Purpose Telehealth is increasingly recognized as a transformative tool in healthcare delivery, particularly in low-resource settings. However, empirical evidence on its impact, especially in educational contexts within developing countries, remains limited. This study’s objective is to investigate the influence of telemedicine and telehealth education on healthcare outcomes from the perspective of postgraduate students in Nigeria's first-generation universities. Design/methodology/approach A mixed-methods design was employed, integrating quantitative survey data from 380 postgraduate students and qualitative insights from 38 Key Informant Interviews (KIIs). The Perceived Impact of Telemedicine Questionnaire (PITQ) assessed perceptions across three domains: healthcare outcomes, telemedicine usage, and telehealth education. Quantitative data were analyzed using descriptive statistics and logistic regression, while qualitative data underwent thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings Participants reported generally high levels of perceived impact across all domains (mean scores: 2.85–2.93). Logistic regression indicated positive but statistically non-significant effects of both telemedicine (p = 0.071; OR = 1.76) and telehealth education (p = 0.118; OR = 1.54) on healthcare outcomes. Thematic analysis revealed strong support for digital health integration, alongside barriers such as infrastructure limitations and policy gaps. Research limitations/implications Several limitations affect the study's findings. This may reflect limited statistical power, possibly due to a small sample size or data collection constraints. Wide confidence intervals including the value of 1 (see Table 8) suggest the effects may lack robustness across contexts. The use of self-reported data introduces subjectivity, potentially affecting accuracy. Additionally, focusing on first-generation university students in a developing country limits generalizability. Future research should use larger, more diverse samples, include objective measures, and explore broader populations to better assess telehealth effectiveness. Practical implications Although statistical evidence of impact was inconclusive, both telemedicine and telehealth education show promise in enhancing healthcare access and professional preparedness. The findings underscore the need for expanded digital health infrastructure and curriculum integration to support Sustainable Development Goals (SDGs) on health and education in low-resource settings. Social implications Strengthening telehealth education within universities has important social implications for healthcare delivery and workforce preparedness. Incorporating practical, hands-on training and simulation-based learning can help bridge the gap between theoretical knowledge and real-world clinical practice. Improved telehealth literacy among future healthcare professionals could contribute to more equitable access to care, particularly in underserved and remote communities. Addressing technical limitations, internet connectivity challenges, and user training needs through collaborative efforts between academic institutions and healthcare providers may further enhance the societal acceptance and sustainability of telemedicine services. Originality/value This study adds value to the existing literature by examining telemedicine from an educational and outcome-oriented perspective, highlighting the relationship between telehealth training, user perceptions, and healthcare delivery effectiveness. Unlike prior studies that focus primarily on clinical implementation, this research emphasizes the role of structured telehealth education in shaping acceptance and utilization trends. The findings provide novel insights into the potential yet currently statistically limited impact of telemedicine, underscoring the need for system-level improvements in infrastructure, training, and interdisciplinary collaboration.

Purpose This paper aims to investigate how retirement and its duration affect functional health, using grip strength as an early biomarker of ageing. It examines the implications of pension policy and cultural context for physical functioning among older adults in Europe. Design/methodology/approach We analyse panel data from the Survey of Health, Ageing and Retirement in Europe, covering 2004–2019. A fixed effects instrumental variable (FE–IV) approach is employed, using eligibility for state pension age as an exogenous instrument to address endogeneity in retirement status. Findings Retirement improves grip strength, particularly among older women and in individualistic welfare regimes. However, extended time in retirement leads to functional decline, especially among men and in collectivist societies. These patterns suggest both health-promoting and health-risk phases within retirement, shaped by policy and cultural environments. Originality/value By linking pension eligibility rules with functional health outcomes across countries, this study provides governance-relevant evidence for designing retirement systems that support healthy ageing. Findings highlight the need for integrating physical resilience programs within retirement policy, tailored to national contexts and cultural norms, to reduce long-term health risks and promote equity in ageing.

Purpose Notwithstanding increased patient safety initiatives, adverse events and their impact on those involved continue. The strategic approaches adopted to manage safety by other high-intensity, high-risk and complex industries, such as aviation, have led to an increase in the systems approach for safety management in healthcare organisations. Professional expertise from members of the European Researchers’ Network for Second Victims (ERNST) highlighted that safety and the second victim phenomenon are interconnected across the healthcare ecosystem, extending beyond individual healthcare organisations. Design/methodology/approach Evidence from different sources, mainly the literature and practitioner professional expertise, was iteratively aggregated and analysed using theoretical systems-based approaches to conceptualise a framework for integrated safety in safety management systems in health. Findings A cross-sectional view of the healthcare organisation affected by adverse events was presented as a baseline. The whole system (system levels) approach, representing the healthcare system at the micro-, meso- and macro-level, adapting the model for integrated care, was then adopted. A safety-generating culture was considered to integrate and network across the levels of the healthcare system. The “system” (processes) approach, also considering external factors, was incorporated. This iterative conceptualisation led to a proposed framework for integrated safety. This framework was applied to systematically make recommendations for actions to support safety across the healthcare ecosystem. Originality/value Aggregation of evidence from the literature, together with expertise from professionals and iterative conceptualisation across models adopting the systems approach, led to a comprehensive framework for integrated safety in safety-management systems.

