The role of social media influencers in shaping destination image and intention to visit Jordan: The moderating impact of social media usage intensity

Social media influencers have become important motivators in shaping tourist attitudes and behaviors. This study analyzed how exposure to influencer content impacts key outcomes for the destination Jordan. A survey of tourists who visited Jordan in the past 3 years measured their perceptions of influencer credibility, content quality, awareness/interest, trust/engagement, destination image, general tourism behavior, and intentions to revisit. Results of SEM analysis found significant positive effects of influencer marketing on both destination image and visit intentions. Awareness/interest and trust/engagement were most impactful, highlighting influencers' role in sparking early motivation. Content quality additionally predicted visit intentions by informing decisions. Perceived credibility made recommendations more persuasive. Furthermore, usage intensity positively moderated the mediated relationships, amplifying effects among heavy social media users. Findings provide theoretical validation of how influencers act as digital opinion leaders. By enhancing destination image through compelling portrayals, influencers shape audience travel interests and behaviors. Managerial implications suggest destinations should invest in influencer campaigns for reach and inspiration while ensuring content quality. Performance tracking informs optimal platform and demographic targeting. Overall, influencer marketing demonstrated significant persuasive appeal for potential tourists. This quantitative study pioneer’s measurement of influencer marketing's tangible impacts on key tourist metrics. The results empirically substantiate the ability of strategically leverage influencers to motivate visitation and guide decision-making. As practitioners refine partnerships for audience growth and branding, academic research must also advance a nuanced understanding of this emerging phenomenon at the confluence of social media and tourism consumer behavior

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely