Adult Stakeholders Research Articles

Employing citizen science to enhance active and healthy ageing in urban environments.

Engaging older residents in problem definition and solution-building is key to the success of place-based initiatives endeavouring to increase the age-friendliness of urban environments. This study employed the Our Voice framework, engaging older adult citizen scientists (n=14) and community stakeholders (n=15) across the city of Birmingham, UK. With the aim of identifying urban features impacting age friendliness and co-producing recommendations for improving local urban areas, citizen scientists participated in 12 technology-enabled walkability assessments, three in-person discussion groups, two one-to-one online discussions, and two workshops with community stakeholders. Together, citizen scientists co-produced 12 local and six city-wide recommendations. These recommendations were embedded into an implementation framework based on workshop discussions to identify age-friendly pathways in urban environments.

Music festival drug checking: evaluation of an Australian pilot program

BackgroundThis paper explores the feasibility of delivering a music festival-based drug checking service in Australia, evaluating service design and stakeholder acceptability.MethodsQuestionnaire and interview data were collected from adult service users and key stakeholders. A mixed methods approach was used to analyse the data on implementation, impact and acceptability.ResultsThe trial service tested 170 substances with more than 230 patrons (including individuals who attended in groups). Adult service users had an average age of 21 years. Voluntary participation in the evaluation resulted in 158 participants completing the pre-service questionnaire, most of whom also completed the post-service (147 participants). Eleven in-depth qualitative interviews were conducted with patrons in the weeks following the drug checking. Concordance between what the patron expected the drug to be and drug checking results occurred in 88 per cent (n = 139) of the sample. Evaluation results show that the experience of testing and the accompanying harm reduction brief interventions positively impacted on patrons’ self-reported drug harm reduction knowledge, trust of health providers and stated drug use intentions. The service was received positively by service users.ConclusionThis is the first independent evaluation of a pilot drug checking service in Australia. Consideration of operational feasibility and self-reported behavioural change suggests that the program was successful, although communication about the interpretation of drug checking results could be improved. Future studies should develop strategies for follow-up and consider the applicability of behavioural change theory.

Patients with Hemophilia and Their Caregivers Prefer Treatment Attributes That Enable a More Active Lifestyle with Lower Risk of Inhibitor Development

Background: The treatment landscape for hemophilia is evolving. Hence it is important to understand how people with hemophilia and their caregivers value attributes of existing and novel prophylactic treatments. A discrete-choice experiment (DCE) was used to quantify preferences for features of hemophilia treatments among adults and caregivers of children with hemophilia in the US. Methods: A cross-sectional, web-based DCE survey was administered to male adults (≥18 years) and caregivers of male children (≤17 years) living with hemophilia in the US. Respondents evaluated 8 pairs of hypothetical hemophilia treatment profiles defined by 6 attributes - number of annual spontaneous bleeding episodes, lifestyle benefits from improvement in function, route of administration, frequency of administration, risk of developing inhibitors or anti-drug antibodies, and risk of hospitalization due to adverse events (AEs). Attributes for the DCE were informed by a literature review and ranking exercise among adult patients, caregivers, physicians, and stakeholders. The DCE data were analyzed using a random parameters logit (RPL) model and used to calculate the maximum acceptable risk (MAR) of AEs respondents were willing to accept for specific improvements in other study attribute levels. MAR is calculated as the point where the disutility of an increase in risk balances the utility associated with an improvement in a treatment attribute. Results: The final sample included 151 adults (average age 40 years) and 151 caregivers (average age 38 years old, 92% female). For the adult sample, avoiding a 30% risk of developing inhibitors or anti-drug antibodies had the greatest relative importance, followed by improving the ability to live a more active life from limited to high, reducing the number of spontaneous bleeding episodes each year from 6 to 0, change in mode of administration from an intravenous (IV) with vial(s) and syringe to mix to a subcutaneous (Sub-Q) injection with pre-filled pen, reducing frequency of administration from once every 2-3 days to once a month, and avoiding a 5% risk of hospitalization due to AEs (Figure 1a). For caregivers, improving the ability to live a more active life from limited to high had the greatest relative importance, followed by avoiding a 30% risk of developing inhibitors or anti-drug antibodies, reducing the number of spontaneous bleeding episodes each year from 6 to 0 annual bleeds, avoiding a 5% risk of hospitalization due to AEs, reducing frequency of administration from once every 2-3 days to once a month, and a change in mode of administration from an IV with vial(s) and syringe to mix to a Sub-Q injection with vial(s) and syringe to mix (Figure 1b). In general, adults and caregivers preferred treatments that needed to be taken less frequently (e.g., once a month compared with every 2-3 days). Adults preferred a Sub-Q injection with a pre-filled pen compared with other routes of administration. Caregivers preferred Sub-Q options to an IV. Looking at the MAR results, caregivers were willing to accept higher risks of developing inhibitors or anti-drug antibodies than adults for improvements in other attributes. Caregivers were willing to accept a risk of developing inhibitors or anti-drug antibodies greater than 30% for an improvement in the ability to live a more active life from limited to high and 21% for a reduction in the number of spontaneous bleeding episodes each year from 6 to 0, compared to 26% and 17% for adults, respectively. Both groups were willing to accept similar levels of risk of hospitalization due to AEs for improvements in other attributes, accepting greater than 5% for improvements in the ability to live a more active life from limited to moderate or high and for a reduction in the number of spontaneous bleeding episodes each year from 6 to either 1 or 0 spontaneous bleeds. Conclusion: Patients and caregivers prefer treatments that enable more active lifestyle with lower risk of inhibitor development. Both groups valued the ability to lead an active life even over reducing spontaneous bleeding, with caregivers placing the most weight on this attribute suggesting that with the changing landscape in hemophilia treatments, patients and caregivers are willing to trade off benefits and risks of hemophilia treatments. These findings highlight the need for healthcare professionals and patients to share decision making based on clinical judgement and individual preferences. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

