Systematic Process Research Articles

Can using the Cochrane RCT classifier in EPPI‐Reviewer help speed up study selection in qualitative evidence syntheses? A retrospective evaluation

AbstractIntroductionUsing machine learning functions, such as study design classifiers, to automatically identify studies that do not meet the inclusion criteria, is one way to speed up the systematic review screening process. As a qualitative study design classifier is yet to be developed, using the Cochrane randomized controlled trial (RCT) classifier in reverse is one possible way to speed up the identification of primary qualitative studies during screening. The objective of this study was to evaluate whether the Cochrane RCT classifier can be used to speed up the study selection process for qualitative evidence synthesis (QES).MethodsWe performed a retrospective evaluation where we first identified QES. We then extracted the bibliographic information of the included primary qualitative studies in each QES, and uploaded the references into our data management tool, EPPI‐Reviewer. We then ran the Cochrane RCT classifier on each group of included studies for each QES.ResultsEighty‐two QES with 2828 unique primary studies were included in the analysis. 56% of the primary studies were classified as unlikely to be an RCT and 40% as being 0–9% likely to be an RCT. 4% were classified as being 10% or more likely to be an RCT. Of these, only 1.7% were classified as being 50% or more likely to be an RCT.ConclusionsThe Cochrane RCT classifier could be a useful tool to identify primary studies with qualitative study designs to speed up study selection in a QES. However, it is possible that mixed methods studies or qualitative studies conducted as part of a clinical trial may be missed. Further evaluations using the Cochrane RCT classifier on all the references retrieved from the complete literature search is needed to investigate time‐ and resource savings.

Arthroscopic and Open Surgery Show Comparable Efficacy in the Treatment of Lateral Epicondylitis: A Systematic Review.

The purpose of this systematic review is to compare the outcomes of open surgery versus arthroscopic surgery in the treatment of lateral epicondylitis, focusing on pain relief, functional recovery, complication rates, and patient satisfaction, in order to provide evidence-based recommendations for clinical practice and identify areas for future research. The systematic review process was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search was conducted across PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science. Studies comparing open and arthroscopic surgery for lateral epicondylitis were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized studies. Outcomes assessed included recurrence pain, persistent pain, infection rates, reoperation rates, nerve-related complications, hematoma, patient satisfaction, visual analog scale, disabilities of the arm, shoulder, and hand score, operation time, and return to work time. Both randomized controlled trials (RCTs) and non-RCTs were included. 14 studies, comprising 6 RCTs and 8 cohort studies with a total of 20153 participants, were included. Both surgical techniques yielded comparable outcomes in terms of recurrence pain (arthroscopic: 0% to 13.3%; open: 2.9% to 13.2%), persistent pain (arthroscopic: 0% to 13.3%; open: 0% to 11.9%), patient dissatisfaction (arthroscopic: 4.9% to 13.3%; open: 3.8% to 16.7%), infection rates (arthroscopic: 0% to 13.3%; open: 0% to 6.7%), reoperation rates (arthroscopic: 2.4% to 7.1%; open: 2.9% to 5.3%), nerve-related complications (arthroscopic: 0% to 6.7%; open: 0% to 7.7%), and hematoma (arthroscopic: 0% to 5%; open: 0% to 6.7%). The surgical time for arthroscopy (34 to 36 min) was generally longer than that for the open group (22.5 to 34.7 min). No significant differences in functional outcomes were observed in the majority of studies. Both arthroscopic and open surgeries provide similar clinical outcomes for lateral epicondylitis, with no significant differences in functional results. Despite longer operative times, arthroscopic surgery is expected to become the preferred approach due to its minimally invasive nature.

