To co-design, deliver and evaluate a suicide prevention workshop aimed at improving the knowledge, skills and confidence of general practice and community staff in rural South Australia. A 2.5-h in-person workshop was delivered across three rural communities on the Eyre Peninsula, Australia. Sixty-seven individuals attended the workshop. Of these, 61 completed a pre- and post-workshop survey (91% response rate). Participants who completed the survey included practice staff (n = 27), mental health or psychosocial support workers (n = 18), community volunteers (n = 6), suicide prevention network representative (n = 4) and other (n = 6). The design of the workshop was guided by Participatory Action Research principles and underpinned by the Double Diamond model. The workshop was co-designed by a multidisciplinary advisory group, including two individuals with lived experience. The objectives of the workshop were to help attendees to: (1) recognise verbal and non-verbal warning signs of suicidal ideation, (2) respond effectively to provide immediate support and (3) connect individuals with appropriate referral services. A mixed-methods pre-post survey assessed changes in participants' confidence, knowledge and skills aligned with these objectives, along with their perceptions of the workshop. Pre- and post-workshop responses were compared using the Wilcoxon Signed-Rank Test, with statistical significance set at p < 0.001. Open-ended survey responses were analysed using a combination of deductive and inductive content analysis. Statistically significant improvements were observed across all evaluation items from pre- to post-workshop, with the greatest gains in recognising subtle behavioural or emotional changes (1.25 points mean difference) and feeling skilled in knowing what services to recommend (1.28 points mean difference). Participants also reported high satisfaction (4.6 ± 0.73) and found the content highly relevant to their roles (4.5 ± 0.78). Content on referral pathways, local services and strategies for responding to suicidal ideation was identified as the most impactful. Including deeper coverage of culturally safe approaches for First Nations people, greater discussion around the differences among genders in the experiences of suicidality and more detailed exploration of specific mental health conditions and self-care strategies for staff were suggested as enhancements. The co-designed workshop effectively enhanced suicide prevention capabilities among frontline and community staff. Its success highlights the value of locally tailored, collaborative training that integrates lived experience and responds to community-specific needs. This model offers a scalable framework for workforce development in suicide prevention.

Family members' perspectives of laws, policies and practices in substance use disorder treatment: Systemic alienation of the family in Canada.

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.

Background: The +AGIL Barcelona program is an evidence-based, real-world, multidomain, and multidisciplinary initiative aimed at promoting healthy aging by enhancing older adults’ intrinsic capacity through a coordinated approach involving primary care, geriatrics and community resources. It aligns with the WHO’s ICOPE guidelines, emphasizing functional independence and an active lifestyle. Co-designed with healthcare professionals and end-users, the program bridges the gap between research findings and real-world practice. Initially implemented at one Primary Care Center (PCC), it showed significant improvements in physical function at three months, sustained at 6 months - even among individuals with cognitive decline. Building on its success, +AGIL is scaled to three PCCs with varied socio-demographic profiles, optimizing local resources to create a sustainable, person-centered care model. Approach: The implementation follows a stepped-wedge, cluster-randomized design, integrating a complex intervention into routine care. Each PCC begins with a baseline control period during which the +AGIL model is co-designed to fit local contexts. Participatory co-creation methodologies, including focus groups and technical sessions, are guided by Participatory Action Research (PAR) principles and actively engaged stakeholders – healthcare professionals, community agents and older adults. To ensure governance and share learning, a motor group oversees the global coordination and strategic decisions, while local implementation groups adapt and manage the program's day-to-day operations. Continuous evaluation identifies barriers and tailors solutions to diverse socio-economic contexts, ensuring seamless integration into routine clinical practice. Results: Preliminary findings indicate high acceptance of the +AGIL Barcelona across PCCs, with improved coordination between healthcare and community resources. The co-creation process yields practical tools, including a desk prism for healthcare professionals, a foldable physical activity guide, and informational brochures for participants and community agents. These tools have strengthened community engagement and empowered stakeholders to support program delivery actively. Implications: The +AGIL Barcelona program exemplifies key pillars of integrated care: a) Person centered-care, co-design approach prioritizes individual autonomy, aligning interventions with participants’ needs and preferences; b) coordinated care, the program fosters collaboration between healthcare providers and community agents to deliver accessible, continuous care that supports aging in place; c) system-based approach, levering existing healthcare and community assets, the program demonstrates system integration and resources optimization. The program’s sustainability and adaptability showcase a model of collaborative leadership and continuous improvement. Its flexible design translates scientific evidence into real-world clinical applications, bridging the gap between research and practice. A unique strength of +AGIL Barcelona lies in its bottom-up development: healthcare teams at each PCC lead the design and solutions, ensuring contextual relevance and alignment with existing workflows. This approach enhances sustainability, supports integration into daily clinical operations, and fosters long-term engagement. Through its replicable and scalable model, +AGIL Barcelona addresses the complex challenges of an aging society, paving the way for inclusive, person-centered, and sustainable healthcare solutions for older populations.

