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Article History

Received: 26 May 2025

Accepted: 22 October 2025

First Online: 25 November 2025

Declarations

:

: This study was approved by the Biomedical Ethics Committee of Xizang University (Approval No. ZDYXLL2024010). All procedures strictly adhered to the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection. For participants who were illiterate, the consent form was read by a trained interviewer in the presence of a literate witness. After confirming their understanding and willingness to participate, the participant provided a thumbprint, and the witness co-signed the form to document the consent process. For the small number of participants under the age of 18 ( n  = 9), a culturally appropriate consent procedure was followed in accordance with the protocols of the 7th National Health Service Survey. This involved obtaining verbal consent from the head of household (huzhu), who is recognized as the primary decision-maker within the family. The head of household was present during the consent process, and the minor’s own assent to participate was also secured. The study design, including participant recruitment and data handling protocols, followed internationally accepted standards for ethical research involving human subjects.

: Not applicable.

: The authors declare no competing interests.