• Industrialization in Ennore is unauthorized, unsustainable, infringed and unjust • Industrialization and urbanization have decreased the area of wetlands by 89.34% • Subnational government had manipulated 1996-CZMP Map to favour political elites • Manipulation had served political elites’ interests, to favor that of global elites • Peri-urban environmental injustice is caused by regulatory capture by the elites Industrialization, urbanization and population growth are the major drivers behind abominable ‘Land-Use Land-Cover Change (LULCC)’, and the loss of local ecosystem services and environmental quality, at peri-urban interfaces. Such dynamics indicate the need to analyse the LULCC pattern, and explore the political drivers behind unsustainable LULCC. This paper, taking ‘Ennore Peri-Urban Region’ as the study area, has adopted a ‘Geospatial Mixed-Methods Case-Study Approach’ that synergises ‘Quantitative LULCC Analysis’ and ‘Qualitative Political Discourse Analysis’. The quantitative LULCC analysis was performed by utilizing ‘Supervised Image Classification’ and ‘Change Detection Analysis’. Quantitative results have revealed that total area of wetland, waterbody and cropland/shrubland has decreased by 89.34%, 14.43% and 10.61% respectively, in the period 1988-2023. Especially, cropland/shrubland has been severely affected in the core industrial region. Such unsustainable LULCC has occurred due to an intensive peri-urban industrialization, and a gradual peri-urbanization. The area under settlement and dense-vegetation have increased by 507.84% and 3.42%, respectively. Qualitative-political discourse analysis has revealed that such an unsustainable peri-urban LULCC has occurred due to the five-year delay in preparing the ‘Coastal Zone Management Plan (CZMP)’ and its map, and the unauthorized manipulation of 1996-CZMP Map by the subnational ‘Government of Tamil Nadu’, without the approval of the national ‘Government of India’. Such delay and manipulation had initially favoured the vested interests of political elites, and eventually that of global urban business elites, through regulatory capture by the latter. These indicate an inefficient, unfair, unequitable, unjust, incoherent and non-transparent intergovernmental environmental governance, and a weak public participation in decision-making.

With the increasing pace of globalization and transnational migration, healthcare systems are becoming more culturally diverse. In Taiwan, demographic changes have introduced increasing numbers of patients from diverse cultural backgrounds into clinical care environments, presenting new challenges for nursing practice. Cultural safety has emerged as an important framework for promoting equitable healthcare and improving the quality of patient care. Under this concept, patients' lived experiences and perceptions of care are used as central indicators of healthcare quality, and healthcare professionals are encouraged to reflect critically on the power dynamics and institutional biases within their healthcare interactions. In this article, the practical implications of cultural safety in nursing practice are discussed in the context of four culturally diverse populations in Taiwan: indigenous residents, migrant workers and other expatriates, sexual and gender minorities, and non-Taiwanese spouses and new immigrants. Language barriers, varied levels of health literacy, culturally shaped health beliefs, and limited social support are all factors that may influence patient trust, engagement in care, and adherence to treatment. When healthcare providers lack cultural sensitivity and reflective awareness, communication gaps and subtle forms of exclusion may occur in clinical encounters. Strengthening cross-cultural communication, encouraging patient participation in decision-making, fostering professional self-reflection, and creating institutional environments that support culturally safe practice are essential strategies to improving care. Therefore, cultural safety offers an important framework for developing strategies to enhance patient trust, improve care experiences, and advance health equity in multicultural healthcare settings.

The art and science of providing patients with helpful information.