Objective: This article analyzes the application of participatory action research (PAR) principles in implementation research to strengthen health systems, proposing an expanded framework of guiding principles to ensure quality, ethical standards, and ongoing learning. Methodology: Qualitative study based on 20 interviews with co-researchers from national and sub-national levels in Liberia and Nigeria, complemented by reflexive analysis of PAR implementation in neglected tropical disease programs. Results: Five additional principles to existing PAR frameworks were identified: (1) recognize communities as units of identity and define stakeholder participation for equitable engagement; (2) enable flexible action planning that builds on existing structures; (3) address health systems and research power differentials; (4) embed relational practices that lead to new political forms of participation; and (5) develop structures for ongoing learning at multiple levels of the system. Conclusions: PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research is needed to explore how these five principles can support the attainment of quality and ethical standards within implementation research (Ozano et al., 2020).

ABSTRACT The purpose of the paper is to provide a methodological reflection on the use of digital methods (podcasting) with youth in a coproduction study grounded in the key principles of Youth-Led Participatory Action Research. Using podcasts as a means of coproduction provided an accessible way to respectfully identify community members’ collective issues, enabling youth co-researchers to be active participants in storytelling and story-sharing. Six reflexive themes are discussed, each reflecting on the experience of coproducing a podcast within the larger YPAR project, along with the challenges faced and best practices for engaging in coproduction research with youth using a digital medium. This ‘reflexive tale’ highlights important considerations of working alongside equity-seeking youth in coproduced research, advances the current understanding of coproduction processes in leisure research, and the use of digital methods.

ABSTRACT Background Open studio is a non-directive, process-oriented approach supporting autonomy, symbolic expression, and relational engagement. One of its central features is a communal studio where participants create simultaneously. While therapeutic benefits have been explored, less is known about how adolescents in psychiatric care experience change through this modality. Aims This qualitative study explored the lived experiences of adolescents in open studio art therapy within a psychiatric day treatment unit, focusing on how they perceived and understood therapeutic change over time. Methods Using a constructivist grounded theory approach, data were drawn from three in-depth interviews with nine participants at different stages of studio engagement. Participants’ artworks were analyzed through an arts-informed lens. The design incorporated Youth Participatory Action Research principles, with adolescents contributing to analysis. Results The analysis produced a process-oriented model, visualised as a flower growing in a shared garden. The model comprises three core categories: therapeutic aspects, process mechanisms, and experiences of change. Therapeutic aspects include the shared creative space, self-expression, and the therapist’s supportive presence. These were interconnected through four mechanisms: connection, inspiration, exploration, and regulation, which supported emotional, creative, and relational engagement. The mechanisms operated within the studio environment and interacted dynamically with participants’ evolving experiences. Therapeutic change was experienced as gradual, non-linear, and personally meaningful. Conclusions and Implications From adolescents’ perspective, the open studio provided a therapeutic space fostering growth, self-understanding, and belonging. Findings offer a conceptual framework for understanding change in adolescent art therapy and support integrating participant-centered methods in clinical research and practice. Plain-language summary This study explored how adolescents in psychiatric care experienced therapeutic change through participating in open studio art therapy. In this type of therapy, young people create artwork alongside each other in a shared space without set instructions or expected outcomes. They choose materials, work at their own pace, and are supported by art therapists who are present, attentive, and non-directive. Nine adolescents took part in the study. Each participated in three interviews during their time in the open studio. Their impressions and reflections on the artworks they created helped researchers understand what made the experience helpful and meaningful. The study identified three main elements that shaped the therapeutic process: Therapeutic aspects: These included the shared creative space, self-expression through art, and the therapist’s supportive presence. Process mechanisms: These describe how participants engaged in the studio: Connection – forming bonds with others, with the studio space, and with one’s own artwork Inspiration – getting ideas from materials, peers, or inner imagination Exploration – trying new things and discovering personal interests Regulation – learning to manage emotions, frustrations, and challenges Experiences of change: These were the personal changes participants described. For some, change was gradual and became clear only in retrospect; For others, change came through sudden insights or breakthrough moments that led to a sense of emotional clarity or new understanding. Together, these elements supported healing, self-understanding, and growth. The open studio became a space where participants could feel safe, creative, and connected. This research highlights how creating art alongside peers in a free, non-directive environment can support adolescents facing mental health challenges. It also emphasises the importance of listening to young people’s voices when studying their care. The model developed in this study may be useful for art therapists, educators, and mental health professionals working with youth.

