Likert Scale Items Research Articles

Students’ Perceptions of Their Speaking Practice with Foreign Interlocutors via Online Platforms

As online platforms become more widely accessible, English learners have greater opportunities to practice speaking with foreign interlocutors, though many remain hesitant due to a lack of confidence in their speaking abilities. This study examines the perceptions of 107 first-semester English learners at a private university who were assigned to use SCMC platforms like Free4Talk, InterPals, and HelloTalk to engage in English conversations with foreign interlocutors. The aim was to understand how these platforms supported speaking practice and identify any challenges faced. Data were collected through a questionnaire that included Likert-scale items and open-ended questions. The results revealed that 78% of students had positive perceptions, indicating that the platforms facilitated their English-speaking practice through real-time communication. However, they also reported technical issues, such as poor internet connectivity, and challenges with engagement, including difficulty finding consistent conversation partners. The study recommends further research into long-term language learner experiences and an exploration of platform features that could enhance English-speaking practice.

Development and validity evidence of an interactive 3D model for thoracic and lumbar spinal fractures pedagogy: a first step of validity study.

Thoracic and lumbar spinal fractures are common in trauma care, requiring accurate classification to guide appropriate treatment. While traditional teaching methods use static 2D images, there is a growing need for interactive tools to improve understanding. This study addresses the lack of interactive three-dimensional (3D) models for teaching the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine classification for thoracic and lumbar fractures. A free and open-access interactive 3D model of thoracic and lumbar spinal fractures was developed. The study aimed to provide preliminary validity evidence. We hypothesized that this model would be a valid educational tool for teaching the AO Spine classification, receiving high scores from senior spine surgeons on a validation questionnaire regarding anatomical realism and pedagogical value. The primary endpoint was the percentage of surgeons rating the model ≥ 8/10 on the Likert scale for content validation. We hypothesized that the 3D model would be validated by at least 75% of participating senior spine surgeons (rating ≥ 8/10) for anatomical realism and pedagogical value. The 3D model was created using the Blender® software, incorporating CT-scan images of a lumbar spine. AO Spine classification was used to recreate spinal fractures animations. The model could be used on any computer or smartphone, directly online. A total of 24 senior spine surgeons (5 professors, 6 fellows, 8 hospital practitioners, and 5 private practitioners) evaluated the 3D model using a structured questionnaire with seven Likert-scale items, assessing anatomical realism, fracture representation, adherence to the AO Spine classification, pedagogical value, and ease of use. A score of ≥ 8/10 was considered a positive validation. Group comparisons were made based on hospital activity and age. The 3D model was positively validated by 92% of surgeons for anatomical realism, 88% for fracture representation, and 92% for adherence to the AO Spine classification. The model's educational value for junior residents was rated positively by 100% of participants. Six out of 24 surgeons (25%) rated the ease of navigation < 8/10. Group comparisons revealed that university-affiliated surgeons rated the model higher overall (mean score 9.25/10) compared to private practitioners, who gave the lowest ratings (mean score 8.6/10). No significant correlation was found between age and ease of navigation (p = 0.948). The developed 3D model of thoracic and lumbar spine fractures is the first of its kind. It provides an innovative, open-access and freely online accessible tool for teaching the AO Spine classification. The findings demonstrate that it is a valid pedagogical tool for teaching the AO Spine classification, with strong support for its anatomical accuracy and pedagogical effectiveness. This study sets the stage for a future validation study with surgical residents. III.

A Study on Student Failure in Dzongkha Examinations at Khasadrapchu Middle Secondary School in Thimphu Distri

Abstract: This research aims to explore the reasons behind student failure in the Dzongkha examination for Classes IV-X at Khasadrapchu Middle Secondary School in the Thimphu District. Despite attempts to improve academic performance, a notable portion of students find it challenging to get passing marks in this important subject. This study adopted a mixed method approach with quantitative data analysis of sixteen Likert scale items, interviews, and three open-ended qualitative survey items with students, and teachers. The primary findings indicate that insufficient language skills, lack of interest, ineffective teaching methods, inadequate learning resources, and inconsistent learning text are the main factors contributing to students’ poor performance in this subject. The objective of this study is to offer perspectives that can guide educational strategies and approaches to enhance student performance in Dzongkha and cultivate a more encouraging learning atmosphere at Khasadrapchu Middle Secondary School.

