Older adults with diabetes frequently access their electronic health record (EHR) notes but often report difficulty understanding medical jargon and nonspecific self-care instructions. To address this communication gap, we developed Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered, EHR-integrated diabetes self-management support tool designed to embed tailored educational statements within the assessment and plan section of clinical notes. This study aimed to validate the clarity, relevance, and alignment of SEE-Diabetes content with the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework from the perspectives of older adults and clinicians. An interdisciplinary team conducted expert reviews and qualitative interviews with 11 older adults with diabetes and 8 clinicians practicing in primary care (family medicine) and specialty diabetes care settings at a Midwestern academic health center. Patients evaluated the readability and relevance of the content, while clinicians assessed clarity, sufficiency, and potential clinical utility. Interview data were analyzed using inductive thematic analysis, and descriptive statistics were used to summarize participant characteristics. Patients (mean age 72, SD 4.9 y; mean diabetes duration 26, SD 15 y) reported that the SEE-Diabetes statements were clear, relevant, and written in plain language that supported understanding of self-care recommendations. Clinicians (mean 13, SD 9.5 y of diabetes care experience) viewed the content as concise, clinically appropriate, and well aligned with patient self-management goals and the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework. Both groups identified the tool's potential to enhance patient engagement and patient-clinician communication, while noting opportunities to improve the specificity of language, particularly within medication-related content. SEE-Diabetes demonstrated content validity as a practical, patient-centered digital health tool for supporting diabetes self-management communication within EHR clinical notes. The findings support its use as a complementary approach to reinforce self-care communication in routine clinical practice and highlight areas for refinement to enhance personalization.

Abstract Introduction Measuring extended Activities of Daily Living (eADLs) is an important part of functional assessment. Several eADL scales are currently used, resulting in heterogeneity and lack of standardisation. Existing scales are potentially outdated, containing activities which are no longer considered relevant by older people. We aimed to explore the perspectives of older adults and healthcare professionals on eADL assessment to inform new approaches to eADL measurement. Method Semi-structured qualitative interviews were undertaken with older adults and healthcare professionals. Perspectives were gathered on preferences around eADL assessment, scale administration and activities that could be included in a new scale. We also explored the contribution of education and digital literacy. Thematic analysis was used to develop themes from verbatim interview transcripts. Results A total of 41 interviews (online and in-person) were conducted with 21 older adults (>60 yrs) and 20 professionals representing different members of the multidisciplinary team. Five themes were developed from interview data. Older adults identified that both physical and social activities should be included in eADL scales, and that technology has changed how eADLs are carried out. They also highlighted that views on the acceptability of receiving help must be considered to ensure accurate scoring. Professionals acknowledged that while eADL assessments could be conducted by a machine, face to face communication has key benefits. Inclusivity was consistently prioritised, with gender roles and financial factors identified as key influencing factors in eADL assessment. Conclusions Participants identified priorities for future approaches to eADL assessment that will offer a holistic assessment of eADLs and be inclusive to all, whilst reflecting the contemporary activities of life in the 21st century. This requires attention to sources of bias which can arise around inequities in education, access and finance. Further research is needed involving older people who are not digitally confident.

Dalit students’ anti-caste and gender struggles against the dominance of the caste Hindus at the university have been examined extensively. However, while studying acts of resistance in higher education, dalit girls’ subjectivities are often overlooked or merged with dalit men’s narratives. Additionally, research on dalit women tends to focus on their conflicts concerning caste Hindu males or more generally. Their specific experiences and agency deserve more scholarly attention. This article draws on semi-structured interview data from a study of dalit women pursuing higher education at a university in Lucknow, Uttar Pradesh. Through the narratives of 30 women in higher education, it explores how they support and empower each other to survive and succeed and questions their invisibility in everyday interactions with peers and teachers at the university.

