The historical context of gender-affirming healthcare (GAH) in Morocco presents a paradox. While Casablanca emerged as a global hub for such medical procedures from the 1950s to the 1970s, access to care was not available to local Moroccan citizens. Currently, transgender and gender non-conforming (TGNC) individuals experience what can be described as a "ban by silence." Although there is no explicit legal prohibition against GAH, its accessibility is effectively undermined by institutional neglect, inadequate medical education, and pervasive socio-religious biases among healthcare providers. This research aims to generate empirical evidence to inform advocacy and programming related to TGNC healthcare rights. This qualitative participatory action research study is grounded in in-depth, semi-structured interviews with 13 TGNC individuals who have sought GAH in Morocco. Participants were recruited in collaboration with a local transgender activist to foster trust within the community. A thematic analysis of the interviews was conducted to identify significant barriers and personal experiences related to accessing care. This analysis was further contextualized through a comparative review of informal care networks in Egypt and Lebanon. The findings indicate a complete absence of GAH within both the public and private healthcare sectors in Morocco. The healthcare environment is characterized by hostility, with inadequately trained providers often refusing care, attempting conversion therapy, or erroneously citing legal prohibitions. Consequently, participants are compelled to resort to unsafe, unregulated hormone therapies without medical oversight, such as the use of birth control pills. Systemic discrimination in education and employment results in considerable economic precarity, with many individuals engaging in survival sex work. Compounded by familial rejection and social stigma, these conditions render life in Morocco untenable, compelling migration as the sole viable option for safety and access to essential medical care. The legislative void in Morocco operates as a "ban by silence," a phenomenon that remains underrepresented in academic literature. This study seeks to address this gap by documenting the lived experiences of TGNC individuals navigating this de facto prohibition. The research advances a participant-led call for urgent reform, prioritizing three key areas: the establishment of legal and accessible pathways for medical transition; mandatory training for medical staff to eliminate discrimination; and the creation of affirming mental health services. Future research should continue to illuminate these invisible barriers to dismantle the systemic neglect that denies TGNC Moroccans their right to health. • Morocco’s ‘ban by silence’ effectively restricts healthcare access for transgender individuals. • State neglect forces TGNC people to seek care through unsafe and unregulated medical networks. • Providers often deny care by citing non-existent and inaccurate legal prohibitions. • Migration is seen as the only way to safely obtain essential medical care and safety.

Access to culturally relevant foods is essential to aging well, particularly for Canadians from ethno-cultural minority groups, including African, Caribbean, and Black communities. Food insecurity is defined as inadequate or unreliable access to affordable, safe, and nutritious food that meets one's needs and preferences. While food insecurity is often framed primarily in economic terms, with limited attention to culturally appropriate food access, it is also closely linked to systemic inequities shaped by policy-making and institutional barriers that ultimately affect dietary intake, mealtime experiences, and overall health among ethnocultural minority groups. In the Canadian long-term care sector, food insecurity is exacerbated among African, Caribbean, and Black residents due to limited access to culturally congruent food options within care environments designed to accommodate the ethnic majority. This project will develop roadmaps to promote healthy aging among African, Caribbean, and Black residents in long-term care homes through culturally relevant food provision as part of resident-centered care. We will use a community-based research approach guided by an intersectionality framework and a Community Advisory Council. The study includes a policy analysis of legislation, policies, and regulations shaping food provision in long-term care homes, supplemented by interviews with policy and decision-makers. Focus groups with key informants in food, aging, or long-term care will identify opportunities for change at organizational and governance levels. Ethnographic site visits to community-based food programs in three Canadian provinces-Alberta, Ontario, and Quebec-will explore how social and cultural factors influence food sourcing, preparation, and provision. Interviews with long-term care stakeholders will examine how promising community practices may be adapted to institutional settings. Finally, we will co-create and share roadmaps to support culturally safe food services and programming for African, Caribbean, and Black residents in long-term care. This equity-focused project aims to increase access to culturally relevant foods in long-term care as part of resident-centered care for African, Caribbean, and Black communities, and contributes to broader efforts to decolonize long-term care through culturally safer and more responsive care for people living in institutional settings.

