Belief Statements Research Articles

Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures.

Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures. We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain. We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, "I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion," which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains. Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

WP7.15 - Surgical dogma… Why change?

Abstract Aims Surgical dogma still persists today despite up-to-date evidence. Implementation of evidence into clinical practice takes on average 17 years. Acute appendicitis is typically managed with surgery, despite evidence recommending a non-operative, antibiotic-only strategy as an appropriate first line treatment in uncomplicated cases. This study investigates barriers to, and facilitators of, changing practice with regards to management of acute appendicitis. Methods Surgeons involved in emergency general surgery in U.K. hospitals were invited to participate in online/telephone semi-structured interviews. Thematic analysis based on the theoretical domains framework was used to develop belief statements. Results 16 interviews were conducted to achieve data saturation. 8 consultant surgeons, 8 surgical trainees from secondary and tertiary centres participated. Numerous barriers and facilitators were identified. There is a lack of awareness of current research with variable interpretation of evidence and its practical applications. There were concerns regarding loss of training opportunities in a “benchmark” procedure; failure of treatment and subsequent complications; missed malignancy and cost implications. Surgeons identified a reluctance to change from long standing practice and recognised their communication may skew patients’ decision making. Decision making practice varied from paternalistic to shared/supported. Surgeons believe they undertake a fully informed consent process, despite some not offering non-operative management as an alternative treatment. Conclusions Numerous barriers and facilitators exist to implementing change and are often based on surgeons’ personal experiences rather than evidence. The identified factors will be used to develop an implementation strategy to drive evidence-based practice and may be transferable to other surgical conditions.

Guideline-based exercise management for hip and knee osteoarthritis: a cross-sectional comparison of healthcare professional and patient beliefs in Ireland

ObjectivesTo identify within-stakeholder agreement and between-stakeholder differences in beliefs regarding exercise for osteoarthritis among general practitioners (GPs), physiotherapists (PTs) and people with hip and knee osteoarthritis (PwOA). A secondary objective...

Implementing the information system for older adult patients post-discharge self-management: a qualitative study.

Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.

Examining Elementary Preservice Teachers’ Beliefs About Literacy Instruction

ABSTRACT This study used semi-structured focus group interviews to examine specific literacy beliefs of 21 elementary pre-service teachers (PSTs) from five teacher education programs across the eastern, southern, and central parts of the USA. The interviews were transcribed and analyzed for statements about literacy beliefs. Each belief statement was also tagged as being positive (+), negative (-), or equal (=) to further identify the nuanced ways in which PSTs expressed each belief. Compared to findings in the field, this study (1) provides clearer explanations and categories of PSTs’ literacy beliefs, (2) captures nuanced understanding of PSTs’ literacy beliefs by examining their affective connotations, and (3) provides an emic perspective from PSTs across contexts. In doing so, the results expand on previous frameworks of literacy beliefs. Further, beliefs related to Teacher Strategy, Engagement, and Literacy Approach were discussed the most by PSTs. Literacy beliefs shared less frequently included beliefs about Culturally Responsive Teaching, and some Literacy Components (LC), such as, LC-Spelling, LC-Emergent Literacy, and LC-Fluency. Of the top three literacy beliefs shared by PSTs, references about Engagement were the most positive. The study suggests implications for literacy teacher educators.

Stakeholders’ experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study

BackgroundSchool-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents’ vaccine views. Study designSemi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February–August 2023. MethodsThe COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. ResultsParticipants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. ConclusionsWe identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents’ vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.

Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours.

Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.

What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework.

Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore. Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements. Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences). In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.

