{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:42:43Z","timestamp":1792582963922,"version":"4.5.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of metabolic syndrome among office workers is markedly high, highlighting an urgent need for effective workplace interventions. In response to this need, a theory-informed healthy lifestyle education intervention was developed and implemented among office workers in Ethiopia, resulting in significant reductions in key metabolic risk factors and improvements in health-related behaviours. However, understanding the implementation process, how the intervention worked in practice, under what conditions, and why is critical to inform scale-up, adaptation, and sustainability. This study aimed to evaluate the implementation process of a nine-month workplace-based healthy lifestyle education intervention, using the Programme Integrity Framework to assess implementation fidelity and the Consolidated Framework for Implementation Research to identify the barriers and facilitators influencing implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convergent parallel mixed-methods process evaluation was conducted to assess the implementation process of a 9\u202fmonth workplace intervention aimed to reduce risk for metabolic syndrome and improve knowledge, attitudes, and healthy lifestyle practices. A total of 226 employees were screened based on waist circumference and blood pressure and allocated to intervention and control groups using cluster randomisation. The intervention group received a personalised lifestyle education programme delivered by trained health promotion experts, while the control group received general health advice on non-communicable disease prevention. Implementation fidelity was assessed across the five domains of the Programme Integrity Framework: adherence, exposure, quality of delivery, participant responsiveness, and programme differentiation, using educator self-reports and direct observations conducted by the principal investigator. Contextual factors influencing implementation were examined using the five domains of the Consolidated Framework for Implementation Research (CFIR): intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. These were assessed through participant self-reports, field notes from review meetings conducted at the third and sixth months, and open-ended questionnaire responses collected from 13 participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Implementation fidelity was high across adherence, exposure, quality of delivery, and participant responsiveness domains, indicating that the intervention was delivered as intended and well-received by participants. However, CFIR-informed contextual analysis identified several barriers to effective implementation, including unsupportive organisational cultures, limited leadership support, weak external policy backing, resource constraints, and community norms that were not always aligned with healthy lifestyle change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study shows that a theory-informed lifestyle education intervention can be delivered with high fidelity and strong engagement among office workers, supporting workplaces as a promising NCD prevention setting. Sustainable scale-up will likely depend on task-sharing with trained non-specialist personnel and embedding workplace health promotion within organisational and policy systems. Future research should work on policy integration, scalability, long-term sustainability, equity, and cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=385666&amp;amp;isClinicalTrial=False<\/jats:ext-link>\n                      , identifier ACTRN12623000409673p.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1893222","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:47Z","timestamp":1791352727000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of a workplace healthy lifestyle education intervention for metabolic syndrome risk reduction in Ethiopia: a mixed-methods process evaluation"],"prefix":"10.3389","volume":"14","author":[{"given":"Sitotaw Kerie","family":"Bogale","sequence":"first","affiliation":[{"name":"National Centre for Epidemiology and Population Health, The Australian National University","place":["Canberra, ACT, Australia"]},{"name":"College of Medicine and Health Sciences, Bahir Dar University","place":["Bahir Dar, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haribondhu","family":"Sarma","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, The Australian National University","place":["Canberra, ACT, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uday Narayan","family":"Yadav","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, The Australian National University","place":["Canberra, ACT, Australia"]},{"name":"International Centre for Future Health Systems, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Kelly","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, The Australian National University","place":["Canberra, ACT, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/2047487319886404","article-title":"The metabolic syndrome\u2013what is it and how should it be