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Article History

Received: 28 July 2025

Accepted: 8 April 2026

First Online: 23 April 2026

Competing interests

: The authors declare no competing interests.

: This study was performed in line with the principles of the Declaration of Helsinki. Regarding the timeline of ethical approval, preliminary informed consent materials were distributed to participants on 01/03/2025, prior to the formal ethical approval granted by the Academic Ethics and Ethics Committee of Nanjing University of Posts and Telecommunications on 15/04/2025 (No. 2025B011). While this timeline categorizes the approval as retrospective relative to the initial participant contact, this specific procedural sequence was strictly mandated by local institutional guidelines and national regulations. According to Article 11 of the ’Measures for the Ethical Review of Biomedical Research Involving Human Subjects’ (issued by the National Health Commission of the PRC, revised in 2016), investigators are legally required to prepare and submit the informed consent materials as a mandatory prerequisite for the formal ethical review application. The preliminary consent process was conducted solely for regulatory compliance, and no experimental data were collected during this phase. Furthermore, during the formal data collection phase in May 2025, informed consent was strictly executed and re-confirmed in accordance with the granted ethical approval. As detailed in the Informed consent section, participants were required to carefully read the study instructions and click an “agree and continue" button before formally completing the questionnaire. This digital consent interface explicitly informed participants of the research purpose, data usage, privacy protection principles, and their right to voluntarily participate or withdraw at any time. This process fully guaranteed the participants’ right to information and autonomy. All collected data were completely anonymous, ensuring the ethical risk associated with this study remained extremely low.

: All participants gave their written and digital informed consent. Participants were clearly informed about the following key aspects: (i) confidentiality, wherein personal information provided by the participants would remain confidential and would not be published or disclosed; and (ii) use of data, wherein the data collected from the participants would be exclusively utilized for academic research purposes and not for any commercial activities. To proceed with the study, participants had to carefully read the instructions at the beginning and click the “agree and continue" button before formally filling out the questionnaire. The preliminary informed consent materials were distributed on March 1, 2025, and the formal digital consent was re-confirmed prior to actual data collection in May 2025.