Deductive Process Research Articles

A Systems Approach to Improving Foundational Reading Skills at a Preschool in India

Holistic Education School located in Mumbai, India, created a strategic improvement plan to address the poor foundational reading skills of its kindergarten students. Curriculum Based Measure (CBM) assessment data showed a rise in reading performance during the implementation of the plan, from 87% of the students scoring below grade level in 2016 to 89% achieving grade level benchmarks in 2021. An instrumental case study qualitative research design was employed to describe the nature of changes made in relation to the increase in performance. Data were collected from a variety of sources and coded through inductive and deductive processes that achieved intercoder agreement of 97.87% and 0.73 Kappa coefficient for reliability. Triangulation, member checking, and clarifying researcher bias, were employed to maximize validity. The findings describe the nature of transformation undertaken by the strategic improvement plan on key systems-level elements like curriculum, professional development, student engagement, parent engagement, and school leadership.

Pemakaian Anggah-Ungguhing Basa Bali pada Buku Ajar Bahasa Bali di SMA: Kajian Sosiolinguistik

The article's objectives were 1) to examine the usage of Balinese language in Balinese language textbooks in senior high schools at the discourse, sentences, and word levels. This is a qualitative research study. The written material comes from a textbook titled Kusuma Sastra for Class XI. Data were obtained using the listening method, which was assisted by note-taking techniques, and analyzed using distributional and distributional methods, which were supported by substitution techniques. Informal approaches are used to provide data analysis, which is aided by inductive and deductive processes. The article's research results: the use of Balinese anggah-ungguhing basa in a textbook titled Kusuma Sastra: (1) at the discourse level: alus, kepara, and mixed), (2) at the sentence level: alus singgih, alus sor, kepara, kasar hormat), and (3) at the word level: alus singgih, alus sor, mider, madia, andap, and kasar).

Inclusion of Students with Disabilities in a Socio-Cultural Perspective: What is the Perception of Physical Education Teachers?

This study aims to examine teachers' perceptions of inclusive physical education in Pekanbaru City and the identity of the factors that influence their perceptions from a socio-cultural perspective. This research is qualitative. The research subjects recruited were physical education teachers in Pekanbaru City. The selection of participants is based on two criteria: (i) teachers who have earned a Bachelor's degree in Physical Education and (ii) teachers who teach students with disabilities in public and private junior high schools. Based on these criteria, only five physical education teachers were found. Individual interviews were conducted with each teacher. Deductive and inductive analysis processes are used to organize and report the data. The results showed that teachers believed general physical education classes were a good place to develop students with disabilities. Teachers realize that students with disabilities can have equal opportunities to participate in general physical education programs and develop social skills. Although the teachers recognized these benefits, they also expressed concern about the instructional and environmental barriers to the inclusion of students with disabilities in mainstream sports programs. Future research should address the importance of teachers' beliefs and practices about effective teaching in inclusive.

STEM 1, 2, 3: Levelling Up in Primary Schools

Recent research advocating the educational value of engaging primary students in authentic integrated STEM inquiry projects also identifies challenges for teachers aspiring to high-quality student-learning experiences. Teachers require support to integrate disciplines, prioritise processes and reasoning over curriculum content, and increase student autonomy in purposeful STEM projects. Within the context of a year-long professional learning program in Australia, an innovative tri-level approach to skill-building for teachers and their students has been developed. The three levels of ‘STEM Skills’, ‘Design Process’ and ‘Integrated STEM Projects’ are intended to successively escalate demands on time, resources and pedagogical change while promoting the development of the dispositions and skills needed to engage in sustained inquiry projects. The teacher participants (n = 11) came from five schools who had just concluded the STEM Academy professional learning program. Semi-structured interviews guided teacher reflection. Data analysis combined inductive and deductive processes to thematize meaning and revealed ways in which the tri-level approach to STEM education supported the development of STEM integration practices. The findings suggest the efficacy of the tri-level approach and its potential value beyond the context in which it was developed.

“You can kind of just feel the power behind what someone's saying”: a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges

BackgroundYouth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes.MethodsWe applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14–26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables.ResultsOur analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment.ConclusionsThis study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.

Cars, Guns, Aging, and "Giving Up the Keys".