managed?","volume":"26","author":"Nilsson","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1186\/s12913-024-11562-3","article-title":"Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCD plus clinics: multilevel analysis","volume":"24","author":"Suapumee","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11906-018-0812-z","article-title":"The global epidemic of the metabolic syndrome","volume":"20","author":"Saklayen","year":"2018","journal-title":"Curr Hypertens Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0240971","DOI":"10.1371\/journal.pone.0240971","article-title":"Prevalence of metabolic syndrome among adult population in India: a systematic review and meta-analysis","volume":"15","author":"Yuvaraj Krishnamoorthy","year":"2020","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1038\/s41467-025-67268-5","article-title":"Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis","volume":"17","author":"Noubiap","year":"2000","journal-title":"Nat Commun"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0289155","DOI":"10.1371\/journal.pone.0289155","article-title":"Prevalence of the metabolic syndrome in African populations: a systematic review and meta-analysis","volume":"18","author":"Bowo-Ngandji","year":"2023","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/bmb\/ldaa039","article-title":"Sedentary behaviour in the workplace: prevalence, health implications and interventions","volume":"137","author":"Bailey","year":"2021","journal-title":"Br Med Bull"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-13-296","article-title":"The contribution of office work to sedentary behaviour associated risk","volume":"13","author":"Parry","year":"2013","journal-title":"BMC Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"185","DOI":"10.47626\/1679-4435-2020-511","article-title":"Association between metabolic syndrome and work: an integrative review of the literature","volume":"18","author":"Santana","year":"2020","journal-title":"Rev Bras Med Trab"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"40","DOI":"10.29080\/jhsp.v5i1.421","article-title":"The dominant factor of metabolic syndrome among office workers","volume":"5","author":"Listyandini","year":"2021","journal-title":"J Health Sci Prev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"34","DOI":"10.15171\/ijoem.2015.492","article-title":"Metabolic syndrome: a common problem among office workers","volume":"6","author":"Alavi","year":"2015","journal-title":"Int. J. Occupat. Environ. Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"20635","DOI":"10.1038\/s41598-021-99913-6","article-title":"Cardiometabolic syndrome and associated factors among Ethiopian public servants, Addis Ababa, Ethiopia","volume":"11","author":"Geto","year":"2021","journal-title":"Sci Rep"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"32S","DOI":"10.1177\/1010539515612123","article-title":"Knowledge, attitudes, and practices on lifestyle and cardiovascular risk factors among metabolic syndrome patients in an urban tertiary care institute in Sri Lanka","volume":"28","author":"Amarasekara","year":"2016","journal-title":"Asia Pac J Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1002\/puh2.133","article-title":"Noncommunicable disease risk factors and cardiovascular risk among adults in Ethiopia: a cross-sectional study","volume":"2","author":"Alamnia","year":"2023","journal-title":"Public Health Challenges"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"6616473","DOI":"10.1155\/2021\/6616473","article-title":"Behavioral and sociodemographic determinants of hypertension and its burden among bank employees in metropolitan cities of Amhara regional state, Ethiopia","volume":"2021","author":"Shitu","year":"2021","journal-title":"Int J Hypertens"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0252298","DOI":"10.1371\/journal.pone.0252298","article-title":"Undiagnosed hypertension and associated factors among bank workers in Bahir Dar City, northwest, Ethiopia, 2020. A cross-sectional study","volume":"16","author":"Dejenie","year":"2020","journal-title":"PLoS One"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1186\/1471-2458-12-213","article-title":"Alcohol drinking patterns among high school students in Ethiopia: a cross-sectional study","volume":"12","author":"Reda","year":"2012","journal-title":"BMC Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s44263-025-00231-0","article-title":"Using the behaviour change wheel framework to develop an integrated intervention for diabetes and hypertension co-management in China: a case report","volume":"3","author":"Yap","year":"2025","journal-title":"BMC Global Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"39266","DOI":"10.1038\/s41598-025-22962-8","article-title":"A healthy lifestyle education intervention for metabolic syndrome risk reduction among office workers in Ethiopia: a single-blind, randomised controlled trial","volume":"15","author":"Bogale","year":"2025","journal-title":"Sci Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S0272-7358(97)00043-3","article-title":"Program integrity in primary and early secondary prevention: are implementation effects out of control?","volume":"18","author":"Dane","year":"1998","journal-title":"Clin Psychol Rev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11606\/issn.1806-6976.smad.2019.150238","article-title":"Fidelity