Abductive Analysis Research Articles

How can we improve Comprehensive Geriatric Assessment for older people living with frailty in primary care and community settings? A qualitative study

ObjectiveWith advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (eg, hospitalisation). Evidence for comprehensive geriatric assessment (CGA), a multidimensional holistic model of care, is...

Patients in pain

Communication research on medical interaction has made inroads into how patients shape treatment outcomes as well as how physician presentation of treatment can shape patient acceptance or resistance. Pain is the number one reason patients visit primary care physicians. The overprescription of opioids for chronic pain remains a major public health problem in the US and constitutes a risk factor for opioid addiction. In this study, we investigated how primary care physicians communicate recommendations for alternatives to opioid treatments for patients with self-reported moderate to serious chronic musculoskeletal pain and examined the relationship between communication strategies and patient resistance to non-opioid treatment recommendations. We relied on a convenience sample of 35 video recorded visits in which musculo-skeletal pain was reported as moderate to severe (or over 5 on the pain scale). Using a combined approach of abductive analysis, conversation analysis and descriptive statistics, we show that physicians are less likely to face patient resistance when they frame their non-opioid pain treatment recommendation as novel and present the treatment as concrete and tailored to the patient’s problem.

University students' access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England.

In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy - that is, how different needs are deemed deserving of health service attention - was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.

Working with epistemic uncertainties: Emerging entanglements within conditional reimbursement practices

ObjectivesHTA agencies are experimenting with conditional reimbursement approaches allowing greater flexibility to cope with epistemic uncertainties generated by new health technologies and pharmaceuticals lacking evidence. While some research into promises and effects of conditional reimbursement is conducted, little empirical research investigates how such policies play out in practice. In this paper, we analyze two cases of conditional reimbursement in the Netherlands. MethodsCase studies were purposively selected. We conducted document analysis combined with semi-structured in-depth interviews (n = 28). We analyzed both case studies together through initial thematic analysis and additional abductive analysis. Results were verified through data triangulation. We performed a member check in which we presented our preliminary analysis during a reflection meeting with key stakeholders. ResultsWe identified three tensions in the practices of CED-schemes: proceduralism versus improvisation, steering professionals versus providing leeway, involving patients as data subjects versus legitimate stakeholders. These tensions explicate several sources of epistemic uncertainties that extend beyond methodological and more well-known socio-political pressures such as from industry on regular reimbursement decision-making process. We note the importance of improvisation work, of normative considerations, and of epistemic hierarchies. ConclusionsWe postulate that the emerging uncertainties within the practice of CED-schemes are to an extent unavoidable as they emerge from the necessarily interactive and normative nature of human relations. We conceptualize this with the notion of ‘epistemic entanglements’, which highlights how normative and scientific dimensions are interwoven in reimbursement decisions. As epistemic uncertainties are difficult to reduce and tame in practice the need for a more reflexive and inclusive approach to conditional reimbursement decision-making becomes apparent. Public interest abstractNew technologies and personalized medicines can have great health benefits for patients, but often not enough knowledge is available to assess whether these innovations live up to their expectations. At the same time, despite this uncertainty, governments need to make a decision about whether or not to reimburse these innovations. Many countries are experimenting with forms of conditional reimbursement: temporarily reimbursement of technologies until more evidence is collected regarding (cost-)effectiveness in practice. Although much literature addresses potential benefits and drawbacks of conditional reimbursement policies, few studies look into how such policies play out in practice. In our research we study two examples of conditional reimbursement practices. We show conditional reimbursement practices lead to three new tensions. We conclude that HTA agencies would benefit from approaches that recognize that evidence-development and normative considerations are intertwined.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder.

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Good Suggestion - But No! Innovation as the Struggle Between Different Roles and Perceptions in a Municipal Organisation

Collaboration has been increasingly recognised as a key for enhancing capacity, effectiveness, and spurring innovation in the public sector. The purpose of this paper is to study empirically how different perceptions and roles within an organisation handle a proposal from strategic management related to engaging a large municipality in collaboration with social entrepreneurs. The primary focus of attention is middle managers, as they stand out as a central counterpart to the administrative and political leadership. The data collection included in-depth interviews, observation and documents. An abductive analysis that combined empirical findings with theoretical insights showed that middle managers controlled positional and professional power bases, enabling them to block the formal lines of authority. The paper contributes to view innovation as a part of the struggle between different roles and perceptions within an organisation and to an explanation for the outcome resulting from different power bases.

Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle.

