Globally, in 2020, less than one-third of individuals with psychosis accessed mental health services. These services are essential for reducing distress and burden, improving symptoms, and preventing adverse outcomes. However, people may not benefit from these services if they do not seek help. Factors contributing to the help-seeking remain poorly understood in South and Southeast Asia, regions with a majority of low- and middle-income countries. We aimed to synthesise evidence reporting the views and experiences of key stakeholders towards help-seeking for psychosis in these regions. This is the first review in this topic area to employ a multiple-perspective approach and to focus on the understudied regions. The PRISMA checklist guided reporting. We systematically searched primary qualitative, quantitative, and mixed-method research in bibliographic databases (CINAHL, MEDLINE, PsycINFO, Embase, ASSIA, Scopus, and PQDT Global), from inception to March 2025. Each article was independently screened by two reviewers. Eligible articles were extracted and synthesised using narrative synthesis, with JBI checklists utilised for methodological quality assessments. We included 57 studies published across 62 articles, 80% of which were rated as moderate or low quality. We inductively developed five themes, comprising 11 subthemes, which highlighted factors influencing and experiences of help-seeking across multiple stakeholders, including perceptions of problems, service quality, stigma, structural circumstances, and social support. Carers' perspectives were dominant and differed slightly from those of service users in their perceptions of problems, suggesting the value of more widely adopting a multiple-perspective approach in help-seeking research.

General practitioners (GPs) working in areas of high deprivation in Scotland formed the 'Deep End' group in 2009 in response to the well-documented inverse care law (ICL). To understand the views and experiences of key stakeholders about responses to the ICL in general practice in Scotland over the past 20 years, and the impact of the Scottish Deep End Project. Qualitative study with key primary care stakeholders (n=17) in Scotland, UK. Semi-structured interviews. Five main themes were identified, reflecting participants' experiences of working in deprived areas and their views on the role of the Deep End. These themes describe how existing measures fall short of addressing the ICL, how intersecting disadvantage complicates service responses, and how sustainability, professional identity, and collective voice shape efforts to improve care in disadvantaged communities. A key recommendation was greater investment in primary care generally, but with graded additional resources for more deprived areas depending on need (a "proportionate universalism" approach). Despite widening health inequalities, and the long-standing evidence of the ICL in general practice in deprived areas, there is a paucity of enduring policies and interventions to tackle the ICL in Scotland. The Scottish Deep End group has created a distinctive platform for general practitioners to collectively challenge the inverse care law. Practitioner-led networks can play an essential role in addressing health inequalities, supporting professionals, and informing policy.

ABSTRACT This study explores the concept of teacher induction, defined as a structured approach to supporting early career teachers (ECTs) in their first year. We understand induction as an ecosystem of actors and practices and offer a new lens to better understand the interdependence amongst stakeholders and their supportive roles. Our thematic analysis of stakeholder interviews is guided by an ‘ecologies of practice’ framework that we adapted to explore stakeholder experiences and tension points through three interconnected dimensions: networks, community interdependence and cycles of growth. The results highlight key enablers, such as mentoring, peer collaboration and adaptable institutional support, alongside barriers like resource constraints, disjointed policies and uneven stakeholder engagement. The study affirms the dynamic and interdependent nature of induction ecosystems, offering a systemic perspective on how local adaptation, connectivity and resources may influence the effectiveness of new teacher support and with important consequences for the future of the profession.

Purpose To explore stakeholder experiences of rehabilitation following complex fractures and identify key components considered important for recovery. Methods Thirty-three individual interviews were conducted with adults who had lived experience of complex fractures (n = 16) and health professionals and commissioners (n = 17). Data were analysed using inductive reflexive thematic analysis. Results Four themes with related subthemes emerged: (1) personalisation—needs-led and holistic, meaningful to the person, and desire to see progress; (2) adjustment to reality—making sense of the situation, support system, and practical reality; (3) accessibility and delivery—skilled and flexible workforce, accessibility, and systems approach; and (4) professional support—guidance and active monitoring, navigating transitions, and supervised physical activity. Conclusions This is the first study to identify rehabilitation components valued by people with complex fractures. Participants considered it important for rehabilitation to be personalised and holistic, delivered by experienced and competent professionals, and focused on meaningful, person-specific activities. However, a perceived mismatch exists between what people want and what current services can provide. Future research should explore how to deliver accessible, personalised rehabilitation that supports long-term engagement while remaining feasible within existing resources.