ABSTRACT As populations age, more older adults require support with decision-making, often relying on informal caregivers. This multi-methods study explores how informal caregivers in the Netherlands participate in healthcare and financial decision-making for older adults, what factors are associated with their involvement in the decision-making process, and how different legal measures facilitate their participation in decision-making. Drawing on survey data from 815 caregivers and 13 in-depth interviews, the study identifies various types of involvement – from supported to substituted decision-making – with mutual decision-making as a distinct category. Participation is affected by the type, complexity and impact of decisions, the older adult’s decision-making abilities, wishes and preferences, and the involvement of others. The need for legal authority varies by relationship and caregiving role. While ex lege measures generally suffice for medical decisions, financial matters often require voluntary measures, which appear inconsistently recognized in practice. When voluntary arrangements are not feasible, adult guardianship measures may offer legal clarity. Although some international rights bodies call for the abolition of substituted decision-making regimes like adult guardianship, this study highlights their practicality in certain contexts. The findings call for legal and policy frameworks that both empower informal caregivers and safeguard the well-being of older adults.

In child and adolescent mental health services (CAMHS), the principles of information provision and participatory decision-making have gained prominence, reflecting both legal mandates and ethical standards. Within the last few years, the number of day hospital treatment programs has increased and political decisions led to a reduction in inpatient beds. Given the structural and procedural differences between the treatment settings, this study examines whether patients' and caregivers' ratings of information and participation differ between an inpatient treatment and a day hospital treatment. Patients and caregivers answered the "Broad Evaluation of Satisfaction with Treatment" (BEST) questionnaire before discharge from inpatient or day hospital treatment. Two exploratory new subscales were pragmatically composed from existing items in the BEST: An information and a participation subscale. Data from 127 children, 93 caregivers, and 136 adolescents regarding their perception of information provision and participation were analyzed to examine potential differences between the settings. Children and caregivers rated information provision and participation equally high in both treatment settings. Adolescents, however, reported higher satisfaction with information provision during day hospital treatment compared to inpatient treatment. Gender and diagnosis affected the evaluations of participation within the adolescent sample. In the child sample, gender had an effect on the ratings of participation. The subscales Information and Participation show good reliabilities in the adolescent and in the caregiver samples, whereas within the child sample, only the participation subscale shows sufficiently good psychometric properties. Despite structural and conceptual differences between the settings, there are no significant differences in the perception of participation. Adolescents in the day hospital, however, reported higher satisfaction with information than adolescents in inpatient treatment. One possible explanation could be a participatory treatment planning tool that is used in the day hospital for adolescents. This tool addresses the item "Goals of treatment discussed" which is located in the information subscale. The subscales of the BEST questionnaire, particularly those related to information and participation, may be helpful in highlighting and fostering person-centered care, especially for adolescents.

Immunization is one of the most impactful public health achievements, significantly reducing childhood morbidity and mortality worldwide. However, gender disparity and women's disempowerment constitute structural barriers in accessing vaccine services in low- and middle-income countries. In Nigeria, widespread differences in social norms and cultural values affect gender roles and influence women's ability to decide their own healthcare needs and participate in household decision-making. This leads to attitudinal differences in uptake of immunization depending on the child's location of residence. Using data from four waves of the Nigeria Demographic and Health Survey, we constructed two empowerment indices that determine whether caregivers participate in household decision-making and have the ability to decide on their healthcare needs. We used a structured spatiotemporal statistical model to determine whether a significant part of childhood vaccination coverage disparities can be attributed to these women's empowerment measures and predicted events at the third administrative level of the country. We considered five vaccination indicators: Bacillus Calmette-Guerin (BCG), zero-dose, receiving a complete dose of DPT, MCV-1 (first dose of measles-containing vaccine), and receipt of all basic vaccinations. The adopted model was validated by comparing the empirical estimates of vaccination coverage level from the data with model projections at the second administrative level. The findings indicate that although empowerment regarding participation in household decision-making and agency over healthcare access is generally associated with increased vaccine uptake, their effects vary considerably across locations and notably among the highly empowered category of women. Although there are efforts to bridge immunization gaps within the country, the study emphasizes the need for tailored strategies that target up-scaling the ability of women and the wider community to participate in the decision-making process and be able to decide on healthcare needs to address regional disparities and improve vaccination coverage.

