Individual Education Research Articles

7.D. Scientific session: Digital health divide in access, use, and effectiveness: Examples from three countries

Abstract The increasing digitalisation of the healthcare system opens up a wide range of opportunities but also poses challenges in reducing inequalities due to unequal technological access as well as social and demographic differences of populations. This so-called digital divide is the opposite of digital inclusion, defined by the United Nations as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”. Indeed, digitalisation is a global phenomenon that permeates all levels of determinants of health inequities, leading to several populations being more disadvantaged. Age, gender, education, and economic status are significant factors amplifying the digital divide’s impact, with older individuals, women, less educated individuals, and economically deprived populations bearing disproportionate effects. Prior literature suggests three levels of digital divide: 1) access to internet and digital technology, 2) individual cognitive and technical competencies in utilizing digital tools, and 3) effectiveness or the optimal functionality and reach of digital technologies. Although there is less consensus with regards to the scope of the divide in the health sector, the three levels are the common reference. Nonetheless, this lack of agreement resulted in existing literature to be concentrated around digital health literacy, or the cognitive and technical abilities to use digital technologies. In addition, while tools such as the Global Digital Health Monitor are valuable to track, monitor, and assess the enabling environment for digital health worldwide, it does not capture the lived experience of the population, including the disadvantaged population groups. This workshop aims to 1) generate discussion on digital health divide and how it can be operationalized and 2) reflect on potential actions to counteract these injustices. Case studies from Germany, Indonesia and Argentina will be presented to diversely contextualize the inequities in digital health and assess plausible interventions. The workshop will be divided into four parts. First, an introduction to the digital health divide will be presented as well as its public health relevance (10 minutes). Second, researchers representing three countries (i.e., Germany, Indonesia, and Argentina) will present digital health divide case studies within their context of expertise (15 minutes). Third, a case-based discussion will be conducted with participants. Participants will be allocated into groups based on the three levels of the digital health divide (i.e., access, use, and effectiveness) and work on recommendations to best operationalize and narrow the digital health divide (25 minutes). Finally, the workshop will conclude with a wrap-up of the group discussion results (10 minutes). Key messages • The digital health divide affects all regions, regardless of income levels. Narrowing the gap is crucial to reduce health inequity and achieve universal health coverage. • By clearly defining the scope and operationalization of the digital health divide, its measurability and usefulness to inform health policies and programs to address this issue can be enhanced.

Introduction to the digital health divide

Abstract This presentation will introduce the concept of digital health divide. It refers to inequalities in accessing and using digital technologies, leading to digital exclusion. Digital inclusion is defined by the United Nations as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”. Indeed, digitalisation is a worldwide phenomenon that permeates all levels of determinants of health inequities, leading to several populations being more adversely affected. Age, gender, education, and economic status are significant determinants amplifying the digital divide’s impact, with older individuals, women, less educated individuals, and economically disadvantaged populations bearing disproportionate effects. The relationship between the digital divide and health leading to the digital health divide can be direct and indirect. Here, access to the latest advancements in health technologies used along the health span (eHealth, mHealth) - from health prevention to patient care - can directly influence the user’s health. However, the lack of access to or use of existing technologies can also indirectly affect their well-being. A globally informative example of this indirect association is the lack of internet access in rural areas during the hard COVID-19 lockdowns, leading to the loss of a school year for many pupils. Indeed, school attendance and attainment are associated with better physical and mental health. Currently, there is a lack of operationalisation of the digital health divide, making it difficult to measure it accurately. The absence of a standardised evaluation and therefore evidence-based information hinders governments and organizations’ efforts to effectively address digital health divide.