Talent Champion among Youth in Malaysia: A Conceptual Analysis

Talent champions are critical in driving a nation’s competitiveness in the new economy. However, Malaysia faces significant challenges in achieving this goal, as reflected by its drop to 45th in the Global Talent Competitiveness Index (GTCI) 2023. Despite the Shared Prosperity Vision 2030 (SPV2030) targeting 35% highly skilled workers, the Malaysian labour force remains dominated by 59.4% semi-skilled workers. This highlights the urgent need to analyse key indicators to improve tertiary education, enhance talent development policies, and benchmark Malaysia’s talent competitiveness against other nations. Aligned with the objectives of the National Education Blueprint, this study aims to explore the need for talent champions among Malaysian youth, to measure the underlying indicators for youth talent champions and to develop a talent champion framework among youth in Malaysia. This study will utilize non-probability sampling, specifically purposive sampling, to select participants from Malaysian higher education institutions and subject matter experts from relevant organizations. Data will be analyzed using both manual methods and content analysis software (NVivo 12). The development of the talent champion framework involves a systematic process that includes data collection and analysis, indicator weighting, framework development, and validation.Talent champion aligns with multiple Sustainable Development Goals (SDGs), including SDG 4 (Quality Education), SDG 8 (Decent Work and Economic Growth), SDG 9 (Industry, Innovation, and Infrastructure), and SDG 10 (Reduced Inequalities). By fostering a competent and competitive workforce, this study aims to support SPV2030’s goals of shared prosperity and strengthen Malaysia’s position in the global talent landscape.

Leveraging Observation Research to Improve Instruction for Students With Intellectual Disability: Guidance for Adapting Tools.

Students with intellectual disability benefit from high-quality instruction in reading and mathematics. This Theoretical Paper outlines the need for effective, evidence-based instructional practices for this population and the potential for observation research to inform such advancements. We report our systematic process of adapting two widely used observation tools initially developed for students with learning disabilities, to address content and instructional practices relevant to classrooms serving elementary students with intellectual disability. Our revised observation tools facilitated more inclusive data collection, taking into account the needs and goals of students with intellectual disability, in addition to their peers for whom the original tool was designed. We offer guidance for researchers and practitioners to make similar adaptations when using research tools intended for other populations or instructional settings.

Evaluation of Companies: Theories, Process and Methods

Business evaluation is the systematic process of analyzing and assessing the performance of an entity, whether it is a company, organization, or project, about specific previously established objectives. This analysis can be performed at any stage of the business life cycle and covers financial, operational, and strategic aspects.

User-centered design and evaluation of the neotoma paleoecology open software ecosystem

ABSTRACT Making paleoecological data accessible, usable, and useful to a global and diverse community of researchers, educators, and students across Earth sciences is an essential yet challenging task. Multiple data access and discovery tools must co-evolve with ever-changing user needs through an iterative, open-ecosystem software development approach. We employ a user-centered design study to evaluate one such ecosystem, the Neotoma Paleoecology Database, whose mission is to advance understanding of global-change processes by providing an expert-curated data resource. Neotoma contains over 11 million observations from 30,000 + datasets across 20,000 + sites, representing proxies of environmental and ecological conditions of the past. Neotoma comprises three interrelated software components – an interactive web mapping application, statistical programming package, and API – that provide different levels of functionality to different audiences. Although development efforts of these software components have involved the user community, Neotoma lacks a systematic evaluation process, which is important for informing the gap between perceived potential and actual utility. We address this knowledge gap using scenario-based design exercises and a usability/utility assessment. Major contributions include actionable insights for enhancing Neotoma's user experience and a user-centered design model that can be adapted to advance the development of other Earth and environmental science software ecosystems.

2022 개정 교육과정 초등학교 학교자율시간에 활용할 실과교육프로그램 개발: 정원에서 공부해요

This study aims to develop a practical garden education program, <Learning in the Garden>, for use during School-designed Autonomous Hours activities in elementary schools, aligned with the 2022 revised curriculum. For program design, the study analyzed the meaning and educational value of garden education and reviewed various domestic and foreign garden education programs. The Learning in the Garden program consists of 6 topics, namely tools, seeds, fruits, vegetables, gardens and the environment, and horticultural therapy. Each topic includes systematic content elements, including knowledge, understanding, process and function, and values and attitudes. The preparation stage sets its necessity and direction, followed by a detailed design of learning goals and content systems, achievement standards, teaching and learning methods, and evaluation methods in the development stage. The program’s teaching and learning method focused on active student participation through experience-oriented learning, cooperative learning, and project-based learning. The evaluation consisted of formative, general, self, peer, and portfolio evaluation, focusing on supporting students’ continuous learning and growth. The <Learning in the Garden> program will allow students to connect with nature and contribute to cultivating ecological sensitivity and a sense of community.

