Open-ended Questions Research Articles

Expanding a classroom to an interactive learning ecosystem. A cookbook based on the ingredients: creativity, collaboration, space, and time serving two Grade 7 classes

Take some secondary school students, leave the classroom, move around, add challenging tasks, let it ‘cook’, check consistency, and add hints if needed. Invite guests to taste what you ‘cooked’. This recipe serves two Grade 7 classes, four teachers, and forty-some relatives. This study is about a school project engaging students for two months in STEAM activities, namely, students planned the first settlements on Mars. The project involved various spaces: the classroom, the school, a virtual classroom, and a museum. We examined students’ involvement, motivation, the learning effect, and soft skills. We also studied the project’s impact on society, for instance, the involved families. The data were collected by using questionnaires based on the Likert scale, open-ended questions, focus groups and observations. We studied what factors make STEAM tasks motivating, the learning environments and the learning outcome. We found three key features: learning spaces, social settings, and meaningful tasks.

Physical Fitness Testing Concerns: Bullying and Inclusion

In February 2020, California Governor Gavin Newsom’s proposed budget recommended suspending the state-mandated physical fitness test (FitnessGram®️) for three years due to concerns over bullying and test discrimination against students who identify as gender non-binary and students with disabilities. The purpose of this study was to gain an understanding of California physical educators’ perceptions of the state-mandated physical fitness assessment. Snowball sampling was used to recruit 1,082 participants who completed a survey with quanti-tative and open-ended questions. Analysis of the open-ended questions indicated the two main themes were “how to improve fitness testing” and “challenges in fitness testing.” It is imperative to consider the needs of all students, including those who identify as gender non-binary or have a disability, and ensure physical fitness testing is conducted in a safe and welcoming environment.

The impact of an aging simulation program for dental students in two community dental clinics.

Clinicians who have not experienced the difficulties that come with aging or disability may be unable to relate to the limitations and experiences of afflicted patients, which is necessary to improve patient-provider connection and treatment outcomes. The purpose of this study was to test the effectiveness of an aging-simulation experience on improving dental students' awareness of aging-related limitations, examine the students' perceptions, and assess planned patient-care modifications based on the aging-simulation experience. A total of 78 dental students who rotated through two extramural clinic sites from August 2021 through October 2022 completed pre-simulation surveys, donned aging simulators in the dental operatory, initiated pre-defined tasks and their corresponding modifications, completed a post-simulation survey, and completed a reflection questionnaire containing structured and open-ended questions. Quantitative responses were analyzed using descriptive frequencies and paired sample t-tests, whereas thematic analyses were used to interpret free-text portion of the reflection questionnaire. Student awareness of the impact of the four aging-related disabilities improved after the experience. Visual impairment was identified as the most difficult symptom to experience during simulation. Students reported increased feelings of empathy and acknowledged the effectiveness of clinical practice modifications to accommodate elderly patients with limitations. Students also expressed intentions to make similar modifications in their future clinical practice and the need for exposure to longer periods of simulated experiences to further clinical practice modifications for elderly patients. The aging-simulation experience is an effective tool for raising dental students' awareness of aging-related difficulties, the need for clinical practice modifications, and increasing empathy.

The impact of an aging simulation program for dental students in two community dental clinics.

Clinicians who have not experienced the difficulties that come with aging or disability may be unable to relate to the limitations and experiences of afflicted patients, which is necessary to improve patient-provider connection and treatment outcomes. The purpose of this study was to test the effectiveness of an aging-simulation experience on improving dental students' awareness of aging-related limitations, examine the students' perceptions, and assess planned patient-care modifications based on the aging-simulation experience. A total of 78 dental students who rotated through two extramural clinic sites from August 2021 through October 2022 completed pre-simulation surveys, donned aging simulators in the dental operatory, initiated pre-defined tasks and their corresponding modifications, completed a post-simulation survey, and completed a reflection questionnaire containing structured and open-ended questions. Quantitative responses were analyzed using descriptive frequencies and paired sample t-tests, whereas thematic analyses were used to interpret free-text portion of the reflection questionnaire. Student awareness of the impact of the four aging-related disabilities improved after the experience. Visual impairment was identified as the most difficult symptom to experience during simulation. Students reported increased feelings of empathy and acknowledged the effectiveness of clinical practice modifications to accommodate elderly patients with limitations. Students also expressed intentions to make similar modifications in their future clinical practice and the need for exposure to longer periods of simulated experiences to further clinical practice modifications for elderly patients. The aging-simulation experience is an effective tool for raising dental students' awareness of aging-related difficulties, the need for clinical practice modifications, and increasing empathy.

Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors

Background Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals. Objectives To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia. Methods We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis. Results Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers. Conclusion The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.

Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study.

Language-concordant health care, or health care in a patient's language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were "very satisfied" or "somewhat satisfied" with the map, 16 (17%) were "neither satisfied nor dissatisfied," and 20 (22%) were "very dissatisfied" or "somewhat dissatisfied." We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients.

Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis.

Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors' lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users' ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670. RR2-10.1136/bmjopen-2021-051166.

Satisfaction with a new patient education program for children, adolescents, and young adults with differences of sex development (DSD) and their parents.

ObjectiveEvaluation of the participant satisfaction with a newly developed interdisciplinary, modular education program for children, adolescents, and young adults with differences of sex development (DSD) and their parents. MethodsThe two-day program including tailored medical information, peer consultation and psychological support aimed to improve diagnosis-specific knowledge and empowerment. Post-training satisfaction was measured using an adapted ZUF-8 questionnaire, scoring from 5 (worst) to a maximum of 26 (best) for persons aged 6–17 and from 10 to 40 points for adults, including 2 open-ended questions. ResultsThe questionnaire, completed by 89 children (6–13 years), 92 adolescents (14–17 years), 47 young adults (18–24 years), and 345 parents, revealed consistent high satisfaction with the program regardless of age or diagnosis (children 24.4 ± 2.1, adolescents 23.5 ± 2.7; young adults 36.0 ± 4.0, parents 36.6 ± 3.4). Neither sociodemographic factors nor diagnosis burden, shame, or informedness showed relevant associations with satisfaction levels. Participants highlighted exchange and open atmosphere as key satisfaction elements. ConclusionSatisfaction with the new education program was high in all examined groups. Implementing it in routine care requires further analysis to determine the program's long-term effects on well-being and knowledge. InnovationThe first educational program for young people with DSD addressing their specific challenges through inclusive language, an open approach to sex and gender and the inclusion of self-help groups.

Willingness to pay for chronic disease management services provided by primary care nurses

BackgroundDue to the rapid increase in chronic diseases in South Korea, the Korean government has expanded chronic disease management to primary care. Thus, the role of primary care nurses is critical. However, the fee for chronic disease management services provided by primary care nurses has not been set, and few studies have evaluated the value of nursing services. This study aimed to estimate the willingness to pay (WTP) for chronic disease management services provided by primary care nurses and to identify the factors that affect WTP.MethodsThis study adopted a descriptive research design and conducted a cross-sectional online survey from January 16 to 18, 2023. The inclusion criteria were community residents aged ≥ 20 years living in South Korea and capable of participating in online surveys. A total of 520 people participated in this study. A contingent valuation method (CVM) was used with double-bound dichotomous choice questions along with open-ended questions. The mean WTP was calculated using a Tobit model.ResultsThe mean WTP of the 520 study participants for one chronic disease management service provided by primary care nurses was 15,390.71 Korean won ($11.90). Factors affecting WTP were having a chronic disease, recognition of primary care nurses, and the first-bid price. Community residents with fewer chronic diseases, high awareness of primary care nurses, and a higher first-bid price showed higher WTP for chronic disease management services provided by primary care nurses.ConclusionsPrimary care is important worldwide due to the increasing number of chronic diseases, and Korea is no exception. However, payment for services by primary care nurses is undervalued compared to their critical role and skills. This has led to problems such as a primary care nurse shortage and burnout. This study estimated individuals’ WTP for chronic disease management services provided by primary care nurses. The results can be used as a basic resource for setting the fee for services provided by primary care nurses. It is also a good starting point to understand the benefits of primary care nurse services.

Willingness to pay for chronic disease management services provided by primary care nurses

