Caregiver-reported experience of integrated care for children with special health care needs and its sociodemographic, health- and network-related correlates in Germany: Cross-sectional results from t

With an estimated global prevalence of 30%, the metabolic dysfunction-associated steatotic liver disease (MASLD) has already become the most concerning chronic liver diseases worldwide []. Generally, MASLD is primarily characterized by progressive intrahepatic fat accumulation, driven by a complex interplay of risk factors including gut microbiota alterations, unhealthy lifestyle behaviors, genetic susceptibility, and multimorbidity []. Increasingly high prevalence worsens the difficulty in management of patients with MASLD, contributing MASLD to the second leading causes of end-stage liver diseases [,]. Additionally, there are various extrahepatic complications associated with MASLD, such as obesity [], cardiovascular disease [], type 2 diabetes [], and so on. Given that numerous adverse outcomes exist and pharmacological options are limited to specific patient subsets [], lifestyle modification remains the cornerstone of therapy for all stages of MASLD []. Therefore, self-management interventions, which are designed to empower patients to adopt and maintain these crucial lifestyle changes, represent the primary therapeutic approach. Self-management interventions are inherently complex, multicomponent processes that necessitate continuous patient engagement in behavioral goal-setting, self-monitoring, and education []. Delivering these interventions solely through the conventional approach of in-person office visits has proven challenging and resource-intensive, which may reduce the effectiveness of lifestyle interventions over time. In contrast, intelligent information technology circumvents geographical and temporal boundaries, thereby enhancing accessibility and providing a foundation for adaptive, individualized patient support []. Therefore, the delivery system is evolving toward a more flexible hybrid model that combines in-person visits, web-based visits, or both []. A systematic review showed that lifestyle modification based on eHealth technologies for patients with MASLD is significantly effective for clinical outcomes and biological markers, such as BMI, aspartate aminotransferase, and alanine aminotransferase []. However, despite this comparable efficacy, these emerging digital tools grapple with significant difficulties in achieving adequate patient uptake and maintaining long-term engagement, which critically limits their ultimate therapeutic potential. Digital health care programs possess an inherent advantage over traditional trials in measuring engagement, as objective measures of intervention usage are readily available to researchers. In that, the conception of retention and adherence deserves more attention. Retention refers to the proportion of participants who remain enrolled and complete the study or intervention follow-up, reflecting trial-level feasibility and continuity []. In contrast, adherence denotes the extent to which participants engage with the intervention as intended, which is typically operationalized using metrics such as task completion, log-in frequency, or duration of use []. Unfortunately, existing systematic reviews of digital interventions for MASLD have focused predominantly on clinical effectiveness [,], reducing participant dropout to a mere denominator correction. Consequently, retention serves simply as a flow-diagram statistic for risk-of-bias appraisal, and adherence is typically evaluated in isolation. Crucially, the structural relationship between these 2 dimensions remains untheorized.