Effects of School Heads’ Guidance and Counselling Strategy for Students’ Character Formation in Public Secondary Schools in Arusha Region, Tanzania

The study focused on the effects of school heads' administrative strategies on students' character formation in public secondary schools in the Arusha region, Tanzania. The study was guided by one research question and one hypothesis, and it employed a convergent design using a mixed methods approach to examine the problem. The research employed probability and non-probability sampling methods to select 177 teachers, 249 parents, 360 students, and 18 school heads from 18 chosen secondary schools. Data were gathered using questionnaires administered to teachers, parents, and students and interviews conducted with the heads of schools. The instruments were validated, and the reliability of the questionnaire was assessed using Cronbach's Alpha coefficient for Likert scale items. For qualitative data, reliability was confirmed through peer review and triangulation. Quantitative data were analysed using descriptive statistics, including mean scores, frequencies, and percentages, and then presented in tables. A hypothesis was tested using simple linear regression at a significance level 0.05. Qualitative data were analysed using contextual analysis and transcription. This study found that schools had a well-defined guidance and counselling programme in place but needed more professional counsellors, and it needed further improvement through external sources. Furthermore, the findings revealed no significant correlation between the guidance and counselling strategies of public secondary school heads and the levels of character development among students in the Arusha Region. This study concluded that while school heads’ guidance and counselling strategy positively affected students' character formation and goal-setting, this was achieved in collaboration with parents and professionals despite challenges and differing viewpoints among stakeholders. The recommendation study encourages teachers to participate actively in counselling seminars and strengthen collaboration with NGOs.

Suburban farmers’ perception about urban sprawl on livelihoods and environment in Ethiopia: Evidence from Sheger City Administration

Urban sprawl is a global phenomenon which is becoming a serious challenge for suburban farm households’ lives and livelihoods. This study was conducted to assess the perception of suburban farmers about urban sprawl in Sheger City, Ethiopia. The research utilized survey data from 393 households selected by multistage sampling and Focus Group Discussion, Key Informant Interviews, and field observation. Two outcome variables were developed from a total of 11 Likert scale items representing socioeconomic and socioenvironmental impacts of urban sprawl. Selected sociodemographic and environmental impact variables were used as predictor variables. Perception indices were computed for each outcome variable for each respondent. Descriptive statistics and ordered logistic regression were employed for the data analysis. Awareness of respondents particularly women about urban expansion and its consequences is noticeably high. 82.4% & 82.5% responded “Agree” to the outcome variables items respectively. Among others, land proximity to main road, land expropriation status, and education were major determinants with their 6.8%, 6.5%, & 1.9% respective probabilities of shaping households’ perception when the two outcome variables are combined. Agriculture and hence land is still a primary source of livelihood for over 70% of the households. The youth is evacuating the sector as the mean age of respondents is closer to retirement. Pre-emptive informal land selling to escape expropriation is escalating urban sprawl in the area. Therefore, inclusive and participatory market-based temporal land valuation, agricultural intensification, and fair compensation were recommended in implementing inclusive, planned and sustainable urbanization.

Perceptions of Pharmacy Faculty Regarding Factors Contributing to Declining First-Time NAPLEX Pass Rates

OBJECTIVEIdentify perceptions from pharmacy faculty across the Academy concerning factors that may be influencing NAPLEX first-time pass rates to highlight potential focused areas of further research based on common experiences. METHODSAn anonymous 43-item Qualtrics™ questionnaire was distributed to faculty members from the American Association of Colleges of Pharmacy. Questions were predominantly 5-point Likert scale items (5=very large impact) and encompassed six domains: pharmacy school factors, COVID-19 educational modifications, testing factors, standardized testing, applicant preparedness, and student factors. Demographic data as well as perceptions were reported with means and standard deviations. RESULTSIn total 600 responses were analyzed. Respondents were predominantly female (66%) and white (78%). Most had a Doctor of Pharmacy degree, residency training, and were practicing as a licensed pharmacist within the Southern and Midwestern US. Respondents indicated that the decline in NAPLEX first-time pass rates is a moderate to large problem (mean 3.64, standard deviation [SD] 0.891), and the top potential influencing factors include student quality (mean 3.99, SD 0.876), student’s critical thinking (mean 3.90, SD 0.947), study habits (mean 3.74, SD 0.920), and admission standards (mean 3.67, SD 1.082). CONCLUSIONSThe top 4 factors indicated by respondents as impacting NAPLEX first-time pass rates were related to the student quality. This result highlights the importance of exploring issues related to pharmacy admissions and the need to implement effective strategies to support an increasing number of potentially less prepared pharmacy students.

Assessing Rodent Attitudes: The Psychometric Properties of the SARod in a Chilean Context.

This study aimed to develop and validate the Scale of Attitudes towards Rodents (SARod) to measure public attitudes towards rodents in a Chilean community context. Utilizing an instrumental design, we gathered data from 497 participants using convenience sampling. The SARod, comprising 22 Likert-scale items, evaluates attitudes across four dimensions: Scientistic, Positivistic, Emotional Negativistic, and Cognitive and Behavioral Negativistic. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the scale's structure and reliability, revealing strong internal consistency (Ω > 0.8) across all factors. Results indicated that higher educational levels and increased interaction with rodents were associated with more positive attitudes, while a greater disposition towards rodent extermination correlated with more negative attitudes. No significant gender differences were observed. The SARod shows robust psychometric properties, offering a reliable tool for cross-cultural comparisons of rodent-related attitudes. This scale can inform targeted interventions and public education campaigns, promoting coexistence and effective rodent management strategies. Further research should explore the application of the SARod in diverse cultural contexts.

Exploring Consumer Satisfaction and Service Quality at Bhatbhateni Supermarket

Background: Customer satisfaction and service quality are pivotal to the success of businesses, particularly in the competitive retail landscape of Kathmandu. Bhatbhateni, as one of the leading retail chains in Nepal, plays a crucial role in offering a wide array of products and services. Understanding customer perceptions regarding service quality and satisfaction is essential for enhancing operational strategies and maintaining a competitive edge in this dynamic market. Objectives: This study aims to analyze the demographic profile of Bhatbhateni's customers, evaluate their perceptions of service quality and satisfaction, identify key service needs and expectations, and assess the likelihood of repurchase and recommendations among customers. Methods: A quantitative research approach was employed, utilizing structured questionnaires distributed to a sample of 120 customers of Bhatbhateni, selected through convenience sampling to ensure a diverse representation of gender and age. The questionnaire encompassed demographic inquiries and Likert scale items measuring customer satisfaction, service quality, and overall service experience. Data analysis involved descriptive statistics to summarize findings and identify trends in customer perceptions. Findings: The results indicated that the sample comprised 53.3% male and 46.7% female customers, with 61.7% of respondents aged between 15-25 years. A substantial 70.0% of respondents felt that Bhatbhateni understood their service needs effectively. In terms of satisfaction levels, 43.3% of customers reported being somewhat satisfied, while 12.5% expressed being very satisfied with the products. Moreover, 45.8% of respondents rated Bhatbhateni's quality management as good, and 41.7% positively rated staff responsiveness. Additionally, 48.3% indicated a high likelihood of repurchasing products, and 61.7% stated they would likely recommend Bhatbhateni to others. Conclusion: The study reveals a generally positive perception of service quality among Bhatbhateni's customers, highlighting key areas of strength and potential for improvement. Customer satisfaction is significantly influenced by the understanding of service needs and the quality of management. These findings suggest that Bhatbhateni is well-positioned for sustained growth through enhanced customer engagement and service delivery. Novelty: This research contributes valuable insights into the relationship between service quality and customer satisfaction within the specific context of Bhatbhateni, a prominent retail chain in Nepal. By employing a structured questionnaire and statistical analysis, the study adds to the limited existing literature on customer service perceptions in Nepal's retail sector. The findings can guide Bhatbhateni and similar businesses in developing targeted strategies to improve customer satisfaction and loyalty, ultimately enhancing business service management practices in the region.

Validation of the blended learning usability evaluation – questionnaire (BLUE-Q) through an innovative Bayesian questionnaire validation approach: a methodological study

The primary aim of this study is to validate the Blended Learning Usability Evaluation - Questionnaire (BLUE-Q) for use in the field of health professions education through a Bayesian approach. As Bayesian questionnaire validation remains elusive, a secondary aim of this article is to serve as a simplified tutorial for engaging in such validation practices in health professions education. A total of 10 health education-based experts in blended learning were recruited to participate in a 30-minute interviewer-administered survey. On a 5-point Likert scale, experts rated how well they perceived each item of the BLUE-Q to reflect its underlying usability domain (i.e., effectiveness, efficiency, satisfaction, accessibility, organization, and learner experience). Ratings were descriptively analyzed and converted into beta prior distributions. Participants were also given the option to provide qualitative comments for each item. After reviewing the computed expert prior distributions, 31 quantitative items were identified as having a probability of 'low endorsement' and were thus removed from the questionnaire. Additionally, qualitative comments were used to revise the phrasing and order of items to ensure clarity and logical flow. The BLUE-Q's final version comprises 23 Likert-scale items and 6 open-ended items. Questionnaire validation can generally be a complex, time-consuming, and costly process, inhibiting many from engaging in proper validation practices. In this study, we demonstrate that a Bayesian questionnaire validation approach can be a simple, resource-efficient, yet rigorous solution to validating a tool for content and item-domain correlation through the elicitation of domain expert endorsement ratings.

Improving Patient Handoffs and Transitions in Care Among Residents: A Chief Resident-Led Initiative.

Effective handoff between pediatric residents is crucial to ensure continuity of care and patient safety.Omissions in information and communication breakdowns can be associated with uncertainty in clinical decision-making and adverse patient events. In our role as chief residents, we were notified of an increase in patient safety alerts due to communication failures and gaps during handoff. We aimed to identify areas for improvement and implement strategies to improve competence in handoff among pediatric residents. We also explored pediatric residents' confidence levels regarding handoff procedures and the effectiveness of our interventions in the transfer of care. Two chief residents conducted direct handoff observations of residents during the transfer of care of inpatients over six months. Residents were scored using a handoff checklist, and formative feedback was provided to each resident after the observation session. Deficits and barriers to properly executed handoff were noted and used to develop a series of handoff workshops. Pre- and post-workshop confidence in handoff skills was calculated from an average of each five-point Likert scale item (1=not at all confident, 5=very confident). Forty pediatric residents were assessed performing inpatient handoff. We observed 38 handoff sessions. All of these involved face-to-face interactions with verbal and written communication in the I-PASS (illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by the receiver) format, allowing the receiver of the information to clarify issues and ask questions. Protocol failures were identified in 50% of the handoffs observed. This included disruptions during handoff (5%), incorrect relay of patient information (26%), prioritizing sick patients (26%), omission of care tasks (10%), and provision of contingency planning (31%).Forty residents participated in the handoff workshops. Regarding confidence in handoff before and after the workshop, 67% of residents initially reported feeling "very confident" or "fairly confident" in their patient handoff skills. After the completion of the workshops, 98% of residents reported "fairly confident" or "very confident" in their ability to perform handoff.Pre- and post-workshop surveys demonstrated self-perceived increases in confidence (P<0.001). Following the completion of the workshops, we conducted observations and found that residents properly executed handoffs, and we received no further patient safety alerts regarding communication breakdowns. We identified several protocol failures in effective handoff among pediatric residents. Chief resident-led targeted workshops addressed these lapses, improved the effectiveness of patient handoffs, and reduced patient safety events related to breakdowns in communication. Our interventions increased confidence in handoff among pediatric residents, and these effects were sustained over time.

