Health inequities are driven by the unequal distribution of resources and power. Local-level actors are closely connected to communities and have the potential to address unfair imbalances in power through health equity interventions. Yet practical strategies on how to do this remain unclear. To address this gap, we conducted a systematic review of five databases, examining how power was addressed in the design and implementation of local-level health equity interventions and their reported impacts. Thirty-eight international studies were analysed using the Health Equity Power Framework and Four Expressions of Power typology. Most articles described community organizing, health education, advocacy, and community funding initiatives. Interventions that strengthened community knowledge, connectedness, and leadership rebalanced power by enhancing individual and collective agency. Shifts in rigid, inequitable structures and institutional processes were observed when interventions activated multiple types of power, across different forms and spaces. Interventions informed by power-centered frameworks and principles, such as empowerment theory and self-determination, helped actors rebalance power dynamics, while entrenched structural and institutional power imbalances moderated efforts to rebalance power. This review underscores the role of local governments, institutions, and community actors in addressing power imbalances and provides practical guidance on strategies to support equitable policymaking.

The transition to motherhood among first-time mothers in China during the first six months postpartum: A qualitative study based on the transition shock model.

ABSTRACT Public private partnerships (PPPs) can facilitate tourism development, yet their success is often undermined by complex power dynamics, particularly in transitional economies. This study investigates the impediments of tourism PPPs in the post-Soviet context of Kazakhstan. Using 27 semi-structured stakeholder interviews and abductive thematic analysis, the study maps the landscape of power and collaboration, revealing a structurally rooted concentration of power within state institutions. This power imbalance marginalizes private actors and impedes effective partnership, resulting in distrust, asymmetrical information sharing, and the dual-edged role of informal networks (“svyazi”). The study contributes to knowledge by demonstrating the complex power dynamics unique to the tourism sector of a transitional economy. It proposes a multi-level action framework to address the strategic, tactical, and operational challenges in tourism PPPs, outlining a pathway toward their more effective implementation in societies with weak institutions.

The aim is to explore co-design facilitators' perspectives and experiences of using co-design to improve intrapartum care in four sub-Saharan African settings. The inquiry focuses particularly on how they fostered engagement, built trust and mitigated unintended consequences during the co-design process. Qualitative interview study with reflexive thematic analysis. Sixteen public and private not-for-profit hospital-based maternity units in Benin, Malawi, Tanzania and Uganda (four per country). A total population sample of 10 co-design facilitators involved in a hospital-based co-design project implemented in maternity units in Benin, Malawi, Tanzania and Uganda were interviewed. Semistructured interviews were conducted between December 2022 and January 2023. Co-design facilitators viewed co-design as a collaborative process to develop contextually relevant solutions. Our findings elucidate their role in facilitating consensus-building and fostering stakeholder ownership amidst significant power divides. They described approaches co-design facilitators take to maintain ongoing stakeholder engagement and manage misaligned expectations in a trusting and collaborative environment, while being mindful of existing tensions and power imbalances. They also highlighted key challenges faced, including navigating norms, power imbalances and unintended consequences. This study underscores the importance of power-sharing, fostering ownership and engaging end users equitably and continuously in co-design efforts, while also being aware of how to address its potential unintended consequences. Further research is needed to understand co-design facilitators' impact on co-design and how to address unintended consequences for stakeholders during and after co-design activities in intrapartum interventions in low-resource settings.

Higher education has undergone a rapid transformation in recent years, driven by the dual pressures of mitigating the long-term effects of COVID-19 and integrating generative artificial intelligence (GenAI) technologies. The pandemic exposed and exacerbated pre-existing inequalities and power imbalances within the sector, necessitating policy adaptations to address issues such as digital inequality, limited social interaction, barriers faced by student researchers in conducting face-to-face data collection, and the protection of mental health. Concurrently, GenAI has emerged as a disruptive technology that is reshaping pedagogical practices, research processes, and supervisory relationships. Although GenAI is widely promoted as a tool that can enhance teaching, research, administration, and student support, it raises critical concerns related to academic integrity, ethics, systemic bias, knowledge ownership, and uneven regulatory standards. Supervisors similarly hold divergent views regarding its usefulness and risks, a tension also reflected in inconsistent journal policies on GenAI use. Guided by the GenAI–Technological Pedagogical Content Knowledge framework (GenAI-TPACK), this study examined the ethical and literacy imperatives necessary for transforming research supervision in the era of GenAI. A systematic literature review was conducted to identify emerging GenAI literacy indicators that facilitate ethical, transparent, responsible, and informed engagement with GenAI during the research process. The review revealed significant gaps in supervisor preparedness, uneven AI literacy among research candidates, and a lack of coherent institutional guidance. The study contributes practical insights for higher education institutions seeking to balance the opportunities and challenges posed by GenAI and offers direction for developing humanising, context-sensitive guidelines for responsible integration in research supervision.