Quantitative measurement and analysis of glottic abduction is used to assess laryngeal function and success of interventions; however, the consistency of measurement over time has not been established. This study assesses the consistency of glottic abduction measurements across visits in healthy patients and anatomic factors impacting these measurements. Review of patients with two sequential flexible stroboscopic exams over seven months from 2019-2022. Images of maximal glottic abduction were captured and uploaded into and measured with ImageJ. Cadaver heads were used to assess the impact of visualization angles on glottic measurements with a monofilament inserted into the supraglottis of each cadaver as a point of reference. Comparisons were done with a paired T-test, T-test, or Mann-Whitney U test as appropriate. Fifty-nine patients and twenty-six cadaveric exams were included. Absolute change in maximum glottic abduction angle (MGAA) was 6.90° (95% CI [5.36°, 8.42°]; p < 0.05). There were no significant differences in change in MGAA by gender or age. Twenty percent of patients had a change of at least 25% in their MGAA between visits. Absolute differences in glottic angle between nasal side for cadaveric measurements was 4.77 ± 4.59° (p < 0.005)-2.22° less than the change in MGAA seen over time (p = 0.185). Maximal glottic abduction angles varied significantly between visits. Factors considered to be contributing to the differences include different viewing windows between examinations due to the position and angulation of the laryngoscope and changes in patient positioning, intra- and inter-rater variations in measurement, and patient effort. N/a Laryngoscope, 134:2793-2798, 2024.

Coaches’ Provision of Structure for Players’ Competence Development: Perspectives of Professional Soccer Coaches and Players in Norway

Developing athletes’ actual and perceived competence is critical to enhancing performance and considered central to coaching. According to self-determination theory, the provision of competence-supportive structure is critical for psychological need satisfaction, optimal motivation, and well-being. Coaches use of structure such as providing clear expectations, instructional guidance, and feedback are well-established coaching practices; however, little is known about how, and to what extent, these types of structure support or thwart players’ perceptions of competence, particularly in high-performance contexts. Five head coaches working in the highest soccer league in Norway, and three players from each of the participating head coach’s squads (N = 15) participated in semistructured interviews. Through abductive analysis, we generated five themes: structure to promote competence; coaching for competence development; relatedness support as a foundation for effective structure; freedom within structure is useful; and shared ownership of, and with, structure. The findings provide evidence that professional soccer coaches and players in this study desire and deliver structure. It is provided in an autonomy-supportive way and built on a relatedness supportive foundation. This study contributes new insight into the importance of competence-supportive structure in coaching, which coaches and those supporting the development of coaches may find useful.

Patient experiences with requests for medical assistance in dying: Perspectives of those with complex chronic conditions.

To explore experiences of patients who have complex chronic conditions (CCCs), such as fibromyalgia and chronic fatigue syndrome, when they request medical assistance in dying (MAID) in Canada. Qualitative study using semistructured interviews. Canada. Individuals with CCCs who had contacted any 1 of 4 advocacy organizations between January 21, 2021, and December 20, 2022, about requesting MAID for suffering related to CCCs or who had applied and been assessed for MAID. Interviews were conducted virtually (by video or audio) and recordings were transcribed. Thematic analysis was conducted in an iterative manner with abductive analysis. As interviews were completed, transcripts were reviewed and emerging themes were discussed at regular intervals. Sixteen individuals were interviewed. All spoke of long-lasting suffering that was unresponsive to an array of medical treatments. Although some participants had hoped to receive MAID immediately following the 90-day assessment period, many mentioned that approval would provide or had provided validation of their illness and a sense of control, especially should their illness become unbearable. Participants sharply distinguished between MAID and suicide, saying they preferred MAID because it offered greater certainty and caused less emotional pain to others. Many said that participating in this research was beneficial because they believed the interviewers truly listened to them. Participants described experiences with CCCs and requests for MAID. This information may provide family doctors with new insight to inform interactions with patients with CCCs.

Scaling research and practice of scholarships impact for peace: The role of theory

The scope of appraising international higher education scholarships’ potential impact on peace should be broadened beyond assessing their contribution to technical recovery and development. Extant research often limits appreciation of this contribution to instrumentalist terms of human capital import, underpinning it with a view of ‘peace’ as a flat phenomenon of technical functions in a neoliberal order. I present here an alternative approach for fuller and more critical examination of scholarships’ potential impact on peace in Palestine. Working within critical realism, I collected qualitative data from 32 Palestinian alumni on their master's scholarship experiences, which I then analyzed in a data-driven, descriptive mode followed by abductive analysis. Descriptive and inferential findings developed from this two-stage analysis demonstrate that the participants’ perceived academic, career, and identity developments relate to peace in Palestine in deeper, more complex ways than advancing career progress and human-sourcing higher education recovery. Interpreted through an interdisciplinary theoretical framework of everyday peace capability, these perceived developments suggest that scholarships enhanced the participants’ ability to reposition themselves in relation not only to conflict but also to a reflexive agenda of individual-national progress, enabled their transgression of oppressive forces disciplining their national and global connections, and expanded their capacity for working with advanced methods of knowing. These findings illustrate the significant role that critical interdisciplinary theorization can play in developing fuller, context-informed understanding of the impact of scholarships and of international academic mobility more broadly. While these findings demonstrate only micro-level effects, i.e., impact on individuals, they have clear implications for scaling research and practice of scholarships impact for peace at the meso- and macro-levels.