BackgroundDue to the rapid increase in chronic diseases in South Korea, the Korean government has expanded chronic disease management to primary care. Thus, the role of primary care nurses is critical. However, the fee for chronic disease management services provided by primary care nurses has not been set, and few studies have evaluated the value of nursing services. This study aimed to estimate the willingness to pay (WTP) for chronic disease management services provided by primary care nurses and to identify the factors that affect WTP.MethodsThis study adopted a descriptive research design and conducted a cross-sectional online survey from January 16 to 18, 2023. The inclusion criteria were community residents aged ≥ 20 years living in South Korea and capable of participating in online surveys. A total of 520 people participated in this study. A contingent valuation method (CVM) was used with double-bound dichotomous choice questions along with open-ended questions. The mean WTP was calculated using a Tobit model.ResultsThe mean WTP of the 520 study participants for one chronic disease management service provided by primary care nurses was 15,390.71 Korean won ($11.90). Factors affecting WTP were having a chronic disease, recognition of primary care nurses, and the first-bid price. Community residents with fewer chronic diseases, high awareness of primary care nurses, and a higher first-bid price showed higher WTP for chronic disease management services provided by primary care nurses.ConclusionsPrimary care is important worldwide due to the increasing number of chronic diseases, and Korea is no exception. However, payment for services by primary care nurses is undervalued compared to their critical role and skills. This has led to problems such as a primary care nurse shortage and burnout. This study estimated individuals’ WTP for chronic disease management services provided by primary care nurses. The results can be used as a basic resource for setting the fee for services provided by primary care nurses. It is also a good starting point to understand the benefits of primary care nurse services.

Chinese consumers’ attitudes towards clothing that incorporate Chinese cultural elements: A mixed method study

In the globalized fashion market, a growing number of fashion brands and designers are utilizing Chinese cultural elements as a branding strategy to create competitive differentiation and attract Chinese consumers. Nevertheless, Chinese consumers’ attitudes towards different styles of clothing that incorporate Chinese cultural elements remain uncertain. Therefore, the present study aimed to investigate Chinese consumers’ attitudes towards clothing that incorporate Chinese cultural elements. The study also explored the factors that influence their attitudes. A mixed method approach was employed to survey 189 Chinese consumers aged 18–30. The survey encompassed attitude scales and open-ended questions. Paired samples t-tests and inductive coding were used in the data analysis. The study’s findings indicated that Chinese consumers illustrated a significantly positive attitude towards Chinese-style clothing incorporating Chinese cultural elements, compared to global-style clothing incorporating Chinese cultural elements. Moreover, five factors influence Chinese consumers’ attitudes, namely cultural experience with Chinese cultural elements, symbolism of Chinese cultural elements, nationalist sentiments, cultural aesthetics and innovation of clothing, and the harmony between the clothing style and Chinese cultural elements. Practical implications to fashion brands and fashion designers are discussed.

Language proficiency and diversity in students’ attitudes towards code-switching: a case study of English as a foreign language classrooms in Italian tertiary education

By relying on a mixed-method approach consisting of a combination of various quantitative and qualitative techniques of data collection and processing, this article delves into the attitudes towards code switching (CS), as expressed by students attending English language and English linguistics courses at two Italian universities. Data are retrieved by means of a questionnaire, submitted to 297 students in total and including both closed- and open-ended questions. Based on concepts such as those of conversational loci, or CS functions – namely academic, managerial and social, all well-rooted in the literature – this article also aims at establishing a link between students’ attitudes and their respective proficiency level in English according to the CEFR. Despite managing to establish that teacher CS is not felt to have a negative impact on their language skills, the data gathered reveal diverse attitudes, also in relation to the specific functions examined. In the conclusion, possible pedagogical implications of classroom CS are proposed and assessed.

Healthcare Workers' Reflections, Experiences, and Sequela Throughout the COVID-19 Pandemic.

Healthcare workers (HCW) experienced significant stress during the COVID-19 pandemic. This qualitative study describes how they contextualized the experience several years later. In August 2023, 1832 HCW at an academic medical center completed a confidential electronic survey; 443 of them responded to an open-ended question about their experiences during the pandemic. The statements were analyzed qualitatively, using a grounded theory approach to allow themes to emerge from the data. Common themes included fear/anxiety (22%), burnout (15%), protecting family from risk (11%), lack of employer support (11%), fear of illness (8%), increased appreciation for life (8%), and exposure to death/illness (5%). HCW experienced substantial stress during the pandemic. Mental health services and structural changes in the healthcare system are needed to protect HCW during future public health emergencies.

Development and validation of the Alimetry Gut-Brain Wellbeing Survey: a novel patient-reported mental health scale for patients with chronic gastroduodenal symptoms

