Unmet Expectations Research Articles

Unveiling the Layers of Faculty Burnout in Canadian Private Universities during the post-COVID Pandemic Period

The COVID-19 pandemic significantly altered the employment landscape, including educational institutions, creating long-term effects for college and university employees. One of the major implications of the pandemic is the systemic transformations in employment and organisational dynamics, that resulted in effects on working conditions and workplace responsibilities. Emotional, physical, and mental exhaustion accompanying these changes have heightened the risk of faculty burnout. This qualitative research, reports on the multifaceted phenomenon of faculty burnout within Canadian private universities amidst the post pandemic. A phenomenological approach was used to conduct indepth interviews with participants, resulting in narrative responses regarding experiential aspects of participants’ workplaces, daily routines, social interactions, and perceptions of organisational support. Notable findings included burnout in eleven distinct categories: technology and tools, career development, intrinsic motivation, psychological factors, social worth, unmet individual expectations, mental and physical health, time constraints, task management, workload, and professional role. The findings were categorized into three overall themes, including organisational factors, individual factors, and work-specific factors. A comprehensive conceptual model was developed to provide a snapshot of the value alignment of these factors to the overall concept of faculty burnout. The results highlight the significance of the intricate interplay of various elements contributing to burnout and offer significant insights into the lived experiences of faculty members within the context of burnout among Canadian private universities during and after the pandemic. The study informs academic researchers and institutional policymakers of the need for adaptable and responsive interventions to support the faculty, especially in the post-Covid context.

Wide-angle simulated artificial vision enhances spatial navigation and object interaction in a naturalistic environment.

Vision restoration approaches, such as prosthetics and optogenetics, provide visual perception to blind individuals in clinical settings. Yet their effectiveness in daily life remains a challenge. Stereotyped quantitative tests used in clinical trials often fail to translate into practical, everyday applications. On the one hand, assessing real-life benefits during clinical trials is complicated by environmental complexity, reproducibility issues, and safety concerns. On the other hand, predicting behavioral benefits of restorative therapies in naturalistic environments may be a crucial step before starting clinical trials to minimize patient discomfort and unmet expectations.
Approach. To address this, we leverage advancements in virtual reality technology to conduct a fully immersive and ecologically valid task within a physical artificial street environment. As a case study, we assess the impact of the visual field size in simulated artificial vision for common outdoor tasks.
Main Results. We show that a wide visual angle (45°) enhances participants' ability to navigate and solve tasks more effectively, safely, and efficiently. Moreover, it promotes their learning and generalization capability. Concurrently, it changes the visual exploration behavior and facilitates a more accurate mental representation of the environment. Further increasing the visual angle beyond this value does not yield significant additional improvements in most metrics.
Significance. We present a methodology combining augmented reality with a naturalistic environment, enabling participants to perceive the world as patients with retinal implants would and to interact physically with it. Combining augmented reality in naturalistic environments is a valuable framework for low vision and vision restoration research.

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Distributed impact of severe mental health conditions in rural Ethiopia, a qualitative study

AimTo explore the distributed impact of severe mental health conditions (SMHCs) among people with lived experience of SMHCs, their family members, and community members.MethodsWe conducted in-depth interviews with family key informants of people with SMHCs (n = 32), people with SMHCs (schizophrenia, bipolar disorder, and major depression) (n = 10), and community members (n = 6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMHCs. Interviews were conducted in Amharic and were audiotaped. We conducted a thematic analysis.ResultsWe identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat. Family members reported stress and hopelessness; some also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed, leading to unmet expectations: being left alone to care for children, unable to go to school or dropping out early. The study participants with SMHCs also spoke about the impacts of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which sometimes led to selling assets, debt, unemployment, forced migration, and food insecurity. Community members emphasised the economic burden and danger related to the aggressive behavior of the person with SMHCs, while the person with the illness and their family members blamed the community for the stigma and discrimination they experienced.ConclusionSMHCs have profound consequences for the person with the illness, their family members, and the community. Future interventions for SMHCs should consider household-level interventions to address economic and care needs and mitigate the intergenerational impact. The community should be considered as a resource as well as a target for intervention.