Despite the global recognition of advance care planning as a critical component of patient-centred end-of-life care, its implementation remains challenged by skill-based deficiencies (e.g., inadequate training), cultural and communication barriers, and system-level structural impediments within healthcare settings. This study aimed to develop and implement a structured advance care planning communication model to improve nurses' communication practices and facilitate patient engagement in end-of-life care discussions. A participatory action research design with embedded mixed methods was conducted from September 2020 to September 2022 in an oncology palliative care unit at an oncology hospital in Beijing, China. The study integrated the Advance Directive Decision-Making Model with the Meaning-Making Intervention. Data collection included surveys, participant observation, and semi-structured interviews across three phases. Four iterative action cycles were used to co-develop and refine the communication model. Quantitative and qualitative data were triangulated through team debriefings to generate meta-inferences. Initial assessments included surveys and observations. Nurses held a foundational knowledge of advance care planning principles (mean knowledge: 68.52%), but expressed hesitation to initiate end-of-life discussions. Iterative cycles developed a three-step communication model. The steps were: (1) Recognize the Present, (2) Life Review, and (3) Face the Future. Post-action data showed improvements in in all areas. Nurses' knowledge increased significantly (mean score increase: 1.90 points). Attitudes scores increased (mean increase = 0.90) Behaviours scores also increased (mean increase = 0.57). Paired t-tests confirmed significant differences for all measures (p < 0.001). Key improvements attributed to the model included the development of time-efficient communication strategies, structured support systems, and adaptive communication techniques tailored to patient needs. The structured three-step advance care planning communication model improves nurse-patient communication and patient engagement in end-of-life decision-making. This model provides a practical framework for initiating and guiding advance care planning conversations in oncology care. Future research is needed to evaluate its applicability in diverse settings and its long-term impact on patient outcomes.

Development of I-HASMEA: A Participatory Action Research Study of a Mobile HIV Self-Management Application for Men Who Have Sex With Men Living With HIV in Thailand.

Intergenerational learning in community settings remains underexplored in lifelong education scholarship, particularly in relation to adult learning, the revaluing of local knowledge, and collective agency in rural contexts. This article addresses this gap through a qualitative participatory action research study conducted in a Thai rice-farming community. It examines how a community-based intergenerational learning initiative, co-developed by older and younger participants, shaped change at personal, relational, and community levels. Eighteen participants aged approximately 15–74 engaged in three iterative cycles of planning, implementation, reflection, and revision. Data were generated through focus group discussions, semi-structured interviews in Thai, participant observation, reflective journals, and visitor feedback, and were analysed thematically using an inductive–deductive approach. Findings show that, when organised as a participatory and learning-centred process, intergenerational learning supported skills, confidence, and agency across generations. Older participants reported renewed purpose and public recognition of their knowledge, while younger participants developed respect for local knowledge and confidence in community contribution. Sustained collaboration fostered trust, empathy, and reciprocal communication. At the community level, the initiative revitalised cultural assets and strengthened collective agency through shared responsibility and community-led action.