Clinical champions are often engaged to implement new evidence-based practices in health care settings. Previous research suggests that the mere presence of a champion does not guarantee successful implementation; therefore, we aimed to identify specific champion attributes and site-level factors that contribute to evidence-based practice adoption. During a Department of Veterans Affairs (VA) quality improvement program, we engaged site champions to implement an advance care planning evidence-based practice with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs). We conducted interviews (N = 99) with champions and leadership at 11 HBPC programs and 6 VA CNH programs. Guided by the Tailored Implementation in Chronic Diseases (TICD) framework and Shea's conceptual model of champion impact, we analyzed interview data to examine champion characteristics and site factors associated with successful adoption of the evidence-based practice. Additionally, we categorized sites as successful or not successful in terms of adopting the evidence-based practice and compared champion characteristics and site factors between these sites using a Matrixed Multiple Case Study approach. Eight HBPC programs (73%) and four CNH programs (67%) were successful. Champions at successful sites believed in the importance of eliciting and documenting Veterans goals of care, were motivated and committed to participating in the project, and were dedicated to serving as champions. Successful sites had champions who engaged in champion activities beyond attending coaching calls, including supporting and educating peers. The degree of leadership support, as well as the relative priority of the project varied; unsuccessful sites mentioned competing priorities and lower levels of leadership engagement. Results suggest that champion belief in the importance of the evidence-based practice, commitment to the program, motivation to serve as a champion, and engagement with peers are characteristics common among champions at sites that successfully adopted the evidence-based practice. At the site-level, the degree of leadership engagement and the priority of implementing the evidence-based practice emerged as factors influencing success. These findings can assist future healthcare interventions and programs in identifying clinical champions for implementing evidence-based practices.

ABSTRACT As artificial intelligence (AI) tools become increasingly embedded in education, concerns about their ethical consequences have intensified. Risks such as plagiarism and the potential erosion of students' critical thinking skills underscore the complexity of integrating AI responsibly. Ensuring the ethical use of these technologies is therefore a central challenge for AI in Education (AIED). Yet, how in‐service teachers' emotional responses intersect with ethical concerns remains insufficiently understood, despite emotions being pivotal in shaping classroom practice and AI‐enabled productivity. Drawing on Appraisal Theory, this case study examines how university English teachers emotionally respond to the ethical principles of AI integration. Thematic analysis of semi‐structured interview data revealed distinct emotional patterns associated with different principles of AI ethics. Beneficence was primarily linked to Challenge Emotions and Achievement Emotions, whereas Non‐Maleficence, Autonomy, Justice, and Explicability were more often tied to Deterrence Emotions and Loss Emotions. Among these, concerns about Autonomy, particularly student dependence on AI and the erosion of critical thinking, emerged as especially salient. These findings highlight the need for context‐sensitive policies, targeted AI training programs, and a stronger emphasis on ethical reflexivity. By showing how teachers' appraisals of ethical principles are closely intertwined with their emotions, the study extends existing research on AI ethics in education and underscores that emotionally informed approaches are indispensable for achieving responsible, sustainable, and human‐centered AI integration.

ABSTRACT This paper discusses instructional practices and the knowledge distribution to groups of students from different social class backgrounds in Norway. The study draws on ethnographic observations and interview data from two similar-performing primary school classes with contrasting social class compositions. It is interested in what happens inside the classrooms beyond the performance indicators. Basil Bernstein’s work on the pedagogizing of knowledge forms the conceptual framework. The study finds a potentially narrowed school experience for students from lower social class backgrounds due to a major focus on basic skills and language. It discusses the meaningfulness of teaching and learning in light of test-based accountability in education policy. Finally, the study argues that national-testing results conceal as much as they reveal about learning in the classroom and mastery of knowledge.

BackgroundPalliative care in community settings can support seriously ill individuals to reduce symptoms and maintain quality of life. However, many individuals decline palliative care, even when they have health concerns. Differences in understanding how palliative care can help manage serious illness may contribute to declining.ObjectiveThis study explores the relationship between individuals' understanding of palliative care, their health concerns, and education levels (a proxy for health literacy).MethodsWe use survey responses from a validated instrument assessing palliative care knowledge and information from semi-structured interviews for 21 seriously ill individuals (n = 3) and family caregivers (n = 18) who were eligible for community-based palliative care services and declined. We explore the relationship between respondents' education, understanding of palliative care, and their concerns about their or their loved one's health.ResultsAmong participants, twelve had a bachelor's degree or more; nine had some college or less. Six participants with some college or less expressed concerned about stress from serious illness. Of these, half (n = 3) did not understand palliative care could help. Conversely, five participants with a bachelor's degree concerned about stress understood palliative care could help. Seven participants with some college or less expressed concerned about medication side effects; four did not understand palliative care could help. Conversely, three participants with a bachelor's degree concerned about medication knew that palliative care could help.ConclusionAssessing health concerns and explaining how palliative care can address those concerns may reduce barriers to accepting palliative care, particularly among individuals with lower levels of education.