The field of developmental science is increasingly interested in conducting research that is more representative, equitable, inclusive and generalizable. One way to achieve these aims is to conduct research that positions communities as key collaborators and central contributors to our scientific inquiries. These principles are evident in community science approaches like community-based participatory research (CBPR) and participatory action research (PAR). We argue that CBPR and PAR can be implemented by developmental scientists. Here, we describe two initiatives that utilized CBPR and PAR. The first initiative is Playful Learning Landscapes (PLL). PLL embeds research from the learning sciences into public spaces to offer playful learning opportunities for children and families, and community science practices are leveraged throughout the process. The second initiative is the Galápagos Education and Research Alliance (GERA). GERA harnesses the tools of community science by working directly with communities in the fragile environment of Galápagos to gather data about ecosystem health and build community-based plans for climate change adaptation. Together, these two initiatives offer rich examples of how CBPR and PAR principles engender active participation from the community throughout the design and evaluation of a research project. We discuss the opportunities and challenges of using community-centred approaches.

This qualitative study protocol delineates the formulation of a community-based mental health intervention aimed at preventing suicidal behavior among adolescent females in Gorontalo, Indonesia a province noted for its high national rates of suicide attempts. The study seeks to investigate the lived experiences, psychosocial challenges, and contextual factors influencing suicidal ideation among adolescent girls, while integrating the perspectives of government stakeholders, academics, and women entrepreneurs. Employing a qualitative descriptive design, data will be gathered through in-depth interviews and focus group discussions, followed by participatory co-creation and co-design workshops guided by the principles of Participatory Action Research (PAR). The co-creation process entails collaboratively identifying priorities, designing intervention components, and refining culturally grounded strategies for community-based mental health support. The findings will inform the development of an inclusive, context-specific, and sustainable intervention model that bolsters suicide prevention efforts and enhances community engagement in low-resource settings.

This community service project promoted sustainable education for early childhood by integrating family health literacy and STEAM-based learning in Pangkalpinang, Bangka Belitung Islands Province, Indonesia. Recognizing that sustainable development education should begin early, the program aimed to strengthen parents’ understanding of holistic child development, combining health, creativity, and environmental awareness. Inspired by the participatory principles of Participatory Action Research (PAR), the project involved three main stages they are planning, action, and observation to foster collaboration among parents, educators, and health professionals. Held on August 30, 2025, the one-day workshop was attended by 30 mothers from diverse backgrounds. Sessions were led by a doctor as well as a lecture in the Faculty of Medicine and Health Sciences of Universitas Bangka Belitung and an early childhood educator, covering children’s health topics, which are nutrition, sleep, and screen time, and STEAM-based hands-on learning using simple household materials. Key activities included the Engineering Building Challenge, where participants, as mothers, built creative projects, and the STEAM Fair, where students from the Wonderchild STEAM class performed their STEAM projects and experiments, that presented in English. The program ran effectively and encouraged active participation, collaboration, and enthusiasm among parents. Observations showed strong interest in integrating STEAM and health principles into family routines. This initiative highlights the importance of community-based education programs in Bangka Belitung and encourages future expansion to include teachers, localized STEAM modules, and sustained collaboration among educators, parents, and health experts.