Persons affected by skin neglected tropical diseases (skin NTDs) commonly face stigma and violence, which perpetuates social exclusion, mental health issues, poverty and impedes health-seeking behaviour. Thus, stigma and violence limit the attainment of World Health Organisation (WHO) 2030 roadmap progress. Evidence on stigma related to skin NTDs pertains largely to leprosy, and experiences focus on the micro level, with limited consideration of the broader meso and macro social and structural conditions underpinning experiences of stigma. This study sought to explore experiences of stigma and violence among persons affected by skin NTDs in Liberia, within the context of an integrated skin NTD programme, including the application of intersectionality theory, considering how experiences change over time and in in relation to gender and condition, and making evidence-based recommendations. This participatory action research study used participatory methods (e.g., photovoice) and worked with persons affected as co-researchers. We drew on longitudinal qualitative data (n=649 participants) from three distinct timepoints during 2019-2023 with respondents from across the health system, prioritising perspectives of persons affected. We conducted gendered thematic framework analysis, guided by a conceptual framework, drawing on the WHO violence typology, stigma forms and the social ecological model. Stigma and violence, commonly attributed to myths and misconceptions, are hindering participation and inclusion. Stigma and violence seem to have reduced, however, emotional violence and internalised stigma remain prevalent. There has been a reported decline in stigmatising attitudes held by formal health workers, but some informal providers (traditional and faith healers) continue to perpetuate harmful myths. Harmful myths and gender shape the manifestation and determinants of violence, often mirroring gender norms and converging with other forms of inequalities, with women disproportionately impacted. Leprosy was associated with the most distressing and de-humanising accounts. The relationship between skin NTDs, stigma and violence is complex and multifaceted - we propose a framework to strengthen understanding. Addressing stigma and violence is paramount in the delivery of equitable, person-centred care, with implications beyond NTD programmes. More evidence is needed to deliver tailored, gender transformative interventions that engage informal providers and community-based groups (CBGs).

Chronic pain is a significant health issue, particularly for women, with South Asian women being an underrepresented group in research. This study aimed to explore the needs and challenges of South Asian women living with chronic pain and develop strategies to address them. Participatory Action Research. Sixteen South Asian women in the United Kingdom, aged 30 to 78 years, participated in three rounds of data collection through focus groups, co-development of two intervention approaches and feedback sessions. Participants completed the full long-form Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) prior to phase 1 and again in phase 3. A paired-samples t-test was conducted using SPSS to determine whether there was a significant difference between pre- and post-intervention scores. Phase one identified two pain management intervention approaches: a tailored written resource and a group peer support intervention. Phase two provided insights into their design. Phase three evaluated the strategies following creation and pilot and identified key themes regarding effectiveness: resource design, effects and continued engagement. Quantitative analysis showed significant improvements in mental well-being scores across the course of the Participatory Action Research process. This study highlights barriers and facilitators to pain management among South Asian women, offering transferable insights for culturally sensitive interventions. Participatory approaches can facilitate the development of culturally tailored interventions with the potential to enhance coping, self-efficacy, empowerment and mental well-being. This study provides methodological and practical guidance for co-designing interventions for underrepresented communities, with implications for broader implementation and future research.

Small rainfed hill farms in the Indian Himalayan Region face ecological fragility, resource depletion, and farmland abandonment, requiring alternative livelihoods for vulnerable communities. This study assesses the economic viability and socioecological impacts of low- cost livelihood interventions for marginalized households in Uttarakhand' s Jyoli village (2020-2022). Using participatory action research, we implemented six eco- friendly interventions i.e. protected cultivation, backyard poultry, beekeeping, vermi- composting, bio- briquetting, and green skilling—among 150 purposively selected households (Scheduled Caste, Below Poverty Line, COVIDaffected, women- headed) from a cluster with baseline mean income ` 13, 134/HH/year. Daily input- output registers, beneficiary surveys, and cost- benefit analyses quantified outcomes over 24 months. Non- beneficiary households (n = 153) provided contextual comparison. Of 150 intervention households, 62 (41. 3%) achieved income doubling to ` 28, 935/HH by September 2022, primarily through poultry (85 HH; 2, 700 birds; B:C 2. 13; ` 69,56,951 revenue despite 17% mortality, χ ² = 4. 8, p = 0. 03) and polyhouses (41 units; 26. 16 t ha-1 vegetable yield—16 × higher than open fields, p&lt; 0. 001; B:C 2. 66, 95% CI: 2. 12–3. 20). Overall project investment of ` 61,4,612 generated ` 97,6,976 output (net ` 5, 15, 515; aggregate B:C 2. 12). Scale of adoption explained 95% of income variance (r = 0. 975, p&lt; 0. 001), while per- household profitability explained 77% (r = 0. 878, p&lt; 0. 001). Complementary activities—beekeeping (81 kg honey; 27–73% pollination- driven crop yield gains), vermi- composting (68 quintals), and green skilling (91% women participants)—enhanced nutrition security and women' s empowerment (73. 2% self- confidence, 70.7% economic gains). However, only 42.9% reported reduced migration. Integrated livelihood models combining poultry with polyhouse- beekeeping can boost income under favorable conditions (support, inputs, demand). Success rate of 41% indicates potential but scalability faces barriers: chick supply, subsidized feed (56. 6% costs), veterinary services, market access, climate risk management. The model' s focus on SC/BPL and ecological benefits (biodiversity, fewer forest fires, water harvesting) offers climate- resilient development paths, though sustainability beyond project are duration remains uncertain.

