Logo: to the web site of Uppsala University

Introduction Childhood cancer and its treatment place substantial demands on parents, causing significant disruptions in multiple areas of life. Parents report psychological, psychosocial, and economic consequences related to their child’s illness. In Sweden, psychosocial support is available to parents via paediatric oncology care during cancer treatment; however, only a minority of parents have access to psychological support after treatment completion. Increasing and improving access to such support could enhance parental mental well-being and help prevent or alleviate negative consequences. One potential solution to provide support is the EJDeR intervention, a co-created workbook- and audio-administered, telephone-guided, low-intensity cognitive behavioural therapy (LICBT) intervention for parents of persons treated for cancer during childhood. Objectives are to examine the feasibility of (1) EJDeR delivered via workbooks, audio files and video case vignettes with telephone guidance from a parent guide, and (2) planned study procedures for a future superiority randomised controlled trial of EJDeR.

Methods and analysis This is a parallel-group, two-arm, pilot randomised controlled trial with a 1:1 allocation ratio. A Parent Advisory Board (PAB) contributes to the research. We aim to recruit 60 parents of persons diagnosed with cancer at age 0–18 years whose treatment was completed 3 months to 5 years earlier. Participants will be randomly allocated to EJDeR plus usual care or usual care alone. EJDeR is delivered over 12 weeks via workbooks, audio files and video case vignettes, with telephone guidance from a parent guide. We will examine feasibility outcomes related to procedural, intervention, and methodological uncertainties using a priori progression criteria following a GO-AMEND-STOP progression framework. We will measure clinical (mental well-being, symptoms of depression, anxiety, and post-traumatic stress) and health economic (health-related quality of life and societal resource use) outcomes at baseline, post-treatment (12 weeks), and follow-up (6 months post-treatment). Data analysis is primarily descriptive.

Ethics and dissemination This trial was approved by the Swedish Ethical Review Authority (Dnr 2025–09024-01, approval date: 2 February 2026). We will obtain written informed consent from all participants and disseminate findings in collaboration with the PAB through peer-reviewed publications, conference presentations, and non-academic dissemination activities such as co-writing plain language summaries and dissemination via childhood cancer organisations.

Trial registration number ISRCTN51549508.

Introduction Childhood cancer survival rates are not equal for all, with disparities existing both between and within low- and middle-income countries and high-income countries, particularly among ethnic minorities and children with migrant backgrounds. Factors such as cultural misunderstandings, language barriers and limited support networks can lead to delays in diagnosis and treatment challenges, which can result in poor health outcomes. Social determinants of health (SDoH), such as housing insecurity and poverty, may worsen these disparities. This protocol outlines a systematic review to examine childhood cancer survival in children with migrant backgrounds compared with non-migrants and to explore the SDoH associated with these survival outcomes.

Methods and analysis We will search MEDLINE (PubMed), Scopus, Web of Science, and Embase for relevant studies, with secondary searches of grey literature. Two reviewers will screen for observational studies, including longitudinal cohort, case–control, cross-sectional and registry-based studies, that report childhood cancer survival outcomes (eg, survival rates, HRs) for both migrant and non-migrant populations. A narrative synthesis will explore SDoH and their association with survival outcomes. If data allow, we will perform random-effects meta-analyses to estimate pooled survival outcomes. Subgroup analyses will examine factors such as geographic region, migration status and type of cancer.

Discussion Understanding factors contributing to childhood cancer survival disparities in migrant populations is critical for informing the development of targeted strategies to address them, ensuring all children, regardless of their migration status, have an equitable opportunity for effective care and improved outcomes.

Ethics and dissemination Ethical approval is not required for this study as it is based on previously published data and does not involve primary data collection. We will publish the results in peer-reviewed journals and present at academic conferences.

PROSPERO registration number CRD42024547239.

Background: Informal caregivers of people living with chronic kidney disease commonly experience mental health difficulties. However, there is currently limited access to scalable psychological interventions such as those using e-mental health platforms. Furthermore, there is an absence of such interventions tailored for this group of caregivers, which may limit acceptability.

Objective: To inform future e-mental health intervention development, this study aimed to explore preferences for e-mental health interventions among informal caregivers of people living with chronic kidney disease.

Methods: A total of 13 informal caregivers of people living with chronic kidney disease participated in semistructured interviews. Eligible informal caregivers lived in the United Kingdom and were recruited via nonprofit organizations and social media advertisements. Semistructured interviews followed a topic guide exploring caregivers’ e-mental health intervention preferences. Data were analyzed using manifest content analysis.

Results: A total of 4 categories and 13 subcategories were generated. “Design preferences” illustrates key intervention design features that were important to caregivers, such as involving caregivers and other interest-holders in the design process. “Content preferences” describes the information caregivers valued in an intervention, such as information about chronic kidney disease and resources to support caregivers. “Support preferences” reflects the characteristics of support caregivers preferred if support was available as part of the intervention, such as peer support and providing support that accommodates individual preferences. Lastly, “Dissemination preferences” describes methods caregivers recommended to promote intervention uptake, such as engaging communication strategies and trusted and accessible sources of information.