Purpose This study sheds light on the multi-dimensional impact of governance quality on child health outcomes, measured by the infant mortality rate (IMR) and under-5 mortality rate (U5MR), across 63 provinces in Vietnam from 2006 to 2021. The study aims to identify which governance dimensions most significantly influence these health indicators. Design/methodology/approach Using a panel dataset spanning 16 years, this study employs the fixed effects (FE) and the two-step system generalised method of moments (SGMM) estimators to analyse the relationship between various dimensions of governance quality and child health outcomes. Governance dimensions include local participation, vertical accountability, transparency, public administrative procedures, control of corruption and public service delivery. Findings The results indicate that overall governance quality has a stronger impact on U5MR than on IMR. Specific dimensions such as local participation, vertical accountability and public service delivery exhibit stronger effects on IMR, while transparency, public administrative procedures and control of corruption have a more pronounced impact on U5MR. Practical implications Policymakers should prioritize targeted governance reforms, focusing on dimensions with the most significant influence on specific child health outcomes, to optimize resource allocation and intervention strategies. Social implications Improved governance quality can enhance healthcare delivery, reduce mortality rates and contribute to broader social well-being, particularly in vulnerable communities. Originality/value This study offers a concise understanding of how different governance dimensions uniquely affect child health outcomes. It emphasizes the need for a multi-dimensional and tailored governance approach to effectively reduce child mortality rates in Vietnam and other developing countries.

Emerald Publishing is committed to the realization of a research and publishing environment built upon transparency, accessibility, and integrity. Accordingly, we have signed the Declaration to #DefendResearch, which aligns with our core values and long-standing mission to contribute to positive change in research and society more broadly.During this time of geopolitical instability, research and higher education face unprecedented challenges. In the United States, recent executive orders are disrupting research, education, and library programs, removing federally funded initiatives that support diversity, equity, and inclusion as well as green energy, climate, health, and other research domains. These measures have led to the termination of critical research grants and created uncertainty for researchers, faculty, librarians, and others who carry out and rely upon the benefits of research itself.#DefendResearch takes a stand against the defunding and censorship of academic research, advocating for the free exchange of ideas and the safeguarding of scholarly work from undue restrictions. This resonates deeply with our commitments to support authors in disseminating their work without fear of suppression.We believe that global research collaboration represents the optimal route to alleviating the numerous challenges facing the world today. Research holds the key to impactful change for the benefit of society, from advancing health care and technology to fostering social justice and environmental sustainability. Publication of rigorous, peer-reviewed research supports and amplifies voices from every setting, ensuring that every editor, reviewer, and author feels valued and respected, and the resultant publications are trusted by millions of readers around the world. In this context, we also restate our commitments to:the highest standards of publication ethicssupporting editorial teams, reviewers, authors, and the libraries who play a vital role in the dissemination of science, under the banners of academic independence and intellectual freedom.We have championed the democratization of knowledge for well over 50 years and are privileged to have published research that has significantly advanced the understanding of societal issues, contributing for example to:systemic approaches to gender equity that have improved healthcare outcomes for womenthe introduction of novel, inclusive education models that accommodate the diverse needs of all students, regardless of their backgrounds, abilities, or learning stylesstudies on class segregation that have informed policies to reduce inequality and promote social cohesionresearch on carbon capture and 3D printing that offer practical applications in reducing emissions and revolutionising manufacturing, making these technologies more accessible and equitablestudies on cryptocurrencies and fintech innovations that help transform global finance and traditional banking, improving financial inclusion and accessibility for underserved communities.The facilitation of rigorous research, real-world application, and impact underscores our approach: discoverable, impactful research that gives voices to diverse contributions.By standing together, the global community can successfully resist censorship, promote open dialogue, and ensure that academic freedom remains a cornerstone of scholarly communication. To quote Benjamin Franklin, one of the Founding Fathers of the United States, “An investment in knowledge pays the best interest.” In this spirit, we invite all those who participate in and engage with research to join together in supporting #DefendResearch.Emerald PublishingApril 2025