Decision-making is a vital aspect of nursing, influenced by factors like experience and specialty. The aim of study to assess the perceived level of decision-making involvement among Jordanian nurses and identify influencing factors. This descriptive cross-sectional study was conducted in 3 major governmental hospitals in Jordan. A convenient sampling method was employed to recruit a total of 230 Jordanian nurses currently working in various departments within these hospitals. Data were collected through an online self-administered questionnaire, specifically the Nursing Decision-Making Instrument (NDMI), which measures nurses’ participation in clinical and organizational decision-making processes. The collected data were analyzed using Pearson’s correlation coefficient (Pearson’s r) to examine the relationship between selected demographic and professional variables (e.g., years of experience, educational level, and department) and the nurses’ levels of involvement in decision-making. The sample’s age ranged from 22 to 54 years (mean = 32.95), and nursing experience spanned 1 to 22 years (mean = 12.35). Nurses managed an average workload of 14.76 patients per shift. Decision-making scores, as measured by the nursing decision-making instrument, ranged from 61 to 92, with a mean score of 71.76. The majority of participants (86.5%) demonstrated a flexible decision-making orientation, while the remaining 13.5% exhibited a more intuitive or analytical style. Statistical analyses revealed significant positive correlations between decision-making scores and age (r = 0.283), total nursing experience (r = 0.371), and departmental experience (r = 0.246). In contrast, workload showed a significant negative correlation with decision-making scores (r = –.460), suggesting that higher patient loads may hinder effective participation in decision-making. The study highlights the need to strengthen nurses’ involvement in decision-making in Jordan. Findings suggest that nursing education should place greater emphasis on building decision-making skills through both training and experience. Health policies should support nurses’ roles in clinical decisions, while workload management such as improving nurse-to-patient ratios can enhance their ability to make effective decisions. Empowering nurses in these areas is essential for improving patient care and overall healthcare outcomes.

Although women's autonomy is key to patient care, the extent to which patients exercise autonomy during clinical consultations in resource-limited contexts such as Zambia remains unknown. This study aimed to examine women's experiences of autonomy in decision-making and respectful treatment in Zambian maternal healthcare. The study was conducted in Lusaka and used a cross-sectional survey design. The sample consisted of 305 women who were conveniently recruited. Data was collected using a questionnaire consisting of sociodemographic data and two validated instruments: the 7-item Mothers Autonomy and Decision-Making Scale (MADM), and the 14-item Measure of Respect (MOR) index. Higher levels of decision-making autonomy, according to MADM, are significantly associated with higher levels of perceived respect in maternal healthcare settings, according to MOR (p < .001). Furthermore, higher education was found to correlate significantly with higher autonomy and respect (p < .001). Both instruments showed an excellent (MADM) and good (MOR) internal consistency among this sample (Cronbach's alpha = 0.959 and 0.851, respectively). Overall, while there's significant variation in responses, there is a slight tendency towards positive experiences in both autonomy and respect in maternal healthcare settings. Health authorities should promote the implementation of autonomous and respectful care for all women, regardless of socioeconomic or educational background, and provide a supportive environment that fosters user participation in decision-making.

Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.

Coastal areas face multidimensional challenges that require participatory, community-driven planning processes to address. Public participation in decision-making is shaped by identity-based and attitudinal factors, including social identity and trust in management entities. Political identity is increasingly recognized as a social identity impacting public trust in government, science, and management approaches. However, little information is known about how political identity impacts participation in coastal governance. We investigated the relationships between political identity, trust, and participation in state-level decision-making processes using an online survey panel of North Carolina residents (N = 1200). Political identity shaped concerns and priorities for coastal management, trust in management entities, and information sources about coastal issues, but did not impact participation in decision-making. Participation in decision-making was positively correlated to trust in management entities and household income and was inversely correlated to age and female gender, meaning that participants were likely to be younger, higher-income, male, and trusting of management entities. These findings can be leveraged to navigate identity-based divisions in coastal communities and bolster public participation in decision-making processes, especially amid the heightened political polarization of environmental and scientific issues that has followed the COVID-19 pandemic.