International Continuing Professional Education: An Interpretive Study of Ecuadorian Educators’ Meaning-Making

The purpose of this qualitative interpretive study was to explore how 43 educators from Ecuador made meaning of a nine-month international continuing professional education (CPE) program at a higher education institution in the United States. Often categorized generally as study abroad, international CPE encompasses unique modalities focusing on adult learners who are professionals in fields such as medicine, law, and education. Participant-constructed concept maps at three different points during the program and semi-structured interviews were analyzed to understand how educators made meaning of their international CPE experience. The findings suggest that educators made meaning of experiences through three main themes: trying to connect to the future application, relating to professional identity, and processing intragroup differences in a “cultural bubble.” The findings suggest that creating new approaches focusing on cohort learning, multiple professions, and program structures may expand innovations in international CPE programs. In addition, stakeholder power and influence should be examined for ethical dimensions of program planning. The findings can inform instruction and administration in similar cross-border CPE programs to meet the needs of adult learners and stakeholders.

Guiding, sustainingand growing the public involvement of young people in an adolescent health research community of practice.

Public involvement in health research and its translation is well recognized to improve health interventions. However, this approach is insufficiently practised and evidenced in relation to young people. This paper presents an analysis of the process of co-producing a framework, partnership modeland a growing network of young people informing and guiding an adolescent health research community of practice. A Living Lab is a participatory research approach that brings together a broad range of stakeholders in iterative cycles of research, design, development, pilot-testing, evaluation and delivery to implement effective responses to complex phenomena. The geographical setting for this study was Sydney, NSW, Australia, and involved both youth and adult stakeholders from this region. The study spanned three phases between July 2018 and January 2021, and data collection included a range of workshops, a roundtable discussionand an online survey. The co-production process resulted in three key outputs: first, an engagement framework to guide youth participation in health research; second, a partnership model to sustain youth and adult stakeholder collaboration; third, the growth of the public involvement of young people with a range of projects and partners. This study investigated the process of co-producing knowledge with young people in an adolescent health community of practice. A reflexive process supported youth and adult stakeholders to collaboratively investigate, designand pilot-test approaches that embed young people's engagement in adolescent health research. Shared values and iterative methods for co-production can assist in advancing mutual learning, commitmentand trust in specific adolescent health research contexts. Young people guiding and informing an adolescent health research community of practice were involved in this study, and one of the participants is a paper co-author.