ABSTRACT As cities respond to climate change, what adaptive measures do residents of rapidly gentrifying neighborhoods prioritize, and why? As part of a Participatory Action Research study in metropolitan Boston, we conducted semi-structured interviews with residents of nine rapidly developing neighborhoods to explore their conceptualizations of resilience to climate change and their desires for climate adaptation. We found that residents in these communities experience climate change through chronic stressors, mainly through heat, high utility bills, and flooding. Residents connect climate resilience to other stressors in their lives like displacement, structural racism, and trauma, and they see strong community ties as a key element of climate resilience. Based on our findings, we argue that adaptation measures that promote community-held notions of resilience should consider the root causes of unjust systems, respond to the compounding stressors in people’s lives, emphasize community ownership and control in interventions, and strengthen social ties by building on networks of community care.

According to estimates, the prevalence of various forms of neurodivergence is much higher among musicians than in the general population. Despite this fact, we know very little about the lived experiences of neurodivergent (ND) musicians in professional settings, such as educational institutions and places of employment. The lack of information leads to a lack of understanding, appropriate support, and inclusion of ND personnel in these spaces; therefore, it is crucial to gather accurate information directly from the population. A Participatory Action Research (PAR) study was planned and organised by ND musicians, which consisted of an in-person event and online follow-up conversations, where members of the community (ND musicians, music educators, music researchers, and neurotypical allies) were invited to discuss various aspects of their vocational education and professional lives. In alignment with the guiding principles of PAR, all participants were invited to contribute to the outputs to ensure their autonomy and utilise their unique expertise to the fullest. Given the quantity and richness of the data and the limited space, detailed discussions about the findings will be published separately. Here, we opted to focus on the methodological approach and procedure to provide a template for using PAR with adult ND communities.

This study examined how community mental health case managers, most of whom were mental health nurses, modified their day-to-day practice to strengthen the therapeutic relationship within community services. Using a participatory action research design across 10 centres in Catalonia, Spain, 24 case managers and 105 patients engaged in two action-reflection cycles. Data from reflective diaries and focus groups were analyzed using inductive thematic analysis. Through cyclical observation and collaborative reflection, participants identified key facilitators and barriers to developing the therapeutic relationship and co-designed two practice innovations: (1) jointly-created informational materials clarifying case-management scope and expectations, and (2) regular mixed patient-professional reflective groups focused on the therapeutic process. Despite structural pressures, heavy workloads, service fragmentation, and limited opportunities for professional reflection, the participatory approach supported sustainable, relationally focused practice change grounded in patient-provider dialogue. Embedding structured reflective spaces within routine care emerged as a practical mechanism to consolidate therapeutic alliance and advance recovery-oriented practice. While findings apply across disciplines, they are particularly relevant to nursing-led and nurse-participating case-management teams, in which continuous therapeutic contact, coordination functions and relational expertise intersect. The study offers a replicable framework for enhancing person-centred care in community mental health settings, and it underscores the value of nurse-involved co-creation and structured reflection to maintain therapeutic presence, align expectations and integrate lived experience into ongoing quality improvement.