While nonhuman animals are often described as family, beloved, irreplaceable when fulfilling a companion animal role, they sit in a complex socio-legal context that does not value them as subjects of a life, but rather as optional appendages to the humans who own them. While this description may not resonate with the depth of emotion and strength of relational ties many humans share with their animal companions, in the context of dwindling housing stock, rising rents and increasing precarity of tenure, the disposability of companion animals upheld at a society level cannot be ignored. This article traces the experiences of tenants and housing stakeholders attempting to navigate the South Australian rental market to secure accommodation for multispecies families. In doing so it furthers existing work calling to situate experiences of housing inequality in their policy and structural contexts by explicitly articulating the intersection between anthroparchy (systemic speciesist domination) and capitalism. I conclude by arguing that despite recent legislative changes around multispecies tenancies, in the current structural context multispecies housing is, and can only ever be, precarious.

<sc></sc> Port-city making within the larger urban expansion discourse has become a defining feature of contemporary development along India’s coasts. The Vizhinjam International Seaport in Kerala exemplifies how infrastructure reconfigures coastal space and ruptures scales, producing dispossession within frontiers. The port infrastructure and its entanglements with stakeholders’ spatial imaginaries produce these complexities within the frontiers, as we explore in this paper. The construction of the port has disrupted the existing system of access and control over resource, traditional livelihood practices, and introduced new forms of exclusion. Among the most affected are small-scale fish workers who depend on coastal land and resources. State-capital forces have facilitated dispossession by legitimising certain claims while neglecting and rendering invisible those of the marginalised. This paper, based on an ethnographic study, engages with discussions involving multiple stakeholders of the port project, particularly the small-scale fish workers. By juxtaposing state documents, VISL documents, and observations and testimonies from the field with wider critiques of frontiers characterised by the spatial imaginaries of stakeholders, the research demonstrates how port-city making perpetuates injustices through dispossession and displacement. It argues that the newly emerged frontiers must be understood in terms of not only economic growth but also affective experiences of stakeholders.

Since the mid-1990s, many countries have introduced Public-Private Partnerships (PPPs) to build hospitals and deliver health services. While numerous studies have been conducted on the policies surrounding PPPs and their social and financial impacts, limited research has focused on the attitudes and perspectives of stakeholders who have experienced the reform- specifically their subject position-takings towards hospital PPPs. Even fewer studies have explored the situation in China, and the theoretical explanations underpinning this policy process remain underdeveloped. This paper aims to fill this gap by examining how healthcare stakeholders in China, particularly public and PPP/private hospital managers and administrators, experience hospital PPPs and investigating the social mechanisms that underpin these experiences. Based on Bourdieu's concepts of field, capital, habitus, and the state, and a case-centred qualitative study, 33 key informant interviews were thematically analysed. The study reveals a field of struggle between the dominant public hospitals and the subordinate PPP hospital for state recognition. Rather than passively accept neoliberal changes in the healthcare field, our participants respond innovatively to hospital PPPs, where there are antagonistic understandings of the role of the state and its relations with the market regarding the financing, provision, and delivery of healthcare. These conflicting position-takings and dispositions reflect how differential power relations - manifested in the disparity in accumulated capital - between public and PPP hospitals materially and symbolically shape the struggling experiences of those working in the system. The study concludes that understanding hospital PPPs as existing in the healthcare field compensates the existing interpretation as a "political strategy" from the pluralist perspective or a "powerful discourse" in a Marxist tradition, and in doing so, the field struggles between public and private/PPP hospitals over state recognition and power differentials in resource allocation can be revealed. The findings also emphasise the importance of defining the boundaries between public and private hospitals, as well as determining the level of private capital involvement in health service delivery and funding.