THE MORPHOLOGY OF GRIEVANCE

Employees/ Workers are the one of the important factors of production in any organisation. A grievance is a term that refers to any discord, discontent, or sense of injustice that arises between an employer and an employee in the workplace. There are various forms of grievances and methods of resolution. This topic will help the organisations to identify the Identify the grievance and its resolution. Worker voice is mainly concerned with Labour. All human beings are different in trainings, skills, Education, family background, attitude, & productivity. Every individual has set of expectations from the organisation and unmet expectations, stressful lives, and self-beliefs (including wicked thoughts) are some of the factors that lead to discontent.

Caregivers' burden of care during emergency department care transitions among older adults: a mixed methods cohort study.

Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it. This mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers also commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists. Comments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a patient's care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels. Caregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home and inadequate communication were most frequently mentioned and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and ED care transitions.

Chinese heritage language learners' motivation and intention to continue learning Mandarin

AbstractThis study explored Chinese heritage language learners' prior Mandarin experiences and their current Mandarin‐learning experiences to reveal factors that influence their motivation and intention to continue or discontinue their Mandarin coursework. Using a Grounded Theory approach, we conducted demographic surveys and semi‐structured interviews with eight participants taking beginner‐level Mandarin courses. Following open, axial, and selective coding procedures, we developed a model portraying factors that influenced HLLs' decision to continue their enrollment in Mandarin classes. The model revealed that their decisions were fueled by ongoing appraisals via their motivational orientations, course expectations, and emotional experiences that drove their approach or avoidance focus. In particular, Mandarin high dropout rates may result from 1) HLLs' unmet course expectations, 2) lack of specific future‐oriented instrumental values, and 3) unpleasant emotional experiences within the class. The study concluded with four pedagogical implications (e.g., adopting task‐based language teaching) to sustain HLLs' motivation in college HL courses.

Complexity and Challenges of Cross-Cover Care in Graduate Medical Education: A Qualitative Study.

Cross-cover care (care for hospitalized patients when the primary team is absent) is a common graduate medical education responsibility; however, it may lead to increased preventable adverse events. Despite understanding the difficulties of cross-cover care, medical educators lack comprehensive knowledge of specific challenges that residents face and how they handle these challenges. This study explores the challenges residents experience when providing cross-cover care. The authors conducted 60 semistructured, qualitative interviews with 20 internal medicine and surgery residents at a single academic institution between October 2021 and April 2022. Each resident participated in 3 interviews, 2 immediately after a shift. Working inductively, the authors generated codes for important themes. Study design and data collection were guided by interpretive description, a qualitative approach for health care research focused on experiences and perceptions to develop meaningful findings. To illustrate residents' workflow and aid in quality improvement efforts, the authors created a process map. Seventeen cross-cover challenges were organized into 7 interrelated and overlapping themes: lack of baseline knowledge, inadequate or inaccurate information transfer from the primary team, unfamiliarity with cross-cover patients, high task volume leading to increased interruptions, ill-defined roles leading to unmet expectations from others, perceived decreased access to resources, and fatigue. The process map illustrates 4 cross-cover workflow components: information transfer from the primary team to the cross-cover team, direct handling of cross-cover tasks that are assigned by the primary team or that arise during the time of cross-cover, information transfer back to primary team and other care team members, and responsibilities that residents have overnight that are not directly related to cross-cover. Residents face substantial challenges when providing cross-cover care, which have important implications for patient safety and resident well-being. The medical community should strive to develop educational and structural interventions to improve this process.

Unveiling the Apathy: Understanding the Causes of Student Disengagement in Student Governance

This study delved into the causes of student disengagement in any form of student-based governance of the University of Cebu College of Arts and Sciences Department's Student Body Organization (CAS-SBO) during the academic year 2023-2024. A descriptive phenomenological research design was employed, exploring participants' experiences in student governance, how these experiences influence their lack of total disengagement and the strategies that could revitalize their engagement and active participation in the said area. Data were gathered through in-depth interviews with twelve students selected via linear snowball sampling, focusing on those with prior governance experience who did not participate in recent CAS-SBO activities. Thematic content analysis revealed nine emergent themes: (1) Lack of Connection, Inequality in Representation, and Faculty Intervention as essential experiences in student governance; (2) Student Unfamiliarity, Feeling Unrepresented, and Unmet Expectations as reasons for disengagement; and (3) Inclusive Activities, Addressing Electoral Disparity, and Empowered Leadership as potential strategies to increase engagement. Based on these findings, the study recommends regular CAS-SBO general assemblies, teambuilding exercises, leadership seminars, and the election of representatives for each degree program to foster more vital student involvement and improve representation. The study also suggests future research topics, including electoral system reforms and former CAS-SBO presidents' experiences.