BackgroundAmerican Indian/Alaska Native (AI/AN) people represent a culturally diverse people group within the United States. AI/AN people experience some of the most severe health disparities in the United States, including behavioral health. A quarter of AI/AN people in the United States live on tribal lands, experiencing significant barriers to mental health resources and broadband infrastructure for telehealth. We developed Amplifying Resilience Over Restricted Internet Access (ARORA)—a mobile health (mHealth) smartphone app, promoting mindfulness practices and community building through AI/AN culture and values. Originally co-designed with both Hopi/Tewa and Navajo youth and adults, this study evaluated app resonance among Hopi/Tewa youth, supporting its iterative design. While we initially planned in-person user testing, this was moved online due to the COVID-19 pandemic.ObjectiveThis study assessed the potential and acceptability of an mHealth app supporting Hopi/Tewa youth practicing mindfulness inspired by their culture, values, and beliefs. This research served as preliminary work for an ongoing, iterative participatory action research study, identifying points of improvement to align with our partner community’s goals.MethodsAfter meeting with 6 community advisory board members and focus groups prior to this study, we developed a prototype for ARORA. This study evaluated intuitiveness and usability through testing and interviews with Hopi/Tewa youth. All meetings with stakeholders were moved online due to the COVID-19 pandemic. Using screen-sharing via Zoom (Zoom Communications, Inc) and Android emulators, we received feedback for the iterative design process.ResultsThis study involved 9 participants aged 16-24 years. Of these participants, 1 was male and 8 were female; all identified as Hopi/Tewa and/or Tewa. This study included a quantitative assessment using a modified version of the User Version of the Mobile Application Rating Scale. The mean score across all questions was 3.71 (SD 0.427), suggesting generally positive reception. Qualitative results from thematically analyzing open-ended focus group data produced 5 open codes and 12 axial themes, reaching thematic saturation after engaging with 9 participants. Qualitative feedback revealed that while its use was generally enjoyable, the ARORA app could be more specific to Hopi/Tewa culture. Finally, we reflect on adaptations made to our initial protocol in response to the COVID-19 pandemic, offering guidelines for future mHealth work involving rural or hard-to-reach communities.ConclusionsIn this evaluation and usability testing of the ARORA prototype, participants expressed interest and engagement in the mindfulness activities. Participants also identified spaces in which the app could improve, both in usability and in cultural groundedness, especially with the visual dimensions of the app. Reflecting on our experience in facilitating remote user testing, we encourage future work in rural mHealth to consider practices for conducting research when in-person meetings are not feasible.

Beyond individual wellbeing in a participatory action research study on self-care, psychoeducation, and radical acceptance in music therapy education

Rural primary healthcare (PHC) systems face persistent challenges related to access, continuity, and responsiveness, particularly in geographically dispersed communities. Nurses constitute the backbone of rural PHC delivery in Saudi Arabia, yet their leadership role in driving locally grounded innovation remains underexplored. This study aimed to examine how nurses lead and sustain primary healthcare innovation in rural Saudi Arabia using a participatory action research (PAR) approach. A qualitative PAR design was employed with 12 registered nurses working in rural PHC centers. The study unfolded across three iterative cycles of planning, action, observation, and reflection. Data were generated through focus group discussions, in-depth interviews, reflective field notes, and documentation of implemented actions. Reflexive thematic analysis was conducted concurrently with data collection, with participants actively involved in interpretation and refinement of findings. Four interconnected themes were identified: (1) leading from the frontline through locally grounded innovation; (2) co-creating solutions with patients and communities; (3) working within rural constraints through adaptive practices; and (4) organizational enablement as a condition for sustainability. During PAR Cycles 2 and 3, nurses implemented and refined ten practice innovations targeting continuity of care, patient engagement, workflow efficiency, documentation burden, and team learning. Sustainability was strongest when innovations were selective, simple, and embedded into routine workflows and protocols. Nurses in rural Saudi Arabia act as key agents of primary healthcare innovation through incremental, relationship-centered changes grounded in everyday practice. Participatory action research offers a robust framework for strengthening nurse leadership, aligning service improvement with community realities, and supporting sustainable rural PHC transformation. Policy and organizational strategies should explicitly enable nurse-led, participatory innovation to advance equitable community health outcomes.