Conducting Virtual Youth-Led Participatory Action Research (YPAR) During the COVID-19 Pandemic

Youth-led participatory action research (YPAR) is an applied research methodology in which youth work in collaboration with adult stakeholders to conduct research projects. YPAR has been traditionally conducted in person, with virtual forums typically serving as ways to share resources and ideas across independent YPAR teams or collecting data. The COVID-19 pandemic, which led to the closure of most public spaces where youth congregate (including schools) and requirements to socially distance, led to translating YPAR projects into completely virtual formats. This paper aims to provide promises and challenges of conducting virtual YPAR during the COVID-19 pandemic. It describes how a team of university faculty, college students, and youth from two community-based youth organizations navigated a YPAR experience during the 2020-2021 academic year. We provide reflections on the impact of the COVID-19 pandemic on (a) the research setting, (b) the building of collaborative relationships, (c) YPAR methodology, (d) youth engagement, and (e) conceptualization of community action and engagement. We end with the implications for the future of YPAR for practitioners.

'I went there in an effort to help the child, but you can see there is corruption in the world': Adults' conceptualisations and enactments of child protection in schools in a challenging context.

Schools have the potential to be sites of support for vulnerable children, but can also be sites of violence perpetration. In this qualitative study we explore how adult school stakeholders in and around two public Catholic primary schools in Zimbabwe conceptualise and enact child protection. We analysed our findings in light of the protracted economic crisis in Zimbabwe; the current policy context for child protection; and the Covid-19 pandemic. We conducted semi-structured interviews with 18 adult education stakeholders in and around one rural and one urban school in the Harare Archdiocese, from October 2020 to January 2021. This comprised 12 school-level stakeholders, including teachers (N = 4), parents (N = 4), school priests (N = 2), and headteachers (N = 2), who were the main focus of this study, and a further 6 high-level education actors. We employed thematic analysis. Adults in this study placed considerable responsibility on children to protect themselves, with often unreasonably high expectations of children’s capacity to prevent abuse. At times they also blamed and stigmatised children, which was gendered, and particularly emerged around adolescent sexuality. Our findings suggest that this was linked to social norms around discipline, protection and gender, but in particular, the way these emerged in relation to the challenges of the context. Policy and interventions to promote child protection in schools in Zimbabwe should incorporate both an attention to the challenges teachers face in contexts of adversity, as well as address a tendency for adult school stakeholders to hold children responsible for their own protection.

S06-4 Exploring correlates of adolescent boys' muscular fitness: a mixed-methods formative study

Abstract Background According to the Elaborated Environmental Stress Hypothesis, anxiety and depression in children are associated with poor motor competence, and these associations may be mediated by social support and self-perceptions. Improving children’s motor competence through school-based physical activity interventions may therefore be a mechanism for promoting positive mental health through psychosocial factors. Co-production provides opportunities to participate in intervention development processes, thereby ensuring that specific needs of stakeholders are targeted. The shared stakeholder ownership of the process provides a context-sensitive basis for acceptable interventions with increased likelihood of them being effectively implemented and resulting in positive outcomes. This presentation describes phase 1 of the Move Well, Feel Good study, which aimed to co-produce and evaluate the feasibility of a primary school physical activity intervention to improve children’s motor competence and mental health. Methods Five primary schools were recruited from a low socioeconomic status community in northwest England. From these schools, stakeholder groups were formed consisting of class teachers, school leaders, physical activity specialists, and children (aged 8-9 years). Stakeholders worked in single and multiple stakeholder groups through a 6-stage process aligned to the Double Diamond Design Approach by employing divergent and convergent thinking processes to discover, define, develop, and deliver a solution to the ‘problems’ of how best to improve children’s motor competence and mental health, and how best to facilitate real-world school context implementation of the intervention. Through this process the child and adult stakeholders worked separately in workshops and engaged in additional learning and consensus activities. The adult stakeholder co-production workshops were informed by the children’s views and current research evidence. Multiple-stakeholder groups worked collaboratively to develop intervention ideas, which were presented, critiqued, and refined in alignment with the TIDieR checklist. Results In the final stage of the process the research team presented the final co-produced interventions back to the stakeholders and a consensus vote was taken to decide which intervention would be implemented in the phase 2 feasibility trial in September 2022. Conclusions School stakeholders’ participation in intervention co-production ensures their ownership of the finalised programme, which may be important for subsequent implementation and engagement.