Gap analysis methodology for mapping baccalaureate and graduate nursing curricula to the AACN Essentials: A step-wise approach.

The floods that hit Aceh Tamiang Regency, Nanggroe Aceh Darussalam Province in November 2025 have seriously affected people's lives. Thousands of homes were submerged, access roads were cut off, infrastructure was damaged, and it's been hard to supply people's basic needs. This emergency situation requires a quick and coordinated response from various parties, including colleges and universities. This community service project aims to provide humanitarian assistance to flood victims through the distribution of basic food supplies, medicines, and other essential items. The partners in this community service project are the flood-affected communities in four locations (Buluh Butung Village, Purwodadi, Kota Lintang Bawah, and Landu) and the Aceh Tamiang Regional General Hospital. The method used is adapted from the principles of participatory action research, which includes team coordination, fundraising, procurement of aid, and distribution through direct delivery, assembly points, and door-to-door visits. The implementation team consisted of 42 people (7 lecturers, 5 students, and 30 volunteers) who successfully raised Rp 138,500,000. The activities were carried out on 5 and 8 November 2025 at five distribution points. The results of the community service programme show that 270 households (approximately 855 people) successfully received assistance in the form of 250 food packages, hundreds of bales of clothing, thousands of medicines and medical supplies, and other essential items. The community responded very positively with great enthusiasm, and the distribution ran smoothly. Feedback from beneficiaries indicated that the food parcels and medicines were highly effective in providing basic necessities, although there were still ongoing needs such as emergency tents, sleeping equipment, and water storage containers. This community service initiative demonstrated the importance of collaboration between colleges or universities, students, and volunteers in rapid disaster response, as well as the effectiveness of multi-location distribution adjusted to actual conditions on the ground.

Health system resilience has become critical in addressing shocks such as emerging and re-emerging disease outbreaks, natural disasters, and conflicts. Collaboration among diverse stakeholders, including health systems and communities, is hypothesized to enhance resilience. However, evidence from low- and middle-income countries, particularly fragile and shock-prone settings like Sierra Leone, remains limited. This study documents the initiation of a participatory action research (PAR) project in Sierra Leone aimed at building health system resilience through collaboration with health and multisectoral stakeholders in the districts of Moyamba and Kailahun. The study employed PAR principles and methodologies, including document reviews, participatory power mapping, and workshops. These methods were used to identify leverage points and co-develop an action agenda for health system resilience. The participatory mapping phase revealed key leaders and their power dynamics within the community and health system. Formal leaders, health sector actors, and religious leaders emerged as the most powerful and trusted figures. Systemic barriers to community leader engagement in public health emergencies were identified, including political affiliations, traditional beliefs, reduced direct community engagement (attributed to low community health worker numbers), and patriarchal gender norms. The co-created action agendas prioritized community engagement, early warning systems and the use of by-laws. The study underscores the potential of community leaders as catalysts for resilient health systems in Sierra Leone. Inclusivity, accountability, and trust are essential for engaging community leaders in health system decision-making processes. Addressing systemic challenges through such engagement can foster health system and community resilience in emergencies.

Preschool classrooms are understudied relative to other educational contexts and typically focus on assessment, basic research, and rarely on participatory research. This study focused on applied and translational approaches with shared power among researchers, teacher, and students at a local preschool. We describe, critically analyze, and reflect on the participatory process from multiple perspectives – researchers, teachers, and administrators. One female lead teacher volunteered her classroom (n=19 students; ages 3-5) to participate. Researchers’ journal reflections, meeting notes, and field observations documented study implementation. Co-planning occurred across three weeks, active implementation spanned five weeks, and dissemination occurred across four months. Using Community Based Participatory Research (CBPR) and Youth Participatory Action Research (YPAR) principles as a framework, these data were qualitatively analyzed to provide reflective journaling and thematic analysis of the implementation process. We describe initial conversations with preschool administrators and the classroom teacher followed by description of seven research steps. The researchers and teacher mutually agreed upon using the Photovoice method because it empowers preschoolers to communicate their knowledge and perspectives in ways researchers could understand. Meetings and co-facilitated data collection fostered co-learning among researchers, preschool students, and their teachers. Dissemination was inclusive and multifaceted through the use of: (1) classroom photo digital displays for the preschoolers to view and (2) an E-brochure shared with parents and administrators. Participatory Research (PR) principles are examined and methodological lessons learned are shared to promote preschool classroom participatory engagement in future research and plans for expanding participatory approaches in preschools are discussed.