Gene therapies (GTs) offer potentially 1-time, curative treatment approaches for inherited and other rare diseases, but their often high upfront costs and small patient populations challenge traditional reimbursement models. In response, US payers and manufacturers have increasingly implemented innovative contracts (ICs) tied to value and outcomes. To share key stakeholder experiences and identify opportunities for efficient and effective innovative contracting solutions for GTs. We used a 6-step multimethod approach, including a literature review, stakeholder interviews, framework development, a virtual convening of stakeholders, and a pre- and postconvening survey. We defined "ICs" as agreements between payers and manufacturers that use real-world outcomes to determine the total price paid for GTs, encompassing various contracting models (eg, rebates, warranties, and performance designs) and terminologies that link outcomes to pricing. We defined "principles" as elements of ICs for successful GT innovative contracting and "practices" as processes and steps for stakeholders to explore feasibility, negotiation, and execution of an IC for a GT. The consensus principles and practices include those that received at least 75.0% of the votes (9 of a possible 12 stakeholders) for minimal or no revisions, prioritizing the top 8 principles and practices with the highest consensus. Eight principles of a possible 18 (44.4%) achieved 75.0% consensus with minimal to no revisions, and 7 of 26 possible practices (26.9%) achieved 100.0% consensus with minimal to no revisions. Principle topics included outcomes, duration, data collection, types of contracts, and patient costs. Practice topics included a focus on feasibility, negotiation, contract term, and evaluation. Stakeholders reviewed additional topics that did not ultimately reach consensus, including the role of patients and providers in innovative contracting. The mixed methods approach enabled the development of nuanced and contemporary principles and practices in innovative contracting for GTs. As more GTs are approved, there may be a need to refresh the principles and practices.

Rapid and sensitive early childhood development is vital for lifelong health, cognition and socio-emotional well-being. Suboptimal care during these formative years increases the risk of developmental delays affecting motor, cognitive, speech, hearing and visual domains. Early identification and intervention can mitigate these risks but structured, integrated service delivery remains limited in many low- and middle-income countries. Since 2014, comprehensive child development centres (CCDCs) have been established under Iran's Ministry of Health to address these gaps, with Tabriz hosting one of the pioneering centres. This qualitative study protocol aims to systematically document the implementation of the Tabriz CCDC over a decade, identifying key facilitators and barriers essential for shaping a scalable, evidence-based model of comprehensive child development services adaptable to Iran's health system. A qualitative, exploratory study design grounded in phenomenology will be employed to explore the lived experiences of key stakeholders involved in implementing the CCDC in Tabriz over 10 years. Purposeful and snowball sampling will recruit diverse participants, including policymakers, healthcare providers and parents of children under five. Data collection will include semi-structured interviews and focus group discussions conducted until thematic saturation is reached. Audio-recorded data will be transcribed verbatim and analysed using framework-guided content analysis. A triangulated approach will integrate document reviews and stakeholder questionnaires to enrich findings. Methodological rigour will be ensured through member checking, peer debriefing and double coding. Ethical considerations such as informed consent and confidentiality will be strictly maintained. The study's reporting will adhere to the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist, guaranteeing transparency, completeness and methodological rigour. This study was approved by the Ethics Committee of Tabriz University of Medical Sciences. Two separate ethical approval codes were issued for the qualitative protocol of this study IR.TBZMED.REC.1404.025 and IR.TBZMED.REC.1404.139. Separate informed consent forms have been developed for all stakeholder groups. Participants will provide oral and written consent before interviews or focus group discussions, and audio recordings will be conducted only with their permission; for those who do not consent to recording, detailed notes will be taken. Participants will be informed of their right to withdraw from the study at any time without consequence. Study results will be disseminated through peer-reviewed journals, scientific conferences and policy meetings to inform future strategies for comprehensive child development services.

The Pharmacists in Primary Care Network (PCN) Program integrated Primary Care Clinical Pharmacists (PCCPs) as core members of the interprofessional team (IPT) in PCNs across British Columbia (BC). Our objective was to evaluate stakeholders' perspectives and experiences with integrating PCCPs into team-based care within PCNs in BC describing the facilitators and barriers to pharmacist integration. This evaluation utilized qualitative research methods and was informed by Qualitative Description methodology. Participants were invited to participate in individual and focus group interviews and included UBC program team members, health authority pharmacy representatives, PCN administrators, and PCCPs. Facilitators included: (i) working in a blended model of care; (ii) UBC program team supports and resources; (iii) PCN-related facilitators, (iv) collaboration between stakeholders; and (v) prior practice experience of the PCCP. Barriers included: (i) PCCP's role clarity; (ii) PCCPs integrating into multiple clinics; (iii) resistance to PCCP co-location hindering relationships with IPT members; (iv) prescriber-initiated referral requirement; (v) technology challenges; and (vi) system-related factors. Broad systemic barriers to the new team-based primary care model in BC challenged PCCP integration along with the evolution and development of the entire IPT. Pharmacist integration was challenged by barriers that stemmed from the lack of understanding of their role and scope and what resources were needed to support them in their role, especially at the PCN level. Understanding the facilitators while addressing the underlying barriers is critical to achieving optimal integration, supporting the satisfaction of PCCPs, and optimizing the provision of team-based patient-centered primary care in BC.

