Virtual reality, face-to-face, and 2D video conferencing differently impact fatigue, creativity, flow, and decision-making in workplace dynamics.

Digital communication technologies are rapidly evolving, and understanding their impact on group dynamics and cognitive performance in professional settings becomes central. This study investigates the psychological impact of different interaction settings-two-dimensional Video Conferencing (VC), Face-To-Face (FTF), and Virtual Reality (VR)-on group dynamics, cognitive performance, and aspects of well-being in a professional context. Utilizing a sample of 40 participants from a large Italian electricity transmission company, the study employs a within-subjects design to explore various metrics, including flow, creativity, fatigue and aspects of interaction. The results indicate that FTF interactions are optimal for idea generation and task absorption. VR, although initially more fatiguing for first-time users, fosters a more collaborative and peaceful environment, encouraging participants to engage more openly with each other. VC was found to be the least fatiguing, but also the least engaging in terms of task absorption and idea generation. Additionally, age-related differences were observed, particularly in the perception of motivational and emotional fatigue in the VR setting. The study provides empirical evidence supporting the integration of VR in professional settings for specific types of meetings, while also highlighting the limitations and areas for future research. These findings have implications for organizational well-being, cognitive ergonomics, and the evolving landscape of remote work technologies.

A Virtual Communication Workshop to Increase Confidence Using Telehealth Modalities.

INTRODUCTION: COVID-19 ended in-person communication training workshops at our institution, so we sought to provide a way for family medicine residents to hone their telephone and audio-visual skills online. METHODS: We developed a 2-hour online workshop where residents practiced delivering serious news to family members via telephone or videoconferencing call and measured participant confidence via pre-, post-, and 6-month surveys. RESULTS: Participant confidence in delivering serious news via telephone and videoconferencing increased. Sustained confidence at 6-month follow-up was not confirmed. DISCUSSION/CONCLUSIONS: Offering an online opportunity to practice delivering serious news by telephone or videoconferencing call appears to be a successful way to bolster confidence. Participants found using realistic scenarios and discussion of best practices most helpful.

Long-term care staffs' experience in facilitating the use of videoconferencing by cognitively impaired long-term care residents during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: During the COVID-19 pandemic, numerous long-term care (LTC) homes faced restrictions that prevented face-to-face visits. To address this challenge and maintain family connections, many LTC homes facilitated the use of electronic tablets to connect residents with their family caregivers. Our study sought to explore the acceptability of this practice among staff members and managers, focusing on their experiences with facilitating videoconferencing. METHODS: A convergent mixed method research was performed. Qualitative and quantitative data collection through semi-structured interviews to assess the acceptability of videoconferencing in long-term care homes and to explore the characteristics of these settings. Quantitative data on the acceptability of the intervention were collected using a questionnaire developed as part of the project. The study included a convenience sample of 17 staff members and four managers. RESULTS: Managers described LTC homes' characteristics, and the way videoconferencing was implemented within their institutions. Affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, and self-efficacy are reported as per the constructs of the Theoretical Framework of Acceptability. The results suggest a favorable acceptability and a positive attitude of managers and staff members toward the use of videoconferencing in long-term care to preserve and promote contact between residents and their family caregivers. However, participants reported some challenges related to the burden and the costs regarding the invested time and staff shortage. CONCLUSIONS: LTC home staff reported a clear understanding of the acceptability and challenges regarding the facilitation of videoconferencing by residents to preserve their contact with family caregivers.

"It gave me a sense of achievement and a sense of purpose"-a qualitative study of patient experiences of a virtually supervised exercise program for adults with advanced cancer and cachexia.