Development of a framework of potential adverse effects of interventions to improve critical thinking about health choices: A mixed methods study.

Background People need critical thinking skills to make well-informed health choices and avoid waste and unnecessary suffering. However, educational interventions can have adverse effects, which is often overlooked. We created a framework of potential harms of interventions to improve critical thinking about health choices. The objective was to identify potential effects and articulate potential mechanisms. We intended to use the framework to inform the development and evaluation of an intervention in Kenya, Rwanda, and Uganda. Methods We created an initial framework drawing on two earlier frameworks. We surveyed external experts using Likert-scale and open-ended items, including researchers, educators, and others, in a variety of relevant fields. We emailed the survey to an international advisory network, and all other experts recommended by respondents. We analyzed the quantitative data using descriptive statistics. We conducted a thematic analysis of the qualitative data. We revised the framework based on those results. To identify any effects missing from the revised framework, we individually interviewed a convenience sample of one teacher from each of Kenya, Rwanda, and Uganda. Results We received responses from 38 of 70 external experts (54%). The quantitative survey data suggested respondents agreed with the initial framework overall. However, the qualitative data led to substantial revisions. The revised framework consists of categories of adverse outcomes; outcomes within each category; sub-outcomes; individuals, groups, and populations that might experience each adverse outcome; beneficial outcomes corresponding with adverse outcomes; and potential mechanisms of adverse effects. There are six categories: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. In the interviews with teachers, we did not identify any effects missing from the revised framework. Conclusions As far as we know, the framework is the first tool of its kind for education research. It can be improved upon and adapted.

Extensiveness of Teachers’ Workload in Determining the Acquisition of Kiswahili Reading Skills Among Pupils in Public Primary Schools in Tanga City Council, Tanzania

The study investigated the extensiveness of teachers’ workload in determining the acquisition of Kiswahili reading skills among public primary school pupils in Tanga City Council, Tanzania. The study employed a convergent design under mixed methods research approach to collect both quantitative and qualitative data simultaneously and compare the results to obtain a more complete understanding of the research problem. The study targeted 80 public primary schools, 80 head teachers, 264 Kiswahili subject teachers, 24 Ward Education Officer and 1 City Council Primary Education Officer. Both probability and non-probability sampling techniques were employed to obtain respondents who participated in this study. The study involved 8 public primary schools, 8 head teachers, 88 Kiswahili reading skills teachers, 8 WEO and 1 CCPEO. Data were collected using questionnaires, and interview guide. Data collection instruments were validated by Mwenge Catholic University research experts. A pilot study was conducted in two public secondary schools. The reliability of questionnaires for Likert scale items was determined using Cronbach's Alpha Coefficient where reliability coefficient r= 0.892 for Kiswahili subject teachers questionnaire was obtained. The reliability for qualitative data was established through peer debriefing and triangulation. The study adhered to research ethical principles throughout the research process. Quantitative data were analyzed using descriptive statistics particularly using frequencies, percentages and mean with the aid of SPSS Version 22. The study concludes that due to their overwhelming responsibilities, teachers find it challenging to give students timely and insightful feedback on their reading progress. Teachers find it challenging to plan and implement enjoyable reading activities that would greatly enhance their pupils Kiswahili reading skills. Teachers are unable to give each pupils the individualized support and attention they need to improve their reading skills in Kiswahili, leaving them with little time and energy. The study recommends that heads of public primary schools can support teachers in working less by making sure that teachers have enough time to plan, organize, assign reading tasks, and help pupils who are failing with learning. The administration of public primary school should make sure that the school has enough teaching and learning resources for Kiswahili reading instruction.

