Development and psychometric validation of the NICU parental agency scale: a multicenter cross-sectional study.

Current dynamics in global health governance point to a growing engagement with traditional Chinese medicine (TCM) within systems of medical pluralism worldwide, a trend that also bears on ongoing discussions of Universal Health Coverage (UHC) (). The World Health Organization (WHO)’s inclusion of traditional medicine in the 11th Revision of the International Classification of Diseases (ICD-11) reflects this trend (), though it is worth being precise about what the inclusion means. The ICD-11 traditional-medicine chapter is an instrument for classification, statistics, and international comparison. It allows traditional-medicine services to be counted in a standardized way, which in turn helps generate reliable data on their safety and effectiveness. The WHO has stated that the traditional-medicine chapter “is neither judging nor endorsing the scientific validity of any Traditional Medicine practice or the efficacy of any Traditional Medicine intervention” (). We therefore treat ICD-11 here as an indicator of the scale at which TCM is already used internationally rather than as a verdict on its clinical value; indeed, its application has been reported in more than 100 countries (); meanwhile, the research on its pharmacological mechanisms, clinical efficacy, and international standardization () continues to grow. Crucially, evaluating therapeutic validity remains the domain of empirical science rather than administrative classification. In that empirical domain, the research on certain interventions has already become substantial. Acupuncture for chronic pain is the clearest case: an individual patient data meta-analysis of randomized trials, covering roughly 21,000 patients, found effects that exceeded sham treatment, persisted over time, and could not be reduced to placebo (). Even so, interventions with this degree of support still meet difficulty once they cross cultural boundaries. The obstacle, at some point, then, lies less in the evidence than in how the underlying knowledge is understood. This is a problem of comprehension rather than access. As discussed in the knowledge translation research (), this friction represents the psychological pressure generated when new health information conflicts with the deeply rooted cognitive schemas of the audience. The resistance, however, is not primarily linguistic. It reflects a deep epistemic divergence: that is, the tension between TCM’s holistic and dialectical logic and the reductionist and evidence-based framework that dominates the discourse of Western biomedicine. The medical system is supported by completely different epistemic and paradigm frameworks. The interaction of different systems in cross-cultural encounters may lead to information stagnation () and complicate effective information exchange, especially when biomedicine conflicts with traditional explanatory models (, ). Against this backdrop, redundant information input is insufficient to overcome the inherent structural resistance in different health belief systems. Unless this fundamental divergence is resolved, the ongoing efforts to reconcile unfamiliar frameworks may lead to cognitive overload and a decline in engagement. Therefore, even technically precise translations may fail to achieve effective communication because they are still conceptually disconnected from the audience’s existing health belief system. Many previous works have been conducted within the framework of the information-deficit model. It was assumed that higher terminology accuracy or wider data dissemination would linearly improve psychological acceptance (, ). This view, however, often overlooks the inherent cognitive friction arising from the collision of medical paradigms. In this context, the mere availability of information is not equivalent to the co-construction of meaning. Empirical observations further suggest that so-called accurate translation may itself trigger what can be described as epistemic fatigue. This term refers to a disconnection experienced by the audience when overwhelmed by conceptual barriers. Such fatigue becomes especially likely when translations impose a high cognitive load on audiences whose pre-existing cultural schemas conflict with the ontology of TCM.