Truth-telling, a community intervention to increase reconciliation after systemic injustices, has been employed recently to increase public awareness of harms perpetuated by the child welfare industry in the U.S. Guided by participatory action research principles, we examined a public truth telling initiative over two years which was co-designed by a trans-experiential team of emerging adults with lived expertise and child welfare system professionals in Kentucky. The aims of the truth-telling events were to raise awareness about the experiences of Black American youth in the Kentucky child welfare system and generate ideas for improvements. We conducted a longitudinal collaborative autoethnography (n = 9, 2 time points) to examine our collective experience of developing and hosting the truth-telling circles and supporting activities. Key themes included the transformative impact on the alumni of receiving validation and acknowledgement, as well as forming social and professional connections. Some concerns related to timing of activities and group dynamics also were reported. In addition, the four lived expert truth-tellers engaged in a systematic consensus workgroup process to select a list of 10 priority practice and policy recommendations, such as child welfare system alumni being hired to provide emotion regulation and self-advocacy skills training directly to youth.

The COVID-19 pandemic highlighted the longstanding social care crisis across the United Kingdom. The need for thorough and sustained change in the entire policy domain of care – defined as paid care workers, including childcare workers, and unpaid carers and those experiencing care – is clear. To achieve such change, the prominence of care as a key policy issue needs to increase. This could be achieved through care becoming anchored in outcomes-based performance measurement frameworks. A number of countries, regions or municipalities use such frameworks, for example in relation to health, the environment, or inequality, and often do so in the guise of ‘wellbeing frameworks’. Scotland, in 2007, introduced the National Performance Framework (NPF) This article presents how a ‘blueprint’ for a new Outcome on Care in the NPF was developed by a team of academic researchers, using a policy review and stakeholder interviews and following participatory action research principles. While the campaign which advocated the inclusion of care in the NPF was ultimately not successful, the article argues that the blueprint can inform discussions on how to embed care firmly in the considerations of policy makers, in Scotland and beyond. It also argues that performance frameworks offer opportunities for a visible celebration of policy success and the identification of barriers to improvement and that they can provide a positive focus to sustain systemic efforts to create ‘countries that care’.

Environmental Impact Assessment (EIA) is the primary technical and administrative instrument for decision-making on projects, activities, and environmental aspects that may generate significant effects on the natural and social environment. In infrastructure projects, the EIA is a prerequisite for initiating construction and operational phases. This article analyzes the relationships between project activities, resulting environmental aspects, and impact assessment using Structural Equation Modeling PLS-SEM. While the conceptual model builds on the factors proposed by Conesa (2009), a distinct methodological approach was adopted, moving beyond traditional qualitative evaluation. A Likert-scale questionnaire was administered to residents of the study area, who assessed the extent to which specific project activities are associated with environmental impacts. Unlike ex ante approaches based on expert judgment and predictive models, this study incorporates an ex-post evaluation, integrating empirical data and the lived experiences of affected communities. This shift aligns with the principles of Participatory Action Research (PAR), emphasizing co-construction of knowledge and active stakeholder engagement. The findings highlight how specific construction activities influence environmental impacts, offering valuable insights for regional planning in Coahuila. The proposed methodological framework can be applied to similar contexts, particularly where PAR-based strategies can be integrated to strengthen transparency, accountability, and collective learning in environmental management. JEL classification numbers: Q51, Q52, Q53, Q54. Keywords: Environmental Impact Assessment, Participatory Action Research (PAR), Structural Equation Model.