People with advanced cancer and cachexia experience significant body weight loss, adversely impacting physical function and quality of life (QOL). Effective, evidence-based treatments for cancer cachexia are lacking, leaving patients with unmet needs. Exercise holds promise to improve patient QOL. However, information on patients' experiences of exercise, including their ability to cope with structured exercise, is limited. PURPOSE: To explore patient experiences completing a structured, supervised exercise program for people with cachexia due to advanced cancer. METHODS: Semi-structured interviews were conducted with participants enrolled in a phase II feasibility, randomized controlled trial to explore their experiences of an 8-week virtually supervised exercise program delivered via videoconference technology. Interviews were analysed using reflexive thematic analysis. RESULTS: Seventeen participants completed interviews (female n = 9, 53%). Main interview themes included the following: (1) Deciding to exercise involves balancing concerns and expectations, (2) the exercise program is a positive experience, and (3) moving forward after the exercise program. While some participants initially held doubts about their physical capabilities and exercise safety, most wanted to exercise to enhance their wellbeing. Participants described the exercise program as a positive experience, offering diverse benefits. Some would have preferred in-person exercise, but all agreed the virtual format increased convenience. Participants emphasized the need to recommend the program to others in similar circumstances. They underscored the necessity and desire for ongoing support to sustain their new exercise habits. CONCLUSION: Based on patient experiences, virtually supervised exercise programming appears to be feasible and meaningful to people with advanced cancer and cachexia.

Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial.

Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.

The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis.

OBJECTIVE: The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS: We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS: The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION: Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.

Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial.

BACKGROUND: Chronic heart failure (CHF) poses a significant burden on both patients and their family caregivers (FCs), as it is associated with psychological distress and impaired quality of life (QOL). Acceptance and Commitment Therapy (ACT) supports QOL by focusing on value living and facilitates acceptance of psychological difficulties by cultivating psychological flexibility. A protocol is presented that evaluates the effectiveness of a dyad ACT-based intervention delivered via smartphone on QOL and other related health outcomes compared with CHF education only. METHODS: This is a single-center, two-armed, single-blinded (rater), randomized controlled trial (RCT). One hundred and sixty dyads of CHF patients and their primary FCs will be recruited from the Cardiology Department of a hospital in China. The dyads will be stratified block randomized to either the intervention group experiencing the ACT-based intervention or the control group receiving CHF education only. Both groups will meet two hours per week for four consecutive weeks in videoconferencing sessions over smartphone. The primary outcomes are the QOL of patients and their FCs. Secondary outcomes include psychological flexibility, psychological symptoms, self-care behavior, and other related outcomes. All outcomes will be measured by blinded outcome assessors at baseline, immediately post-intervention, and at the three-month follow-up. Multilevel modeling will be conducted to assess the effects of the intervention. DISCUSSION: This study is the first to adopt an ACT-based intervention for CHF patient-caregiver dyads delivered in groups via smartphone. If effective and feasible, the intervention strategy and deliverable approach could be incorporated into clinical policies and guidelines to support families with CHF without geographic and time constraints. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04917159. Registered on 08 June 2021.

Tailored videoconferencing counselling program to support family carers of people living with dementia during the transition to permanent residential care: a pilot and feasibility randomised trial.

BACKGROUND: Decisions surrounding the permanent residential care placement of people living with dementia can be stressful and distressing; however, providing access to targeted information and support prior to placement may help carers better cope. This mixed methods study aimed to test the feasibility, acceptability, and potential benefits of providing a tailored, individual counselling program (the Residential Care Transition Module), delivered via videoconferencing, to Australian family carers of a relative with dementia during the transition to permanent residential care. METHODS: A total of 18 family carers were randomly allocated to receive either the counselling intervention (six sessions delivered over 12 weeks) or a check-in call, delivered by a trained Transition Counsellor. Both groups received help-sheets about residential care, coping with placement, and managing feelings. Carers completed online surveys about stress, guilt, anxiety, depression, grief, and support for caring at baseline and four months post-baseline. Carers were also invited to participate in semi-structured exit interviews, conducted after follow-up surveys were completed. Process data relating to recruitment, retention, intervention dose and delivery were collected via logs. Quantitative data were analysed using descriptive statistics and repeated measures ANOVA. Qualitative data, relating to feasibility, acceptability, and perceived benefits of the program, were analysed using the 'framework' approach developed by the Medical Research Council to inform the process evaluation of complex interventions. RESULTS: Qualitative findings indicated that delivery of the counselling program during the transition period was deemed by participants to be feasible and acceptable. Delivery via videoconferencing was deemed convenient and acceptable, with few technical issues. The skills and knowledge of the Transition Counsellor were perceived to be important mechanisms of impact. Though not statistically significant, promising quantitative findings were identified in terms of reduced carer stress and guilt and improved support for caring. CONCLUSIONS: Delivery of a tailored counselling program via videoconferencing to family carers of people living with dementia during the transition to residential care was feasible and acceptable. The program has the potential to improve transitional support to family carers. TRIAL REGISTRATION: This study was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12621001462875.