Exclusion, inclusion and belonging in mainstream and disability sport: Jack’s story

ABSTRACT Concepts of exclusion and inclusion in sport, physical activity and physical education settings are mostly anchored to discussions about access to and opportunities in physical and social spaces from the perspective of non-disabled adult stakeholders. In this article, we use individual interviews and two creative non-fiction accounts to explore the views of an adult with cerebral palsy (CP), named Jack, who reflects on his embodied experiences of mainstream and CP youth football. This approach enabled us to provide a more nuanced and sophisticated consideration of the exclusion/inclusion dichotomy by centring Jack’s construction of identity and feelings of belonging in the spaces his body inhabited. Particular attention is paid to the interactions and relationships that Jack developed with teammates and coaches, and the (often ableist) constructs of ability that pervade mainstream and CP settings, all of which served to influence Jack’s sense of belonging. We end by encouraging scholars to centre the experiences and amplify the voices of disabled young people, and to consider inclusion as intersubjective experiences associated with feelings of belonging, acceptance and value that are dynamic and in flux. The concept of embodied belonging can help us to move researchers beyond a simple critique of disabling socio-spatial power relations towards the construction of new knowledge that enhances understandings of disability, place, and space.

Stakeholder perspectives on a patient-centred intervention (DIALOG+) for adolescents with common mental disorders in Colombia: A qualitative study.

Patient and stakeholders' involvement in the development of mental health interventions is a central part of the research process as end-user's input can improve the design of patient-centered interventions. This is particularly important when developing interventions directed towards improving the mental health of children and adolescents. The rising prevalence of mental health disorders in this population requires special attention and the development of interventions that include them as active participants is crucial. Our aim is to explore the perspectives and opinions of adolescents, parents, educators/youth workers, and clinicians regarding the appeal and usability of an existing patient-centered digital intervention (DIALOG+), which aims to improve quality of life. As part of a broader study aiming to adapt and test DIALOG+, we conducted Online Focus Groups (OFGs) with adults and adolescents in two cities in Colombia. The existing DIALOG+ intervention was introduced to participants, followed by a structured discussion regarding the opinions and views of stakeholders. A framework approach was used to identify the main themes followed by content analysis to aid adaptation. We conducted 10 OFGs with a total of 45 participants. A positive feature highlighted by all groups was the innovation of including a digital intervention in a traditional medical visit. Additionally, participants considered that the active role that adolescents have when using the intervention empowers them. Barriers identified included concerns from clinicians related to the time required during consultations and confusion with terminology. Furthermore, additional domains that are particularly relevant for the adolescent population were suggested. Data obtained suggest that overall, the DIALOG+ intervention and supporting app are seen as innovative and appealing to adolescents as well as adult stakeholders. However, concerns raised about the availability of time to apply the intervention, the app interface and the language and terminology require modification.

Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study.

Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines. The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and25 years, and 81.8%identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0%identified as female, and 37.0%as male. The data were analyzed using thematic analysis to identify key themes. Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students'agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach. The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.

Investing in activism: Learning from children’s actions to stop child marriage

This article draws on child activists’ experiences in Bangladesh and Ghana, who mobilised to stop potential child marriages from their respective Child Forums and Children’s Parliaments. Case studies were undertaken with 75 child activists, 10 girls whose child marriages had been stopped, and 22 adult stakeholders. The children’s activism disrupted intergenerational relations – unsettling adults’ attitudes towards children – and depended on such relations – children were successful in stopping child marriages because they drew on critical social capital and mobilised key stakeholders. Children’s activism thus has lessons for children’s participation literature more generally, in the synergies between children’s mobilisation and intergenerational relations.