The influence of living environments on subjective health literacy in fourth-graders in Germany

Abstract Background Evidence suggests that worse family affluence is related to low health literacy in children. Still, for the targeted promotion of health literacy, a more nuanced understanding is needed of how living environments affect health literacy in early life. This study explores the relationships between health literacy and indicators of living environments in the neighborhood and at home. Methods A representative sample of 4th-graders (age 8-11) was surveyed from Oct. 2022 to Feb. 2023 in North Rhine-Westphalia, Germany. We included the HLS-Child-Q15 to assess subjective health literacy, 4 items about the neighborhood (e.g., “neighborhood is a good place to play outside” or “I often see people smoking in the neighborhood”), and 4 items about home (e.g., “there’s always fruit and vegetables at home” or “it’s important to my parents that I exercise”). The tendency to answer in a socially desirable way was controlled for with a validated scale. Likert-scale items were dichotomized for use in linear regression. Results n = 1085 students are included, 50.3% are female. The mean age is 9.5 years (SD=.6). The regression model explains 17.8% of variability in health literacy (corr. R²). Significant (p&amp;lt;.05) predictors for high health literacy were birthplace (Germany, not Germany), agreement to the statements “I often see people exercising in my neighborhood”, “my parents can answer all my question about health”, “there’s always fruit and vegetables at home”, “it’s important to my parents that I exercise”, but also social desirability scores. Family affluence was not a significant predictor. Conclusions In this sample of 4th-graders, subjective health literacy could not adequately be explained by family affluence. Indicators of living environments seem to be better suited to explore variability in health literacy. These findings can be used to explore entry points for the promotion of health literacy early in life and to identify groups at risk for low health literacy.

Task shifting to improve practice efficiency: A survey among general practitioners in non-urban Baden-Wuerttemberg, Germany

Background Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice efficiency to address this mismatch. Objectives Exploring GPs’ motives and beliefs towards task shifting in non-urban Germany and identifying potential factors influencing these. Methods The cross-sectional survey was disseminated by mail in three waves between July 2021 and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items on demographics and practice characteristics as well as 15 Likert-scale items addressing motives and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items were analysed descriptively, influencing factors on motives and beliefs were identified using multiple linear regression. Results Response rate was 24.2% (281/1162), with respondents comparable in age and gender to all GPs in Baden-Wuerttemberg. GPs’ motives and beliefs towards task shifting are positive overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more positive among younger GPs and those participating in the GP-centred care programme. Conclusion This study describes GPs’ motives and beliefs towards task shifting in non-urban Germany. Identifying younger GPs and those participating in the GP-centred care programme as particularly endorsing may help design future interventions aiming to improve efficiency in general practice in non-urban Germany.

Effectiveness of chatbots in improving learning experience in an online course

ABSTRACT This study analyzes the effectiveness of a chatbot in enhancing online learning, addressing the lack of support in traditional online courses. Two questionnaires were administered to participants, providing qualitative data on various aspects of the learning experience. The first questionnaire measured satisfaction, engagement, self-regulation and usefulness in three different groups of participants. The second questionnaire included open-ended questions and Likert scale items, gathering qualitative feedback and perceptions specifically from the group that used the chatbot. Additionally, this study incorporates quantitative analysis to evaluate the chatbot's impact on learning outcomes and student engagement. We used ANOVA to test whether there is a significant difference in learning outcomes among the three experimental groups. To determine which groups have significantly different means, we performed the Tukey post hoc test. Analysis of the data collected aims to measure the impact of chatbot integration on learner satisfaction, engagement, self-regulation, learning outcomes, usefulness and usability. The results contribute to the understanding of chatbots as support tools in e-learning environments, and indicate that the integration of chatbots within e-learning platforms aims to improve the learning experience and foster learner success.