Age-associated changes can impair abilities for safe driving and the use of firearms. We sought to examine multiple perspectives on reducing access to firearms, including similarities and differences compared to reducing driving. Online focus groups and 1-on-1 interviews were conducted (November 2020 to May 2021)in the United States with: older adults who drove and owned firearms; family members of older adult firearm owners/drivers; professionals in aging-related agencies; and firearm retailers/instructors. Recorded sessions were transcribed, coded, and analyzed following a mixed inductive-deductive thematic analysis process. Among 104 participants (81 in focus groups, 23 in interviews), 50 (48%) were female, and 92 (88%) White. Key similarities: decisions are emotional and challenging; needs change over time; safety concerns are heightened by new impairments; prior experiences prompt future planning; tension between autonomy and reliance on trusted others; and strategies like reframing may ease transitions and avoid confrontations. Key differences: "retirement" was not an acceptable term for firearms; reducing driving may affect daily independence more, but there are few alternatives for the psychological safety conferred by firearms; and there are specific firearm-related legal concerns but more driving-related regulations, policies, and resources. The similarities and differences in the processes and preferences related to reducing driving or firearm access have implications for the development of resources to support planning and action. Such resources for the public and providers might empower older adults and their families to make voluntary, shared decisions, and reduce injuries and deaths.

A Review of Durability Issues of Reinforced Concrete Structures Due to Coastal Soda Residue Soil in China

Soda residue soil (SRS) is a man-made engineering foundation soil formed by soda residue; it is mainly distributed in coastal areas in China. SRS is rich in a variety of corrosive salts, among which the concentrations of chloride ions are about 2–3 times that of seawater. These highly concentrated chloride ions migrate and diffuse in reinforced concrete (RC) structures built on coastal SRS through multiple transport mechanisms. However, current research on the durability of RC structures exposed to the coastal SRS environment has not led to the publication of any reports in the literature. SRS may be classified by analyzing the quantitative relationships among the corrosive ions it contains. In this paper, the deterioration of RC structures due to the corrosive saline-soil environment in China is discussed, and advances in RC structure durability under such circumstances are reviewed. Our findings show that a corrosive environment, especially when this is a result of coastal SRS, has a significant influence on the deterioration of RC structures, greatly threatening such buildings. A series of effective measures for enhancing the durability of RC structures in saline soil, including improvements in concrete strength, reductions in the water–binder ratio, the addition of mineral admixtures and fiber-reinforcing agents, etc., could provide a vital foundation for enhancing the durability of RC structures which are at risk due to coastal SRS. Vital issues that must be investigated regarding the durability of RC structures are proposed, including the transport mechanism and a prediction model of corrosive ions, dominated by chloride ions (Cl−), in SRS and RC structures, the deterioration mechanism of RC materials, a long-term performance deduction process of RC components, durability design theory, and effective performance enhancement measures. The findings of this paper provide some clear exploration directions for the development of basic theories regarding RC structure durability in coastal SRS environments and go some way to making up for the research gap regarding RC structure durability under corrosive soil environments.

Factors in integrating academic electronic medical records in nursing curricula: A qualitative multiple case studies approach

BackgroundAcademic electronic medical records are useful simulation-based educational tools that assist health professional students develop their skill sets for digital health practice. Despite this, their utilisation in pre-registration nursing curricula is uncommon in Australia and New Zealand. AimTo explore factors surrounding integration of academic electronic medical records into pre-registration nursing curricula in Australia and New Zealand. DesignExploratory qualitative multiple case studies approach with purposive sampling set within a larger research project. MethodsSemi-structured interviews conducted with course leaders from six nursing schools. Data were analysed in an iterative content-driven deductive and inductive process using open-coding and categories. Case analysis involved within case and cross-case analysis. ResultsFindings revealed different factors that impacted the utilisation of academic electronic medical records in nursing curricula including factors influencing adoption, barriers and challenges with implementation, enablers for integration and perceived benefits for students' clinical practice preparation. Reasons for not using academic electronic medical records, barriers for implementation, and preparation of students for clinical practice in the absence of these simulation tools were also highlighted. ConclusionOur findings suggest that use of academic electronic medical records in nursing curricula is still evolving and that their adoption and application within programs is not straightforward. While there are many factors unique to the schools using such resources, factors including decisions around curriculum incorporation, optimising available resources to support students' learning, and developing faculty capability to teach with academic electronic medical records were common considerations. Lack of funding and access to local educational tools were ongoing barriers for adoption. Further research examining curriculum timing and preparation, possibilities of partnerships to share resources, and evaluation in meeting students' needs is necessary.