measurement in school-based mental health interventions: a systematic review","volume":"15","author":"Garcia","year":"2019","journal-title":"SMAD Rev Eletron Saude Mental Alcool Drog"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s13012-020-01065-0","article-title":"Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the consolidated framework for implementation research","volume":"15","author":"Ndejjo","year":"2020","journal-title":"Implement Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0353519","DOI":"10.1371\/journal.pone.0353519","article-title":"Balancing adaptations and fidelity of implementation strategies to optimize primary healthcare in Ethiopia: lessons from embedded implementation research","volume":"21","author":"Bogale","year":"2026","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"ref26","volume-title":"Guidelines on Clinical and Programmatic Management of Major Non Communicable Diseases","year":"2016"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1838719","DOI":"10.3389\/frhs.2026.1838719","article-title":"A general framework for fidelity assessment","volume":"6","author":"Fixsen","year":"2026","journal-title":"Front Health Serv"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e70132","DOI":"10.1111\/eip.70132","article-title":"To fidelity and beyond: development of an implementation fidelity tool for early intervention for eating disorders services","volume":"20","author":"Hyam","year":"2026","journal-title":"Early Interv Psychiatry"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e029954","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"O\" Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3389\/fpubh.2019.00003","article-title":"Enhancing the impact of implementation strategies in healthcare: a research agenda","volume":"7","author":"Powell","year":"2019","journal-title":"Front Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1093\/eurjcn\/zvag027","article-title":"Nurse-led counselling and smartphone-based coaching for dietary behaviours, weight management, and cardiometabolic risk in middle-aged Chinese in Hong Kong: a randomized controlled trial","volume":"25","author":"Yang","year":"2026","journal-title":"Eur J Cardiovasc Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"44347","DOI":"10.1038\/s41598-025-27899-6","article-title":"Personalisation of the Dutch combined lifestyle intervention SLIMMER improves participant retention and weight loss in people at risk for cardiometabolic disease","volume":"15","author":"Oosterman","year":"2025","journal-title":"Sci Rep"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s12529-021-09961-5","article-title":"The fidelity of training in behaviour change techniques to intervention design in a national diabetes prevention programme","volume":"28","author":"Hawkes","year":"2021","journal-title":"Int J Behav Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/17437199.2025.2534001","article-title":"Addressing fidelity within complex health behaviour change interventions: a scoping review of fidelity frameworks and models","volume":"20","author":"Toomey","year":"2026","journal-title":"Health Psychol Rev"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s44155-025-00291-5","article-title":"Barriers and facilitators for implementing NCD-related health promotion activities in the workplace: a scoping review","volume":"5","author":"Muthuperumal","year":"2025","journal-title":"Discov Soc Sci Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e70163","DOI":"10.1002\/smi.70163","article-title":"Barriers and facilitators to participation in interventions for employee health and wellbeing in the university context","volume":"42","author":"Bailey","year":"2026","journal-title":"Stress Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1575179","DOI":"10.3389\/frhs.2025.1575179","article-title":"Fidelity, not adaptation, is essential for implementation","volume":"5","author":"Fixsen","year":"2025","journal-title":"Front Health Serv"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"S622","DOI":"10.1192\/j.eurpsy.2022.1594","article-title":"The feasibility of an implementation fidelity tool for the monitoring of a multidisciplinary lifestyle focused approach for inpatients with mental illness","volume":"65","author":"Den Bleijker","year":"2022","journal-title":"Eur Psychiatry"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.3390\/ijerph16081454","article-title":"Built environment and health behaviors: deconstructing the black box of interactions\u2014a review of reviews","volume":"16","author":"Travert","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/978-981-97-2085-9_123","volume-title":"Handbook of Concepts in Health, Health Behavior and Environmental Health","author":"Njoku","year":"2026"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1136\/bmj.n1679","article-title":"Adapting interventions to new contexts\u2014the ADAPT guidance","author":"Moore","year":"2021","journal-title":"BMJ"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1737047","DOI":"10.3389\/frhs.2026.1737047","article-title":"Balancing fidelity and flexibility: a case study presentation of an augmented dynamic adaptation process for socio-technical innovations in healthcare","volume":"6","author":"Sullivan","year":"2026","journal-title":"Front Health Serv."