Enhancing English Speaking Skills through PowerPoint Presentation Techniques: A Study of EFL Learners

The researcher did a study to investigate the impact of presentation techniques in elevating English-speaking skills among English as a Foreign Language (EFL) learners. This study applied a quantitative approach and employed a structured questionnaire using Likert-Scale items to assess students' perceptions of how the presentation methods impact their speaking abilities. A sample of university EFL learners especially the students in General English class of Elementary and Pre-Intermediate I participated in the study, providing insights into their experiences with presentation-based learning activities. Descriptive and inferential statistical analyses were conducted to evaluate the relationship between using presentation techniques and the perceived improvement in speaking proficiency. The findings reveal that students perceive presentation techniques as significantly beneficial for enhancing their speaking skills and fostering greater engagement and confidence during oral communication tasks. This research highlights the importance of integrating effective presentation methods in EFL instruction to promote learners’ speaking development. It provides recommendations for educators seeking to enhance language acquisition in the classroom.

Integrative nursing interventions: knowledge, attitudes and practice in home nursing services in Germany-a quantitative and qualitative online survey.

Integrative nursing interventions (INI) play a significant role in healthcare, particularly in the prevention and treatment of chronic diseases. Integrating evidence-based INI into healthcare aligns with global initiatives such as the WHO's Decade of Healthy Aging 2020-2030. Many INI are low-threshold practices, empowering patients to independently manage health. However, the extent to which INI are used by home-care nursing-services (HNS) remains largely unknown. This study aims to explore the field of INI in German HNS regarding nurses' use of INI as well as attitudes, subjective knowledge, and information needs on the subject. A cross-sectional anonymous online survey with 29 Likert scale items and two open-ended questions was conducted between April 2023 and July 2023. The survey targeted nurse managers of HNS in Baden-Württemberg, Germany. Descriptive analysis was performed for quantitative data, while content analysis according to Kuckartz was applied to analyze open-ended text responses. In total, n = 68 out of n = 1,331 HNS took part in the survey yielding a response rate of 5.1%. Their overall attitude toward INI was clearly positive (10-point Likert scale M ± SD: 8.37 ± 2.22). The average self-assessed knowledge level about INI was moderate (M ± SD: 5.39 ± 2.76). Almost half of the participants (45.6%) declared to incorporate INI in patient care. Most participants (84.2%) lacked employees with additional qualifications in INI. The INI used most were medicinal herbal teas (61%), compresses (57%), and aromatherapy (48%). Acupressure showed the greatest disparity between actual use in participating HNS (4.3%) and interest in further education (61%). The most common symptoms for which INI are used are pain, respiratory problems, anxiety, and palliative care. The main challenges reported for the use of INI in HNS are financial aspects, qualification and limited resources (staff and time). This exploratory study provides the first insights into nurses' attitudes, self-assessed knowledge, and utilization of INI in German HNS. Overall response rate was low (5.1%), therefore, the results should be interpreted with caution. Urgent action is needed to address financial aspects and further education on INI, to promote integration of INI in HNS to the best possible extent.

Case Reports in Education: A Virtual Orthopaedic Surgery Summit Enhances Medical Student Confidence in Preparedness for Orthopaedic Surgery Subinternships.