ObjectiveThere is currently a lack of validated questionnaires designed specifically to assess mental health within patients with chronic gastroduodenal symptoms. This research describes the multi-phase process used to develop and validate a novel mental health scale for patients with chronic gastroduodenal symptoms, the Alimetry® Gut-Brain Wellbeing (AGBW) Survey.MethodsA patient-centered multi-phase process was implemented. In Phase 1, the most relevant concepts for this patient population were selected from existing mental health scales, using data from 79 patients. In Phase 2, an interdisciplinary panel of experts generated scale items. In Phase 3, the scale underwent pre-testing with gastroenterologists (n = 9), health psychologists (n = 3), and patients (n = 12), with feedback incorporated over multiple rounds. Lastly, the psychometric properties of the scale were assessed in a sample of 311 patients via an online survey.ResultsThe AGBW Survey comprises a patient preface, 10 close-ended questions, and an optional open-ended question. This multidimensional scale assesses general mental health, alongside specific subscales relating to depression, stress, and anxiety. The subscale and total scores demonstrated high internal consistency (α = 0.91 for the total scale; α = 0.72–0.86 for subscales) and good convergent, divergent, concurrent validity, and known groups validity, with large effect sizes.ConclusionThe AGBW Survey is a brief, valid, and reliable scale for assessing mental health in patients with chronic gastroduodenal symptoms. It can be used as a tool to complement physiological tests and has the potential to guide psychological referrals, inform multidisciplinary management, and evaluate treatment outcomes.

Development and validation of the Alimetry Gut-Brain Wellbeing Survey: a novel patient-reported mental health scale for patients with chronic gastroduodenal symptoms

ObjectiveThere is currently a lack of validated questionnaires designed specifically to assess mental health within patients with chronic gastroduodenal symptoms. This research describes the multi-phase process used to develop and validate a novel mental health scale for patients with chronic gastroduodenal symptoms, the Alimetry® Gut-Brain Wellbeing (AGBW) Survey.MethodsA patient-centered multi-phase process was implemented. In Phase 1, the most relevant concepts for this patient population were selected from existing mental health scales, using data from 79 patients. In Phase 2, an interdisciplinary panel of experts generated scale items. In Phase 3, the scale underwent pre-testing with gastroenterologists (n = 9), health psychologists (n = 3), and patients (n = 12), with feedback incorporated over multiple rounds. Lastly, the psychometric properties of the scale were assessed in a sample of 311 patients via an online survey.ResultsThe AGBW Survey comprises a patient preface, 10 close-ended questions, and an optional open-ended question. This multidimensional scale assesses general mental health, alongside specific subscales relating to depression, stress, and anxiety. The subscale and total scores demonstrated high internal consistency (α = 0.91 for the total scale; α = 0.72–0.86 for subscales) and good convergent, divergent, concurrent validity, and known groups validity, with large effect sizes.ConclusionThe AGBW Survey is a brief, valid, and reliable scale for assessing mental health in patients with chronic gastroduodenal symptoms. It can be used as a tool to complement physiological tests and has the potential to guide psychological referrals, inform multidisciplinary management, and evaluate treatment outcomes.

Development of the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA): A De Novo IGA of Cutaneous Manifestations of Dermatomyositis.

Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by a distinctive debilitating skin rash and skeletal muscle weakness. It is unclear if existing clinical outcome assessment (COA) measures include the concepts of priority to patients and those necessary to fully capture improvements in the active cutaneous manifestations of DM. This study aimed to develop the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA), a de novo IGA, for use in clinical trials of adult DM. Eight DM clinical experts participated in 60-min qualitative interviews consisting of concept elicitation and cognitive debriefing methodologies. Concept elicitation comprised open-ended questions with follow-up probes to explore clinicians' experiences of treating patients with DM, the impact of symptoms on patients' quality of life, and the severity levels of disease characteristics to explore DM progression. Cognitive debriefing required the clinical experts to perform a review of the CDM-IGA, designed to assess the severity of cutaneous disease activity of DM. After the interviews, a consensus meeting with three clinical experts was held to agree on any outstanding issues relating to the CDM-IGA. The CDM-IGA was iteratively developed using the opinions of nine clinical experts. Feedback provided by all clinicians agreed that erythema was the main active cutaneous manifestation of DM and should be the primary characteristic on the CDM-IGA, split by erythema color and extent. To determine cutaneous disease severity, experts suggested adding a metric called secondary changes, which combined erosion/ulceration and lichenification, which could modify the patient's final score. Three clinical experts suggested that a photo-guide to support assessments of erythema across different skin tones could be beneficial. A novel CDM-IGA was developed for use with adult patients with DM in clinical trials, based on an iterative development process that combined qualitative feedback from clinical experts of DM and importantly adult patients living with DM.