ABSTRACTIntroductionWhile health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).Methods and analysisThis ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.Ethics and disseminationThe Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).

Existing research on in-person and virtual visitation is predominantly quantitative, focusing on the effectiveness and safety of these practices in the intensive care unit (ICU). Significant differences may exist in the experiences of diverse stakeholder groups regarding ICU visitation across these modalities. Consequently, we aim to explore the lived experiences of patients, family members, and healthcare providers with in-person or virtual visitation practices in the ICU. A descriptive phenomenological qualitative study will be conducted to gain an insight into the in-person or virtual visitation practices of the patients, family members, and healthcare providers. Participants will be recruited through purposive sampling from ICUs of three large public hospitals in Southwest China, focusing on stakeholders (patients, family members, and healthcare providers) involved in ICU family visitation. Sociodemographic information of participants will be collected. In-depth individual interviews will be conducted using a semi-structured interview guide until data saturation is achieved. The study will adhere to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Data analysis will follow Colaizzi's seven-step phenomenological method. NVivo 15 will be employed for data management and analysis. This study is expected to uncover variations in implementation, elucidate stakeholder perspectives, identify challenges inherent to each approach, and ultimately advance the development of family visitation practices in ICUs.

BackgroundDigital health innovations address health care accessibility challenges in low- and middle-income countries. Babyl, Rwanda’s largest telemedicine platform, reached 450 of 510 health facilities and enrolled 2 million patients before halting in September 2023 for system redesign. Limited research has explored implementation experiences and user perspectives that influenced its sustainability.ObjectiveThis study aims to explore user experiences and implementation lessons from Babyl’s digital health platform, examining drivers that supported or hindered adoption and scale-up. This qualitative study uniquely examines the lived experiences of diverse stakeholders, active users, lapsed users, nonusers, health care providers, and Babyl agents to understand implementation challenges that contributed to the platform’s halt.MethodsA qualitative, cross-sectional study used 20 focus group discussions (FGDs) and 32 key informant interviews (KIIs) across 12 health centers in ten districts with diverse utilization rates, geographic locations, and Babyl agent availability. FGDs captured collective community perspectives while KIIs provided in-depth individual experiences, enabling data triangulation. FGDs included active users, lapsed users, registered nonusers, and eligible nonregistrants. KIIs involved health center heads, health care providers, and Babyl agents. Data were analyzed using thematic analysis following Braun and Clarke’s framework. Data saturation was achieved when no new themes emerged from the last 3 FGDs and 5 KIIs. All transcripts were validated through member checking with a subset of participants, and intercoder reliability was established with a Cohen kappa of 0.82 across 2 independent coders.ResultsFive themes emerged: (1) knowledge and perceptions of digital health, (2) enablers and barriers to utilization, (3) experience and satisfaction, (4) benefits, and (5) improvement suggestions. Participants held positive perceptions of digital health for improving access and reducing wait times. Key enablers included qualified providers, convenience, privacy, and Babyl agents. Major barriers included negative perceptions of remote care quality, service delays, limited digital literacy, device access challenges, and inadequate health facility integration. Users reported high satisfaction with consultations but experienced process confusion. Patient and provider perspectives diverged: patients emphasized convenience, while providers expressed concerns about diagnostic limitations without physical examination. Digital literacy and smartphone access were pronounced barriers among rural and older participants. Recommendations included community mobilization, universal agent deployment, expanded coverage, and sustainable financing.ConclusionsMultiple implementation challenges at individual, community, health system, and policy levels contributed to Babyl’s discontinuation. Critical lessons include the importance of genuine health system integration, sustainable financing, stakeholder engagement, and gradual scaling. Findings provide insights for Rwanda’s health sector digitalization and other African nations investing in telemedicine platforms.