Decoding Consumer Sentiments: A Regression analysis on Beliefs and Attitudes towards Advertising in General

Studies investigating overall consumer beliefs and attitudes towards advertising have been conducted from time to time in different parts of the world. Researchers have also investigated if and which beliefs of respondents towards advertising significantly predict consumer attitude towards advertising in general but any such exclusive study is still scant in Indian perspective. This study attempts to bridge the gap by examining the consumers’ overall beliefs and attitudes towards advertising in North India. The respondents were given 32 belief statements from which eight belief factors were extracted using exploratory factor analysis (EFA), which were further validated by performing confirmatory factor analysis (CFA). Using regression analysis, it has been found that seven of the eight extracted factors significantly predicted consumers’ attitudes towards advertising in general. The obtained results reflected that consumers in Northern India have developed negative overall beliefs towards advertising compared to the beliefs explored in earlier studies conducted in other parts of the world. The findings of this study on consumer beliefs and attitudes towards advertising in North India open avenues for future research by highlighting the unique nuances in this region. Further investigations could delve into the specific cultural, socioeconomic, and demographic factors shaping these negative beliefs.

Understanding implementation of findings from trial method research: a mixed methods study applying implementation frameworks and behaviour change models

BackgroundTrial method research produces recommendations on how to best conduct trials. However, findings are not routinely implemented into practice. To better understand why, we conducted a mixed method study on the challenges of implementing trial method research findings into UK-based clinical trial units.MethodsThree stages of research were conducted. Firstly, case studies of completed projects that provided methodological recommendations were identified within trial design, conduct, analysis, and reporting. These case studies were used as survey examples to query obstacles and facilitators to implementing method research. Survey participants were experienced trial staff, identified via email invitations to UK clinical trial units. This survey assessed the case studies’ rates of implementation, and demographic characteristics of trial units through the Consolidated Framework for Implementation Research. Further, interviews were conducted with senior members of trial units to explore obstacles and facilitators in more detail. Participants were sampled from trial units that indicated their willingness to participate in interviews following the survey. Interviews, and analysis, were structured via the Capability, Opportunity, Motivation Model of Behaviour. Finally, potential strategies to leverage lessons learned were generated via the Behaviour Change Wheel.ResultsA total of 27 UK trial units responded to the survey. The rates of implementation across the case studies varied, with most trial units implementing recommendations in trial conduct and only few implementing recommendations in reporting. However, most reported implementing recommendations was important but that they lacked the resources to do so. A total of 16 senior members of trial units were interviewed. Several themes were generated from interviews and fell broadly into categories related to the methods recommendations themselves, the trial units, or external factors affecting implementation. Belief statements within themes indicated resources issues and awareness of recommendations as frequent implementation obstacles. Participation in trial networks and recommendations packaged with relevant resources were cited frequently as implementation facilitators. These obstacles and facilitators mirrored results from the survey. Results were mapped, via the Behaviour Change Wheel, to intervention functions likely to change behaviours of obstacles and facilitators identified. These intervention functions were developed into potential solutions to reduce obstacles and enhance facilitators to implementation.ConclusionsSeveral key areas affecting implementation of trial method recommendations were identified. Potential methods to enhance facilitators and reduce obstacles are suggested. Future research is needed to refine these methods and assess their feasibility and acceptability.

Proceed with care and intention: Factors to consider when introducing a doctoral-level route to occupational therapy registration in the UK

Introduction: Several United Kingdom Higher Education Institutions are seeking accreditation of new, doctoral entry routes to occupational therapy. This research explored stakeholder perspectives regarding the implications of introducing this additional pre-registration pathway. Method: A mixed-method design gathered data via four virtual events ( n = 42). Descriptive statistics summarise the levels of agreement with prepared belief statements. Qualitative data from online functions were subject to reflexive thematic analysis. Findings: Participants agreed that introducing pre-registration doctorates was beneficial (68%) and an exciting opportunity with the potential to expedite evidence-base expansion (68%). Recognising the challenges, eight emergent themes coalesced into a statement guiding future work: ‘It will take an ongoing commitment from all of us to influence, shape and take positive actions to make structural changes to enhance equity and justice into and within the profession encompassing the themes of value, visibility, viability, expectations, perceptions, equity and diversity, accessibility and clarity of vision. Continued dialogue and communication, with compassionate listening, is required for this’. Conclusion: An additional pre-registration doctoral route into United Kingdom occupational therapy is broadly welcomed, acknowledging the need for ongoing dialogue. The emergent themes provide a framework for proceeding with care and intention as discussions move towards implementation and may assist other nations having similar debates.