An Ecological Investigation of Polish Olympic Coaches’ Career Pathways and Their Experiences of Career Transition to Olympic Coaching Roles

Most research on coaching adopts a Western, predominantly Anglo-Saxon, vantage point. This study sought to fill the gap in the literature by providing an Eastern European perspective on transition to high-performance coaching. Ten Polish Olympic coaches were interviewed to glean insights into their career pathways, cumulatively spanning the last three decades. First, using abductive analysis, three patterns of nonlinear career pathways were identified: teacher-track, club-coach track and athlete fast-track. Next, contextual and reflective thematic analyses were employed to examine the environmental constraints affecting role transitions. Consequently, drawing on Bronfenbrenner’s bioecological model, the Ecological Model for Coach Development was proposed to offer an alternative perspective on career transitions. The findings provide evidence for the situated and relational nature of career transitions as processes occurring in nested environmental contexts. We claim that advancing knowledge on transitions requires not only zooming into coaches’ lived experiences of transitioning in/out of coaching roles, but also zooming out on macrolevel societal transformation processes, historically rooted values and belief systems, as well as mesolevel institutional constraints that steer career pathways and shape experiences. The study’s ecological orientation has the potential to enhance coaching education and practice by accounting for contextual complexity and temporality.

Patterns of disruptions: Complexities of discursive-embodied triggers and resilience responses of individuals with autoimmune diseases

ABSTRACT Individuals with autoimmune diseases face a multiplicity of adverse disruptions throughout their lives that can span physical, emotional, social, and financial contexts. We employed the communication theory of resilience as a theoretical framework to explore how individuals with an autoimmune disease construct the connections between triggers and communicative resilience responses within their narratives. Utilizing abductive analysis, we identified four overarching trigger patterns: (1) linear, (2) cyclical, (3) compounding, and (4) branching. In examining the triggers and health journeys of individuals with autoimmune diseases, we can practically aid physician communication approaches for patients with complex symptomologies, diagnostic journeys, and trigger patterns.

Newly qualified secondary school teachers’ perspectives on workplace learning

ABSTRACT There is a gap between knowledge needed at work and knowledge and skills developed through formal education. Certain aspects can only be learned within the actual workplace. This article focuses on workplace learning for newly qualified teachers’ (NQTs), a learning that is integrated in the processes and experiences gained through work. Through emails and interviews the study follows 15 NQTs during their first year of teaching in Norwegian secondary schools and explores what and how they learn, seen from their own perspectives. Through an abductive analysis of the data the study aims to develop insights that can help improve teacher education as well as the induction phase for NQTs. The teachers in the study experienced steep learning curves and lack of formal mentoring. The first year of teaching was characterised by several features that impeded the professional growth. The majority of reported learning experiences were self-initiated, rendering the acquired knowledge somewhat incidental. The NQTs could have been better prepared for the comprehensive teaching role. Furthermore, both formal and informal workplace learning could have been given more attention and been better supported within the schools.

Co-Creation of Navigational Spaces When Facilitating Children’s Play

Facilitating children’s play is an important but potentially frustrating task for teachers in the field of Early Childhood Education and Care. Play is often understood as essential for children, and frequently being excluded from play is often experienced as problematic; Still, teachers are often uncertain about how to do play and there is a growing concern about the disappearance of play. This study aims to explore and identify navigational spaces for teachers to exercise agency when facilitating children’s play, and this article presents the co-creation of four such spaces. The co-creation has been done through a series of workshops and play initiations over six months, explored by ECEC teachers in conjunction with the author. The workshops are anchored in critical theory, and the idea is that the participants enrich the project through their various forms of expertise. Abductive analysis through workshops and a thematic analysis of sound and video recordings of these events shows the co-creation of the navigational spaces of framing, conditioning, timing, and knowledging to be central. To be able to co-create these navigational spaces, the repeated collective questioning and knowledge contributions of teachers and the researcher seem to be a central factor. By critically considering and exploring co-creational possibilities both the researcher and the teachers extended their play-facilitating repertoire and made the play-facilitating efforts increasingly explicit. This suggests that it is possible to simultaneously develop practice and scientific knowledge if interactions between the education sector and academia are facilitated. These insights will be beneficial for further investigations and innovations.

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual model

IntroductionInspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care.MethodsThe qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory.ResultsThe qualitative results show that the CHWs’ outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care – as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs’ approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW.DiscussionThe conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances.