Cancer clinical trials are essential for advancing therapeutic innovations; however, patient enrollment remains a persistent challenge globally. Understanding the attitudes and willingness of patients with cancer to participate in clinical trials is critical for improving recruitment strategies. While previous studies have explored barriers and facilitators, few have integrated multiple data sources or used emerging analytical approaches, such as large language models (LLMs), to capture the multidimensional nature of patient decision-making. Furthermore, limited research has examined these perspectives within the Chinese health care context, where cultural, economic, and systemic factors may uniquely influence participation decisions. This study aimed to examine the attitudes and willingness of patients with cancer to participate in drug clinical trials in China by (1) identifying key themes influencing patients' decision-making processes, (2) comparing thematic findings derived from investigator-led qualitative analysis with those generated by 2 LLMs (Gemini Pro 2.5 and DeepSeek R1), and (3) evaluating the complementary value of hybrid analytical approaches in qualitative health research. A multistage qualitative study was conducted using 2 data sources: semistructured face-to-face interviews with patients with cancer (n=11) from a tertiary hospital in Shanghai and publicly available comments from 2 Chinese online health communities (Zhihu and Yuaigongwu). Of the 3148 initial comments, 219 met the inclusion criteria after systematic screening. Three parallel analytical approaches were used: investigator-led thematic analysis, Gemini Pro 2.5-assisted analysis, and DeepSeek R1-assisted analysis. Both LLMs received identical, structured prompts. Thematic outputs were systematically compared to identify convergent and divergent findings. The 3 analytical methods jointly identified 7 core themes: treatment selection, financial burden relief, uncertain therapeutic efficacy, uncertainty regarding control groups, lack of cognition, misconceptions, and physician trust. Substantial thematic overlap was observed between investigator-led and DeepSeek R1 analyses (8 shared themes, including family-involved decisions and service-related factors) and between investigator-led and Gemini Pro 2.5 analyses (3 shared themes, including regional disparities and autonomous decision-making). Method-specific themes included recognition of medical value (investigator only), insufficient clinical data (DeepSeek R1 only), and lack of information resource (Gemini Pro 2.5 only). These findings highlight the multidimensional nature of trial participation decisions, encompassing treatment expectations, economic considerations, risk perceptions, cognitive factors, trust relationships, and structural barriers to accessibility. The willingness of patients with cancer to participate in clinical trials is shaped by a complex interplay of treatment expectations, economic considerations, risk perceptions, cognitive factors, and relational dynamics. The hybrid analytical framework demonstrated complementary strengths: human analysis provided contextual depth and cultural sensitivity, while LLMs offered efficiency and identified additional thematic dimensions. These findings underscore the need for patient-centered communication strategies, transparent trial information, and culturally tailored recruitment approaches. Future research should expand sample diversity and further validate the use of LLMs in qualitative health research.

Educational research identifies participatory decision-making as a key factor in improving students’ academic success in secondary education. Collaboration between parents and teachers creates a supportive environment that enhances student engagement, development, and achievement by aligning school and home expectations. This study examined the influence of parent–teacher collaboration on educational outcomes in public secondary schools in Makueni County, Kenya. It focused on participatory decision-making, communication quality and timeliness, collaborative learning and development, and parental involvement in resourcing and volunteering. Guided by social capital theory and Bronfenbrenner’s ecological systems theory, the study adopted a descriptive research design. The target population comprised 1,965 respondents from 390 public secondary schools. Using stratified sampling, 295 respondents were selected from 59 schools, including principals, deputy principals, Board of Management chairpersons, Parent–Teacher Association chairpersons, and student presidents. Data were collected using structured questionnaires and analyzed quantitatively. The findings revealed a moderate, positive, and statistically significant relationship between participatory decision-making and students’ academic performance (r = 0.646, p = 0.000). Schools were found to consistently involve parents in decision-making through regular meetings, reflecting a commitment to participatory governance. The environment also encouraged open expression, with parents feeling comfortable sharing their views. Communication between schools and parents was perceived as timely and consistent, facilitating effective information sharing and coordinated responses to emerging issues. Additionally, parental volunteering was encouraged, contributing to students’ sense of responsibility and community engagement. The study concluded that effective parent–teacher collaboration enhances academic performance by improving communication, fostering shared decision-making, and promoting active parental involvement. It recommends that school administrators and Boards of Management strengthen structured mechanisms for parental engagement. Furthermore, the Ministry of Education should establish and enforce policies that promote school–community partnerships, including clear guidelines on the frequency of parent engagement and expectations for involvement in academic and co-curricular activities.

Shared decision-making is widely promoted in ICUs but remains challenging. As sedation strategies evolve, more conscious patients can participate, yet studies often overlook their experiences, focussing on family and clinicians. To explore the expectations of conscious ICU patients regarding their participation in shared decision-making and identify the factors influencing their level of engagement. A qualitative descriptive study was used. The data were collected using semi-structured interviews conducted between July and August 2024 at a university hospital in Hangzhou, China. Data were subjected to thematic analysis. Twelve conscious adult ICU patients (GCS = 15) with full decision-making capacity were recruited. We identified 10 subthemes that were classified into three themes: (a) transfer of decision-making power: family members are better spokespersons, physician's authority, limited space for autonomy; (b) the complexity of patients' participation in decision-making: family-centred decision-making preferences, silent compromise and altruism, fluidity in decision-making; and (c) factors influencing the transfer of decision-making power: low decision-making efficacy, negative emotions, the financial costs of each decision and information vacuum. Conscious ICU patients prioritise respect, clear communication and sufficient information over asserting their rights. They rely on family support and find ICU decision-making stressful and fluid. Decisions should consider the family's well-being, as members may conceal their views for harmony. Culturally adapted models are needed to help patients express their needs. Understanding the decision-making preferences of conscious ICU patients is crucial for improving shared decision-making. Providing clear communication, emotional support and culturally sensitive approaches can help patients actively engage in the decision-making process.

Osteoporosis is characterized by decreased bone mineral density and deterioration of bone microarchitecture, leading to increased skeletal vulnerability and susceptibility to fracture. These fractures impose a substantial clinical, social, and economic burden, significantly elevating morbidity and mortality. However, a relevant gap persists in diagnosis and therapeutic management, particularly within primary care. This document presents the first consensus recommendations developed by four scientific societies (SEIOMM, SEMERGEN, semFYC, and SEMG), derived from a Delphi process and supported by the most current scientific evidence. Its objective is to unify clinical criteria and improve coordination across healthcare levels. The recommendations are structured around: identification and assessment of fracture risk, treatment, follow-up, and referral criteria. The use of 10-year fracture risk assessment tools such as FRAX (Fracture Risk Assessment Tool) and dual-energy X-ray absorptiometry (DXA) is proposed for risk stratification, and clear guidelines are established for initiating treatment based on the patient's profile. The importance of treatment adherence, periodic reassessment, and patient participation in decision-making is emphasized.