Recent research points to the complications in the power dynamic between researchers and the researched within the arena of international inclusive education and development due to the unquestioned assumption of the supremacy of western/Eurocentric epistemologies. Ableism and perceptions of disability add additional layers of complexity that are currently under-researched. Presenting evidence from our experiences of conducting disability-related research in India and Colombia, in this paper we argue that it is necessary for researchers to identify their own positionality, or an understanding of their own power and privilege, and their insider/outsider status, using self-reflexivity as a research tool towards a deeper understanding of how factors like class/caste and language, can influence both the power dynamics and the outcomes of the research, thus reducing some of the imbalances in power and enabling more equitable relationships with participants.

In half-bridge converter series microgrid (HBCS-MG) systems, output fluctuations caused by varying wind speeds and solar shading induce active power imbalances among generation modules (GMs). This imbalance increases susceptibility to overmodulation distortion and restricts the active power regulation range. To address these challenges, this paper proposes a variable carrier level phase disposition SPWM (VCLPD-SPWM) strategy to enhance the active power regulation depth of GMs at the modulation level. Assuming a stable DC-link voltage for the half-bridge converters (HCs), the power distribution characteristics and switching durations of GMs under PD-SPWM are analytically examined. Subsequently, the carrier level transition points and periods for the maximum regulation range under VCLPD-SPWM are derived, alongside the corresponding power increments and negative power characteristics of each GM. Finally, theoretical calculations, simulations, and experimental results validate the feasibility and effectiveness of the proposed strategy, demonstrating its superiority over carrier phase-shifted modulation strategies.

ABSTRACT Participatory Action Research (PAR) is championed as a transformative methodology fostering empowerment and collective inquiry, yet its application among Technical and Vocational Education and Training (TVET) graduates in contexts of socio-economic precarity exposes tensions around power imbalances, survival pressures, and institutional constraints. Drawing on a Freirean-inspired study with National Certificate (Vocational) [NC(V)] graduates in South Africa, this article interrogates how precarious living conditions hinder sustained participation and how institutions often appropriate participatory approaches for bureaucratic or policy purposes, thereby weakening their radical potential. While recognising these challenges, the article argues for reflexive adaptations such as trust-building, context-responsive participation, and critical examination of structural barriers. Engaging with contemporary debates in Educational Action Research on the risks of depoliticising participatory methodologies, it calls for a rethinking of PAR that explicitly reclaims its political and transformative roots in Freirean pedagogy. Methodologically, the study draws on life narrative interviews, learning cycle group discussions, and the formation of a student movement to foreground the lived struggles and agency of TVET graduates. In doing so, it contributes to current conversations on how participatory methodologies can remain viable and transformative in structurally constrained environments.