Medical specialists' use and opinion of video consultation in Denmark: a survey study.

BACKGROUND: The COVID-19 pandemic accelerated the use of telemedicine which is seen as a possibility to reduce the pressure on healthcare systems globally. However, little research has been carried out on video as a consultation medium in medical specialists' practice. This study investigated the use of and opinion on video consultation among specialists in Denmark. METHODS: An online survey on use of video consultation, as well as relevance of and opinion on video consultation, was distributed to all 963 medical specialists in private practice in Denmark throughout May and June 2022, resulting in 499 complete answers (response rate: 51.8%). Data were analysed using descriptive and logistic regression analyses, and data from open text fields were analysed using thematic network analysis. RESULTS: Among the respondents, 62.2% had never used video consultation, while 23.4% were currently using video consultation, most particularly among psychiatrists. A total of 47.3% found video consultation medically irrelevant to their specialty, especially radiologists, plastic surgeons, ophthalmologists and otorhinolaryngologists. According to the specialists, video consultation was most suitable for follow-up consultations and simple medical issues, where the patient had an established diagnosis. In these cases, mutual trust remained present in video consultations. Better access for the patients and fewer cancellations, especially for psychiatrists, were highlighted as benefits. IT problems were reported as obstacles hindering optimal use of video consultation. CONCLUSION: The political aspiration to digitization in healthcare systems should be rooted in professionals' and patients' perceptions and experiences with video consultation which emphasize that it is not a standard tool for all consultations.

A systematic review of synchronous telepharmacy service models for adult outpatients with cancer.

BACKGROUND: Telephone and videoconsults are known synchronous telepharmacy modalities being used to respond to the demand for outpatient pharmacy services. However, little is known about the evidence for cancer telepharmacy service models. OBJECTIVES: To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers, and barriers. METHODS: A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and EMBASE in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focused services was applied; data extraction and narrative analysis were then performed. RESULTS: From 2129 non-duplicate articles, 8 were eligible for inclusion, describing 7 unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment, and discharge follow-up. Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management, and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 726 telephone consults involved at least one intervention. When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 months vs 3.7 months, p = 0.001). Reported enablers included physician buy-in, staff resources, and correct utilisation of technology, while identified barriers included time investment required and technical issues. CONCLUSION: Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care.

Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study.

BACKGROUND: Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). OBJECTIVE: This study aimed to investigate patients' views on 1 ERP session at home via videoconference and its impact on treatment outcome. METHODS: A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. RESULTS: Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. CONCLUSIONS: Results highlight the importance of administering therapist-guided ERP sessions in patients' natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients' natural environment and foster the generalization of ERP conducted in clinical settings.

SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use.

INTRODUCTION: Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use. METHODS: Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion. RESULTS: Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement. CONCLUSIONS: Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.

Video consultation and treatment in the community smoking cessation therapy success rates in patients with mental illness: a randomized controlled trial.

PURPOSE: Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. MATERIAL AND METHOD: Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. RESULTS: Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. CONCLUSION: The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients' motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.

Parents' Experiences with Postpartum Support Groups using Videoconferencing: Perceptions of Safety in the Virtual Space.

PURPOSE: To explore new parents' experiences with web-based videoconferencing as a mechanism of offering postpartum virtual support groups. STUDY DESIGN AND METHODS: Virtual support sessions and individual interviews were conducted to explore participants' experiences with virtual postpartum groups. RESULTS: Thirty-seven parents participated in seven virtual support sessions and 19 participated in individual interviews. Participant narratives centered on perceptions of safety when engaging in virtual support groups. Tools within the virtual space (camera; mute) created a relational paradox which provided safeguards but also hindered the building of trust. Participants described negotiating the fear of harm and judgment within virtual spaces alongside feelings of security in connecting from the safety of their homes. CLINICAL IMPLICATIONS: The virtual environment provides a forum for new parents to access information and support and an avenue for engagement with maternal child nurses and care providers. Awareness of how parents perceive safety in the virtual environment is an important part of facilitating and structuring parent groups on videoconferencing platforms. Nurses should be familiar with videoconferencing technology and be able to guide parents. Experience facilitating virtual groups to ensure safety and security while providing needed support is a valuable nursing skill.