Addressing Educational Inequities in Urban Slums: A Narrative Review

This study examines the challenges faced by children living in urban slums regarding access to education, drawing insights from a systematic process 27 published journal articles, academic papers and Seminar reports are selected Among these, 16 were chosen for detailed discussion, resulting key findings on socio-economic barriers, parental education levels, and awareness gaps hampering educational opportunities for slum-dwelling children. Findings prevalent problems as inadequate infrastructure, ineffective teaching methods, and parental disengagement exacerbating educational disparities. Study highlights interventions including skill development programs, targeted public initiatives, and policy reforms to address these challenges. Recommendations emphasize collaborative efforts among stakeholders to implement educational policies, improve infrastructure in government schools, and enhance parental awareness. Adopting diverse social work approaches is recommended to address the multifaceted challenges confronting slum communities. Implementing these interventions can contribute to fostering more equitable and inclusive education system, thereby advancing the well-being of all children in urban slums.

Strategic Site Selection for Bio-LNG Plant in Indonesia: A Multi-Criteria Scoring Method Approach

In Indonesia, the energy sector is still predominantly reliant on fossil fuels, with renewable energy, including liquefied biomethane (Bio-LNG), playing a limited role. Nonetheless, Indonesia has significant potential for Bio-LNG development due to its abundant organic waste resources such as Palm Oil Mill Effluent (POME) from palm oil mills. Having approximately 891 Palm Oil Mills in Indonesia and being spread mostly in Sumatra, this study aims to select a strategic location for a Bio-LNG plant that can enhance logistical efficiency and economic viability for the plant. This study uses Multi-Criteria Decision Making (MCDM) methodologies to assess potential sites based on key criteria: Land Availability, Distance to Source of Feedstock, Distance to Customer Locations, Jetty Availability, and Future Business Developments. This study has narrowed down into focusing on provinces with substantial raw material potential, Riau Province, particularly Dumai City and its surroundings, which emerges as a pivotal hub. Secondary data are gathered to conduct a systematic scoring process evaluates and integrates each criterion to generate a comprehensive ranking of potential sites. The selected site for the Bio-LNG plant is Location 1, at the coordinates of 1.662056, 101.707092, Pelintung, Medang Kampai Subdistrict, Dumai City, Riau. Its strategic positioning, proximity to key transportation routes, availability of abundant feedstock, and access to necessary infrastructure make it an ideal choice. This study aims to advance Bio-LNG infrastructure in Indonesia, promoting cleaner energy solutions, and enhanced supply chain efficiency.

Power and emission estimation of plastic waste pyrolysis-derived fuel blends in internal combustion engines

Energy, especially from fossil fuels, is essential for everyday life, while plastic waste is an increasing environmental threat. Plastic waste disposal methods such as landfilling and burning cause pollution. Therefore, a process is needed that converts plastic waste into fuel. The object of the study is the engine performance. The problem to be solved is the relationship between the use of a mixture of fossil fuels and pyrolysis fuel on the performance of internal combustion engines. This research uses a systematic data collection process to obtain accurate and reliable results. The necessary equipment, including a dynamometer and gas analyzer, was prepared, and the engine was warmed up to a stable operating temperature of 80 °C. The motorbike is then positioned on the dynamometer with the rear tires aligned and the front tires secured to prevent movement. Data collection was carried out at engine speeds of 2000, 3000, 4000, 5000, and 6000 rpm, using three fuel mixtures: 10 % plastic pyrolysis fuel with 90 % RON 90, 20 % plastic pyrolysis fuel with 80 % 90 RON, and 30 % plastic pyrolysis fuel with 70 % RON 90. Each test was repeated three times, with the output power measured using a dynamometer and exhaust emissions (CO and HC levels) recorded using a gas analyzer. The test results show that the optimal fuel mixture to produce maximum engine power is a PE-RON 90 mixture with a ratio of 20:80, providing the best performance at medium to high engine speeds (3000–6000 rpm) with low CO emissions. The highest power output (1.05) occurs at 4000 rpm, while the PE-RON 90 30:70 alloy produces the best power performance at 6000 rpm (0.78 % CO). Additionally, the pyrolysis fuel blend significantly reduces CO and HC emissions, with the PE-RON 90 30:70 blend showing the lowest CO (0.78 % at 6000 rpm) and consistently reducing HC emissions across the rpm range

Manajemen Pendidik dan Tenaga kependidikan di UPT Sekolah Dasar Negeri 179 Gresik