Lessons Learned from Adopting Sustainable Agricultural Practices to Address Food Insecurity and Climate Change Risks: Opportunities, Constraints, and Limitations

Conventional agriculture has been blamed for its ecological and economic concerns. Consequently, sustainable agriculture has emerged as a feasible and viable alternative for addressing food insecurity and climate change risks, despite its low uptake and unmet expectations. This study examined the opportunities, challenges, and limitations of adopting sustainable agriculture. To do this, a questionnaire survey and group discussions were used to collect information from a random sample of households. The collected data were examined using the percentage, priority ranking, and content analysis. Farmers have mentioned several economic benefits and ecological viability of sustainable agriculture: enhanced soil fertility, improved vegetation coverage, reduced land degradation, generated employment, and increased water availability. These results have then led to increased agricultural productivity, reduced carbon emissions, and improved food security. However, it was found that lack of information, limited institutional support, labour shortages, and fragmented farmland are the major constraints to adopting sustainable agriculture. Other problems include an increased workload, waterlogging, sedimentation, loss of cultivated and grazing land, the spread of external predators, and the emergence of diseases and pests. All of these problems may prohibit farmers from fully accepting and implementing sustainable agriculture. Hence, it is imperative to organize on-the-spot demonstrations, information-sharing, and capacity building for farmers and extension workers in order to comprehend the attributes, benefits, and constraints of sustainable agriculture. Farmers should also be given technical and financial assistance to implement sustainable agricultural practices. It is imperative that policymakers and development actors must establish and empower local institutions to promote sustainable agriculture, in order to fully explot its potential benefits and expand its reach to areas that are prone to drought and water shortages.

Expectation dissonance: the role of perceived negativity bias in enterprise social media in explaining accountability and support

PurposeEnterprise social media (ESM) are expressive spaces where users exchange emotional workplace communication. While some studies have explored how positive emotions may be contagious, little research explored the notion that negative communication may accumulate on enterprise social media. This study explores perceived negativity bias and its correlates in the context of ESM.Design/methodology/approachThis study relies on survey data collected from 599 employees of a global organization. The response rate was 18.7%. Structural equation modeling was used to test the hypotheses.FindingsThe results contribute to research on ESM by demonstrating that perceived negativity bias is positively related to feelings of accountability and negatively associated with social support. Furthermore, the results indicate that unmet communication expectations on ESM can have implications for perceived social support beyond online contexts and accountability through perceived negativity bias.Research limitations/implicationsThe findings demonstrate how employees' unmet expectations about ESM use increase feelings that a digital environment is disproportionately negative, which may create an “unsafe” space for employees and a fear of being held accountable for their contributions. This study highlights how the Expectation-Disconfirmation Theory provides a fruitful framework for studying enterprise social technologies.Originality/valueThis study suggests that work is not merely a rational endeavor, and that emotions and personal feelings (including negative ones) may shape workplace communication on ESM. We contribute to research on ESM use by using the Expectation-Disconfirmation Theory as a lens to study antecedents and implications of perceived negativity bias.

Chronic pain patients’ evaluations of consultations: A matter of high expectations or expectations unmet?

ObjectiveThis study tests two hypotheses about spine pain patients’ expectations for consultations and their negative evaluations. High expectations may be impractical or unachievable and can set patients up for disappointment. Unmet expectations are the absolute difference between expectations before the visit and perceptions of expectations actually enacted. MethodWe conducted a single-site prospective study using pre- and post-consultation surveys. Patients (N = 200) were English-speaking individuals aged 18–75 presenting for an initial consultation for musculoskeletal pain. Analyses were conducted in SPSS v. 28.0 using mixed modeling to account for interdependence among cases. ResultsContrary to initial predictions, higher pre-consultation expectations for shared decision-making were positively linked to post-consultation satisfaction, trust, and agreement. Exceeding expectations in shared decision-making, history-taking, examination, and interpersonal skills significantly enhanced post-consultation outcomes. ConclusionsResults support the unmet expectations hypothesis over the high expectations hypothesis. Increased expectations and exceeding these expectations in key areas of patient-physician interaction were positively associated with improved consultation outcomes. Practice implicationsFindings highlight the importance of exceeding multifaceted patient expectations in physician evaluations. Yet, physicians must first understand the nature and source of each patient’s expectations pre-consultation, which vary across individuals in aspirational and realistic dimensions.

