting their use in clinical practice is often lacking. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment for insomnia and has demonstrated effectiveness in people with cognitive impairment in a small number of trials. Digital CBT-I (dCBT-I) overcomes many of the obstacles associated with accessing CBT-I (such as limited availability of therapists and transportation) whilst presenting others (such as internet access and digital literacy). Aim To undertake a mixed-methods analysis of the usability and acceptability of a dCBT-I intervention (\n                    <ns3:italic>Sleepio<\/ns3:italic>\n                    ) among people with cognitive impairment. Methods Participants will be community-dwelling adults aged \u226550 years with cognitive decline and probable insomnia. Study partners (being caregivers, family or friends of participants) will be recruited, if available, to examine how their involvement influences usability and acceptability. Participants will be given access to\n                    <ns3:italic>Sleepio<\/ns3:italic>\n                    , a fully automated and personalised dCBT-I programme delivered over the course of six weekly sessions. Usability and acceptability will be assessed by a bespoke questionnaire incorporating the System Usability Scale and the Usability Metric for User Experience - Lite (UMUX-Lite). Semi-structured interviews will explore participants\u2019 experience of using the intervention. Conclusion By examining barriers and facilitators to the usability and acceptability of\n                    <ns3:italic>Sleepio<\/ns3:italic>\n                    among people with cognitive impairment, this study will provide insight into the potential efficacy of the intervention in this population whilst informing the design of a future definitive clinical trial.\n                  <\/ns3:p>","DOI":"10.12688\/hrbopenres.14177.1","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T07:10:08Z","timestamp":1750230608000},"page":"68","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A protocol for a mixed-methods analysis of the usability and acceptability of a digital cognitive-behavioural therapy for insomnia (dCBT-I) intervention (SleepioTM) in participants with cognitive impairment."],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9767-5907","authenticated-orcid":false,"given":"Patrick","family":"Crowley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelyn","family":"Flanagan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alasdair L.","family":"Henry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1499-673X","authenticated-orcid":false,"given":"R\u00f3n\u00e1n","family":"O'Caoimh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"661-670","DOI":"10.1111\/bjhp.12251","article-title":"Sleep is a modifiable determinant of health: implications and opportunities for health psychology.","volume":"22","author":"S Kyle","year":"2017","journal-title":"Br J Health Psychol."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"e820-e826","DOI":"10.1016\/S2468-2667(23)00182-2","article-title":"The need to promote sleep health in public health agendas across the globe.","volume":"8","author":"D Lim","year":"2023","journal-title":"Lancet Public Health."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"727-34","DOI":"10.5665\/sleep.1846","article-title":"Sleep: a health imperative.","volume":"35","author":"F Luyster","year":"2012","journal-title":"Sleep."},{"key":"ref-4","article-title":"Why we sleep.","author":"M Walker","year":"2018"},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"1052-63","DOI":"10.1093\/aje\/kwp023","article-title":"Sleep duration in the United States: a cross-sectional population-based study.","volume":"169","author":"P Krueger","year":"2009","journal-title":"Am J Epidemiol."},{"key":"ref-6","first-page":"271-290","article-title":"Insomnia in older adults.","volume":"8","author":"V Nguyen","year":"2019","journal-title":"Curr Geriatr Rep."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"40-81","DOI":"10.1093\/sleep\/16.1.40","article-title":"Sleep in normal aging and dementia.","volume":"16","author":"D Bliwise","year":"1993","journal-title":"Sleep."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"1255-73","DOI":"10.1093\/sleep\/27.7.1255","article-title":"Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan.","volume":"27","author":"M Ohayon","year":"2004","journal-title":"Sleep."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"50-8","DOI":"10.1159\/000335363","article-title":"Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients.","volume":"33","author":"B Guarnieri","year":"2012","journal-title":"Dement Geriatr Cogn Disord."},{"key":"ref-10","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2020.101308","article-title":"Objective measurement of sleep in mild cognitive impairment: a systematic review and meta-analysis.","volume":"52","author":"A D'Rozario","year":"2020","journal-title":"Sleep Med Rev."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"397-405","DOI":"10.1016\/j.sleep.2023.12.010","article-title":"Sleep structure assessed by objective measurement in patients with mild cognitive impairment: a meta-analysis.","volume":"113","author":"J Wei","year":"2024","journal-title":"Sleep Med."