Eastern oysters (Crassostrea virginica) provide critical ecosystem services, yet populations along the northern Gulf Coast are declining due to environmental stressors, such as water quality issues and predation. To evaluate how threats to oysters are perceived across stakeholder groups, we surveyed oyster Farmers and Resource professionals in Mississippi and Alabama about predator impacts, seasonal patterns, and mitigation strategies. Survey responses (n=21) were analyzed using descriptive statistics, Fisher's Exact tests, Mann-Whitney U tests, and t-tests. Farmers and Resource professionals identified multiple predators as important sources of mortality, but their relative rankings differed across groups. Resource professionals consistently viewed southern oyster drills as the greatest threat, whereas Farmers reported more evenly distributed impacts across predators. Differences also emerged in perceptions of how salinity influences predation and in the feasibility of management practices such as varied height deployment, although both groups identified similar effective strategies. Farmers expressed greater optimism about the future of oyster cultivation compared to Resource professionals. These findings demonstrate both areas of consensus and divergence in local ecological knowledge and natural resource management perspectives, highlighting the need for improved communication and integration of stakeholder experiences into predator management and restoration planning.

Background: Seven Ontario Health Teams (OHTs), each a group of cross-sectoral health service organizations, were chosen by the Canadian province of Ontario to lead the modernization of home and community care. We explore how stakeholders across sectors experienced and negotiated the task of balancing standardization and local needs, required by this work. Approach: As part of a qualitative evaluation of OHTs’ implementation plans, we conducted semi-structured interviews (26) and focus groups (4) with cross-sectoral participants, monthly interviews with team leads, and monthly observations of key team meetings with a subsection of three teams, from November 2023 to October 2024. Participants included senior managers from hospitals, home care and community organizations, physicians, care coordinators, patients, caregivers and OHT staff members. We also conducted a document review of relevant system-level guidance and OHT-level program proposals. We aimed to understand the key elements of each home care model and what helped and hindered its development. Results were shared with each OHT, allowing stakeholders the opportunity to provide input into and learn from our findings. Results: We focus here on a key theme that emerged from our data – the tension between the need to standardize while simultaneously catering to local needs. This tension manifested at system, sectoral, managerial, provider and patient levels. OHT stakeholders found that while system stakeholders had tasked them with testing new homegrown models of homecare delivery, their transformational ideas for how the care coordinator might work within the new models, for instance, were circumscribed by homecare accountability agreements, contracts and union regulations. The home care sector’s attempts to standardize its policies to ensure uniformity of patient experience was interpreted as a lack of understanding of local context by other OHT members. OHT managers’ attempts to test innovations at different sites to enable local adaptations was sometimes met with push back from providers working on the ground. Finally, patients and family members were concerned that the initiative did not account for what truly mattered to them. We found that the tension between localization and standardization could be mediated by experienced organizational leaders able to creatively navigate between both impulses, managers able to centre the voices of patients and family members, and patients and family members able to remind people of what mattered to them. Implications: We identified the importance of communication a) across sectors, so that all stakeholders were aware of the pressures that a specific sector may be facing and the rationale for it, to mitigate the apportioning of blame, and b) with on-the-ground providers so that they understood the rationale for change and the value of them guiding it. We are in the process of sharing these findings with system and policy stakeholders as well, to build awareness of some of the challenges to innovation that are beyond the control of OHTs themselves. The audience for these findings includes other jurisdictions navigating the task of striking a balance between localization and standardization.

Same-day antiretroviral therapy (ART) initiation (SDI) is globally recommended to improve ART uptake. However, retention in care and viral suppression in South Africa remain suboptimal. This study evaluated the experiences of healthcare providers, patients, and community stakeholders in implementing the ART Same-day Counselling and Initiation (ASCI) Standard Operating Procedure (SOP), focusing on facilitators, barriers, and policy implications for improving HIV treatment outcomes. Using implementation frameworks, qualitative data from providers, patients, and community structures were analyzed alongside findings from a randomized controlled trial involving 142 newly diagnosed individuals initiated on ART on the same day as diagnosis. Evaluation of the ASCI SOP demonstrated improved six-month outcomes compared with standard initiation: retention in care (83% vs. 72%), viral suppression (81% vs. 69%, p = 0.04), and reduced loss to follow-up (17% vs. 28%, p = 0.05), with no significant mortality difference. These gains were linked to structured psychosocial support, patient navigation, and community follow-up. Key facilitators included multidisciplinary collaboration, psychosocial support, and community engagement, while major barriers involved healthcare system overload, patient-level challenges, and lack of standardized tools to assess treatment readiness. Policy reform to scale up the ASCI SOP should emphasize interdisciplinary support, consistent monitoring, and integration within national health systems. Overall, the preliminary evidence suggests that implementing the ASCI SOP model improved same-day ART uptake, retention, and viral suppression. Expanding this model to other provinces could strengthen HIV program performance and accelerate progress toward South Africa's treatment goals.