Conclusions: Caregivers identified a number of e-mental health intervention design and delivery preferences that should be considered when developing e-mental health interventions for caregivers of people living with chronic kidney disease. To ensure such interventions are acceptable, feasible, and relevant, co-design approaches should be adopted during the intervention development process.

People with dementia are living longer in the community and reliance on informal caregivers is increasing. Few studies have focused on the experiences of adult-daughter caregivers (daughter caregivers), who may have increased risk of depression and lack of support compared with spousal caregivers. We aimed to explore the experiences of accessing and receiving formal and informal support among daughter caregivers of people living with dementia in Sweden. We conducted semi-structured interviews with 23 daughter caregivers. A topic guide was used to explore experiences of accessing and receiving formal and informal support in their caregiving role. We analyzed the interviews using reflexive thematic analysis. We generated two themes: Types of support, and Mismatched support. The first theme, with subthemes Sharing experiences, Professional support, and Getting some relief, captured the caregiver support context with different types of support accessed and received by daughter caregivers, with peer support and informational support identified as important components of caregiver support. The second theme, with subthemes Lack of tailoring to daughter caregivers’ needs and Difficulties navigating support, captured how daughter caregivers perceived existing support to be inadequate to meet their specific needs and the complex structure of available support limited their opportunities to access support. Daughter caregivers experience a mismatch between the type of support accessed and received and their specific support needs. Support better tailored to the needs and situation of daughter caregivers of people with dementia in Sweden is required. The potential of utilizing peer support for caregivers warrants further research.

Introduction: In low- and middle-income countries (LMICs) such as Tanzania, non-adherence and treatment abandonment are major factors contributing to low childhood cancer survival rates. Providing guardians with reminders and information via an SMS intervention may increase adherence and reduce treatment abandonment. The purpose of the GuardiansCan project is to reduce guardians' abandonment of children's maintenance therapy for acute lymphoblastic lymphoma (ALL) in Tanzania, thereby increasing ALL survival rates in the country by developing and evaluating an SMS intervention. We report initial results from phase one of a mixed-method examination of public contribution activities in the GuardiansCan project. We aimed to: recruit guardians of children treated for ALL to a Guardian Advisory Board (GAB) to contribute to the design and conduct of Study II within the GuardiansCan project (Study II) and the wider GuardiansCan project; and examine the acceptability, feasibility, and impact of GAB members' contribution from the perspective of GAB members and public contribution coordinators (coordinators).

Methods: We adopted a convergent parallel mixed-methods design, using impact logs and semi-structured interviews, with data integrated at the point of analysis. During four workshops, GAB members provided suggestions and recommendations, which were recorded in impact logs. GAB members and coordinators were interviewed about the acceptability, feasibility, and impact of GAB members' contributions.

Results: Nine guardians were recruited. GAB members made 63 suggestions and recommendations, of which 50 (79%) were implemented. Semi-structured interviews resulted in seven categories: Meaning and value, Motivation and willingness to volunteer, Suggestions and areas for improvement, Barriers and challenges, Facilitators, Personal impact, and Research impact.

Conclusion: Findings suggest GAB members' contribution was acceptable and feasible, and had an impact on both the research and GAB members themselves. Findings can inform how to meaningfully involve public contributors in LMICs.

Anxiety and depressive disorders are global health challenges, placing a significant burden on adults and healthcare systems in low- and middle-income countries (LMICs), such as Ghana. Social determinants of mental health, including poor healthcare access and poverty, may be associated with their prevalence. However, a paucity of prevalence data poses challenges for intervention planning and resource allocation. This review aimed to (1) examine the prevalence of anxiety and depressive disorders and symptoms among adults in Ghana, and (2) explore social determinants of mental health potentially associated with anxiety and depressive disorders and symptoms. We searched electronic databases and secondary sources from inception until September 30, 2024. Meta-analyses were performed to estimate the pooled prevalence. Narrative synthesis explored social determinants potentially associated with anxiety and depressive disorders and symptoms. We included 38 studies (22,587 adults). Pooled point prevalence of anxiety and depressive disorders and symptoms was 40.3% (95% confidence interval [CI]: 31.8-49.4%) and 33.0% (95% CI: 27.7-38.8%), respectively. Most studies (37 studies) reported the prevalence of symptoms and not disorders. Social determinants of mental health, including educational attainment and urban environment, were associated with higher levels of anxiety symptoms, while ethnicity and traumatic experiences were associated with higher levels of depressive symptoms. There was a high degree of heterogeneity, and the majority of studies used self-report screening tools, which may have skewed prevalence estimates. More than a third of adults in Ghana were found to experience anxiety and depressive symptoms, and social determinants of mental health may be associated with prevalence. High-quality research and contextually appropriate interventions targeting the identified social determinants of mental health associated with anxiety and depressive symptoms are needed to reduce disparities and improve the mental well-being of adults in Ghana.