ABSTRACT Studies of instructional videos usually focus on the modalities in videos. This study aims to compare the effects of content type on video-watching behaviour, collected scores, and cognitive load levels. The study follows an explanatory mixed design, where 40 volunteer high-school students were assigned to interact with two videos (academic vs. non-academic). System logs, including quiz scores, screen recordings, and interview data, were used as data sources. The results indicated that interacting with non-academic content provided a more convenient learning experience with less frequent navigational elements. Similarly, learners spent a longer time on academic content. Moreover, trying again was the most frequent action, followed by backward, which was preferred to re-watch the related content before/after the quiz interaction. Although having the same design approach apart from the content, the learners found the academic content challenging. On the other hand, the quiz scores for non-academic content were higher than those for academic content. Finally, the reported cognitive load levels were not significantly different from each other. The overall findings point out that interactive videos might not guarantee satisfactory learning experiences because the content of the videos might influence certain patterns of video watching as well as the learning gains.

This article discusses the impact of Covid-19 on disabled people’s experiences of walking in the UK, using survey and interview data from the project Walking Publics/Walking Arts: Walking, Wellbeing and Community During Covid-19 . Built environments are often encountered by disabled people as hostile and exclusionary. Our research identifies ways that this inequality was significantly magnified during the pandemic, including through overcrowded public spaces, increased street furniture and lack of facilities. Alongside attending to everyday walking experiences, we draw upon creative walking tactics and the work of walking artists, which enable imaginative encounters at multiple scales. These demonstrate how creativity can iterate alternative trajectories which embed accessible infrastructures and facilitate different ways of encountering, moving through and being in the city.

The urban First Nations population in Australia is rapidly increasing. The health policy and research focus on urban First Nations Australians, however, is limited. To contribute to addressing this situation, The University of Queensland Poche Centre for Indigenous Health (UQ Poche Centre), a First Nations-led health research centre, is working closely with urban Aboriginal Community-Controlled Health Services (ACCHS) across Australia. Our study examined urban ACCHSs stakeholders' perspectives of the health and wellbeing of urban First Nations Australians and identified their priorities for a national Indigenous urban health research agenda. Ten stakeholders were recruited for in-depth interviews from ACCHS that were members of the Research Alliance for Urban Community-Controlled HealthServices (RAUCCHS), a partnership between the UQ Poche Centre and urban ACCHS focused on achieving equitable health outcomes for urban First Nations Australians. Six stakeholders identified as First Nations Australians. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed using inductive thematic analysis. Stakeholders highlighted a lack of research focused on the health of urban First Nations Australians.Specific priority areas they identified for an urban First Nations health research agenda were:evaluating the effectiveness and adaptability of Indigenous models of care, strengthening care pathways between ACCHS and specialist services, examining the intersection of cultural identity, racism and determinants of health, and greater investment in Indigenous research governance structures and processes. There is a clear opportunity for researchers to engage with RAUCCHS members to establish a body of urban First Nations health research in Australia that responds to their research priorities.

Mediterranean welfare states have generally been treated as a homogeneous group; a ‘family of sinners’ that requires structural reforms to tackle persistent problems. While this applied until the Great Recession, new evidence suggests significant departures from this trajectory. Why did Mediterranean countries move from dualization and retrenchment to more generous measures in 2020, especially in outsiders’ protection? Taking the pandemic as a symmetric shock, we investigate welfare state responses in three Mediterranean regimes - Spain, Portugal and Italy. We find that, while all three departed from past austerity logics, Spain adopted a more encompassing response, entailing generous support towards both core and peripheral workers. Italy and Portugal, instead, persisted in a dual model of core segment protection with transfers for the most vulnerable. Drawing on interview and documentary data, we explain this divergence with the interplay between policy learning on the Left and patterns of ‘crisis corporatism’.

Abstract This study examines the interaction patterns and perceptions of university students who used ChatGPT during the English essay writing process. Twenty university students in Korea were divided into two groups based on English proficiency: 10 advanced learners and 10 intermediate learners. Participants completed essay writing with the assistance of ChatGPT, and their interaction logs were collected throughout the process. The logs were analyzed using Epistemic Network Analysis (ENA) to identify interaction patterns across proficiency levels. In addition, thematic analysis of interview data was conducted to examine learners' perceptions of ChatGPT-supported writing. ENA results showed that advanced learners used ChatGPT primarily during the prewriting stage for information gathering, word choice exploration, and translation, and later shifted to refining expressions during drafting. In contrast, intermediate learners relied more heavily on ChatGPT during drafting, particularly for lexical and syntactic exploration. Thematic analysis revealed that although learners recognized ChatGPT as an efficient and supportive tool for English essay writing, they also noted its limitations, including unclear information sources and insufficient contextual understanding.