Influence of Public Participation on Implementation of County Government Projects: Case of Makueni County, Kenya

Projects are the foundation of local development in any nation that is developing. Despite the significance of county government projects to society, the majority of these initiatives have delayed, failed, or otherwise fallen short of their goals. The study aimed at assessing the influence of public participation on implementation of county government projects: case of Makueni County, Kenya. The study was guided by following specific objectives; to determine the influence of public participation in project identification process, budget preparation process, governance process and monitoring and evaluation process on implementation of Makueni county projects. A descriptive research design was used for this study. There were 330 project personnel working on projects throughout all Makueni County constituencies and this formed the study population. Thus, the target population was the project committee members, executive project management consultant members and technical officers involved in implementation of the projects for the last at least three years at Makueni sub-counties. Using a stratified random sampling procedure, 99 respondents (30% of the population) were chosen from the target population. The study used primary methods in data collection using questionnaires. Content analysis method was used to examine the qualitative data from the open-ended questions. The statistical package for social sciences (SPSS) version 22 was used to interpret the quantitative data from the closed-ended questions. Descriptive statistics, such as frequencies, percentages, standard deviation, and arithmetic mean, were used to examine the results. Inferential analysis was used in determination of the relationship between the variables. The results of the analysis were subsequently shown in charts and tables. The coefficient results show results that budget preparation process and governance process have a significant positive influence on project implementation, with standardized coefficients of 0.555 and 0.761, respectively. Meanwhile, monitoring and evaluation has a significant negative influence on project implementation with a standardized coefficient of -0.479. Project identification pross, on the other hand, does not have a statistically significant impact on project implementation.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study.

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. A cross-sectional survey design. An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively. Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health. All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence. We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). No patient or public contribution.

An exploration of frontline health professional's current understanding of non-fatal strangulation.

To explore frontline health professionals' current understanding of non-fatal strangulation and their need for and support for a comprehensive education and screening package to support health delivery. A descriptive mixed-method approach was chosen to analyse responses to an anonymous, online survey consisting of ten Likert scale, open-ended and five demographic questions. 103 frontline health professionals (nurses, doctors, paramedics, midwives) participated in this study. Content analysis of the Likert scale and open-ended questions describing the subjective experiences and perceptions of the participants was undertaken along with percentage and frequency counts of the rated Likert responses. The findings identified that 51.1% of health professionals do not ask about strangulation routinely and that 59% of health professionals reported receiving no formal education or professional development on NFS to enhance their knowledge or inform clinical practice. No health professionals identified mild traumatic brain injury as a consequence or sign of strangulation, nor did they identify an understanding that 50% of people may have no visible injuries after being strangled. Health professionals also do not routinely document the different agencies referred to or involved in supporting the person who experienced NFS. Findings suggest that frontline health professionals lack the confidence, skills and education needed to meet medical obligations to their patients and to fulfil their duty to 'do no harm'. Frontline health professionals would welcome a comprehensive education and screening package to guide recognition and response to non-fatal strangulation in their clinical settings. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The purpose of the study was to understand and explore health professionals' knowledge about non-fatal strangulation so that improved education around better screening, and management of trauma-focused care to people who have been subjected to non-fatal strangulation could occur. This review contains no patient or public contribution since it examines health professionals' knowledge of identifying non-fatal strangulation and the screening and assessment tools used in clinical practice.

An exploration of frontline health professional's current understanding of non-fatal strangulation.

To explore frontline health professionals' current understanding of non-fatal strangulation and their need for and support for a comprehensive education and screening package to support health delivery. A descriptive mixed-method approach was chosen to analyse responses to an anonymous, online survey consisting of ten Likert scale, open-ended and five demographic questions. 103 frontline health professionals (nurses, doctors, paramedics, midwives) participated in this study. Content analysis of the Likert scale and open-ended questions describing the subjective experiences and perceptions of the participants was undertaken along with percentage and frequency counts of the rated Likert responses. The findings identified that 51.1% of health professionals do not ask about strangulation routinely and that 59% of health professionals reported receiving no formal education or professional development on NFS to enhance their knowledge or inform clinical practice. No health professionals identified mild traumatic brain injury as a consequence or sign of strangulation, nor did they identify an understanding that 50% of people may have no visible injuries after being strangled. Health professionals also do not routinely document the different agencies referred to or involved in supporting the person who experienced NFS. Findings suggest that frontline health professionals lack the confidence, skills and education needed to meet medical obligations to their patients and to fulfil their duty to 'do no harm'. Frontline health professionals would welcome a comprehensive education and screening package to guide recognition and response to non-fatal strangulation in their clinical settings. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The purpose of the study was to understand and explore health professionals' knowledge about non-fatal strangulation so that improved education around better screening, and management of trauma-focused care to people who have been subjected to non-fatal strangulation could occur. This review contains no patient or public contribution since it examines health professionals' knowledge of identifying non-fatal strangulation and the screening and assessment tools used in clinical practice.