Perceptions of cancer prevention options for Lynch syndrome (LS) in a multi-national convenience sample.

77 Background: LS is among the most common cancer (CA) syndromes affecting 1:280 individuals and portends high lifetime CA risk. Clinical trials are currently evaluating whether frameshift peptide vaccination (FSPVAX) could reduce LS CA risk. FSPVAX enhances immune response to diverse FSP neoantigens in MSI-H tumors and has shown promising results in an MSH2-mutant mouse model and metastatic MSI-H CRC. However, negative public attitudes towards vaccination and evidence suggesting low uptake of ASA chemoprevention (CP) among patients with LS could undermine success of this novel therapy. Here, we benchmark attitudes towards FSPVAX for CA prevention against colonoscopy (COLO) and aspirin or NSAID chemoprevention (CP). Methods: The PREVENTLynchII survey (IRB 20-8014) was distributed electronically to 1) participants in the Fox Chase Cancer Center (FCCC) Risk Registry and 2) members of two online LS support groups. Patients were invited to complete the one-time survey after providing informed consent. Demographic and personal CA history were collected. Attitudes were measured on 9-point scales indicating low vs high agreement with belief statements: e.g. “Colonoscopy is a convenient way to lower my risk of LS-related CA.” Results: Overall 296 participants at FCCC, nationally, and internationally completed the survey. Median age was 52.6 years [23-78], 84% female, and 95% White. Affected genes included MLH1 (20.3%), MSH2/EPCAM (35.5%), MSH6 (28.7%), and PMS2 (15.5%). Use of CP was uncommon (32.1% and 5.1% respectively). Stratified analyses of COLO perceptions by sex, age, and personal history of CA showed no differences. Interestingly, US pts viewed ASA as more convenient than non-US, and with lower risk of side effects (p=0.007), but were no more likely to use or recommend CP. Compared to COLO, FSPVAX was overall viewed as more convenient, but side effect concerns were higher, and perceptions of efficacy were lower (all p<0.001), while compared to CP, FSPVAX was less convenient and fostered greater concerns about side effects, but was viewed as having higher potential preventive efficacy (all p<0.001). FSPVAX perceptions showed high variability: pts >50 (p=0.003) and CA pts (p=0.01) saw FSP as more convenient (p=0.003) than younger and unaffected pts. CA pts reported higher reassurance than unaffected (p=0.04), while those >50 were more likely to participate in an FSPVAX study (p=0.04). US pts perceived more side effect risk of FSPVAX than non-US (p=0.003). Conclusions: Concerns about ASA CP and FSPVAX convenience, side effects, and efficacy are common among US and international patients with LS. [Table: see text]

Designing a Behaviour Change Wheel guided implementation strategy for a hypoxaemic respiratory failure and ARDS care pathway that targets barriers

BackgroundA significant gap exists between ideal evidence-based practice and real-world application of evidence-informed therapies for patients with hypoxaemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS). Pathways can improve...

PRE-SERVICE ENGLISH TEACHERS’ BELIEFS ON READINESS OF TEACHING SPEAKING SKILLS

In recent years, researchers have focused on how students and teachers perceive language learning and teaching. However, few studies have been conducted on pre- service teachers’ and teachers’ beliefs about teaching speaking skills. Therefore, the purpose of this study is to examine pre-service EFL teachers’ beliefs about their readiness to teach speaking skills. In particular, the researcher aimed to find out which speaking skills pre-service EFL teachers felt ready or unprepared to teach, and to what extent pre-service EFL teachers perceived themselves as ready to teach speaking skills. The participants of the research are 61 undergraduate senior students enrolled in the English Language Teaching program at Khoja Akhmet Yassawi International Kazakh-Turkish University in Turkestan. A mixed-method research design approach was used and samples from both quantitative and qualitative sections were utilized. Factor analysis was performed for the validity of the scale developed in this study, and the reliability of the scale was determined by Cronbach’s alpha coefficient (0,92). The results of the study showed that the majority of the participants gave positive responses to the belief statements about teaching speaking skills. However, some participants stated that they did not agree with some statements of belief. Several interpretations and suggestions were derived from the results of the present study.