This study aims to analyze the management of educators and education personnel at UPT Sekolah Dasar Negeri (SDN) 169 Gresik, with a focus on the management process, the influencing factors, and the outcomes related to enhancing the professional competence of educators. This research employs a descriptive qualitative approach, utilizing data collection techniques such as direct observation, in-depth interviews, documentation, and document analysis. The data were analyzed thematically, following a systematic process of data grouping, data reduction, data presentation, and conclusion drawing. The findings indicate that the management of education personnel at UPT SDN 169 Gresik encompasses several stages: planning, implementation, and evaluation. During the planning stage, a schedule is established, and additional responsibilities are assigned to teaching staff beyond their teaching duties. The implementation stage includes supervising task execution and providing training aimed at improving professional competence. The evaluation stage is conducted periodically through interviews, documentation collection, and performance assessments of teaching staff based on established school management standards. Factors influencing this process include the quality of human resources, school policies, and prioritized student needs. The results of this management approach demonstrate an enhancement in the professional competence of educators, which positively impacts the achievement of educational standards at UPT SDN 169 Gresik. This study concludes that systematic management of educators and education personnel, grounded in student needs, can lead to improved quality of education. The findings may serve as a valuable reference for other educational institutions seeking to manage their teaching staff effectively and efficiently.

Clinical response to neurofeedback in major depression relates to subtypes of whole-brain activation patterns during training.

Major Depressive Disorder (MDD) poses a significant public health challenge due to its high prevalence and the substantial burden it places on individuals and healthcare systems. Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) shows promise as a treatment for this disorder, although its mechanisms of action remain unclear. This study investigated whole-brain response patterns during rtfMRI-NF training to explain interindividual variability in clinical efficacy in MDD. We analyzed data from 95 participants (67 active, 28 control) with MDD from previous rtfMRI-NF studies designed to increase left amygdala activation through positive autobiographical memory recall. Significant symptom reduction was observed in the active group (t = -4.404, d = -0.704, p < 0.001) but not in the control group (t = -1.609, d = -0.430, p = 0.111). However, left amygdala activation did not account for the variability in clinical efficacy. To elucidate the brain training process underlying the clinical effect, we examined whole-brain activation patterns during two critical phases of the neurofeedback procedure: activation during the self-regulation period, and transient responses to feedback signal presentations. Using a systematic process involving feature selection, manifold extraction, and clustering with cross-validation, we identified two subtypes of regulation activation and three subtypes of brain responses to feedback signals. These subtypes were significantly associated with the clinical effect (regulation subtype: F = 8.735, p = 0.005; feedback response subtype: F = 5.326, p = 0.008; subtypes' interaction: F = 3.471, p = 0.039). Subtypes associated with significant symptom reduction were characterized by selective increases in control regions, including lateral prefrontal areas, and decreases in regions associated with self-referential thinking, such as default mode areas. These findings suggest that large-scale brain activity during training is more critical for clinical efficacy than the level of activation in the neurofeedback target region itself. Tailoring neurofeedback training to incorporate these patterns could significantly enhance its therapeutic efficacy.

A Rapid Review of Psychedelic-Assisted Therapy in the Context of Palliative Care.

Psychedelic-assisted therapy (PAT) involves supported experiences with psychedelic medicines in carefully curated environments. Early evidence suggests possible utility of PAT for addressing psychosocial-spiritual-existential concerns, yet gaps remain in understanding findings related to PAT's role in palliative care. This rapid review aims to synthesize current literature on applications of PAT in the context of palliative care. Through a systematic process, we identified 34 articles published between January 2021 and July 2024. Protocols varied yet included common components of participant screening, preparation, dosing, and integration. Psilocybin was the most commonly studied compound. Results support safety and initial efficacy of PAT for psycho-spiritual-existential outcomes among carefully screened and highly homogonous samples of patients with serious illness (predominantly cancer). Current efforts and challenges around integrating PAT into systems of palliative care were highlighted. Additional work is needed to (1) explore PAT's safety and efficacy within more diverse samples and contexts, (2) train palliative care providers on PAT, (3) determine systems of care delivery best suited for translation of PAT into practice, and (4) begin developing policy solutions to support safe and equitable access to PAT. Because many patients lack access to basic psychosocial-spiritual-existential care, careful consideration is needed around integration of PAT. The psychedelic substances which are the topic of this article are not currently FDA approved for use in the United States.