Pesticide use in agriculture is a pressing but complex sustainability problem. It involves various stakeholders and trade-offs between health, environmental, agroeconomic, and sociopolitical objectives. To address the problem, effective policy mixes must be designed. For this, they must be evaluated for their probability of achieving the diverse objectives, considering stakeholder preferences for trade-offs and risks. Previous studies have evaluated the coherence of objectives and the consistency and congruence of instruments to assess the effectiveness of policy mixes. However, they overlook the influence of nondesign activities in policy formulation that are shaped by interests. To grasp the full potential of policy mixes, evaluations must consider stakeholder preferences and measure consequences across multiple objectives. This study aims to conduct such an evaluation. We adapted a participatory multicriteria decision analysis using multiattribute value and utility theory to evaluate seven mixes of policy instruments for reducing agricultural pesticide risks in Switzerland. Our evaluation included the consequences of the policy mixes for 16 objectives, predicted from expert interviews and literature, and the preferences of stakeholders in economy, administration, and civil society. Stakeholder preferences, including rarely considered attitudes toward the risks of gains and losses for specific objectives, were decisive for the performance of the policy mixes. Despite conflicting preferences and high uncertainty, we found that one policy mix of risk-based tax incentives on pesticide use and an adapted pesticide approval process performed best for all. This finding was surprising given the limited support from some stakeholders for the tax incentives when asked directly. We conclude that a value-based evaluation of policy mixes could enrich policy choice architecture. Focusing on stakeholders' preferences for achieving policy objectives can inform decision-making by identifying effective policy mixes with a potential for consensus in contentious debates about how to reduce agricultural pesticide risks. • Participatory multicriteria decision analysis process to address complex problems. • Evaluation of various policy mixes to reduce agricultural pesticide risks. • Evaluation considering trade-offs, uncertainty, and stakeholder preferences. • Rarely considered attitudes to risk affect policy mix performance under uncertainty. • Focusing on objectives can help find policy mixes with consensus potential.

Gender parity in education has improved in many countries alongside global and local efforts to promote gender equity. However, in Malaysia, male participation in related fields, especially science, technology, engineering, and mathematics (STEM), is increasingly at risk due to a subtle trend of a reversed gender parity index. This qualitative research aims to examine what makes up an inclusive STEM program, with specific foci on curriculum co-creation and gender responsiveness. Through purposive sampling of various stakeholders (n=47), several rounds of focus group discussions and interviews were conducted. Thematic analysis revealed key components of an inclusive STEM program, and strategies for promoting gender-responsiveness when co-creating this program. Moreover, these findings highlight the importance of enhancing students’ engagement in STEM through participatory decision-making and tailored interventions. The research contributes to both theory and practice by making recommendations for developing more inclusive, gender-responsive learning environments in STEM education.

Global conservation efforts are often constrained by limited understanding of the social processes that shape human-wildlife interactions and broader social-ecological systems. We examined local conceptions of human well-being in conservation strategies across eight villages in Cameroon and Kenya, with a focus on how well-being priorities influence capacities for human-wildlife coexistence. Using a grounded qualitative approach, we employed a holistic, locally grounded, and equity-conscious well-being framework that centers diverse local voices and examines how nature contributes to multiple dimensions of living well. Our findings reveal that vulnerable groups, including women and younger men, perceive inequities in access to resources and participation in community decision-making, shaping their well-being priorities and influencing their perceptions toward coexistence with wildlife. The results highlight the importance of strengthening internal social cohesion and integrating equity considerations into conservation program design to support both human-wildlife coexistence and social-ecological resilience.

Equity, diversity and inclusion (EDI), patient engagement and shared decision-making are important considerations throughout clinical trials, including the research ethics review stage. Meaningfully integrating these considerations can enhance the relevance and generalisability of trial results and reduce participation barriers among equity-deserving populations. Presently, it is unclear to what extent such guidance is provided at the ethics application stage for clinical trials. This study aimed to report the degree of guidance on EDI, patient engagement and shared decision-making in clinical trial research ethics documents. This was an embedded mixed methods study conducted in collaboration with Clinical Trials Ontario. This study analysed research ethics board (REB) forms and templates from 17 institutions across seven provinces in Canada. 15 REB application forms, 9 protocol templates and 17 informed consent document (ICD) templates were assessed for guidance related to EDI, patient engagement and shared decision-making. The Place of residence, Race, ethnicity, culture and language, Occupation, Gender and sex, Religion, Education, Socio-economic status, Social capital (PROGRESS)-Plus framework, International Association for Public Participation Spectrum of Public Participation, Patient-Oriented Research Level of Engagement Tool, Indigenous Research Level of Engagement Tool and shared decision-making standards guided our coding. We engaged with patients and persons with lived experience to inform interpretation, reporting and dissemination. EDI guidance from 15 ethics application forms and 9 protocol templates predominantly covered the 'Race, ethnicity, culture, language' (n=14; 93.3%), 'Age' (n=13; 86.7%) and 'Gender and sex' (n=12; 80%) categories of PROGRESS-Plus but lacked nuance on diverse gender identities (n=1; 6.7%). Patient engagement guidance mostly covered the 'inform' level (n=7; 46.7%) and applying 'knowledge in practice' with non-Indigenous (n=7; 46.7%) or Indigenous communities (n=13; 86.7%). All 17 (100%) ICD templates included guidance on information about options, disclosures, key elements, ethical issues and study design. No guidance was available on time-dependent relationships, empowering patients and communities in co-leading trials or providing structured guidance in making trial participation decisions (all n=0; 0%). We provided a comprehensive view of EDI, patient engagement and shared decision-making guidance in trial ethics applications in Canada. REB guidance may be strengthened in several areas to support the inclusion of equity-deserving populations in trials, meaningful engagement with patients and Indigenous communities and evidence-informed, values-aligned decisions about trial participation.