Exploring the association between cyberchondria and attention to negative information

Abstract Objectives This study aimed to preliminarily evaluate the relationship between cyberchondria and attention to negative information. Methods The data utilized for this analysis was obtained from a cross-sectional and web-based survey conducted in China between March and April, 2024. All participants were recruited from an online panel belonging to a survey company. Cyberchondria was assessed using the Chinese version of the Cyberchondria Severity Scale - 12 item (CSS-12). Attention to negative information was measured using the negative subscale of the Attention to Positive and Negative Information Scale (APNIS). A multivariable linear regression model was employed to evaluate the relationship between cyberchondria and attention to negative information. Results Out of 344 participants, 315 (91.6% response rate) completed the questionnaire and provided valid responses. Approximately 51.7% (n = 163) were female, 83.8% (n = 264) had completed tertiary or higher education, and 52.7% (n = 166) were urban residents. The average age was 32.6 years (SD = 6.0). The mean score for CSS-12 was 40.6 (SD = 7.8, range: 18-59). The mean scores for the different dimensions of the CSS-12 were: excessiveness, 10.6 (SD = 2.4); distress, 10.3 (SD = 2.7); reassurance, 10.6 (SD = 2.5); and compulsion, 9.1 (SD = 2.7). The mean score for the negative subscale of APNIS was 31.9 (SD = 8.6, range = 12-52). Multivariable linear regression models revealed a statistically significant relationship between cyberchondria and attention to negative information (beta = 0.42, p < 0.001), after adjusting for background characteristics. Conclusions Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. Therefore, it’s beneficial to develop strategies and interventions that provide accurate, balanced online health information and educate individuals about the risks of excessive online health searches. Key messages • Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. • It is beneficial to develop strategies and interventions that provide accurate, balanced online health information.

Educational attainment and cardiovascular outcomes in prostate cancer: observations from 3700 men in 6 countries in the RADICAL PC study

Abstract Background Educational attainment has been associated with improved cardiovascular outcomes in individuals with or at high risk for cardiovascular disease (CVD). There is little information on the relationship between education and CVD outcomes in individuals with cancer. Also, we have limited understanding of what mediates the relationship between education and these outcomes. Purpose To evaluate the relationship between educational attainment in patients with PC and CVD event (CVE) or all-cause mortality. Methods We prospectively studied 3,778 men with PC from 55 sites in 7 countries (median age 69 years), 46% on ADT. Inclusion criteria were one of: PC diagnosed in the past 12 months; started ADT within the past 6 months; or plan to start ADT in the next month. Educational attainment was classified as those who attained primary school education vs. those who attained high school education vs. those who attained greater than high school education. Participants were followed for a median of 2.5 years from enrolment to document CVE: myocardial infarction, angina, stroke, cerebrovascular disease, peripheral arterial disease, arterial revascularization, heart failure, venous thromboembolism, and atrial fibrillation. The primary outcome for this analysis was CVE or death. All outcomes were evaluated by Cox proportional hazards models adjusted sequentially for age, race, physical activity levels, tobacco use, and alcohol use. Results Among 3,778 participants, 726 (19%) achieved primary school education, 1,001 (27%) high school, and 2,051 (54%) greater than high school education. On univariate analysis, as compared with participants with greater than high school education, those with high school education and primary school education had respective HR (95% CI) of 1.33 (1.05-1.69) and 2.19 (1.71-2.83). Adding age, race, tobacco, and alcohol use to the Cox model progressively attenuated the association between education and the primary outcome. Eventually, after adjustment for these characteristics and physical activity levels, the relationship between education and the primary outcome was no longer significant (Table). Conclusion This finding suggests that patterns of tobacco and alcohol use and physical activity, which are modifiable behaviors, account for the relationship between education and death or CVE in patients with prostate cancer.Table

Does perceived usability of a multi-component mobile device intervention improve health-related quality of life?