Local Quality Management for Developing Schools’ Capacity Building: A Multiyear Study from Sweden

In recent decades, there has been a growing body of research that highlights local education authorities (LEA) as potential contributors to support school capacity building and result development. Despite this, there are few empirical studies that have explored what effects different strategies and policy actions from the LEAs actual have over time. Based on results from a five-year research project in a major Swedish municipality, the aim with this multiyear and multi-level study is to explore the effects of a LEA’s quality management processes of six schools’ capacity building. The results from the study show a clear strengthening of the schools’ improvement agenda, improvement organization and improvement leadership of the six schools. Two LEA strategies can be distinguished as especially important to explain the school improvements: i) systematic and long-term data-based school improvement routines and processes; ii) quality dialogues for monitoring and support. Two conclusions can be drawn: i) the importance for the LEA to be responsive so its improvement strategies are integrated into the schools’ local school improvement system; ii) the importance that the LEA work with multifaceted strategies containing aspects of control and accountability and learning and support.

Sentinel testing, analytical sigma metrics and a risk management approach as part of a simplified method verification/validation process

Introduction Verification and validation of analytical methods are crucial aspects of quality assurance in a laboratory. This study aimed to develop a risk analysis and assessment tool to streamline the process of identifying so-called ‘sentinel’ tests. Materials and methods The Roche Cobas 8000 systems were evaluated to analyze 83 serum analytes, including routine chemistry, immunoassays, and therapeutic drugs. A failure mode and effects analysis were conducted to produce an analytic risk rating. This was achieved by multiplying the scores for Sigma metrics, the score for potential damage extent, and the score for environmental factors. Each test was assigned a typical risk priority number (RPN). Tests with an RPN of ≤9 were rated as low risk and ranked as ‘B’. Tests with an RPN of >10 were considered high risk and graded as ‘A’. Results Regarding the Cobas C701/ISE, 17 of 54 methods were rated as ‘A’ and subject to a systematic method review process. A total of 37 methods were assigned a rank of ‘B’ and hence were eligible for a selective verification process. Concerning the Cobas E801, 10 out of 29 methods were classified as ‘A’ and, therefore, require a systematic verification process. A further nineteen methods were assigned a rank of ‘B’ and hence eligible for a select verification. Conclusions This study demonstrated the high effectiveness of the risk analysis and assessment model developed to identify sentinel tests in the lean management of the verification/validation process.

Quantitative Data Quality Assurance, Analysis and Presentation.

Quantitative data quality assurance is the systematic process and procedures used to ensure the accuracy, consistency, reliability, and integrity of data throughout the research process. Effective quality assurance helps identify and correct errors, reduce biases, and ensure the data meets the standards needed for analysis and reporting. This paper provides an overview of key issues to consider when working with data and reporting findings.

Stakeholder perspectives on the current status and potential barriers of patient involvement in health technology assessment (HTA) across Europe.

There are wide variations in the practices of patient involvement in health technology assessment (HTA) in Europe. The field is lacking a consensus on good practices, leading to divergent processes, methods, and evaluation of patient involvement. To identify potential good practice approaches and current gaps, a structured online survey was conducted among HTA stakeholders, including HTA practitioners, patient stakeholders, industry representatives, and others who had experienced patient involvement in HTA. The questionnaire was co-created by HTA experts, patient stakeholders, and industry representatives and disseminated between 29 April and 14 September 2022. Responses (n=168) were submitted from thirty-two European countries by HTA practitioners (n=33), patient stakeholders (n=75), industry stakeholders (n=42), providers (n=5), academics (n=7), and others (n=6). The responses indicated that "allowing access to treatments that have demonstrated value"is the principle rationale for conducting HTA. In terms of the importance of patient involvement, there was consensus across stakeholder groups that "patients have insights and information [that] no other stakeholder has" and that patient involvement is important "to inform HTA which evidence is most patient-relevant". Shortcomings were identified in the lack of systematic and transparent processes, an unsatisfactory level of information and guidance, and minimal communication and collaboration. The diverse stakeholders who responded highlighted the need for improving specific aspects of patient involvement practices, including better guidance and information, a more consistent flow of communication between the HTA body and participating patient stakeholders, and the need to develop and implement a consensus on good practices.