Methods to develop and evaluate attitudinal scales to measure farmer perceptions: Using sheep scab as an example.

There is limited information on the attitudes and opinions of British sheep farmers when preventing and managing sheep scab in their flocks. Attitudes are examples of latent traits, which are not directly observable. They must be measured indirectly which can be achieved using measurement scales. Attitudinal measurement scales are used frequently in research, but are seldom evaluated prior to use, particularly in veterinary research. Therefore, the aim of this study was to identify and assess latent traits which influence the control of sheep scab with the use of exploratory factor analysis, and then further evaluate these factors with the use of item response theory to determine how they perform as scales. An online survey was completed by 726 British sheep farmers during October 2021 (725 useable responses), which included a section with 37 belief statements related to the opinions and attitudes of sheep farmers around the management of sheep scab. These belief statements were developed and adapted from previous research. During the analysis, they were subjected to exploratory factor analysis, which suggested that the scales performed reasonably well. The scales were then evaluated further by item response theory. The graded response models for each attitudinal scale were assessed by graphical evaluation. They demonstrated that the scales were able to distinguish those respondents with low perceptions of control, responsibility, and trust, and those who had high perceptions of luck. This study provides insights into some of the factors influencing the management of sheep scab, and how well these scales perform. Additionally, it further highlights the importance of evaluating attitudinal scales for use in research, and that exploratory factor analysis alone does not provide enough information on how well they perform.

Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist

BackgroundComputerized clinical decision support systems (CDSSs) can improve care by bridging knowledge to practice gaps. However, the real-world uptake of such systems in health care settings has been suboptimal. We sought to: (1) use the Theoretical Domains Framework (TDF) to identify determinants (barriers/enablers) of uptake of the Electronic Asthma Management System (eAMS) CDSS; (2) match identified TDF belief statements to elements in the Guideline Implementation with Decision Support (GUIDES) Checklist; and (3) explore the relationship between the TDF and GUIDES frameworks and the usefulness of this sequential approach for identifying opportunities to improve CDSS uptake.MethodsIn Phase 1, we conducted semistructured interviews with primary care physicians in Toronto, Canada regarding the uptake of the eAMS CDSS. Using content analysis, two coders independently analyzed interview transcripts guided by the TDF to generate themes representing barriers and enablers to CDSS uptake. In Phase 2, the same reviewers independently mapped each belief statement to a GUIDES domain and factor. We calculated the proportion of TDF belief statements that linked to each GUIDES domain and the proportion of TDF domains that linked to GUIDES factors (and vice-versa) and domains.ResultsWe interviewed 10 participants before data saturation. In Phase 1, we identified 53 belief statements covering 12 TDF domains; 18 (34.0%) were barriers, and 35 (66.0%) were enablers. In Phase 2, 41 statements (77.4%) linked to at least one GUIDES factor, while 12 (22.6%) did not link to any specific factor. The GUIDES Context Domain was linked to the largest number of belief statements (19/53; 35.8%). Each TDF domain linked to one or more GUIDES factor, with 6 TDF domains linking to more than 1 factor and 8 TDF domains linking to more than 1 GUIDES domain.ConclusionsThe TDF provides unique insights into barriers and enablers to CDSS uptake, which can then be mapped to GUIDES domains and factors to identify required changes to CDSS context, content, and system. This can be followed by conventional mapping of TDF domains to behaviour change techniques to optimize CDSS implementation. This novel step-wise approach combines two established frameworks to optimize CDSS interventions, and requires prospective validation.

Applying the Theoretical Domains Framework to Develop an Intervention to ‘Re-implement’ Parent–Child Interaction Therapy (PCIT)

Parent–Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven ‘re-implementation’ intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) ‘Environmental Context and Resources’, specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) ‘Social/Professional Role and Identity’, with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.