PurposeThis study is conducted to understand an emerging public health problem in the garb of polycystic ovarian syndrome (PCOS) that affects about 6–21% of women in reproductive age from a systems perspective.Design/methodology/approachThe research is conducted in two phases. In phase 1, 15 women suffering from PCOS were interviewed to generate a knowledge map using an interpretive phenomenological research approach. The emerging themes were divided into four categories, namely individual, familial, societal, organizational, medical and systemic. In phase 2, five workshops were conducted with six invited actors to generate a causal loop diagram (CLD) of PCOS. The Standards for Reporting Qualitative Research (SRQR) are used in this study.FindingsA CLD from an individual's perspective with implications on organizational, societal and system levels.Research limitations/implicationsAwareness of “lifestyle diseases” is increasing, and this research shall help future studies put PCOS in the larger psychosocial context. The geographical location of respondents can be a limitation, as the causal linkages could only be true for the research site.Practical implicationsThe CLD provides a comprehensive understanding of complex emerging phenomenon of PCOS.Social implicationsThe paper draws attention to factors such as frequently changing doctors, withdrawal from work, medication fatigue, inclination to adopt due to infertility, etc.Originality/valueThis is the first such paper laying out the causal relationships between factors at the individual levels and connecting them to societal, organizational and system levels. This mapping can be useful for policymakers and industry leaders to empathize with PCOS sufferers so that their working conditions can be managed better.

PurposeThis research contributes to a better understanding of the effects of public demographic and population policy. The study investigates whether a considerable increase in birth grants in 2006 in the Czech Republic resulted in a higher number of births.Design/methodology/approachTo quantify the effects, we work with the administrative, statistical daily data (1993–2016) on the number of births and use time series analysis tools. In particular, we estimate a time series regression model via the ordinary least squares (OLS) technique with robust standard errors, testing placebo effects and the differences between the trend-forecasted values in the absence of the grant change.FindingsOur results, spread over several time windows covering up to a ten-year period after the intervention, show that the intervention significantly and positively affected the number of births in the post-intervention periods. The evidence obtained from the econometric analysis of the time series clearly shows that after the demographic and population policy change, there was an average increase of 17–19 births daily when the data was analysed up to 2016. Therefore, the conclusion is that the policy intervention led to expected and desired policy outcomes.Originality/valueThe study provides the stakeholders and policymakers with an experience of the public policy aiming to support fertility, which has reached its expectations.

PurposeThe importance of consumer experience in service industries, particularly healthcare, is widely acknowledged as it captures the intricacies of quality management. In tandem with the emerging research trends that evaluate service excellence through user experience, this study renders a performance analysis of the dimensions of consumer experience that individually or collectively shape healthcare consumers’ perceptions of service quality.Design/methodology/approachA cross-sectional study was conducted across 13 mid-tier corporate hospitals to collect data from 438 patients. The data was processed through factor analysis in SPSS to confirm sample adequacy and factor extractability. Further, two independent multi-criteria decision-making (MCDM) tools, Fuzzy Technique for Order Performance by Similarity to Ideal Solution (F-TOPSIS) and Grey Relational Analysis (GRA), were executed to render performance analysis of identified factors.FindingsUsing F-TOPSIS, factors such as “information” and “hospital environment” received higher performance ratings, while items related to “communication with doctors” and “humanistic care” received lower rankings. Minor yet anticipated deviations were observed while verifying performance scores using GRA. Nonetheless, both outcomes exhibited a strong correlation coefficient of 97.14%, confirming analytical consistency.Originality/valueHitherto, such usages of hybrid MCDM techniques have rarely been executed to convey a clear understanding of consumers’ experiences in healthcare services. Moreover, the findings provide a clear insight into consumers’ key response areas, which can further be translated to maximize consumer gratification, thus assisting healthcare managers in improving service performance and clinical decision-making.

PurposeThe purpose of this paper is to estimate the possible impact of the COVID-19 pandemic on the hospitalization and hospital mortality of the patients with gallstone disease and chronic liver diseases (CLD) in the worst pandemic period in Ukraine.Design/methodology/approachA retrospective comparative analysis of annual reports data of all economy subjects, which conducted economic activity in medical practice for 2019 and 2021. Data was accepted from the Ministry of Health of Ukraine, the National Security and Defense Council of Ukraine (NSDC) and the State Statistics Service of Ukraine (SSSU).FindingsThe total hospitalization rates for diffuse liver disease and cholelithiasis significantly decreased during the peak of the COVID-19 pandemic in Ukraine, compared to the values of 2019. At the same time, the rates of in-hospital mortality for these diseases have significantly grown. Also, various proportions of similar trends were described in other countries during the first wave of the pandemic.Originality/valueThis paper highlights the fact that regulatory restrictions and the fear of the population of referring to healthcare facilities considering the high risk of getting an infection had significant disruption to medical care for patients with gallstone disease and CLD. Improving the management of medical resources and strengthening all kinds of institutions in the healthcare system must be thought about if similar challenges appear in the future.