A systematic review of measures of mania and depression in older people with bipolar disorder.

Previous research on bipolar disorder (BD) primarily focused on younger adults, with limited research on older adults. This systematic review is the first to investigate how mania and depression are measured in older adults with BD. The searches were completed in April 2024 using the databases PsycINFO, CINAHL Plus, MEDLINE, and Embase. Fifteen studies with a total of 1041 participants were included. These studies used quantitative measures to assess mania and depression in participants aged 50-98 with BD I or II. The studies' risk of bias was evaluated using the appropriate critical appraisal tools. The Young Mania Rating Scale (YMRS) was the most commonly used measure of mania, while the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hamilton Depression Rating Scale (HAM-D) were the most commonly used measures of depression. The pooled analysis revealed that older adult scores on the YMRS were relatively similar to younger cohorts in both euthymic and manic states. Variability in scores was seen across the depression scales. The review followed rigorous systematic processes. However, in some studies, the participant's mood state was unknown, possibly impacting their pooled scores on the measures. The findings from the review add to our existing knowledge regarding the presentation of mania and depression in later life. There is still a great disparity in research developed for the older BD population. Large-scale studies are warranted to inform the development of tailored measures and interventions to improve the outcomes for this population.

The impact and importance of serious games in maritime education: an empirical application

ABSTRACT Gamification and serious gaming have emerged as alternative approaches in learning and decision-making across various domains. In maritime education and the inland waterways sector, where traditional methods may fall short in engaging learners effectively, the development of tailored serious games presents a unique opportunity. This research assesses the educational value of a serious game designed for the maritime industry and inland waterways. The game was developed through a systematic process involving a literature review, stakeholder consultations, and expert input. The methodology included iterative design, user testing, and feedback collection from participants across various sectors. The game features tasks simulating port operations, equipment handling, and inland navigation, followed by quizzes to reinforce learning. Data analysis was performed to evaluate user engagement, knowledge retention, and satisfaction levels. Evaluation results indicate high user engagement, improved knowledge retention, and participant satisfaction. This research underlines the potential of serious games in maritime education, offering innovative solutions to bridge the gap between theoretical knowledge and practical application, thereby maximizing learning outcomes and preparing individuals comprehensively for the challenges of the maritime industry and inland waterways sector.

A study protocol for the policy intervention design and development of the implementation strategies for direct access to physiotherapists in primary care: a sequential mixed-method study using implementation mapping and a Delphi survey

BackgroundIn many Asian jurisdictions, patients are required to obtain referrals from registered doctors before consulting physiotherapists. In contrast, countries such as the United States, the United Kingdom, and Australia have a direct access model for physiotherapists designed across different healthcare settings and under prescribed conditions. While research has demonstrated the benefits of direct access, issues remain on the appropriate policy design for direct access in the context of patient safety and organizational challenges in the implementation. Recently the policy to allow direct access in primary care context is being considered in Hong Kong. This study aims to examine the intervention design options for the policy of direct access to physiotherapists and identify corresponding implementation strategies, to inform the appropriate intervention design for direct access to physiotherapists and the implementation strategies.MethodsWe adopt a systematic process for developing the design of the policy and the implementation strategies using an Implementation Mapping approach informed by Consolidated Framework for Implementation Research (CFIR). We will conduct literature reviews to understand the different aspects of policy intervention design and employ qualitative in-depth interviews and focus group discussions to understand key stakeholders’ perspectives related to the direct access model. The identified barriers and facilitators associated with policy implementation of an acceptable intervention design will inform the development of an effective implementation strategy tailored to the implementation context. Our approach will involve mapping the research evidence and the subsequent findings from the stakeholders’ deliberations into the CFIR domains and referencing the Expert Recommendations for Implementing Change (ERIC) to develop the acceptable intervention characteristics and the corresponding implementation strategies. These insights will be further validated in a Delphi Expert Survey, for a consensus-based approach.DiscussionThis study employs a sequential mixed-method approach to explore the intervention characteristics for an acceptable intervention design in the policy formulation and the corresponding implementation strategy for direct access to physiotherapists. Integrating research insights into actionable policy recommendations and refining these recommendations in a Delphi Survey will inform the appropriate policy intervention design and implementation strategy for direct access to physiotherapy services.