Traditional Ecological Knowledge (TEK) represents community-rooted ecological wisdom and insight developed over centuries through repeated, long-term engagement with the surrounding environment. Drawing on publications from 1990–2024, this review assesses the ways how TEK support and reinforce biodiversity conservation and it interface with formal scientific practice and knowledge systems. Through a review of narrative methodology, the research delineates four dominant themes: convergence and divergence between TEK and scientific conservation, actionable integration pathways, structural and epistemic constraints, and the factors and conditions that can strengthen support for successful cross-knowledge collaboration. Findings show that TEK plays a vital role in strengthening environmental assessment, ecosystem restoration, climate-adaptive practices, and sustainable resource governance; however, structural barriers remain such as unequal power dynamics, constrained legal protection, and insufficient acknowledgement of indigenous people’s rights. In parallel, evidence from case studies demonstrates that robust TEK integration materialises in contexts and ambience where trust partners cultivate trust, engage in participatory decision-making and adhere to Free, Prior and Informed Consent arrangements. Based on the above, the study concluded that respecting TEK holders’ sovereignty and ensuring ethically grounded collaboration are essential for more just, culturally grounded and resilient conservation futures.

Cardiac rehabilitation (CR) is an effective intervention for improving outcomes in patients with coronary heart disease (CHD). However, the actual participation rate is unsatisfactory and exhibits significant gender disparities. This study aimed to investigate gender-specific determinants of the decision to participate in CR among patients with CHD, together with underlying causes. Cross-sectional study. A cross-sectional survey of 264 patients with CHD from 3 Chinese tertiary hospitals between February 2024 and February 2025. Data were collected using questionnaires based on the Information Need in Cardiac Rehabilitation scale, the Chinese version of Cardiac Rehabilitation Barriers Scale, the Family APGAR index questionnaire, and the International Physical Activity Questionnaire-Short Form. There were 158 men aged 66 (SD = 13.3) and 106 women aged 66 (SD = 11.0). 55.1% of men CHD patients decided to participate in CR, significantly higher than in women patients (34.0%; χ2 = 11.351, p = 0.001). Logistic regression analysis for men indicated that the facilitators of the decision to participate in CR were the level of family functioning and ≥ 2 comorbidities. The barriers included emergency/safety information needs and functional status. For women, the facilitators were retirement, family functioning level, being overweight/obesity, ≥ 2 comorbidities, and work/vocational/social factors. The barriers included medication information needs, logistical factors, and functional status. Fairlie decomposition revealed gender differences primarily driven by work/vocational/social factors (contribution: 71.19%), functional status (50.50%), and retirement (-39.16%) (all p < 0.05). This study highlights the necessity of gender-specific interventions during the decision-making phase for CR. Healthcare professionals should tailor CR strategies to address women's social role barriers and men's emergency risk concerns, while enhancing family functioning and targeting support for functional status and work-related factors. STROBE checklist, cross-sectional. Three tertiary hospitals assisted in participant recruitment.