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"4-16","DOI":"10.1016\/j.smrv.2017.06.010","article-title":"Sleep disturbances increase the risk of dementia: a systematic review and meta-analysis.","volume":"40","author":"L Shi","year":"2018","journal-title":"Sleep Med Rev."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"552-566","DOI":"10.1016\/j.tins.2016.05.002","article-title":"Sleep: a novel mechanistic pathway, biomarker, and treatment target in the pathology of Alzheimer's disease?","volume":"39","author":"B Mander","year":"2016","journal-title":"Trends Neurosci."},{"key":"ref-14","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsw032","article-title":"Sleep, cognitive impairment, and Alzheimer's disease: a systematic review and meta-analysis.","volume":"40","author":"O Bubu","year":"2017","journal-title":"Sleep."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"572-628","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.","volume":"404","author":"G Livingston","year":"2024","journal-title":"Lancet."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"803","DOI":"10.3390\/ijms20040803","article-title":"Sleep disturbance as a potential modifiable risk factor for Alzheimer's disease.","volume":"20","author":"E Minakawa","year":"2019","journal-title":"Int J Mol Sci."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"2559-2566","DOI":"10.1111\/ene.15391","article-title":"The European Academy of Neurology Brain Health Strategy: one brain, one life, one approach.","volume":"29","author":"C Bassetti","year":"2022","journal-title":"Eur J Neurol."},{"key":"ref-18","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-019-0571-3","article-title":"Sleep dysregulation, memory impairment, and CSF biomarkers during different levels of neurocognitive functioning in Alzheimer's disease course.","volume":"12","author":"C Liguori","year":"2020","journal-title":"Alzheimers Res Ther."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"361-70","DOI":"10.1016\/0197-4580(82)90024-0","article-title":"Sleep, EEG and mental function changes in senile dementia of the Alzheimer's type.","volume":"3","author":"P Prinz","year":"1982","journal-title":"Neurobiol Aging."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"395-406","DOI":"10.1055\/s-0037-1604351","article-title":"Sleep disturbance, cognitive decline, and dementia: a review.","volume":"37","author":"A Wennberg","year":"2017","journal-title":"Semin Neurol."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"777-96","DOI":"10.2165\/00023210-200115100-00004","article-title":"Sleep disturbances in patients with Alzheimer's disease: epidemiology, pathophysiology and treatment.","volume":"15","author":"M Vitiello","year":"2001","journal-title":"CNS Drugs."},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"248-256","DOI":"10.1002\/(sici)1099-1166(199804)13:4<248::aid-gps770>3.0.co;2-0","article-title":"Determinants of carer stress in Alzheimer's disease.","volume":"13","author":"C Donaldson","year":"1998","journal-title":"Int J Geriatr Psychiatry."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"336-341","DOI":"10.1111\/scs.12626","article-title":"Burden of caregivers of patients with Alzheimer's disease.","volume":"33","author":"A Pudelewicz","year":"2019","journal-title":"Scand J Caring Sci."},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"112-20","DOI":"10.1097\/01.JGP.0000192499.25940.da","article-title":"Factors associated with caregiver reports of sleep disturbances in persons with dementia.","volume":"14","author":"S McCurry","year":"2006","journal-title":"Am J Geriatr Psychiatry."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"P247-P255","DOI":"10.1093\/geronb\/55.4.p247","article-title":"Predictors of institutionalization of cognitively impaired elders: family help and the timing of placement.","volume":"55","author":"J Gaugler","year":"2000","journal-title":"J Gerontol B Psychol Sci Soc Sci."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"123-35","DOI":"10.1007\/BF01321316","article-title":"Sleep problems in the community elderly as predictors of death and nursing home placement.","volume":"15","author":"C Pollak","year":"1990","journal-title":"J Community Health."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"610-622","DOI":"10.4140\/TCP.n.2017.610","article-title":"Therapy update for Insomnia in the elderly.","volume":"32","author":"S Lam","year":"2017","journal-title":"Consult Pharm."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"2052-2081","DOI":"10.1111\/jgs.18372","article-title":"American Geriatrics Society 2023 updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults.","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc."},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"82-94","DOI":"10.1016\/j.maturitas.2019.06.007","article-title":"Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: a systematic review and meta-analysis.","volume":"127","author":"R O'Caoimh","year":"2019","journal-title":"Maturitas."