ABSTRACT Digital transformation is increasingly reshaping how social enterprises organize work, engage stakeholders, and pursue social value. While prior research has examined digitalization in hybrid organizations, limited attention has been paid to how responsibility for inclusive digital transformation is enacted internally. Focusing on work integration social enterprises (WISEs), this study conceptualizes digital transformation as a form of responsible and inclusive organizational change, in which technological innovation must be aligned with social responsibility toward vulnerable internal stakeholders. Drawing on 73 qualitative case studies from 13 European countries, we adopt a persona‐based analytical approach to examine how different internal actors experience, enable, or constrain digital transformation processes. Our findings identify three strategic capabilities—inclusive leadership for digital change, strategic flexibility for inclusive innovation, and inclusive and accessible human‐centered digital strategy—and show how these capabilities are enacted through distinct internal stakeholder personas. By integrating digital transformation research with a human‐centered and responsibility‐oriented perspective, this study contributes to the literature by explaining how inclusive digital transformation depends on the alignment between leadership strategies and the lived experiences of internal stakeholders in hybrid organizations.

ABSTRACT This study explores the experiences of teachers and stakeholders involved with an Australian First Nations initial teacher education pathway with a long history of working to secure a reparative educational future. Using the lens of Decolonising Race Theory (DRT), we critically analyse interview data to identify ongoing tensions between DRT tenets of the logic of elimination and reparative activism and explain how these forces work to simultaneously create and undo reparative futures of education. Whilst not diminishing the gains that have been made through reparative activism over time, we argue that a deeper and more nuanced understanding of the ongoing interactions between settler-colonialism and reparative activism is required, with attention to the everyday, implicit, and explicit experiences of First Nations peoples to ensure much more than a restorative gloss to the future of Australian education.

ABSTRACT This study explores the application of Ketso workshops and mobile methods to capture diverse perspectives in tourism research and stakeholder collaboration. Ketso, a participatory tool, allows participants to express ideas visually and collaboratively, promoting inclusivity. Mobile methods, including walking interviews and informal interactions, offer real-time insights in situ, emphasising the influence of physical and environmental contexts on behaviour. The empirical focus is the Fife Coastal Path in Scotland, a long-distance trail traversing industrial towns, rural communities, and fishing villages, managed by a mix of private landowners, local authorities, and charities. Through this complex setting, the research approach surfaced diverse stakeholder interests and exposed tensions around branding, visitor management, and sustainability. The research demonstrates that Ketso and mobile methods are valuable independently but especially effective when combined, providing part of a comprehensive toolkit for researchers seeking to understand complex consumer and stakeholder experiences across various settings.

BackgroundHealth information systems (HISs) are essential for strengthening health systems in underserved areas. However, many HISs in Africa are still in the early stages of implementation, and existing systems often suffer from imbalances in data availability. Their optimization is faced with various challenges, including limited resources, which restricts their scalability.ObjectiveThe aim of this study is to identify contextual barriers that hinder the optimization of HIS in African underserved settings. Specifically, the study adopts the lens of frugal innovation (FI) and information and communication technologies for development (ICT4D) to explore ways to enhance the quality of health care delivery for low-income populations.MethodsA qualitative research approach involving 32 participants was used. The study was guided by the central theme: contextual barriers and challenges hindering the optimization of HISs.ResultsFour major thematic categories emerged from the data: HIS contextualization, health system factors, service provider issues, and HIS integration. The findings offer valuable insights that can contribute to transforming HISs in underserved settings and improving health care quality.ConclusionsThe findings reflect stakeholder experiences in underserved communities in Nairobi, Kenya, and may be transferable to similar settings, subject to local governance, resources, and workflows. Despite the transformative potential of HISs in low- and middle-income countries, progress remains limited due to poor digital infrastructure and contextual barriers resulting in minimal impact from capital-intensive digital health investments and persistent data challenges. Using FI and ICT4D lenses, 4 key barriers were identified: health system, HIS contextualization, HIS integration, and HIS service provider. Rethinking HIS strategies through FI and ICT4D can enable affordable and sustainable, user-centered solutions. Future research should test scalability, sustainability, and interoperability impact in diverse settings.