This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles. This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework. Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities. Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes. We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted. Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD. The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.

The expansion of financial technology promises greater financial inclusion, yet for many female street vendors (pedagang kaki lima/PKL) in Indonesia, it has instead created a form of digital entrapment. This study employed a qualitative, retrospective case study methodology to investigate the lived experiences of 10 purposively selected women who had engaged with online lending services (pinjol). Drawing on Jan van Dijk’s four-level digital divide framework, we conducted a thematic analysis of in-depth interview data to assess their levels of vulnerability. Findings indicate that the decision to use online loans was not driven by well-developed business strategies but rather by persuasive advertising and immediate personal needs. Participants frequently misinterpreted the presence of OJK (Financial Services Authority) logo as a universal guarantee of safety, while lacking the skills to critically evaluate interest rates, loan conditions, and data-privacy risks. The perceived affordability and accessibility of these platforms came at a significant cost, particularly in terms of personal data exposure, which further exacerbated participants’ financial and emotional vulnerabilities. Rather than fostering financial independence, online lending entrenched a “gali lubang tutup lubang” (robbing Peter to pay Paul) cycle of indebtedness that undermined their livelihoods, mental well-being, and social environments. This study shows that for women working in the informal sector, fintech’s promise of inclusion often masks structural dynamics that reproduce exploitation and deepen precarity in developing-country contexts.

As social pedagogues we have a keen interest in initiatives benefiting groups that are often overlooked or groups that suffer from multiple disadvantages. The Wellbeing Jobs Club is one such initiative. Set up by a community trust, this club takes a holistic approach to supporting those trapped within the negative cycle of unemployment, recognising the effects that this can have on mental health and overall well-being. Our evaluation of the service collected survey and interview data from both club participants and job coaches. All participants were free to attend under their own volition and were always met with unconditional positive regard. This service provided a source of care and support with everyday challenges that caused attendees high levels of anxiety, and unique needs of a very diverse group were catered for. This club was clearly a lifeline for some of the most vulnerable in our communities and we call for increased funding for this and similar initiatives.

Providing care aligned with patient values is key to high-quality cardiovascular care. However, it is unclear how recipients of a ventricular assist device (VAD) engage in values-centered discussions during the postimplantation period. To understand how recipients of a VAD engage in conversations focused on clarifying what matters most. Sequential explanatory mixed methods study. Adult recipients of a VAD were recruited from a Southeastern U.S. outpatient clinic. Participants completed a cross-sectional survey characterizing values discussions (with whom, who is present, timing, frequency, location, feelings). A subset completed a semi-structured interview to provide a richer understanding of survey findings. Survey respondents (response rate 31%; N = 32) were 37 to 77 years, mostly male (59%) and non-Hispanic Black (53%). Qualitative analysis (n = 12) identified 3 themes: (1) Relational trust and emotional safety, (2) Timing and readiness, and (3) Contextual fit and communication environment. Synthesis of findings revealed congruence between survey and interview data. Patients indicated comfort with trusted, approachable individuals who were willing/able to offer support (with whom/who is present); acceptance and clarity about their new reality/identity (timing), trusting relationships built over time (frequency), and in-person interactions (location) were key; negative experiences emerged from frustration, conflict, negative attitudes, and lack of understanding (feelings). Findings highlight the importance of relational trust, emotional readiness, and a supportive communication environment in facilitating values-centered discussions and offer practical guidance for nurses to foster meaningful, values-centered discussions by prioritizing continuity, accessibility, and emotional safety in their interactions.

ABSTRACT This study examines the effects of a theatre-based intervention on the social skills of adolescents with intellectual disabilities attending a special education high school. Employing an explanatory sequential mixed-methods design, the research combines quantitative and qualitative approaches to provide a comprehensive understanding of observed changes during the intervention period. In the quantitative phase, a pre-test – post-test control group design was used. Social skills were measured using the Social Skills Assessment Scale, completed by classroom teachers. Statistical analyses revealed a significant increase in teacher-rated social skills of students in the experimental group compared to the control group, with a large effect size. In the qualitative phase, semi-structured interviews were conducted with trainers to explore their observations of students’ social development. Thematic analysis of the interview data revealed two overarching themes: development of social interaction and communication skills and personal growth and emotional development. The findings suggest that structured theatre-based practices may be associated with positive social skill trajectories within this specific school context, particularly in supporting adolescents with intellectual disabilities during the transition to adulthood.

