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The widespread deployment of telehealth (TH) has been conducted in the absence of any clear understanding of how acceptable these devices are to patients. One potential limitation of the widespread deployment of TH is that patients may refuse. Moreover an understanding of the reasons for refusing to use TH devices will provide an understanding of the barriers.

This investigation from the Whole Systems Demonstrator (WSD) programme, a pragmatic cluster randomised controlled trial into the effectiveness of TH, examined reasons for patients in the intervention cohort of the trial refusing TH, and the potential barriers to its deployment.

Active rejection of the TH intervention was the most frequent reason for withdrawal. After examination of trial-related, health, socio-demographic, cognitive, emotional and behavioural factors, patients diagnosed with diabetes, as opposed to heart failure or chronic obstructive pulmonary disease, and patients’ beliefs about the acceptability of the intervention predicted whether or not they withdrew from the trial because of the intervention.

Beliefs that the TH intervention resulted in increased accessibility to care, satisfaction with equipment and fewer concerns about the privacy, safety and discomfort associated with using TH equipment predicted continued participation in the WSD trial. Findings suggest that potentially modifiable beliefs about TH predict those more likely to reject the intervention. These findings have important implications for understanding individual differences in the acceptance of TH and subsequent success in mainstreaming TH in healthcare services.

The ancient settlements of the M'zab Valley in Algeria, called ksour, are still being used by local inhabitants a thousand years after their construction. The main objective of this study was to discover why, despite the formation of new residential areas, these settlements have been able to survive and maintain their original functions.

The authors used the concept of living heritage sites as an analytical framework. The field data were collected through semi-structured interviews and analyzed through qualitative content analysis.

This study revealed that the reasons for the survival of these settlements were cultural and social rather than physical. Four main factors play a role in the survival of these settlements: (1) solidarity and unity among the inhabitants, (2) built environment as an ancestral heritage and a symbol of identity, (3) comfort and convenience in ksour and (4) social control and adherence to tradition. However, some concerns have arisen in recent decades that may endanger the viability of these settlements in the future, requiring more attention from the government.

While previous studies on urban heritage and World Heritage Sites (WHSs) have mainly focused on tourism development and conservation issues, this paper emphasized a less-studied aspect of these sites, i.e. continuity and sustainability. All previous studies on the WHSs of the M'zab Valley have addressed the traditional architecture and the climatic design of houses without sufficiently addressing other factors that have contributed to the sustainability and resilience of these settlements.