Abstract Background Good health-related quality of life (HRQL) is essential to healthy aging. Prior studies have demonstrated that mobile device technologies can promote HRQL in older adults. However, evidence of technology acceptance in older adults is often inconsistent and poorly understood. Purpose This study aims to 1) describe technology acceptance using efficiency, learnability, user experience (i.e., acceptability), and perceived control from the USABILITY survey of a multi-component mobile device intervention consisting of a wearable activity tracker (Fitbit Versa), access to Lose It app, and text messages (for experimental group only) in older adults at risk for cardiovascular disease, and 2) examine the correlation between technology acceptance and changes in HRQL before and after using each component of the digital intervention. Methods Data were collected using a purpose-built technology usability survey, and HRQL was assessed using the 12-Item Short Form Survey (SF-12), which measured perceived physical and mental health. Correlations were used to identify associations between technology acceptance and HRQL. Results The mean age of participants (n=54) was 65.4 ± 6.0 years; a majority were females (60%), married (53%), Hispanic (66%), and had a high school education or higher (76%). Table 1 shows that the experimental group had considerably higher HRQL at three months, but no differences in technology acceptance were noted. Fitbit technology adoption was found to be correlated with physical HRQL (r=304, p=0.027). The Lose It app showed no correlation with HRQL. Despite receiving higher usability ratings, SMS messages were not correlated with physical or mental HRQL. Conclusion Our findings demonstrate that older persons at risk for cardiovascular disease find mobile device intervention components acceptable. However, each component affected physical and mental health differently. These findings inform more complete technology acceptance models for older individuals' technology design, education, and deployment. Older persons prefer personalized communication, such as customized text messages, as the most favored aspect of the multi-component mobile device intervention. It warrants a larger clinical trial to determine its efficacy on HRQL.

Social determinants and drivers of use of SARS-CoV-2 self-tests in a French national cohort study

Abstract Background Self-tests for SARS-CoV-2 became quickly available after the onset of the epidemic. They were especially recommended for high-risk and hard-to-reach populations. This study examines whether self-tests successfully reached vulnerable groups during first months of availability in France. Methods The EpiCov study is a national population-based cohort study conducted in France during the Covid-19 pandemic. Primary outcome variable was use of self-test at last SARS-CoV-2 test, among those who reported testing at least once between May-July 2021. Univariate and multivariate binomial weighted logistic regressions were run, stratified by age group (16-24 yrs, 25-59, 60+), to identify social determinants and drivers of use of self-tests. Results Overall, 11% of the population who tested for SARS-CoV-2 between May-July 2021 reported using a self-test as last test. Demographic factors were highly predictive of use of self-tests among 25-59 y/o, but not among younger and older age groups. Use of self-tests was highest among 16-24 y/o, people with higher education, lowest population density areas, and people with high overall frequency of testing. Use was lowest among 60+ y/o, unemployed and retired people, and first-generation immigrants. When stratifying by age, 16-24 y/o with high perceived Covid-19 risk were more likely to use self-tests (aOR 1.99, 95% CI 1.10-3.59). Among 25-59 y/o, in-person workers were more likely to use self-tests than remote workers (aOR 1.91 [1.20-3.05]). Among 60+ y/o, employed people were more likely than retired people (aOR 3.97 [2.30-6.85]). Conclusions With higher utilization in low population density areas and among frequent testers, convenience may be a primary driver of use of self-tests. Additional drivers include perceived risk among younger people and exposure at work for those ≥25 yrs. Inequities in use were observed, with lower use among people with low education, older age, and immigrants. Key messages • Use of self-tests in France during the Covid-19 pandemic was low among vulnerable population groups, including people with lower education, immigrants, and older individuals. • Drivers of use included geographical access to healthcare services, perception of risk among younger respondents, and exposure at work among adults aged ≥25 years.

What Is Known About Curriculum Modifications? A Scoping Literature Review

Modifying the curriculum is a common practice used to support students with individual education plans (IEPs). All 13 provinces and territories in Canada (and their associated federally run schools) permit the use of curriculum modifications yet, despite their frequent use, the efficacy of this long-standing practice has rarely been studied. This scoping literature review maps what is currently known about curriculum modifications. Findings reveal two significant issues with the terminology used in the existing literature—inconsistent use of terms and conflation of terms. Additionally, the limited research available reports that while some students identified as having intellectual disability may benefit from modified curricula in certain contexts, other groups of students may experience harm. These findings lay a foundation for future research on curriculum modifications, an area that warrants urgent attention from the anti-oppression movement within special education.