A qualitative study of factors influencing adult stakeholder concussion communication with youth athletes

ABSTRACT Research suggests adult stakeholder (coach, referee and administrator) communication about concussion influences the likelihood of athletes reporting concussive symptoms. The goal of this study was to develop a conceptual model to describe factors contributing to adult stakeholder (AS) concussion communication with youth athletes, to inform future concussion education interventions. We conducted a qualitative interview study with n = 63 AS in youth American football and football (soccer) in Washington and Georgia, analysing interviews using a coding structure based on the Theory of Planned Behavior. Across our sample, AS could describe concussion symptoms and mechanism in detail (Knowledge). AS believed that playing with a concussion could be dangerous, though many had experienced a concussion themselves and not had any negative outcomes (Attitudes). AS believed they were responsible for concussion safety (Normative beliefs), but described that messaging from institutions did not emphasise the role of AS in concussion safety. AS were comfortable in their ability to engage in concussion communication (Self-efficacy), but some expressed concern that talking about concussion might not improve safety but instead result in overreport of symptoms (Controllability). In conclusion, AS have good knowledge of concussion safety, but no clear mandate from their institution to discuss concussion with youth athletes, and concerns that such communication would not improve safety. Future research should utilise these findings to improve the effectiveness of concussion educational interventions for coaches, referees and administrators.

Stakeholders’ perceptions of adolescents’ sexual and reproductive health needs in Southeast Nigeria: a qualitative study

ObjectivesThis study explored the perceptions of adult stakeholders on adolescents sexual and reproductive health (SRH) needs, variations of perceived needs by different social stratifiers and adolescent’s perceived interventions to address...

Human-Centered Design for Public Health Innovation: Codesigning a Multicomponent Intervention to Support Youth Across the HIV Care Continuum in Mozambique.

Adolescents and young people represent a growing proportion of people living with HIV (AYAHIV), and there is an urgent need to design, implement, and test interventions that retain AYAHIV in care. Using a human-centered design (HCD) approach, we codesigned CombinADO, an intervention to promote HIV viral suppression and improve antiretroviral therapy (ART) adherence and retention in care among AYAHIV in Nampula, Mozambique. The HCD process involves formative design research with AYAHIV, health care providers, parents/caretakers, and experts in adolescent HIV; synthesis of findings to generate action-oriented insights; ideation and prototyping of intervention components; and a pilot study to assess feasibility, acceptability, and uptake of intervention components.CombinADO promotes ART adherence and retention in care by fostering peer connectedness and belonging, providing accessible medical knowledge, demystifying and destigmatizing HIV, and cultivating a sense of hope among AYAHIV. Successful prototypes included a media campaign to reduce HIV stigma and increase medical literacy; a toolkit to help providers communicate and address the unique needs of AYAHIV clients; peer-support groups to improve medical literacy, empower youth, and provide positive role models for people living with HIV; support groups for parents/caregivers; and discreet pill containers to promote adherence outside the home. In the next phase, the effectiveness of CombinaADO on retention in care, ART adherence, and viral suppression will be evaluated using a cluster-randomized control trial.We demonstrate the utility of using HCD to cocreate a multicomponent intervention to retain AYAHIV in care. We also discuss how the HCD methodology enriches participatory methods and community engagement. This is then illustrated by the youth-driven intervention development of CombinADO by fostering youth empowerment, addressing power imbalances between youth and adult stakeholders, and ensuring that language and content remain adolescent friendly.

Examining the perspectives of adult working learners and key stakeholders using critical race theory

PurposeThis article reports on a critical race theory (CRT) analysis of the perspectives of providers of employer-supported educational opportunities and adult learners, who identified as Black, indigenous or as a person of color, and were employed in service industries.Design/methodology/approachA review of the literature was used to shape an initial interview protocol. Data were collected from working learners in retail, hospitality, restaurants and healthcare industries. An “a priori” coding scheme that drew from CRT was applied to transcripts during analysis.FindingsAnalysis revealed that working learners' skills, experiential knowledge, learning mindset, language flexibility and knowledge gained from previous learning experiences were not consistently acknowledged by employers. CRT analysis illustrated that endemic racism exists within educational opportunities and in workplace learning.Originality/valueCRT has not been widely used to examine adult education practice, especially for workforce development and employer-based education programs. This research expands the use of CRT in adult education and encourages critical conversations around equity in learning opportunities offered by employers. CRT informed data analysis uncovered barriers to equitable learning opportunities and workplace learning. A discussion of inequities in work-based learning illustrates there is insufficient awareness of implicit bias, which points to the need for initiatives focused on social justice.