},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"255-262","DOI":"10.5664\/jcsm.8986","article-title":"Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline.","volume":"17","author":"J Edinger","year":"2021","journal-title":"J Clin Sleep Med."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"125-33","DOI":"10.7326\/M15-2175","article-title":"Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians.","volume":"165","author":"A Qaseem","year":"2016","journal-title":"Ann Intern Med."},{"key":"ref-32","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14035","article-title":"The European Insomnia guideline: an update on the diagnosis and treatment of insomnia 2023.","volume":"32","author":"D Riemann","year":"2023","journal-title":"J Sleep Res."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"923-947","DOI":"10.1177\/0269881119855343","article-title":"British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update.","volume":"33","author":"S Wilson","year":"2019","journal-title":"J Psychopharmacol."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"63","DOI":"10.12688\/hrbopenres.13988.1","article-title":"A protocol for the systematic review and meta-analysis of clinical trials of interventions to improve sleep in people with mild cognitive impairment or dementia. [version 1; peer review: 1 approved with reservations].","volume":"7","author":"P Crowley","year":"2024","journal-title":"HRB Open Res."},{"key":"ref-35","doi-asserted-by":"publisher","first-page":"136-144","DOI":"10.1080\/07317115.2017.1384777","article-title":"Neuropsychological functioning in older adults with mild cognitive impairment and Insomnia randomized to CBT-I or control group.","volume":"41","author":"E Cassidy-Eagle","year":"2018","journal-title":"Clin Gerontol."},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"778-789","DOI":"10.1080\/15402002.2018.1518223","article-title":"\"Sleep Well, Think Well\" group program for mild cognitive impairment: a randomized controlled pilot study.","volume":"17","author":"S Naismith","year":"2019","journal-title":"Behav Sleep Med."},{"key":"ref-37","doi-asserted-by":"publisher","first-page":"3-13","DOI":"10.1177\/1460458216656472","article-title":"A randomized controlled pilot study of CBT-I Coach: Feasibility, acceptability, and potential impact of a mobile phone application for patients in cognitive behavioral therapy for insomnia.","volume":"24","author":"E Koffel","year":"2018","journal-title":"Health Informatics J."},{"key":"ref-38","doi-asserted-by":"publisher","first-page":"315-325","DOI":"10.1016\/j.sleep.2020.08.020","article-title":"Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials.","volume":"75","author":"H Soh","year":"2020","journal-title":"Sleep Med."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"1-10","DOI":"10.1016\/j.smrv.2015.10.004","article-title":"Efficacy of internet-delivered cognitive-behavioral therapy for insomnia \u2013 a systematic review and meta-analysis of randomized controlled trials.","volume":"30","author":"R Zachariae","year":"2016","journal-title":"Sleep Med Rev."},{"key":"ref-40","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3390\/healthcare12010106","article-title":"Information and communication technology-based application for cognitive behavioral therapy among community-dwelling older adults with Insomnia: development and validation study.","volume":"12","author":"Y Lee","year":"2024","journal-title":"Healthcare (Basel)."},{"key":"ref-41","doi-asserted-by":"publisher","first-page":"1539-1550","DOI":"10.3233\/JAD-210657","article-title":"Feasibility and preliminary efficacy of an Internet-delivered intervention for insomnia in individuals with Mild Cognitive Impairment.","volume":"84","author":"M Mattos","year":"2021","journal-title":"J Alzheimers Dis."},{"key":"ref-42","doi-asserted-by":"publisher","first-page":"A189","DOI":"10.1093\/sleep\/zsae067.0441","article-title":"0441 sleep disturbance in MCI: a pilot study of a Cognitive Behavioural Therapy digital intervention (SUCCEED).","volume":"47","author":"C Hoyos","year":"2024","journal-title":"Sleep."},{"key":"ref-43","doi-asserted-by":"publisher","first-page":"271-278","DOI":"10.1080\/02699052.2022.2034182","article-title":"A qualitative examination of the usability of a digital Cognitive Behavioral Therapy for Insomnia program after stroke.","volume":"36","author":"T Smejka","year":"2022","journal-title":"Brain Inj."},{"key":"ref-44","doi-asserted-by":"publisher","first-page":"955-962","DOI":"10.1007\/s11606-018-4390-1","article-title":"Increasing access to and utilization of Cognitive Behavioral Therapy for Insomnia (CBT-I): a narrative review.","volume":"33","author":"E Koffel","year":"2018","journal-title":"J Gen Intern Med."},{"key":"ref-45","doi-asserted-by":"publisher","DOI":"10.4324\/9781003377986","article-title":"Qualitative research: the essential guide to theory and practice.","author":"M Savin-Baden","year":"2023"},{"key":"ref-46","doi-asserted-by":"publisher","first-page":"77-101","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology.","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol."},{"key":"ref-47","doi-asserted-by":"publisher","first-page":"174-183","DOI":"10.1016\/j.sleep.2019.10.007","article-title":"Is digital Cognitive Behavioural Therapy for Insomnia effective in treating sub-threshold insomnia: a pilot RCT.","volume":"66","author":"D Denis","year":"2020","journal-title":"Sleep Med."},{"key":"ref-48","doi-asserted-by":"publisher","first-page":"186-92","DOI":"10.1097\/01.pra.0000320120.68928.e5","article-title":"Cognitive-Behavioral Treatment for anxiety in patients with dementia: two case studies.","volume":"14","author":"C Kraus","year":"2008","journal-title":"J Psychiatr Pract."},{"key":"ref-49","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004183","article-title":"The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder.","volume":"4","author":"C Espie","year":"2014","journal-title":"BMJ Open."},{"key":"ref-50","first-page":"653-659","article-title":"Functional Assessment Staging (FAST).","volume":"24","author":"B Reisberg","year":"1988","journal-title":"Psychopharmacol Bull."},{"key":"ref-51","doi-asserted-by":"publisher","first-page":"303-8","DOI":"10.1001\/archneur.56.3.303","article-title":"Mild cognitive impairment: clinical characterization and outcome.","volume":"56","author":"R Petersen","year":"1999","journal-title":"Arch Neurol."},{"key":"ref-52","doi-asserted-by":"publisher","first-page":"2412-4","DOI":"10.1212\/wnl.43.11.2412-a","article-title":"The Clinical Dementia Rating (CDR): current version and scoring rules.","volume":"43","author":"J Morris","year":"1993","journal-title":"Neurology."},{"key":"ref-53","doi-asserted-by":"publisher","first-page":"131-156","DOI":"10.1177\/0733464816642582","article-title":"A new tool for assessing mobile device proficiency in older adults: the Mobile Device Proficiency Questionnaire.","volume":"37","author":"N Roque","year":"2018","journal-title":"J Appl Gerontol."},{"key":"ref-54","doi-asserted-by":"publisher","first-page":"373-83","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.","volume":"40","author":"M Charlson","year":"1987","journal-title":"J Chronic Dis."},{"key":"ref-55","doi-asserted-by":"publisher","first-page":"577-590","DOI":"10.1080\/10447318.2018.1455307","article-title":"The System Usability Scale: past, present, and future.","volume":"34","author":"J Lewis","year":"2018","journal-title":"Int J Hum Comput Interact."},{"key":"ref-56","doi-asserted-by":"publisher","first-page":"180-182","DOI":"10.1177\/2327857920091021","article-title":"A simplified System Usability Scale (SUS) for cognitively impaired and older adults.","volume":"9","author":"R Holden","year":"2020","journal-title":"Proc Int Symp Hum Factors Ergon Healthc."},{"key":"ref-57","doi-asserted-by":"publisher","first-page":"2099-2102","DOI":"10.1145\/2470654.2481287","article-title":"UMUX-LITE: when there's no time for the SUS.","author":"J Lewis","year":"2013"},{"key":"ref-58","doi-asserted-by":"publisher","first-page":"241-251","DOI":"10.1080\/0142159X.2022.2057287","article-title":"A practical guide to reflexivity in qualitative research: AMEE guide no. 149.","volume":"45","author":"F Olmos-Vega","year":"2023","journal-title":"Med Teach."},{"key":"ref-59","doi-asserted-by":"publisher","first-page":"1245-1251","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for Reporting Qualitative Research: a synthesis of recommendations.","volume":"89","author":"B O\u2019Brien","year":"2014","journal-title":"Acad Med."},{"key":"ref-60","doi-asserted-by":"publisher","first-page":"1483-4","DOI":"10.1111\/jgs.13507","article-title":"Technology use and frequency and self-rated skills: a survey of community-dwelling older adults.","volume":"63","author":"L Scanlon","year":"2015","journal-title":"J Am Geriatr Soc."},{"key":"ref-61","doi-asserted-by":"crossref","article-title":"A protocol for a mixed-methods analysis of the usability and acceptability of a digital Cognitive-Behavioural Therapy for Insomnia (dCBT-I) intervention (Sleepio) in participants with cognitive impairment","author":"P Crowley","DOI":"10.12688\/hrbopenres.14177.1"}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T08:24:14Z","timestamp":1769070254000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":61,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.14177.1","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.15590.r48112","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.15590.r52555","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.15590.r48112","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/hrbopenres.15590.r52555","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.15590.r48112, Alexandra Hinterberger, Salzburg University, Salzburg, 18 Aug 2025, version 1, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1#referee-response-48112","order":0,"name":"referee-response-48112","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15590.r52555, Inga Antonsdottir, Johns Hopkins Medicine, Baltimore, Maryland, 22 Jan 2026, version 1, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-68\/v1#referee-response-52555","order":1,"name":"referee-response-52555","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Health Research Board [DTICTN-2021-003]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}