Exploring Electronic Personal Health Record usage in Northern Italy: a cross-sectional study

Abstract Background The Electronic Personal Health Record (EPHR) is a patient-centered tool that enables citizens to manage their health information. The EPHR has been implemented worldwide, including in Italy, and holds immense potential, but it has shown a generalized underutilisation. Therefore, this paper aims to identify its fulfillment and the reasons behind its poor use, potentially uncovering the key to unlocking its benefits. Methods A survey was distributed on social media and in the waiting rooms of vaccination facilities in a Region of Italy. Multivariable regression models were conducted to detect a connection between the general population’s usage of the EPHR and specific independent variables. Results Of the 1634 respondents, 710 activated the EPHR, especially women, Italians, highly educated, unemployed, with good health but affected with chronic diseases. Amongst those who activated the EPHR, the multivariate analysis showed that the number of accesses to the platform was significantly associated with lower age (adjusted Odds Ratio (adjOR) 0.96 p = 0.015), higher level of education (adjOR 2.17 p = 0.029), unemployment (adjOR 5.61 p = 0.008) and considering the information on the EPHR complete (adjOR 3.83 p = 0.001). As age increases, the perceived ease of access to the EPHR decreases (adjOR=0.98 p = 0.049). Having a higher level of education (adjOR=0.41 p = 0.042), autonomy in reading health materials (adjOR=0.32 p = 0.043), and less self-confidence in filling out medical forms (adjOR=0.61 p = 0.033) were linked to a decrease in perceived ease of access. Conclusions The study showed that the EPHR is more utilised by specific categories of citizens, especially the young and those with higher education. More efforts should be made to increase access to the EPHR for the whole community by making it more intuitive and user-friendly. The present study provides valuable foundations to foster the implementation of a platform for sharing health data at a European level. Key messages • The Electronic Personal Health Record (EPHR) is underutilised despite its potential; it’s mainly accessed by young and highly educated individuals. • Efforts to increase EPHR usage must focus on improving accessibility and ease of access, as well as enhancing user confidence and autonomy in managing health information.

Urban Air Mobility Passengers’ Profiling: Evidence from Milan Airports, Italy

Urban air mobility (UAM) is expected to offer new travel options for passengers to and from airports in the near future, despite uncertainties associated with regulatory issues, environmental concerns, and societal impacts. This paper analyzes the socioeconomic and behavioral factors that could influence users’ modal choices (including UAM services) for accessing and egressing airports. Using revealed and stated preference data collected at Milan airports (Italy), mixed logit and hybrid choice modeling specifications are estimated and compared with profile potential UAM passengers. Our findings suggest that the level of service, socioeconomic factors, and trip-related variables explain passengers’ choices better than latent traits such as fear of flying, propensity for technological advances, and expectations about the safety of UAM services. In other words, the additional complexity of hybrid choice modeling is not justified by the slight gain in likelihood compared with the estimated mixed logit model. The results also indicate that high-income individuals traveling for business purposes are the most likely demand segment to use UAM services, at least initially. Moreover, highly educated individuals and employees who have their travel expenses reimbursed for work trips are less likely to choose UAM services for airport access or egress, preferring traditional ground taxis.

Food purchase and consumption behavior during the COVID-19 pandemic lockdown in Bangladesh: association between sociodemographic composition