Artificial-Intelligence-Based Design for Circuit Parameters of Power Converters

Parameter design is significant in ensuring a satisfactory holistic performance of power converters. Generally, circuit parameter design for power converters consists of two processes: analysis and deduction process and optimization process. The existing approaches for parameter design consist of two types: traditional approach and computer-aided optimization (CAO) approach. In the traditional approaches, heavy human-dependence is required. Even though the emerging CAO approaches automate the optimization process, they still require manual analysis and deduction process. To mitigate human-dependence for the sake of high accuracy and easy implementation, an artificial-intelligence-based design (AI-D) approach is proposed in this article for the parameter design of power converters. In the proposed AI-D approach, to achieve automation in the analysis and deduction process, simulation tools and batch-normalization neural network (BN-NN) are adopted to build data-driven models for the optimization objectives and design constraints. Besides, to achieve automation in the optimization process, genetic algorithm is used to search for optimal design results. The proposed AI-D approach is validated in the circuit parameter design of the synchronous buck converter in the 48 to 12 V accessory-load power supply system in electric vehicle. The design case of an efficiency-optimal synchronous buck converter with constraints in volume, voltage ripple, and current ripple is provided. In the end of this article, feasibility and accuracy of the proposed AI-D approach have been validated by hardware experiments.

Perspective of smokers and healthcare professionals toward real-time video counseling smoking cessation program in general out-patient clinics in Hong Kong: a qualitative study.

This study aimed to explore the perceptions and experiences of individuals that currently smoke and healthcare professionals on using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong. This was a qualitative study using face-to-face semi-structured interviews based on the extended technology acceptance model. All interviews were audiotaped and transcribed verbatim. Two investigators coded the transcripts independently. Thematic analysis was adopted. Individuals that currently smoke and healthcare professionals who had experience using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong were recruited. Purposive sampling was adopted. 18 participants were interviewed to reach data saturation. Themes that emerged from thematic analysis of data were the main outcome measures. The emerged themes were refined and verified via inductive and then deductive processes until data saturation was reached. Two core themes, which were in coherence with the extended technology acceptance model, namely (i) perceived ease of use and (ii) perceived usefulness, were identified. Under perceived ease of use, we identified 2 subthemes: (i) convenience and (ii) measures to facilitate the use of real-time video counseling. Three subthemes were identified under perceived usefulness: (i) empathy and rapport, (ii) measures for pandemics, and (iii) service outcome. Our study provided a culture-specific perspective of users towards real-time video counseling. It identified users' opinions on the easiness and usefulness of the service. Those could provide clues for future improvement and development of using real-time video counseling in healthcare services.

Educational Servant-Leaders and Personal Growth

Background: Servant leadership is a leadership approach based on universal values and involves an ethical, practical, and meaningful way to live and lead. Servant leadership has been adopted around the world as a follower-centered transformational leadership paradigm focusing on identifying and meeting the needs of others. Purpose: The purpose of this research was to explore servant leadership and the personal growth phenomenon with the context of education. Research Design: This study used an exploratory collective case study which addressed how servant leader principals and superintendents understood and facilitated the personal growth of those they serve. Data Collection: Data were collected from questionnaires and semi-structured interviews and analyzed through inductive and deductive processes. Results: Two findings emerged from the study: 1. to facilitate the growth of others, educational servant-leaders utilized emotional intelligence and; 2. facilitated growth through the principles of a learning organization. Conclusion: Implications of the study suggested that participant servant leaders instituted paradoxical approaches, which leveraged the polarity between individual and group to facilitate the growth of staff as well as their organizations.

Teachers’ Perspectives Implementing Inquiry-Based Learning in the International Baccalaureate Primary Years Program

The International Baccalaureate Primary Years Program (IBPYP) curriculum for students ages 3–12 is implemented using inquiry-based learning. However, there is a lack of understanding of primary international teachers’ perspectives about implementing inquiry-based learning in this setting. This basic qualitative study's purpose and research question addressed the identified lack of understanding about international IBPYP teachers’ perspectives in an urban setting in the International Baccalaureate Africa, Europe, and Middle East region about their implementation of inquiry-based learning. The Reggio Emilia approach served as the conceptual framework of this study. Data were gathered from 11 participants through semi-structured interview questions, triangulated through a researcher journal, audit trail, and thick descriptions during a deductive and inductive coding process. The results of this study indicated six themes emerging from the data: how teachers plan their units, training required, the flexibility of curriculum, student-centered instructional strategies, maintaining a learner-centered focus, and limitations to implementation. The findings of this study could help educators improve their implementation of the inquiry-based learning component of the IBPYP and aid administrators in evaluating the school schedule and teacher training. Recommendations include studies focused on how teachers implement inquiry-based learning and administrators’ role related to implementation, which could create positive social change with future educators meeting the learning outcomes reported in past studies about the IBPYP.