Building Researchers' Capacity for Embracing the Engagement of Older Adults in Research

The Sage Resource Project aimed to broaden the pool of researchers who include the voice of older adults using long-term services and supports (LTSS) in research processes. We developed training to build researcher capacity to engage older adults through the development of Sage Model research advisory boards. Methods included training strategies for learning mode, design, duration, and emphasis of content that were informed by results of a researcher needs assessment and input from 2 older adult research advisory boards. Over 100 researchers registered for a 4-webinar series. All respondents to webinar evaluations (22) reported learning about topics that aligned with webinar objectives and had interest in engaging older adult stakeholders and/or developing an older adult research advisory board in the future. Representatives from five universities expressed interest attending online interactive workshops to build advisory boards. Lessons learned identify directions for research on best practices for developing older adult advisory groups.

Factors influencing school re-entry among adolescents in Kenya.

BackgroundThe number of out‐of‐school children and adolescents has been increasing globally. In sub‐Saharan Africa, an estimated 23 million adolescents leave school due to poverty, teenage pregnancy, and unspecified illnesses. The reasons for absenteeism are well‐known but the factors involved in the decision to return to school have not been analyzed. This study aimed to identify the factors that promote primary school re‐entry among chronic adolescent absentees in rural sub‐Saharan Africa.MethodsQualitative data were gathered through participant observation, in‐depth interviews, and focus group discussions involving nine pupils who returned to school after chronic absenteeism and 140 adult stakeholders in Mbita sub‐county, Kenya. Data were analyzed using thematic analysis.ResultsThe thematic analysis results showed that four factors promoted school re‐entry, namely: (1) social norms: “school for a better life”; (2) linkage of community and school; (3) supportive environment; and (4) using discipline to make adolescents serious about their education.ConclusionsSchool re‐entry among chronic absentees in Mbita sub‐county is promoted by both community and school factors. It was observed that social norms regarded an education as a “passport to a better life.” Adolescents, teachers, and community leaders view education as a means of improving one’s socio‐economic status. Two essential elements of health‐promoting schools, a supportive environment and a linkage with community, effectively promoted returning to the school among adolescents. The introduction of health‐promoting schools was recommended to implement a school re‐entry policy in Kenya effectively.

Rethinking pedagogical practices with care-experienced young people: lessons from a sport-based programme analysed through a Freirean lens

ABSTRACT Background: Several studies demonstrate the benefits of socially critical work in sport pedagogy, which value young people’s strengths, capabilities, knowledge, and resources. This body of research argues that young people have the agency to analyse their social contexts and to negotiate the forces that impede their choice of possibilities. While advocacy for a more transformative education process through sport has grown over the years, there is little research that aims to explore pedagogical practices with care-experienced young people (e.g. those who have been removed from their families and placed in the care of the ‘state’). Purpose: This article draws on Paulo Freire’s critical pedagogy as a theoretical framework to examine pedagogical practices with care-experienced young people in a sport-based programme. Participants and settings: This case study took place at a football-in-the-community programme in the West Midlands region of England, which aimed to develop the skills necessary to support care-experienced young people’s transition from primary to secondary school. Participants included eight key adult stakeholders involved with the delivery, and ten care-experienced young people. Data collection/analysis: The research was conducted in two phases to understand the specific pedagogic practices employed within the programme. In the first phase, all adult participants took part in semi-structured interviews designed around their understanding of the programme and their perceptions about what care-experienced young people gained from it and why. For the second phase, observations of the programme were employed as well as a variety of participatory methods with young people such as drawings, mind mapping and photo-elicitation. Findings: The analysis resulted in the identification of three key themes relating to pedagogic practices: (a) problem-based learning with spaces of freedom; (b) contextualised learning activities; and (c) developing mutual trust and respect. By critically analysing a sport-based programme, this paper highlights how specific pedagogic practices might create spaces for empowering care-experienced young people, and the challenges and tensions in this process. Implications: We conclude by outlining how a Freirean critical pedagogy could be better utilised for care-experienced young people within sport-based programmes, in order to recognise their knowledge in naming, critiquing and negotiating barriers to their engagement in their sport context.

Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol.

Background: Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making. Aim: To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting. Methods: A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development. Registration: This protocol has been submitted for registration on PROSPERO, registration number CRD42020189568 and is awaiting review.