BackgroundBangladesh suffered a severe COVID-19 wave from June to August 2021, which forced the government to impose emergency nationwide lockdown measures for three months with discontinuities. The sudden lockdown strongly affected the dietary preferences, financial circumstances, and social interactions of citizens.MethodsIn this comprehensive study, we collected sociodemographic information as well as data on food purchase and consumption behaviors from 1,350 adults in Bangladesh during the weeks of enforced confinement. The association between the sociodemographic factors (viz., gender, age, education status, income, occupation, and household size) and food purchase and consumption behaviors were determined by conducting bivariate and multivariate logistic regression models reporting as odds ratios.ResultsThe descriptive result reveals that 49.63% of the participants experienced wage reductions, with many people enduring reductions of up to 75%; 12.22% lost their jobs. Besides, a decline in the frequency of shopping was observed by 35.04%; and 24.52% avoided outdoor shopping during the pandemic period. Additionally, 28.74% of participants purchased less overall, while 19.48% purchased significantly fewer items per trip compared to the pre-pandemic period. The multivariate analysis shows a prominent increase in online grocery shopping (OR: 4.03, 95% CI: 2.38–6.83, p < 0.001) and meal delivery services (OR = 5.19, 95% CI = 3.21–7.17, p < 0.001) among higher educated individuals compared to the individuals having no institutional education. The personnel having formal jobs purchased 2.34 times more from online grocery sites (95% CI = 0.34–4.08, p = 0.003) compared to the unemployed one. In contrast, a notable increase in panic buying and stockpiling was observed, driven by scarcity and escalating prices of essential food items. The frequency of meals with families, active engagement in meal preparation, and the exploration of novel recipes also increased notably.ConclusionsThe consumption of takeaway food and inter-meal snacks increased significantly with the education level of individuals. These findings highlighted that a prolonged pandemic could magnify economic vulnerability in Bangladesh.

Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Organizational Strategies for Providing Foreign Language Education Services to Adults Over 45: International Practices and Approaches

Organizing educational services for people over the age of 45 is essential for their personal development, economic participation, social inclusion, and mental well-being. International and local legislation supports these initiatives, aiming to provide equitable and inclusive educational opportunities for all ages and to use the benefits of these people being fruitfully involved in the economic and social life of a country. The article aims to examine the strategies for providing educational services to adult learners (citizens over the age of 45) in different countries (European countries, the USA, Australia, China, Ukraine, Brazil, and Japan), with a focus on whether this process is integrated into social services and formal and informal education systems within the framework of the concept of lifelong learning. The methods included literature review on databases such as Google Scholar, JSTOR, and ERIC; comparative analysis of educational policy documents; case studies and reports from different nations; meta-analysis; field observations; and others typical to the field of comparative education and general education. They were utilized to provide a comprehensive and well-rounded analysis of how different countries organize and implement foreign language education services for adults over the age of 45. The findings reveal that the approaches to providing foreign language education for adults over 45 varies widely across different countries, reflecting each nation's unique historical traditions, cultural values, and current societal needs. This diversity in practice can be categorized into four main groups: services provided by social services; formal education systems; informal education systems; and self-organized services to present the prevailing approach to providing foreign language education for individuals over 45 in each country. The study concludes that the provision of foreign language learning services for individuals over 45 varies significantly across countries, reflecting diverse historical traditions, cultural attitudes, and current needs. Whether through social services, formal education systems, informal educational channels, or self-organization, each country’s approach highlights the importance of adapting educational services to meet the needs of an adult population seeking continued personal and professional growth.

Feasibility and pilot study of Indonesia’s first telehealth support program for gynecological cancer survivors undergoing chemotherapy

Most Indonesian gynecological cancer survivors experience chemotherapy side effects on their physical and mental health as they face unmet needs of supportive care, which increases the likelihood of discontinuing treatment. Interventions in telehealth assist survivors in resolving these issues. The aim of this pilot study was to determine the feasibility of fighting distress, self-efficacy, health effects, and sexual (FoRSHE-X) interventions and evaluate their potential impact on distress level, side effects knowledge and management, self-efficacy, and sexual quality of life. The study involved gynecological cancer survivors who underwent chemotherapy and participated in ten weeks of individual social media-based education, tele-coaching, and teleconsultations, from September 2023 to June 2024. The study feasibility and pilot outcomes were evaluated using descriptive statistics and qualitative thematic analysis. Of the twelve women recruited, six (50%) completed the study, filled out pre- and post-intervention questionnaires, and participated in interviews. Fifty-four virtual education, coaching, and consultation sessions were performed individually. The statistical results indicated that participants were highly satisfied with the telehealth program, which significantly increased their knowledge (p=0.02), health practices (p=0.04), and self-efficacy (p=0.01). The qualitative analysis highlighted participants' and coaches' perspectives on the study’s acceptance, barriers, and recommendations. In conclusion, this pilot study suggests that a definitive trial to assess the FoRSHE-X interventions is feasible, acceptable, and can be applied not only to gynecological cancer survivors but also to other types of cancer, thereby broadening the potential impact of the study.