Monetary penalties for refusal of mandatory Covid-19 vaccination: state’s right to regulate vs people’s rights and freedom in health care

PurposeThe Covid-19 pandemic has persisted for almost three years. States have since then enforced laws, policies and measures believed to be the most effective to handle the global pandemic. Along this line, the Indonesian Government opted to implement mandatory vaccination and refusal of which entails monetary penalties. Hence, this study aims to analyze two legal issues that touch upon the realm of International Human Rights Law: first, whether state has the authority to implement the said mandatory vaccine program to those who refuse to be vaccinated, and second, how is the more appropriate legal policy to obligate vaccination but without coercive sanction.Design/methodology/approachThis is a normative legal research that uses a qualitative method with case studies, conceptual, historical and comparative approaches. A descriptive-analytical deduction process was used in analyzing the issue.FindingsThe results present, as part of state’s right to regulate, it has the authority to enact mandatory vaccination with monetary penalties to fulfil its obligation to protect public health in times of emergency; this is legal and constitutional but only if it satisfies the requirements under the International Human Rights Law: public health necessity, reasonableness, proportionality and harm avoidance. Alternatively, herd immunity is achievable without deploying unnecessary coercive sanctions, such as improving public channels of communication and information, adopting legal policies that incentivize people’s compliance like exclusion from public services, subsidies revocation, employment restrictions, higher health insurance premiums, etc.Research limitations/implicationsThis study analyzes in depth the following issues: of whether the government has the authority to apply mandatory vaccination laws enforced through monetary penalties for those who refused to be vaccinated and how does the government implement the appropriate legal policy to enforce mandatory vaccination without imposing penalties for non-compliance while maintaining a balance between the interests of protecting public health and the human rights of individuals to choose medical treatment for themselves, including whether they are willing to be vaccinated. Hence, the political affairs, economic matters and other non-legal related issues are excluded from this study.Originality/valueThis paper hence offers a suggestive insight for state in formulating a policy relating to the mandatory vaccination program. Although the monetary penalties do not directly violate the rule of law, a more non-coercive approach to the society would be more favorable.

Supporting pre-service teachers’ integration of engineering into STEM lessons throughout engineering-infused training

ABSTRACT Background Training both pre – and in-service teachers who are capable of planning and enacting engineering design–based science instruction are critical for integrating engineering into K-12 science curricula. Purpose This study investigates pre-service teachers’ efforts to integrate engineering into their lesson plans. Sample 13 pre-service chemistry teachers, enrolled in a 13-week engineering-infused integrated STEM course, were the participants of the study. Design and Method Considering the purpose of the study, qualitative design was deemed to be the best fit including qualitative data collected through lesson plans and reflection papers. To assist pre-service teachers’ learning, 13-week engineering-infused integrated STEM was started with the information about the engineering profession and how engineers work. Additionally, pre-service teachers engaged in six integrated STEM activities including engineering design cycle. After each activity, the participants were asked to write a reflection paper on what they learned about engineering, the engineering design process, and integrated STEM. Finally, the participants had three chances for analyzing strong and weak integrated STEM lesson plans and planning integrated STEM lesson planning experience with mentors. The pre-and post-course lesson plans (n=26) were analyzed using existing codes from the related literature, which is a deductive coding process. Later, an inductive approach was used to determine the categories of engineering integration into the lesson plans. Four categories (ranging from a complete engineering lesson to a science lesson with no engineering link) were formed. Reflection papers were used to support the findings. Result The results showed that none of the pre-plans included engineering. However, after participated in a 13-week integrated STEM course, all post-course lesson plans integrated engineering through the use of engineering design processes to some extent. Conclusion The training with different experiences seems promising for pre-service teachers to learn engineering integration into STEM lesson plans.

Using a Patient Work System Model to Systematically Assess the Social Determinants of Health

Exploration of patient work through the lens of the Patient Work System model (PWS) has typically concentrated on clinical tasks, noting only how broader contextual factors shape these tasks. The purpose of this research was to use the PWS to begin to explore patient work originating directly from these broader contextual factors, referred to as the social determinants of health. Transportation access to maternal health services was used as a topic for a case study. Semi-structured interviews with eight health care and human services professionals were analyzed through deductive and inductive processes. The results reflected the main factors of the PWS and identified unique sub-factors under person, physical environment, and organizational environment. This preliminary work demonstrates that there is potential to use the PWS to examine patient work arising from SDoH.