The role of network structure in integrated water management: a case study of collaboration and influence for adopting nature-based solutions

IntroductionIntegrated water management (IWM) involves a range of policies, actions, and organizational processes that go beyond traditional hydrology to consider multifaceted aspects of complex water resource systems. Due to its transdisciplinary nature, IWM comprises input from diverse stakeholders, each with unique perceptions, values, and experiences. However, stakeholders from differing backgrounds may disagree on best practices and collective paths forward. As such, successful IWM must address key governance principles (e.g., information flow, collective decision-making, and power relations) across social and institutional scales. Here, we sought to demonstrate how network structure impacts shared decision-making within IWM.MethodsWe explored a case study in Houston, Texas, USA, where decision-making stakeholders from various sectors and levels of governance engaged in a participatory modeling workshop to improve adoption of nature-based solutions (NBS) through IWM. The stakeholders used fuzzy cognitive mapping (FCM) to define an IWM model comprising multifaceted elements and their interrelationships, which influenced the adoption of NBS in Houston. We applied grounded theory and inductive reasoning to categorize tacit belief schemas regarding how stakeholders viewed themselves within the management system. We then used FCM-based modeling to explore how unique NBS policies would translate into more (or less) NBS adoption. Finally, we calculated specific network metrics (e.g., density, hierarchy, and centrality indices) to better understand the structure of human-water relations embedded within the IWM model. We compared the tacit assumptions about stakeholder roles in IWM against the quantitative degrees of influence and collectivism embedded within the stakeholder-defined model.Results and discussionOur findings revealed a mismatch between stakeholders' external belief statements about IWM and their internal assumptions through cognitive mapping and participatory modeling. The case study network was characterized by a limited degree of internal coordination (low density index), high democratic potential (low hierarchy index), and high-efficiency management opportunities (high centrality index), which transcended across socio-institutional scales. These findings contrasted with several of the belief schemas described by stakeholders during the group workshop. We describe how ongoing partnership with the stakeholders resulted in an opportunity for adaptive learning, where the NBS planning paradigm began to shift toward trans-scale collaboration aimed at high-leverage management opportunities. We emphasize how network analytics allowed us to better understand the extent to which key governance principles drove the behavior of the IWM model, which we leveraged to form deeper stakeholder partnerships by identifying hidden opportunities for governance transformation.

Plurilingual practices in Higher Education: An analysis of student perceptions from a South African University

This study describes student perspectives on the teaching and learning of a newly introduced University language acquisition course. It identifies three basic components of teaching and learning, namely teaching approaches, teaching and learning resources, and assessment of learning. The study focuses on how students perceive these basic components of teaching and learning by investigating how 1st-year students at a university in South Africa perceive the teaching and learning of the Sesotho First Additional Language (FAL) course (a newly introduced course in the university). Hence the objectives of this study are to establish the views of 1st-year Sesotho FAL students regarding the teaching approaches used by the lecturers presenting the course; the teaching and learning resources used in the course; and the quality of assessments applied in the course. Guided by complex dynamic systems theory, the study employs a survey methodology. A questionnaire comprising both close-ended belief statements as well as open-ended statements for students to respond to was administered to 51 study participants purposefully selected. Quantitative data were analysed using IBM SPSS, while qualitative data were analysed by the researchers themselves. Results emerging from the data reveal that 1st-year students generally find their lecturers’ teaching approaches and assessment methods satisfactory; however, they perceive the teaching and learning resources used by their lecturers in teaching Sesotho as inadequate. This finding points to the need for further dialogue broadly on the quality of teaching and learning, quality of assessment criteria and the availability of teaching and learning resources provided for presenting newly introduced courses in higher education institutions (HEIs); and specifically on the level of preparation of lecturers in these courses tasked with the teaching and learning.

Individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare: A cross-sectional survey.

The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings. A cross-sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five-point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change. From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) - mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) - identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non-night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non-night and 70% night workers; 74% non-night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non-night compared to a night shift (p = 0.002). Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D.