Impact and Policy Implications of Transition Education Practices on IDEA Indicator 13 Scores and Indicator 14 Outcomes

Federal special education policies require state departments of education to collect data to measure progress in attaining state performance plan goals, with Indicators 13 and 14 measuring the Individual Education Program (IEP) transition process and post-high school student outcomes. Research suggests that higher transition indicator scores result in better post-school outcomes, but no research has yet demonstrated the impact transition education practices have upon indicator scores. This study identified transition education practices that impacted one state’s transition Indicators 13 (transition IEP process compliance scores) and 14 (post-high school outcomes). Eighty-three secondary special educators from 36 districts identified the extent their students engaged in various evidence-based transition practices. Hierarchical cluster analysis identified five transition education themes. Multivariate analysis of variance revealed few statistically significant results and several meaningful effect sizes indicating specific transition education practices that impacted Indicator 14 outcomes. Districts with students actively involved in IEP meetings had higher Indicator 13 scores and 14 outcomes. Districts with high to moderate number of students with paid jobs and money management experience had higher Indicator 14 outcomes. Districts that taught students to set postsecondary goals had higher Indicator 14 outcomes. Other results are described and policy implications discussed.

Relationship Between Socioeconomic Status and Basic Auditory Processing in Young Adults.

The current study aimed at investigating the relationship between socioeconomic status (SES) and basic auditory processing in young adults with normal hearing. Specifically, we sought to determine whether SES metrics, including parental education, parental occupation, and individual education attainment, influenced performance on tasks of basic auditory processing. Secondarily, we also aimed at understanding the interactive effects of SES and working memory on basic auditory processing. A total of 38 young adults were included in the study. Self-reported SES measures were recorded through Likert scales, and auditory processing measures included tests for temporal fine structure (TFS) and spectrotemporal sensitivity (STS). Pearson correlation analyses were conducted to probe the relationships between SES indicators and auditory processing performance. Multiple linear regressions were conducted to understand the interactive effects of SES and working memory on auditory processing performance. The analysis revealed no significant correlation between SES measures and basic auditory processing performance across TFS and STS tasks. Furthermore, analysis investigating the interaction between SES and working memory also yielded nonsignificant results. These findings indicate that, within this specific age cohort, SES information may not be indispensable for assessing basic auditory processing. Our study suggests that SES may not significantly influence basic auditory processing in young adults with normal hearing. However, further research with larger sample sizes and longitudinal designs is warranted to confirm these findings and explore potential age-related differences in the impact of SES on auditory processing across the lifespan.

Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life.

Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.

The Alarming Exodus of Nigerian Professionals: The Devastating Consequences of Human Capital Flight and Migration on Nigeria's Economic Development

Purpose: This study rigorously investigates the phenomenon of human capital flight and migration in Nigeria, emphasizing the alarming exodus of skilled professionals and its profound implications for the nation's economic development. By contextualizing brain drain within the broader landscape of labour mobility, this work seeks to elucidate the factors driving the migration of educated individuals, particularly in critical sectors such as healthcare, education, and technology. Materials and Methods: Utilizing a mixed-methods approach, this research synthesizes qualitative data from academic literature, policy documents, and empirical studies, alongside quantitative analysis drawn from migration statistics and socioeconomic metrics. This robust methodological framework supports a comprehensive exploration of the interplay between migration, brain drain, and national development, facilitating a deeper understanding of the ramifications of skilled labour loss. Findings: The findings indicate that Nigeria's alarming exodus of professionals is intricately linked to a confluence of factors, including systemic corruption, deteriorating infrastructure, and limited employment prospects. This human capital flight significantly undermines the quality and accessibility of essential services in critical sectors, leading to substantial socio-economic disparities. Consequently, the loss of skilled labour constrains Nigeria's competitive edge and stunts its economic resilience and growth potential. Implications to Theory, Practice and Policy: This inquiry extends beyond descriptive analysis to propose a nuanced framework for understanding the theoretical implications of human capital flight and migration in developing economies. It underscores the urgent need for policymakers to undertake comprehensive strategies that address the root causes of this phenomenon, fostering a conducive environment that retains talent while enhancing human capital investment and innovation capacity.