Major neurocognitive disorders (MNCDs) frequently lead to difficulties in performing activities. Several studies have shown that people living with an MNCD benefit from the use of learning optimization methods from cognitive rehabilitation, such as error-free learning, motor encoding, spaced retrieval, and fading, which promote the safe pursuit of their meaningful activities. However, while the principles of learning optimization methods are relatively straightforward, the personalized application of these methods to the specific situations encountered can be more difficult. The aim of this study was to describe the codevelopment process, including the validation of a web application called "Aide-Mémoire-Interactif (AMI)," a tool to help in personalizing learning optimization methods. To design the web application, participatory action research based on a codevelopment and validation process was carried out. The various stages leading to the codevelopment of the AMI web application were grouped into 3 phases: (1) assessment of caregivers' needs (identification of situations frequently encountered by people living with an MNCD); (2) production of the first version of the AMI web application; and (3) validation of the AMI application. Individual interviews and workshops were conducted with 20 participants (caregivers, health and social service professionals, and community organization workers) to obtain a diversity of viewpoints and application contexts of use. The AMI web application was developed through an iterative, participatory process involving caregivers and professionals. Participants identified daily situations requiring the use of learning optimization methods and provided feedback that guided successive refinements to the content, answer choices, navigation, and personalization features. The logical architecture was built according to the rationale underlying learning optimization methods. The final version enables users to generate tailored strategies for specific situations, access educational capsules, and save personalized strategies. Participants reported improved clarity, usability, and relevance. This participatory action research enabled the codevelopment and validation of the AMI web application to support the operationalization of learning optimization methods for people living with an MNCD by personalizing them to the situations encountered daily as well as to the underlying cognitive difficulties. By involving caregivers, professionals, and users, this process contributed to the development of a web application that meets user needs and their appreciation.

Abstract This study explores how positive psychology interventions enhanced staff confidence and well‐being in fulfilling official languages (OL) obligations within an Irish university. The 14‐month participatory action research (PAR) study aimed to address challenges relating to language anxiety and foster a more collaborative and empowering language support environment. A language coach, a new role at the institution, engaged in intentional reflective dialogue (Kato, 2012) with 15 members of a newly established Irish language support network (LSN). Participants were administrative and frontline staff with varying levels of Irish language proficiency. Extensive data were collected using short surveys; audio‐recorded language coaching sessions, workshops and meetings; learner diaries; reflexive reviews; blog entries and comments; electronic correspondence; researcher observations; short video outputs; and semi‐structured interviews. Findings show that the practices involved in creating the language coach and LSN infrastructure, alongside participatory actions and initiatives, had a significant impact on affect, positive individual and group behaviors, and institutional effectiveness in meeting OL requirements. A “care‐full” approach to institutional compliance with language legislation is proposed, highlighting how relational practices can support change. Four key themes are discussed: (a) characteristics of a positive institution, (b) balancing positive emotions and behaviors in compliance settings, (c) a shift from individual uncertainty to collective confidence, and (d) the constellation of actors involved in building institutional effectiveness. This study highlights how participatory principles, language coaching, and a co‐constructed value set can foster a positive institutional culture. It offers insights into the characteristics of positive institutions, OL support, and the scope of PAR as a reflexive and transformative methodology.

Purpose This study aims to illuminate how women educational leaders can utilize third spaces to resist hegemonic leadership norms, engage in critical identity reflection and enact antiracist leadership practices within K-12 districts and schools located in the United States. Design/methodology/approach The authors employed a comparative qualitative design to examine two participatory action research studies they respectively led, which utilized similar community learning exchange processes in contrasting racialized and sociocultural contexts. Findings Despite contextual differences, both studies found that third spaces facilitated participants’ ability to: (1) create safe spaces for learning and connection, (2) reflect on sociocultural and sociopolitical identity and (3) enact forward-looking conceptions of educational leadership. Practical implications The findings from this comparative study suggest a promising new professional learning modality for K-12 women educational leaders and possibly other marginalized groups. Originality/value Although third spaces have been applied in various contexts, the authors found limited applications in educational leadership professional learning spaces.