Sexual violence in psychiatric in-patient care has received increasing attention following persistent evidence of sexual violence and harassment on wards. However, patients' subjective experiences remain under-examined, limiting the evidence base to inform safeguarding, gender-sensitive design and trauma-informed practice. To synthesise qualitative evidence on patients' experiences of sexual violence and perceived risk within psychiatric in-patient settings. We conducted a systematic review and qualitative synthesis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PROSPERO registration no. CRD42024595945). MEDLINE, Embase and PsycINFO were searched from inception to October 2024, supplemented by reference list screening and citation tracking. Inclusion criteria were peer-reviewed qualitative studies reporting patients' first-hand accounts of sexual violence or perceived sexual safety in psychiatric in-patient care. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklist, and data were analysed by thematic synthesis. Six studies published between 1998 and 2025 met the inclusion criteria, with most focusing on female patients in mixed-gender wards. Three overarching themes were developed: (a) 'a culture of permissiveness and dismissal' - patients downplayed harassment and abuse and staff routinely dismissed concerns; (b) 'everyday fear, hypervigilance and resistance' - the constant threat of harm generated chronic distress, with safeguarding responsibility shifted onto the patients; and (c) 'gendered power dynamics in open or mixed-gender spaces' - open ward layouts, inadequate boundaries and legal detention compounded vulnerability to harm. Sexual violence in psychiatric in-patient care is enabled by ward cultures that normalise harm, weak safeguarding and gendered power imbalances. Urgent action is needed to implement trauma-informed, gender-sensitive practices and secure spatial boundaries and consistent incident responses, alongside policies that enable safe disclosure and accountability.

Cyberbullying behaviors manifest uniquely in different regions, shaped strongly by local slang, dialectal expressions, and cultural context. Code-mixed Chinese–English colloquial language (Cantonese) is commonly used in Hong Kong, Macau, and parts of southern China. Code-mixing is the use of multiple languages concurrently, and Cantonese text includes distinct phonetic, lexical, and syntactic features that are not exhibited in datasets developed for either Chinese or English applications. In this study, a privacy-aware code-mixed cyberbullying dataset (PCCD), containing 14,115 annotated tweets organized into 1668 sessions, was developed. Personally identifiable information and well-known identifiers, such as the names of famous celebrities, politicians, and organizations, were replaced with randomly generated dummy names. The anonymized data empirically demonstrated improved performance in terms of precision, recall, and F1 score, indicating a greater generalization ability when handling unseen participants. To the best of our knowledge, the PCCD is the first code-mixed Chinese–English dataset that includes abuser and victim identity annotation. Our dataset facilitates the development of robust cyberbullying detection tools that researchers and developers can use to accurately measure aggressiveness, attack frequency, and abuser–victim power imbalance in a dialogue session.

Mob violence is an emerging threat to the rule of law in Pakistan, often fueled by religious incitement, blasphemy allegations, and perceived failures in the legal system. This study aims to examine the social, legal, and procedural barriers to preventing mob violence in Pakistan from a criminal justice perspective. Drawing on qualitative interviews with 44 elite respondents (judges, lawyers, and police officials), this research explores the underlying causal factors that contribute to mob violence in Pakistan and the systemic limitations of the criminal justice system in addressing this issue. Thematic and cross-referenced analyses reveal an intersection of drivers, including widespread distrust in legal institutions, weak law enforcement capacity, a collective moral justification mindset, and the paradoxical role of religious and tribal leaders as both instigators and mediators. The findings indicate how procedural delays, lack of accountability, and technological deficiencies within the criminal justice system contribute to normalizing extrajudicial actions. The study also illustrates the strategic role played by community influencers in both escalating and de-escalating mob violence, revealing a power imbalance that further undermines formal justice mechanisms. Finally, the study highlights the need for a multidimensional reform approach that includes strengthening police response capacity, regulating religious rhetoric, and accelerating judicial proceedings in order to reinforce Pakistan's criminal justice system.

Sharing data and biospecimens is both a scientific imperative and an ethical duty in research and public health, yet global asymmetries in capacity and power risk perpetuating inequality rather than alleviating it. To genuinely advance global health equity, data sharing efficiency should be measured not by the volume or speed of data transfer, but by the deliberate flow of benefits, capacity and decision-making authority to structurally disadvantaged regions. This requires a complementary shift. First, advanced partners must move from directing to enabling, focusing on building local technical, analytical and governance capacities to ensure solutions are rooted where they are needed most. Second, less-resourced actors must reframe data sharing not as a risky obligation, but as an opportunity for leadership-actively shaping research agendas and harnessing the power of open science. Consequently, sharing mandates must be explicitly tied to tangible interventions and demonstrated successes in improving health outcomes, supported by sovereign, federated data systems and reformed academic incentives that valorise capacity building and equitable collaboration as core research outputs. We, therefore, urge health researchers, funders, publishers and agencies to collectively transform sharing of data and biological materials into an equity-centred process that actively rectifies historical power imbalances. By shifting emphasis from the data themselves to the people, systems and processes that translate data into action, we can ensure sharing serves as a true bridge to equity-one that actively advances global health for all.