Organizing implementation in healthcare: Balancing orders of worth

In this paper we direct attention to unavoidable conflicts between disparate value systems co-existing within organizations. Drawing on John Law's concept of ordering and Boltanski and Thévenot's orders of worth, we understand incompatibilities inherent in implementation and governance as competing orders. In extracting and articulating competing orders from our abductive analysis of semi-structured interviews with primary care managers (n = 32) in a Swedish county council, we hope to enable actors to utilise and address them as they engage in implementation work. The potential of such an approach is exemplified by analysing a regional case of health promotion implementation pursued in 2019, in a Swedish county council. Early approaches to implementation and governance have entailed linear models emphasizing program fidelity. Critics have broadened this view by calling for optimization of multiple values and more room for professional judgment. We seek to add to this development by attending to how healthcare practices often entail different and at times conflicting configurations of patients, professionals and priorities. The county council in our case study attempted to steer primary care providers towards health promotion work. To capture the realities of the organization that primary care managers described, we propose that three competing orders can be discerned in primary care: the order of immediate care, focusing on professional judgments of the most pressing needs of patients; the order of accessible care, in which patients themselves define what needs should be cared for; and the order of future health emphasizing prevention of health in the future population. Each order enacts a specific prioritization between patients and a vision of what is or should be primary in primary care. Organizing implementation, we suggest, requires a balancing of orders of worth.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis.

Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme. Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

Patient-driven decisions and perceptions of the ‘safest possible choice’: insights from patient-provider conversations about how some breast cancer patients choose contralateral prophylactic mastectomy

Objective Observe patient-clinician communication to gain insight about the reasons underlying the choice of patients with unilateral breast cancer to undergo contralateral prophylactic mastectomy (CPM), despite lack of survival benefit, risk of harms, and cautions expressed by surgical guidelines and clinicians. Methods & Measures WORDS is a prospective study that explored patient-clinician communication and patient decision making. Participants recorded clinical visits through a downloadable mobile application. We analyzed 44 recordings from 22 patients: 9 who chose CPM, 8 who considered CPM but decided against it, and 5 who never considered CPM. We used abductive analysis combined with constructivist grounded theory methods. Results Decisions to undergo CPM are patient-driven and motivated by perceptions that CPM is the most aggressive, and therefore safest, treatment option available. These decisions are shaped not primarily by the content of conversations with clinicians, but by the history of cancer in patients’ families, their own first-hand experiences with cancers among loved ones, fear for their children, and anxiety about cancer recurrence. Conclusion The perception that CPM is the safest, most aggressive option strongly influences patients, despite scientific evidence to the contrary. Future efforts to address high CPM rates should focus on patient-driven decision making and cancer-related fears.

Running blind: the sensory practices of visually impaired runners

ABSTRACT In this article, we consider what it means to be running blind. As an idiom, this phrase refers to doing something through guesswork, without a plan or pre-existing knowledge; instead, our notion of running blind offers an alternative perspective. Drawing upon a novel theoretical approach, which is multidisciplinary and engages with the work of visually impaired (VI) and non-VI scholars, we establish the rich, creative and diverse sensory practices of VI runners. The data in this article is drawn from a qualitative study involving eight blind and partially sighted participants, who each took part in two semi-structured interviews. Using abductive analysis, our discussion is organised around the route: 1) Knowing the route; 2) Navigating the route; and 3) Pleasures of the route. While VI runners’ sensory practices are unique, there are significant commonalities in our participants’ experiences of running blind, including the mapping process, agency and freedom en route, multisensorial modes of navigation and more-than-visual running pleasures. This article demonstrates the importance of exploring non-ocularnormative conceptions of sport and physical activity, which is of value for VI runners, guide runners and key stakeholders alike.

Towards a model of Teachers’ Continuing Professional Development (CPD): a border crossing journey with embedded contradictions, ethical dilemmas and transformative possibilities

ABSTRACT Shulman (1989) argued how ‘outrageously complex’ teaching is and how reform imperatives driving standards should not lead to standardisation and the subsequent loss of soul. We assert that framing a model of teachers’ Continuing Professional Development (CPD) is similarly ‘outrageously complex’, a multifaceted construct that has professional, personal and political ends and purposes and is concerned with needs beyond that of the individual teacher, such as the teaching profession, schooling system, economic and social needs, as well as the wider public-interest values of the state. For this study, we worked as a community of inquiry, drawing from theoretical pluralism in order to conduct an abductive analysis of existing models of teachers’ CPD. Our model of teachers’ CPD offers an explanatory framework that positions teachers’ values, goals and dreams at the centre, involves a relational border crossing journey rather than a final destination, and necessitates ethics (philosophy), critical reflexivity and the empirical as productive ways of staying with the embedded contradictions, ethical dilemmas and transformative possibilities of an advanced professional practice. We present this new model of CPD not as a final analysis but rather as a theory worthy of further research and consideration.