Background Although emergency departments serve as ‘safety nets’ for the medically underserved, emerging research indicates that certain minority groups, including transgender and gender diverse people, report challenges having their needs met in this setting. Objective The objective of this study was to explore the experiences of transgender and gender diverse youth accessing and receiving care in emergency departments. Design This was a qualitative study using a critical participatory action research methodology co-designed and executed in partnership with transgender and gender diverse youth. The theoretical underpinnings for the study included the Gender Minority Stress Framework, erasure, and intersectionality. Setting(s) The study was led from Ottawa, Canada, but was conducted online to be available to transgender and gender diverse youth across the country. Participants Participants (n = 14) ranged in age from 18 to 25, with a mean age of 22 years old. Most identified as nonbinary (n = 10, 71%) and/or as transmasculine (n = 8, 57%), used they/them pronouns (n = 11, 76%), and reported queer sexual orientation (n = 8, 57%), white ethnoracial identity (n = 12, 86%), and having completed some university (n = 11, 79%). Methods Data collection was completed via interview, journaling, and art-based approach. Data analysis was completed during focus groups using thematic analysis. Results Participants reported feeling that they were not trusted by healthcare providers to know themselves or their health needs. In response, participants reported employing adaptive strategies to conceal stigmatized attributes and promote those that align more closely to social norms. Conclusions Ultimately, this study offers novel insights into the experiences of transgender and gender diverse youth accessing and receiving care in the emergency department and suggests that the capacity of transgender and gender diverse youth as valued ‘knowers’ is greatly underestimated.

This 4-year longitudinal Youth Participatory Action Research (YPAR) study employed over 300 peer-to-peer oral history interviews conducted by 112 mostly Dominican American 10th graders in Upper Manhattan and the South Bronx to examine how conjunctural crises—immigration enforcement, pandemic, and digital toxicity—impact youth from immigrant households. Building on YPAR scholarship and immigration studies, this curriculum-embedded project positions youth as knowledge producers and activists for their communities and generation. Key findings reveal punitive immigration policies created pervasive fear, forcing youth into premature adult mindsets and responsibilities. Students identified school as simultaneously overwhelming and a refuge, and social media as a “double-edged sword” providing community while exposing them to objectification and predators. Despite structural marginalization, youth demonstrated sophisticated analytical capacity, developing critiques of anti-immigrant rhetoric while building solidarity through shared truth-telling. The participatory design of the project challenges deficit narratives while modeling democratic knowledge production.

International medical graduates (IMGs) are important to supplement domestic workforce gaps in rural general practice in Australia. However, there is no evidence about how to support IMGs longitudinally to achieve such careers. This research aimed to explore the integrated challenges for IMGs across the pathway from migrating to specialising as a general practitioner (GP) in a rural location, to inform what coordinated strategies might be needed. A qualitative participatory action research study of multi-staged one-hour semi-structured qualitative interviews and two-hour focus groups exploring IMG experiences from migration to pursuing rural GP careers in Australia. Participants had different roles across the prevocational and vocational rural general practice training system; IMGs were prioritised. An initial focus group in February 2025, consulted a 10-person Project Advisory Group. Data were transcribed and deductively and inductively coded for themes. Between March and May 2025 further focus groups and interviews were done with 31 wider participants, to deepen thematic insights. In July 2025, the Project Advisory Group we re-consulted to refine and confirm the themes. Overall, 68% of respondents were IMGs; 46% from towns < 15,000 population and a range of roles across rural general practice training. We found three temporal stages representing different challenges: migrating and acclimatising; moving to new workplaces and communities; and training as a specialist GP in a rural location. Cross-cutting themes were complexity and frustration and the informal exchange of information and advice from other IMGs over these stages. Sub-themes identified specific issues at each stage including, limited access to relevant and tailored information for planning their life and career, limited GP career mentorship and tailored training advice and insecure pathways with variable quality supervised learning. IMGs also lacked recognition of past training and experience and had limited opportunities to address skills gaps through nuanced learning to help them adjust to the scope and responsibilities involved in rural GP careers. IMGs may experience three-staged challenges and specific issues as they navigate the pathway to establishing a rural GP career in Australia. To mitigate an overreliance on informal supports between IMGs, targeted and coordinated resources, education and training may be needed.