Pharmacists are integral to advancing equitable healthcare, implementing culturally safe practices that address power imbalances, racism, and institutional barriers. Ethnicity-based eligibility criteria (EBEC) have improved treatment access in some settings, but little is known about how community pharmacists experience and implement these criteria in practice. This study aimed to explore pharmacists' perceptions of (i) applying EBEC in community pharmacy; (ii) the extent to which the provision of education or resources would be useful in the future. A descriptive cross-sectional survey of registered and pre-registrant pharmacists in Aotearoa, New Zealand, was conducted. Participants were recruited via professional and researcher networks, with data collected anonymously using a piloted survey on Qualtrics®. Quantitative responses were analysed with descriptive statistics, and qualitative data were inductively coded and refined through team consensus to identify themes. Two hundred and eighteen pharmacists (median age band 36-45years, median of 20years pharmacy experience) completed the survey. Although most pharmacists felt comfortable applying EBEC, half felt implementation would have been better supported if training or resources were available. Participants had limited experience discussing ethnicity with patients and wanted to be better equipped to discuss eligibility with those who were eligible, and with those who opposed the use of EBEC. Resources needed to focus on evidence-based justification of EBEC, definitions of ethnicity, and role modelled conversations. When implementing new types of eligibility criteria for community pharmacy services, pharmacists need sufficient and appropriate training and resources for effective implementation.

The paediatric intensive care unit (PICU) is a highly stressful environment affecting children, families and staff. Patient diaries, common in adult intensive care and valued for supporting psychological recovery, are less established in PICUs. Further research is needed to address gaps in understanding diary impact within paediatric settings. The aim of the study was to examine how PICU patient diaries are used by children, families and HCPs. The qualitative approach, Constructivist Grounded Theory, was adopted to ground the meanings and actions constructed by the participants. Eleven families were intensively interviewed initially during their child's PICU admission to a combined general and cardiac unit in the UK. Six families were interviewed post-discharge from the hospital, at follow-up. Ninety-five nurses and health care assistants were interviewed in five focus group interviews. PICU diaries provided a communication tool which strengthened relationships between the parent and their child, nurses and other family members by Creating Connections. The relationships fostered were viewed as Impacting Emotionally on parents and nurses. In an environment with an imbalance of power, the diary supported parental autonomy by Empowering Involvement to make decisions. Providing clear explanations of their child's PICU admission, the patient diary filled any gaps in memory and offered an easily understandable permanent record. Therefore, the diary was a valuable resource supporting Making Sense of the child's complex critical illness journey. The UPDATE study provides an understanding of the role of PICU diaries as a tool for both parents and nurses. These diaries serve as clear and accessible records, bridging gaps in knowledge. By empowering families and healthcare professionals, PICU diaries support the navigation of the complexities inherent in PICU admissions and contribute to Making Sense to enhance clinical practice and compassionate care. The theory generated offers understanding of the impact and use of PICU diaries and the multidimensional use of the diary for the child's parents and nurses to explain and understand the critical illness experience.

Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States.

ABSTRACT CITES has demonstrated a persistent trend of regulatory tightening over five decades, raising critical questions about both equity and effectiveness in global conservation governance. This study examines how structural power imbalances and dominant Northern narratives within the Convention have systematically marginalized pluralistic conservation discourses, disproportionately disadvantaging Global South states. Through mixed‐methods analysis—combining voting pattern data from CITES Appendix amendment proposals (CoP3–CoP19) with case studies of giraffes, European eels, and totoaba—this study reveals systemic inequities in decision‐making processes. Findings indicate that Northern countries disproportionately promote “strict conservation” narratives, targeting Southern species, with upgrade proposals adopted at significantly higher rates than downgrades despite equivalent voting thresholds. Concurrently, sustainable utilization strategies face institutional barriers in Southern states, further reflecting structural inequities. Our study shows that centralization within CITES correlates with the underrepresentation of Southern voices and the disproportionate influence of Northern‐dominated NGOs. Ultimately, we argue that CITES’ regulatory tightening reflects neocolonial dynamics, prioritizing Northern ethical narratives over resource sovereignty and local realities. Thus, to ensure more equitable and effective governance, reforms must democratize decision‐making processes and better respect pluralistic conservation discourses.

