BACKGROUND
Globally, there is an urgent need to scale up rehabilitation services to meet growing demand to address health inequities, particularly in remote and isolated areas. Digital technologies, particularly tele-rehabilitation, offers a promising solution to bridge this gap by enhancing patient access, outcomes, and cost-effectiveness. The ROSIA (Remote Rehabilitation Services for Isolated Areas) project, a pre-commercial procurement (PCP) initiative funded by the European Commission, has spent 4.5 years driving market innovation and delivering digital solutions that foster an integrated ecosystem for remote rehabilitation, ultimately enhancing patient outcomes.

APPROACH
ROSIA project involved 12 partners across five countries – Ireland, Spain, Portugal, Netherlands, Denmark. With an aim develop a scalable, value-based model of care and promoting supported self-management of rehabilitation and grounded in a tailored integrated care model designed to optimise both quality of care and clinical resource utilisation. The PCP framework mandated an iterative three-phase approach. Phase 1 focused on comprehensive co-creation and design with patients, clinicians, and technical partners. Phase 2 saw the development and prototyping of innovative digital solutions. Phase 3 advanced the field testing of two solutions, and recently concluded and with patient groups from the National Rehabilitation Hospital (NRH) in Ireland, Servicio Aragonés de Salud in Spain, and Centro Hospitalar e Universitário de Coimbra in Portugal.

RAISE and REHABILIFY platforms targeted outpatients undergoing rehabilitation programmes; and an example from NRH were patients with an acquired brain or spinal cord injury. For assessing the ‘system usability’ of these platforms the System Usability Scale (SUS) - a validated 10-item questionnaire with 5-point Likert scale; was disseminated to patients and clinical teams. The SUS tool was one of three tools identified as measurable indicators towards KPI’s (Key Performance Indicators) and set as a quantifiable deliverable for both solutions providers to compete.

RESULTS
With percentage changes ranging from 48.5% to 60.93%; the initial findings from the SUS data collated from patients across all three sites; show a substantial improvement in patient-related behaviours; including adherence, perceived autonomy, and ease of self-management. The consistent achievement across NRH, SALUD Aragón, and CHUC indicates a project-wide success in promoting greater patient engagement and self-care compared to the estimated baseline. However, for clinical teams across the regions the results from SALUD Aragón showed a 0% satisfaction rate: with NRH in Ireland reporting only 12.5% and both falling short of the 25% target.

IMPLICATIONS
ROSIA’s innovation set out to addresses global challenges in health equity and the need to scale up rehabilitation services to strengthen value-based integrated care targeting geographically isolated populations. ROSIA’s Phase three pilot sought to bridge the gap from hospital to home; and validate an innovative and user-friendly tele-rehabilitation platform supporting continuous care for patients at home. Despite positive feedback from patient groups, significant challenges were reported from clinical teams,; and related to platform usability, technical support, and organizational factors. These, and other KPI's may limited the solution's perceived value and acceptance among the healthcare professionals and exploitation of a solution/s. Further analysis is required to understand wider ‘validation’ hurdles on tech-driven telerehabilitation innovation.

Background:
Recruiting and retaining healthcare professionals in rural and island areas remains one of Scotland’s greatest challenges, directly impacting access, equity, and the sustainability of services. The NHS National Centre for Remote and Rural Health and Care (established in 2023) leads a coordinated national response to these challenges through research, evaluation, and innovation programmes focused on strengthening the rural health and care workforce. One such initiative—the Skye Community-Engaged Recruitment Group—has pioneered a model of locally driven, system-supported recruitment and retention that integrates community engagement into workforce planning. This work aligns with the Sustainable Development Goals (SDGs), particularly those addressing reduced inequalities and improved health and wellbeing.

Approach:
The National Centre has developed a Menu of Options for Improved Recruitment and Retention, mapping evidence-informed, contextually adaptable strategies for workforce attraction, induction, and retention across Scotland’s rural, remote, and island (RRI) settings. This includes mechanisms for community participation, such as the “Living Library” (developed in collaboration with the University of Aberdeen and rural communities), which documents practical tools and examples of community-enhanced recruitment. The Skye model, evaluated through co-designed qualitative and developmental approaches, provides a transferable framework underpinned by five evaluation dimensions: Effectiveness, Impact, Relevance, Efficiency, and Sustainability (EIRES).

Results:
Findings indicate that structured community involvement strengthens the visibility and attractiveness of rural posts, supports early integration of new staff, and enhances professional belonging. The evaluation framework developed through this collaboration provides a replicable tool for assessing the effectiveness and sustainability of community-engaged workforce initiatives. Early insights from testing the framework suggest improved coordination between communities and health boards, greater local ownership, and enhanced workforce resilience.

Implications:
Embedding community insight within workforce policy and practice can transform recruitment from a transactional to a relational process. The National Centre’s programmes illustrate how community-engaged models can contribute to achieving equitable, sustainable rural health systems by addressing workforce gaps at both structural and human levels. The next phase involves scaling and adapting the framework across diverse rural contexts in Scotland, offering an evidence-based, SDG-aligned model for regions worldwide seeking to strengthen integrated rural health and care systems.