Digital storytelling (DST) is an innovative pedagogical approach that integrates multimedia creation, personal narrative, and autonomy in L2 education. Yet, its influence on learner engagement remains underexplored in asynchronous delivery modes and non-conventional language learning settings, common in post-pandemic instructional practice. This study thus examines the engagement patterns of 34 student-teachers of English in an afterschool asynchronous DST task about teacher identity. The study further scrutinises their emotional engagement, given its impact on other engagement domains, and its relevance for online instructional design. Data were collected through a background information questionnaire, a validated student engagement questionnaire, and semi-structured interviews that focused on emotional engagement. Questionnaire data were analysed quantitatively using descriptive statistics and repeated measures ANOVA, and interview data were examined qualitatively using thematic analysis and specific emotional engagement-related frameworks. Results indicated participants’ higher cognitive and behavioural engagement, and lower emotional engagement. Their emotional engagement comprised positive emotions and anxiety, which emerged from specific subjective task values, autonomy, and task affordances in interaction with self-imposed personal standards and perceived digital skills. These findings challenge the common conceptualisation of emotional engagement merely as positive affect in L2 tasks and signal the importance of task- and learner-related factors in an engagement-driven online L2 pedagogy.

ABSTRACTBackgroundPatients admitted to intensive care units (ICU) generally require expensive, advanced technological interventions as well as a high level of specialised and timely care to survive their medical crisis. Work in this setting can generate significant pressures for ICU nurses.AimTo understand and prioritise ICU nurses' preferences for improving their work system based on the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.Study DesignUsing a sequential exploratory mixed‐methods design, qualitative interview data were first collected from ICU nurses employed in a tertiary hospital in Iran to identify interventions for improving their work system. Data saturation guided sample size. Directed content analysis was used for extracting themes representing areas for intervention. The qualitative data were then integrated into an Analytic Hierarchy Process for weighting and prioritising the identified interventions using quantitative pairwise comparisons and mathematical calculations.ResultsFourteen ICU nurses were interviewed. Directed content analysis of the transcribed data yielded 17 themes impacting nurses' well‐being and performance. The Analytic Hierarchy Process indicated that the themes with the highest priority for improving the ICU work system for nurses were Workload and Staffing, and micro‐level Support and Resources—associated with SEIPS Organisation and Person components, respectively. Notable intervention importance was also found for themes Collaboration and Support, Equipment and Technology Enhancement, Culture and Management, and Spatial Design and Arrangement.ConclusionsICU nurses identified a high number of challenges in their work environment. Modern decision‐making analyses were able to quantify and prioritise their preferences. These provide direction for designing future interventions.Relevance to Clinical PracticeAs technological advances continue to support patient survival, there is a need for judicious decision‐making in providing immediate and long‐term solutions for associated changes in the work system faced by critical care nurses to ensure nurse well‐being and patient care.

This qualitative study examined the integration of Artificial Intelligence (AI) in sustainable freshwater fishery management within the Okavango River ecosystem, combining primary field research with a comprehensive document review. The investigation explored how AI technologies, including machine learning and predictive analytics, can enhance fish stock assessment, habitat monitoring, and resource administration to achieve ecological and socio-economic sustainability. The study emphasizes the Okavango River's unique biodiversity and its critical importance to local communities while assessing AI's potential to transform traditional fishery management approaches. The research employs a dual-method approach, utilizing both face-to-face semi-structured interviews with key stakeholders (fishers, vendors, and officials) and a systematic review of relevant policy documents and documentary reviews. Thematic analysis of interview data and document content reveals key insights about AI adoption challenges, implementation opportunities, and practical applications in freshwater fisheries. Findings demonstrate AI's transformative potential in enabling real-time data collection, predictive population modeling, and overfishing prevention. However, significant barriers emerge, including technological infrastructure gaps, institutional resistance, and capacity-building needs among local stakeholders. By synthesizing field data with existing literature, this study makes a novel contribution to sustainable fishery management discourse, offering context-specific, AI-integrated strategies for the Okavango River ecosystem. The research proposes policy recommendations that address both technical implementation challenges and ethical considerations, grounded in empirical evidence from multiple data sources. Ultimately, this study highlights the critical role of AI in balancing ecosystem conservation with socio-economic development, while demonstrating how mixed-method approaches can strengthen research outcomes in environmental technology studies.