Medical school curricula offer limited exposure to orthopaedic surgery, and few national initiatives aim to prepare students for orthopaedic surgery subinternships, which are critical for success in matching into orthopaedic residency. In this study, we evaluated the effectiveness of a single-day virtual "Subinternship Summit" for medical students in 2 key areas: 1) enhancing participants' confidence in their preparedness for orthopaedic subinternship rotations and 2) mitigating any disparities based on student characteristics, such as race/ethnicity, gender, or whether or not the student's school is affiliated with a "home" orthopaedic program. In March 2024, a single-day national virtual summit was held, featuring panels on topics relevant to performance during orthopaedic subinternships. The panelists included senior medical students, orthopaedic residents, and attending orthopaedic surgeons from across the United States. Surveys were administered to participants through Qualtrics before and after the summit to collect demographic data and to assess confidence in 6 domains of subinternship performance using 5-point Likert-scale items: overall preparedness, on-call responsibilities, "soft skills," role in the operating room, role in the outpatient clinic, and understanding of resources. Our analysis included descriptive statistics, paired t tests, and multivariable linear regression. Significance was set at p < 0.05. Of 787 medical students who registered for summit, 426 attended, of whom 180 (42%) completed both the presummit and postsummit surveys. Before the summit, students reported low confidence in all domains, with 5 of 6 domains averaging less than moderate (3/5 points). Multivariable analysis revealed no differences in presummit confidence across various demographic characteristics. After the summit, all 6 domains showed significant increases in confidence, with the lowest average being 4/5 (all, p < 0.001). This virtual summit effectively increased medical students' confidence in their preparedness and knowledge about orthopaedic surgery subinternships. Given the weight of subinternship performance in the match process, such an initiative may have the potential to increase medical students' success in residency applications. Level V. See Instructions for Authors for a complete description of levels of evidence.

Student voice and choice in the virtual classroom: engagement strategies

The coronavirus pandemic has compelled a transition to distance and online education, requiring instructors and students to adjust swiftly. During this transition period, it became crucial to prioritize comprehending students’ perspectives and decision-making within virtual educational environments. The present study investigates the strategies a GPCOM (Purposive Communication) instructor employs at a premier university to enhance student autonomy and decision-making through student voice and choice in the online learning environment. Data were collected via a survey comprising Likert scale items and open-ended questions from the 335 participants who participated in the study. The study results indicate that educators significantly facilitate student engagement in expressing their thoughts and ideas, promoting self-discovery, critical thinking, and collaborative problem-solving. Student preferences noted that active learning, utilization of technology, and engagement in class discussions were prominent options. Several strategies were employed to promote student engagement, such as fostering cooperation, implementing interactive gamification techniques, establishing real-life linkages, facilitating class debates, and encouraging self-directed learning. This study emphasizes the crucial role of instructor assistance in virtual learning while recognizing and integrating student preferences. Doing so aims to create a well-rounded and captivating virtual learning experience.

Initial development of a sleep health literacy scale

ObjectivesHealth literacy includes the skills necessary for effective communication with health professionals, understanding health instructions, and recognizing health needs. Our study aimed to create a novel measure of sleep health literacy—an individual's capacity to comprehend sleep-related information and navigate sleep-related healthcare services. MethodsThe Sleep Health Literacy scale consists of two subscales: “Sleep Health Communication” (11 Likert-scale items assessing access to resources and communication with healthcare providers) and “Sleep Health Knowledge” (46 true/false items assessing specific knowledge of sleep health). The Sleep Health Literacy scale was completed by 154 undergraduate students (mean age=20.96years; 79.87% female) in study 1. In study 2, an additional sample of 251 participants (mean age=20.23years; 79.87% female) completed the Sleep Health Literacy scale, along with measures of convergent and discriminant validity. ResultsExploratory factor analysis results in study 1 revealed a two-factor structure for the “Sleep Health Communication” subscale (“comprehension” and “critical application”). The subscale demonstrated good internal consistency (α = 0.81) and inter-item and item-total correlations. On the “Sleep Health Knowledge” subscale, participants answered 76.36% of items correctly. In study 2, the Sleep Health Literacy had good convergent validity with Sleep Beliefs Scale and the All Aspect of Health Literacy Scale. ConclusionsThe Sleep Health Literacy scale offers a standardized measure to assess sleep health literacy, an understudied domain that has important links to health. This measure may allow researchers and clinicians to better understand how to improve sleep health. Further validation of the Sleep Health Literacy scale is warranted in more diverse samples.