Empowerment for behaviour change through social connections: a qualitative exploration of women’s preferences in preconception health promotion in the state of Victoria, Australia

BackgroundHealth behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women’s understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period.MethodsThis qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework.ResultsNine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making.ConclusionsWomen valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

Understanding Preconception Women's Needs and Preferences for Digital Health Resources: Qualitative Study.

BackgroundImproving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors.ObjectiveThis study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health.MethodsThis codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants’ lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants’ perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework.ResultsIn total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women’s busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions.ConclusionsCodesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors.

Developing a Health Care Transition Intervention With Young People With Spinal Cord Injuries: Co-design Approach

BackgroundSuccessful transition from pediatric to adult health care settings supports long-term health management and better overall outcomes in all domains. However, young people with spinal cord injuries (SCIs) continue to report challenges and unmet needs during the transition process. Including end users in health care research and intervention design is paramount as interventions designed in this way better meet their specific needs and are often more innovative. Although studies have reported involving young people with chronic conditions in the development of health care transition (HCT) interventions, few details have been provided as to how this was achieved.ObjectiveThis study outlined the co-design and development of an HCT intervention to support young people with SCIs. It contextualized the co-design process, methods, materials used, and steps implemented from defining the problem to conceiving and designing the solution. This was accomplished by understanding and listening to end users’ needs and recommendations for HCT.MethodsUsing participatory methods, this qualitative study reports the co-design of an HCT intervention to support young people with SCIs and parents or caregivers. Two co-design workshops were conducted: one with young people with SCIs and one with parents and caregivers. Categories were defined through a hybrid deductive and inductive qualitative content analysis process that was informed by the Care Transitions Framework and guided the development of the HCT intervention. Following the creation of a prototype intervention, young people with SCIs, parents and caregivers, and key pediatric SCI stakeholders provided feedback on the intervention content and design in focus groups. Similar to the workshops, the focus groups were analyzed using a hybrid deductive and inductive qualitative content analysis process informed by the Care Transitions Framework. The Enhancing the Quality and Transparency of Health Research guidelines for qualitative research (Consolidated Criteria for Reporting Qualitative Research) were applied.ResultsOverall, 4 young people and 4 parents or caregivers participated in the co-design workshops. Key recommendations for the HCT intervention were that participants wanted a “one-stop shop” for all their transition information needs and an editable portable medical summary to take with them to appointments. On the basis of the analysis of participants’ recommendations from the workshops, it was determined that a website would be an appropriate hosting platform for the interventions. The focus group feedback on the design and content of the prototype website was extremely positive, with minor recommendations for improvement.ConclusionsThis is the first study to co-design and develop an HCT intervention in partnership with young people with SCIs and parents and caregivers. Although the study sample was small, it has shown that it is possible to meaningfully engage and empower young people with SCIs and parents and caregivers in the co-design of an HCT intervention.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2021-053212

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites

BackgroundIn an effort to address the current opioid epidemic, a number of hospitals across the United States have implemented emergency department-based interventions for engaging patients presenting with opioid use disorder. The current study seeks to address gaps in knowledge regarding implementation of a sub-type of such interventions, emergency department-based peer support services, in rural areas by comparing implementation of rural and urban programs that participated in Indiana’s Recovery Coach and Peer Support Initiative (RCPSI).MethodsWe conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI. We conducted interviews with representatives from each program at 3 time points over the course of the first year of implementation. Our deductive coding process was guided by the Consolidated Framework for Implementation Research (CFIR) and an external context taxonomy.ResultsWe identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics: rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context: rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Inner setting: rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals: some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process: rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans.ConclusionsFindings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.

HEGEL'IN PRATIK FELSEFESINDE HAK İLIŞKISININ YAPISAL KOŞULLARI

The article explores aspects of the dialectical deductive process of the concept of free will, the principal organizing and operating concept in Hegel's Philosophy of Right. In this respect, it reflects on the structural components of the concept of free will, which is the starting point of the science of right, since the relation of right is for Hegel the realization of free will. In parallel, it attempts to highlight some crucial points with respect to the speculative dialectical method that underlies the Hegelian argument at this juncture. In that respect, the article aspires to a brief reconstruction of the formal and substantive presuppositions of Hegel's mature practical philosophy.