Individual Education Plan Priorities: Insights From the Autistic Community and Educators Supporting Autistic Learners

ABSTRACTIndividual education plan (IEP) quality is a strong predictor of student outcomes and progress towards their goals. In the Republic of Ireland, unlike many other jurisdictions, IEPs are not compulsory, regulated or assessed. Therefore, the aim of our co‐produced, mixed‐methods study was to identify and understand the IEP priorities of the autistic community as well as educators supporting autistic students in the Republic of Ireland and Northern Ireland. In total, 109 participants completed the survey. Sixty‐five of the participants were non‐autistic educators, 34 were autistic non‐educators, and 10 were autistic educators. Social inclusion, independence and communication were IEP goals prioritised by all participant groups. Promotion of autistic well‐being was the primary reason for these priorities. The impact of these findings, particularly as they relate to Initial Teacher Education, is discussed.

EDUCATION OF REFUGEE CHILDREN WITHIN THE INTREF PROJECT FRAMEWORK

Amidst growing migratory movements and hurdles of assimilation, the INTREF initiative strives to craft a comprehensive strategy for the schooling of refugee children, melding e-learning, emotional and social support, along with adaptable teaching methods. This endeavor learns on principles like linguistic diversity, cross-cultural skills, and customizing the educational journey, crucial for assimilation and triumph within academic settings. Studies indicate the indispensability of bespoke linguistic assistance, cognizance of cultural variances, and personalized educational tactics for the seamless school transition and societal assimilation of children in refuge. The project devised a survey instrument aimed at evaluating the baseline educational scenario in the participating nations and formulating education plans tailored to specific needs. This survey zeroes on four pivotal areas: linguistic proficiency, cross-cultural consciousness, embracing diversity, and pedagogical customization. Feedback from 31 students, 30 teachers and 28 parents revealed a pressing need for augmented linguistic aid in Slovenia, heightened cross-cultural understanding, and classroom method modification to enrich the academic experiences of culturally diverse children. The findings also underscore a discernible discrepancy between the perspectives of educators versus those of parents and children. The insights from this survey lay the groundwork for creating innovative instructional units and resources, finely adapted to the needs of children in refuge. By forging links between theoretical insights and practical application, as well as among various educational stakeholders, INTREF is ready to enrich the discourse and practices surrounding inclusivity, and endeavor made increasingly pertinent by the recent global disruptions, including the migratory dilemma and the COVID-19 outbreak. Keywords: educational system, individualization of education, integration practices, intercultural competence, refugee children

The Next Era of Assessment Within Medical Education: Exploring Intersections of Context and Implementation.

In competency-based medical education (CBME), which is being embraced globally, the patient-learner-educator encounter occurs in a highly complex context which contributes to a wide range of assessment outcomes. Current and historical barriers to considering context in assessment include the existing post-positivist epistemological stance that values objectivity and validity evidence over the variability introduced by context. This is most evident in standardized testing. While always critical to medical education the impact of context on assessment is becoming more pronounced as many aspects of training diversify. This diversity includes an expanding interest beyond individual trainee competence to include the interdependency and collective nature of clinical competence and the growing awareness that medical education needs to be co-produced among a wider group of stakeholders. In this Eye Opener, we wish to consider: 1) How might we best account for the influence of context in the clinical competence assessment of individuals in medical education? and by doing so, 2) How could we usher in the next era of assessment that improves our ability to meet the dynamic needs of society and all its stakeholders? The purpose of this Eye Opener is thus two-fold. First, we conceptualize - from a variety of viewpoints, how we might address context in assessment of competence at the level of the individual learner. Second, we present recommendations that address how to approach implementation of a more contextualized competence assessment.