Deterministic power imbalances - measures to minimise the impact of high PV and battery storage penetration and electricity market rules

Equitable access to health care is supported as families experience cultural safety, reducing inherent power imbalances. Current measures of cultural safety focus on First Nations Peoples; no framework or measure has been identified for families of multicultural background who access children's health services. To identify how culturally safe care is assessed, measured, and monitored for families of multicultural background who access children's hospital services. This scoping review followed Joanna Briggs Institute Manual for Evidence Synthesis. The search included terms for: 'population' of multicultural families of children aged birth to 17years; 'concept' of experience of cultural safety; and 'context' of hospital-based care. Databases included PubMed, Cochrane, Epistemonikos, Cumulative Index to Nursing and Allied Health Literature, MedLine, PsychINFO, Scopus, Proquest, and secondary search of references from included studies. Data were evaluated using thematic analysis, and narrative discussion aligned with the World Health Organization Framework for improving the quality of paediatric care. Seven manuscripts were included, and four themes identified: 'Resources', 'Effective communication', 'Shared decision making', and 'Feeling supported'. Central to experience of multicultural safety is respectful verbal and nonverbal communication, supported through self-reflection by staff, allocation of extra time for families to seek clarity, and availability of interpreters. Most important to families was an experience of being respected as nurses and care providers listened carefully and showed interest in family culture. We will translate findings by partnering with families to develop a tool to measure experience of multicultural safety in hospital-based care for children and families.

One of the emerging paradigms in contemporary criminal justice is victim-centered justice, which emphasizes the recognition, protection, and active participation of victims throughout legal proceedings.This paper analyzes legal, institutional and socio-cultural aspects of victim based justice in Pakistan wherein the criminal justice system has been offender-based. In spite of the constitutional guarantees of dignity, equality of law and access to justice, and the pledges of the international human rights frameworks, the victims are not central in practice in Pakistan. Through a qualitative research design, the study evaluates the provisions of the constitution, statutory laws, judicial practices, and policy frameworks that involve the protection of the victim. The important legal means such as the Pakistan Penal Code, the Code of Criminal Procedure, and legislation specific to the victim are assessed based on how effective they are in protecting the rights of the victims. The courts and case law, United Nations findings, and academic sources mention the systemic lack of legislation, institutional infirmities and socio- cultural obstacles that hinder access to justice. The results show that the legal framework in Pakistan does not have a full-fledged codification of the rights of the victims and therefore the protection is fragmented and not well implemented. There are institutional issues like substandard training, bureaucratic delays, insufficient victim support, and poor coordination which also contribute to the poor delivery of justice. It has been found that the patriarchal norms, stigma, and power imbalances hinder victim participation; therefore comprehensive reforms, codification of victim rights, institutional strengthening, and restorative justice are essential.

ABSTRACT This paper explores how marginalised young women in Uganda navigate access to social protection, addressing a gap in understanding how marginalised people experience social protection in protracted crises contexts and informing more responsive system design. Uganda’s multiple challenges – unemployment, poverty, weak governance, post-conflict legacies and normalised violence – undermine social protection provision and access, disproportionately affecting young women facing intersecting inequalities. While social navigation research explores agency-structure relations, it overlooks gendered and intersectional dynamics in crises. Similarly, traditional social protection approaches often position young women as passive recipients, disregarding their agency. Drawing on qualitative, participatory research with local researchers and ten marginalised young women in Teso and Karamoja as part of a larger project, we found that, despite structural constraints, young women exercise agency navigating complex structures that both facilitate and hinder social protection access. They cultivate social networks, and negotiate power imbalances through obliged tolerance, shapeshifting, resistance and avoidance. This research foregrounds young women’s agency, challenges assumptions of passivity, and contributes to debates on social protection and social navigation in crises, particularly in African contexts.