The phenomenon of ‘person-centred integrated care’ (PCIC) emerged in literature, policy and practice to meet the increasing care needs of a growing older population. This population is living longer with increased levels of complex chronic illness and multimorbidity and at enhanced risk of care fragmentation. Person-centredness is considered a core element of integrated care and quality care (WHO, 2021) and integrated care is central to person-centred care (PCC) (Institute of Medicine, 2001). Despite the desirability of the PCIC approach, progress has been slow (Greenfield et al, 2014; Riste et al, 2018). Evaluations of PCIC have tended to be service-centred in terms of their focus on outcomes and assessment of successful practice, rather than person-centred (Liljas et al, 2019; Berntsen et al, 2018; Greenfield et al, 2014). There is a marked lack of research on the effects of integrated care and its person-centred outcomes on service users (Baxter et al, 2018), including older people. There is also a recognised knowledge gap regarding experiences of PCIC or PCC in the context of integrated care. This knowledge gap is particularly true for older people, with few qualitative research studies focusing on their lived experiences of and perspectives on PCIC. This study sought to address these knowledge gaps regarding the successful application of person-centredness in integrated care contexts and older people’s PCIC experiences.

This study explored older peoples’ PCIC experiences in the context of the Irish National Integrated Care Programme for Older People (NICPOP), applying the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2021) as its overarching theoretical framework. Its four research objectives were: i) to explore the nature of relationships experienced within integrated care; ii) to explore the integration of personhood within PCIC; iii) to ascertain the enablers and barriers to the delivery of PCIC; and iv) to identify the outcomes of PCIC. Using qualitative multi-case study methodology, the research design consisted of focus groups with three multidisciplinary staff teams at sites using diverse care models; staff summaries relating to care interventions; and 29 semi-structured interviews with 33 older people and carers.

Following reflexive thematic analysis, ten themes articulated the experiential dimension of PCIC: 1) Feeling under an umbrella; 2) Being cared for holistically; 3) Knowing that someone has my back; 4) Being able to trust the system over time; 5) Being seen and known in my own home; 6) Being supported to live well independently; 7) Knowing what to expect from integrated care; 8) Feeling involved in my care; 9) Enjoying care; and 10) Being supported as a carer. The six key insights of this study were: 1) the importance of holistic PCIC approaches informed by lived experience and psychosocial context; 2) PCIC optimises care experiences and supports older people to live well independently; 3) Experiences of coordination and management continuity of care are essential for positive PCIC experiences; 4) Significance of relational care and therapeutic relationship between staff and older person; 5) Feeling involved and enjoying care as central outcomes of PCIC; and 6) Carers as service users with PCIC needs.

Background:
Obesity is a complex societal health issue affecting nearly 30% of Canadians. Beyond its clinical definition, people living with obesity (PLWO) experience persistent social and structural barriers that influence their wellbeing. As nearly half of the determinants of health for PLWO are socio-economic, effective responses require collaboration beyond healthcare systems. In this context, a participatory research initiative, led by a citizen and a researcher, was launched to co-create the first intersectoral learning community for, with, and by PLWO in a rural region of Québec.

Approach:
Using a participatory qualitative design, this study applied a participant-observation approach to analyse interactions and collaboration dynamics among actors engaged in three co-design workshops (March–June 2025). The analytical framework drew on Bilodeau, Parent, and Potvin’s model of effective intersectoral collaboration, identifying six key conditions for successful intersectoral collaboration. Twenty-two participants from health, community, municipality, and patient-partner sectors took part. Methods included structured observation grids, field notes, and audio recordings, thematically coded with NVivo using a deductive approach and triangulated analysis.

Results:
The workshops fostered active engagement across diverse stakeholders and revealed the evolution of collaborative dynamics. Patient partners initiated most discussions and played a central leadership role. Exchanges evolved from broad ideas in the first workshop to context-adapted solutions in the second. The online session showed reduced engagement, highlighting the importance of in-person interaction. The persona method proved to be a key facilitator for grounding discussions in lived experience and stimulating creative solution-oriented dialogue, leading to concrete cross-sector partnerships particularly between health and community actors. Missing representation from the education sector was identified as a gap for future iterations. Across sessions, participants identified and expanded a repertoire of relevant local initiatives and initiated collaborations beyond the workshops, illustrating both the potential and fragility of sustained cross-sector engagement in rural settings.

Implications:
This study highlights how a structured, participatory learning community can strengthen integrated, person-centred care for people living with obesity (PLWO), particularly in rural settings. The workshops led to the first cross-sector collaborations beyond the learning community, demonstrating how such approaches can enhance local capacity, empower people with lived experience, and promote integrated, equity-oriented care. The findings suggest that intersectoral collaboration, trust-building, and adaptive facilitation methods are essential for sustainable community partnerships. The model provides transferable lessons for integrated care initiatives that aim to embed co-design with people with lived experience and address other complex health issues requiring cross-sector collaboration.