BackgroundThe project RIVER-EU works with the migrant community in Greece, the Turkish females and Moroccan females in the Netherlands, the Ukrainian minority in Poland, and marginalized Roma communities in Slovakia to remove health system barriers to childhood vaccination, such as a lack of culturally and linguistically appropriate information, financial barriers and insufficient capacities, coordination and delivery of health care.MethodsThe RIVER-EU project uses a longitudinal process to facilitate sustainable health system change based on the Population, Intervention, Environment and Transfer (PIET-T) models of transferability and principles of participatory action research. To address health system barriers, six useful evidence-based interventions were assessed for their transferability. Based on the final selection in each country, interventions were tailored under consideration of specific needs and contextual conditions for the further implementation process.ResultsA multilevel intervention approach with selected and trained health promoters from the community is potentially transferable with specific adaptations in all countries. Key elements are principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost. Barriers and facilitators for transferability showed that no evidence-based intervention is transferable as intended and that tailoring to context is essential, requiring specific process guidance.ConclusionsThe process of understanding health system barriers to vaccination, identification of transferable intervention approaches, tailoring, implementation and evaluation of interventions to enable their transferability needs an in-depth engagement with the communities and their context. RIVER-EU will develop a guideline to assist policy makers, professionals and scientists who aim to remove health system barriers to vaccination in their specific context.

The implementation of peer-led programs provided by individuals with lived experience of mental disorders has been increasingly acknowledged as a key component in improving the quality of mental health services. When considering research on eating disorders, peer-led online programs may be an alternative approach to enhancing participants' well-being. Furthermore, increasing evidence suggests that mindful self-compassion (MSC) may be a helpful approach to strengthening self-compassion as a prevention program for eating disorders. However, the feasibility and acceptability of online group-based peer-led MSC programs remain unexplored in this context. In this pilot study, using a single-arm pre-post pilot design, lived experience experts delivered and managed the program themselves and collected the data. Participatory action research principles informed the study's quantitative design. Adults with symptoms of eating disorders were invited to participate. The primary outcome was to assess the feasibility and acceptability of the MSC program, measured by the dropout rate, attendance rate, and client satisfaction. As a secondary outcome, the program's preliminary efficacy on self-compassion and psychological well-being was investigated. Twenty-five people contacted the user organization, and all agreed to participate. However, 18 participants (78%) responded to the questionnaires at both measurement points. Two participants dropped out. The attendance rate was excellent, with 35% of the participants achieving 100% attendance, 39% completing seven of the eight group sessions (87.5% attendance), and 26% of the participants achieving 75% attendance. The participants reported to be very satisfied with the MSC program, with a total mean score of 14.4 (SD = 1.42, 95% CI [13.7, 15.1]) out of a maximum of 16 points. The participants also showed significant improvement in self-compassion and psychological well-being. The findings indicate that the program was both feasible and acceptable for adults with eating disorder symptoms. Additionally, participants reported significant improvements in self-compassion and psychological well-being. However, as this was the first study to examine such a program in this context, these preliminary findings warrant further research. Nonetheless, these findings suggest that peer-led online MSC programs may offer an accessible, community-rooted, and person-centered addition to ED services, particularly for individuals underserved by traditional models.

ABSTRACTWe discuss a multi‐year partnership between Centre College and the Danville‐Boyle County African American Historical Society (DBCAAHS) that focused on training students to execute and archive semi‐structured oral history interviews with members of the local Black community who experienced Danville's urban renewal and school integration period. The project culminated with a large‐scale public history exhibition and an archival website. Pedagogically, the project successfully made visible local manifestations of structural racism, both to Centre students and the community. We argue that this project demonstrates a successful fusion of Participatory Action Research (PAR) with ethnographic methods from cultural anthropology. In carrying out this project within several college courses, we further show that tying principles of PAR to ethnographic methods reconciles some of the historical tensions that applied anthropology has had with the community‐engaged learning model in higher education. We continue implementing PAR in this article by analyzing debrief interviews with both research participants and students, whose inferences and feedback demonstrate the current outcomes and inform the future shape of the project.