  Background

Collaborative data analysis (CDA) in qualitative research is an approach for working with public contributors as co-researchers in analysing data. Different approaches have been outlined in a Best Practice Framework for CDA: (1) consultation; (2) development; (3) application; and (4) development and application. Four characteristics of successful CDA are also presented; that the CDA process is: (1) co-produced; (2) realistic within available time and resources; (3) manageable for public contributors; and (4) effective in handling group dynamics and expectations. We adopted a development and application approach to CDA to analyse data from a qualitative study embedded within the single-arm feasibility trial ENGAGE, exploring the acceptability and feasibility of a cognitive behavioural therapy intervention (EJDeR) for parents of children treated for cancer, and study procedures.

Objectives

Overall aim: to describe and reflect on the CDA approach used. Specific objectives: to (1) describe the CDA approach used; (2) reflect on the CDA approach used and map reflections onto characteristics of successful CDA; (3) summarise the potential impact of the CDA approach used on findings; and (4) report the costs of the public contribution activities.

Methods

Three public contributors collaborated with three research team members to analyse 36 qualitative interviews using the Framework Method. Public contributors received training and supervision, completed all analysis steps, independently developed coding frameworks, applied them to the data and interpreted findings. Together with research team members, they took part in a workshop to reflect on the CDA approach used, with reflections mapped onto four characteristics of successful CDA.

Findings

In the reflection workshop, the CDA approach was described as including the characteristics of successful CDA, for example, that public contributors handled demands of the process well, and that relationships and power dynamics were well managed. Potential impact on findings included public contributors bringing in nuances to the analysis overlooked by research team members, for example, their analysis highlighted that participants in ENGAGE experienced difficulties differentiating between EJDeR and ENGAGE study procedures. Public contributors and research team members categorised data in slightly different ways. The total cost for public contribution activities was ≈21,963 EUR.

Conclusion

The CDA approach used extends the Best Practice Framework for CDA by providing an example of CDA adopting a development and application approach. Our description of the CDA approach used may inform other researchers interested in CDA, and contributes to ongoing conversations about embedding ethical and equitable public contribution throughout the research lifecycle.

Patient or Public Contribution

Public contributors and research team members contributed to the reflections described and writing, editing, and reviewing the manuscript.

Objectives

Experiences of daughter caregivers are underrepresented in the broader caregiving literature, with studies commonly focusing on spousal caregivers. We aimed to explore challenges experienced by daughter caregivers, reporting varying severity of depressive symptoms, of a parent with dementia in Sweden. This study is situated within a wider research program to inform the development of psychological support for this underserved caregiver group.

Method

Following a semi-structured topic guide, we interviewed 23 daughter caregivers. We used reflexive thematic analysis to analyze the interviews. We did not compare and contrast challenges expressed by daughter caregivers experiencing different levels of depression severity; however, symptom severity is reported to contextualize findings.

Results

We generated one overarching theme, Changing Roles and Expectations Over Time, and four themes: Caregiver Role – Expectations; Puzzle of Life – Balancing Roles; Relationship with the Parent – Reciprocity, and Anticipating the Inevitable – Loss and Grief. Daughter caregivers reported challenges balancing multiple roles, difficulties prioritizing their own well-being, relationship difficulties with their parent, and anticipatory grief, with challenges changing over the dementia trajectory.

Conclusion

Future research should explore support needs across specific phases of the dementia trajectory to inform the development of tailored psychological support.

Introduction

The health of underserved populations, including sexual and gender minority forced migrants, is a pressing global concern. Public contribution in research has the potential to enhance prioritisation and aid in intervention development, but has been criticised due to a lack of sufficient diversity and engagement with underserved populations.

Methods

The core research team conducted eight workshops together with eight experts by lived experience to prioritise and guide future peer support intervention research. Activities included brainstorming, pathway mappings, ranking procedures, storytelling exercises, photovoice sessions and individual open-ended writing sessions. Open-ended reflective meetings and manifest content analysis of material, as well as documentation, guided the progress towards final results.

Results

Peer support was identified as an intervention with the potential to reduce mental health burdens, enhance the capacity to integrate into society and provide access to basic needs. Peer support interventions aiming to reduce health inequities by promoting language proficiency and employment attainment were identified as prioritised areas. A range of considerations and barriers regarding the modality of interventions, the training of peer supporters and recruitment strategies needs further examination in research.

Conclusions

Our findings illustrate the importance of public contribution when planning research addressing support for underserved and marginalised populations. Public contribution efforts targeting underserved populations such as ours will help researchers gain an in-depth understanding of prioritised research questions and pragmatic study procedures. In regard to research for sexual and gender minority forced migrants, we recommend prioritisation of intervention development that promotes mental health and reduces loneliness through support from peers in group settings and from peer mentors, informational support and capacity-building.

Patient or Public Contribution

Representatives acting as experts by lived experience contributed as research partners throughout the procedures and workshops.