Cognitive, psychological, and physiological effects of a web-based mindfulness intervention in older adults during the COVID-19 pandemic: an open study.

BACKGROUND: The development of effective strategies to maintain good mental health of older adults is a public health priority. Mindfulness-based interventions have the potential to improve psychological well-being and cognitive functions of older adults, but little is known about the effect of such interventions when delivered through internet. During the COVID-19 pandemic we evaluated short- and long-term cognitive, psychological, and physiological effects of a mindfulness-based intervention (MBI) delivered via web-based videoconference in healthy older adults. METHODS: Fifty older adults participated in an 8-week MBI, which comprised structured 2-h weekly group sessions. A comprehensive evaluation encompassing cognitive (verbal memory, attention and processing speed, executive functions) and psychological assessments (depression and anxiety symptoms, mindfulness, worries, emotion regulation strategies, well-being, interoceptive awareness and sleep) was conducted. Additionally, electroencephalography (EEG) data were recorded before and after the MBI and at the 6-month follow-up (T6). Data were analyzed using an intention-to-treat approach, using linear mixed models adjusted for age. The effect size for time was computed as omega squared. RESULTS: We observed significant improvements from pre-MBI to post-MBI and at the T6 across several measures. These improvements were notable in the areas of verbal memory (California Verbal Learning Test, p ≤ .007), attention and executive functions (Trail Making Test A and BA, p < .050), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, p = .0002 for self-regulation and p < .05 for noticing, body listening, and trusting dimensions), and rumination (Heidelberg Form for Emotion Regulation Strategies, p = .018). These changes were associated with low to medium effect size. Moreover, we observed significant changes in EEG patterns, with a decrease in alpha1 (p = .004) and an increase in alpha2 (p < .0001) from pre-MBI to T6. Notably, improvements in TMTBA and rumination were correlated with the decrease in alpha1 (p < .050), while improvements in TMTA were linked to the increase in alpha2 (p = .025). CONCLUSIONS: The results of our study show that a web-based MBI in older adults leads to improvements in cognitive and psychological measures, with associated modulations in specific brain rhythms. While these findings are promising, further controlled studies are required to validate these preliminary results. TRIAL REGISTRATION: The trial has been registered with the United States National Library of Medicine at the National Institutes of Health Registry of Clinical Trials under the code NCT05941143 on July 12, 2023.

Use of telehealth for paediatric rehabilitation needs of Indigenous children - a scoping review.

Telerehabilitation is proposed as a promising avenue to enhance service accessibility for Indigenous communities, yet its application for Indigenous children remains relatively unexplored. This scoping review followed the PRISMA-ScR framework to explore current knowledge on the use of telerehabilitation for Indigenous children. Ten scholarly databases, seven grey literature databases, reference searches, and expert consultations were utilised to identify relevant studies. Included articles discussed the use of telerehabilitation provided by rehabilitation professionals (e.g. occupational therapist (OT), physical therapist (PT), speech and language pathologist (SLP) to Indigenous children and/or caregivers. Seven studies were included. Telerehabilitation was explored in different ways, the most common being real-time videoconferencing by SLPs. While some studies explicitly acknowledged cultural responsiveness within both the research process and the intervention, most were not designed for Indigenous children and their caregivers; rather, these participants were included with non-Indigenous participants. Successful implementation and sustainability of telerehabilitation services requires addressing technological limitations, understanding, and respecting diverse worldviews, and co-developing services to meet the unique needs of Indigenous families. Telerehabilitation has been rarely used with Indigenous children and when it was, little attention was given to cultural considerations. These findings emphasise that future telerehabilitation interventions should be truly community-led to ensure cultural relevance.