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1016\/S0140-6736(19)30041-8","article-title":"Health effects of dietary risks in 195 countries, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"393","author":"Afshin","year":"2019","journal-title":"Lancet"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1093\/jn\/nxz158","article-title":"The relative caloric prices of healthy and unhealthy foods differ systematically across income levels and continents","volume":"149","author":"Headey","year":"2019","journal-title":"J Nutr"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e0342108","DOI":"10.1371\/journal.pone.0342108","article-title":"Facilitators and barriers of physical activity, sedentariness and exercise adoption among healthcare professionals in Lagos state, Nigeria\u2013a qualitative review","volume":"21","author":"Maduafokwa","year":"2026","journal-title":"PLoS One"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1767861","DOI":"10.3389\/fpsyg.2026.1767861","article-title":"Motivation and behavioral mechanisms of physical activity in community-dwelling elderly populations","volume":"17","author":"Wei","year":"2026","journal-title":"Front Psychol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e100490","DOI":"10.1136\/bmjopen-2025-100490","article-title":"Application of the socio-ecological model to understand the drivers of excessive alcohol and salt consumption: a qualitative study in Ghana","volume":"15","author":"Mensah","year":"2025","journal-title":"BMJ Open"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e70149","DOI":"10.1111\/scs.70149","article-title":"Exploring the experiences of individuals with type 2 diabetes in the context of alcohol use and lifestyle change: a phenomenological study","volume":"39","author":"Mantzouka","year":"2025","journal-title":"Scand J Caring Sci"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1750114","DOI":"10.3389\/fpubh.2026.1750114","article-title":"Factors influencing the implementation of workplace-based health interventions for non-communicable disease prevention: a scoping review","volume":"14","author":"Bhandari","year":"2026","journal-title":"Front Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"11786329251387227","DOI":"10.1177\/11786329251387227","article-title":"Workplace wellbeing in action: a qualitative exploration of a champion-led approach in healthcare","volume":"18","author":"Knezevic","year":"2025","journal-title":"Health Services Insights"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"ehag099","DOI":"10.1093\/eurheartj\/ehag099","article-title":"2026 ESC guidelines on cardiac rehabilitation: developed by the task force on cardiac rehabilitation of the European Society of Cardiology (ESC) endorsed by the European Society of Physical and Rehabilitation Medicine (ESPRM) and world Organization of Family Doctors (WONCA)","author":"B\u00e4ck","year":"2026","journal-title":"Eur Heart J"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1038\/s41746-025-02054-7","article-title":"Systematic review of dynamically tailored eHealth interventions targeting physical activity and healthy diet in chronic disease","volume":"8","author":"Hietbrink","year":"2025","journal-title":"NPJ Digit Med"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3390\/bs7030062","article-title":"A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients","volume":"7","author":"Pamungkas","year":"2017","journal-title":"Behav Sci"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/nyas.12844","article-title":"Family interventions to improve diabetes outcomes for adults","volume":"1353","author":"Baig","year":"2015","journal-title":"Ann N Y Acad Sci"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/1742395309352254","article-title":"Emerging models for mobilizing family support for chronic disease management: a structured review","volume":"6","author":"Rosland","year":"2010","journal-title":"Chronic Illn"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e003390","DOI":"10.1136\/fmch-2025-003390","article-title":"Global evidence on the effectiveness of task-shifting and task-sharing strategies for managing individuals with multimorbidity: systematic review and meta-analysis","volume":"13","author":"Gong","year":"2025","journal-title":"Fam Med Community Health"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"e0315027","DOI":"10.1371\/journal.pone.0315027","article-title":"Community health worker optimization of antihypertensive care in HIV (COACH): study protocol for a pilot trial of an intervention to improve hypertension care among Tanzanians with HIV","volume":"19","author":"Min Htike","year":"2024","journal-title":"PLoS One"}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.2025861","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1893222\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:56:12Z","timestamp":1792580172000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1893222\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":58,"alternative-id":["10.3389\/fpubh.2026.1893222"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1893222","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1893222"}}