Feeling social change in the gut: gyāstrik and the problematisation of domestic roles among Newar women in contemporary Nepal

Drawing upon 15 months of research conducted in 2018–2019 in Bhaktapur, Nepal, this paper examines how middle-class women experience and make sense of gyāstrik (an umbrella term for multiple gut disorders) as an embodiment of social change. Enumerating dietary injustices and distress following unmet middle-class expectations of well-being and domestic intimacy as a primary cause of the condition, these women narratively problematised social norms and found ways out through the concomitant vocalisation of physical pain and social discontent. While illness epistemologies differ (with the persistence of mind-body dichotomies on the one hand and the centrality of notions of well-being and ideals of self-care on the other), these accounts demonstrate both a passive and active role of the gut in the social change experience, inviting to take the gut as the site where somatic modes of ‘attention’ and ‘action’ enable the navigation of personal life trajectories and the negotiation of social change itself.

Being a patient in a crowded emergency department: a qualitative service evaluation

BackgroundEmergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however,...

Unmet Expectations, Unmet Needs, and Uncertainty–A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic

Abstract: Traumatic childbirth can have wide-ranging consequences for birthing individuals. Data were obtained from a large-scale ( N = 1,210) online survey of perinatal experiences in the United States. Utilizing a Reproductive Justice framework, we analyzed open-ended responses regarding the most difficult aspects of pregnancy and childbirth from 54 participants who solely identified their births as traumatic. We identified the following themes: Mental and Emotional Toll; The Toll of Relentless Work Expectations; The Embodied Toll; Complications and Interventions; Loss of Control: Bodily Autonomy; and Loss of Control: Interactions with Medical Systems and Professionals. Results underscore the inadequacy of perinatal support in the United States, highlighting the imperative to address policy and research to advance the UN Sustainable Development Goals of Good Health and Wellbeing and Gender Equality.

LeFort Colpocleisis: Unmet Expectations about Correction of Urinary Symptoms Are Related to Disappointment and Regret

ABSTRACT Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student’s t-test, Fisher’s Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates.

Efecto de normas de persuasión en el servicio personal shopper

Some key disadvantages of online computer sales stem from unmet consumer expectations, insufficient product knowledge, and product returns. This study examined cognitive route factors and persuasive norms in online advertisements to determine the purchase intention of personal shopper services for laptops. Covariates included gender, educational level, marital status, prior shopping experiences, monthly income, and workplace location. The results approach indicate that peripheral route advertising messages positively impact the purchase intention of personal shopper services, especially among women. Findings also demonstrate that monthly income and educational level influence the purchase intention of laptops when aided by a personal shopper. It was found that women prefer personal shoppers providing clear responses, while men prefer those with technical knowledge. Additionally, women prefer to pay for the personal shopper service as 3% of the purchase value, whereas men favoured a single payment. Finally, the purchase intention for the personal shopper service is higher among women. The potential effects of advertising messages on the purchase intentionof the service are discussed.

Stressors and Coping Strategies Employed by Post Cesarean Birth Mothers in North Central, Nigeria

Objectives: Childbirth is exciting, and a very joyful experience in women’s live. As much as its beauty, childbirth often bring about a lot of stress, which requires coping and adaptation for the mother; especially for mothers who undergo caesarean birth. Most importantly, whether or not the caesarean birth was successful, it however creates memories, sometimes bad experiences and unmet expectations difficult for post caesarean birth mothers (PCBM) to cope and in some cases may leave the mother with those memories for life. Thus, this study explored lived experiences related to stressors and coping strategies employed by PCBM in Asokoro District Hospital, Abuja, Nigeria.Material and Methods: a phenomenological-hermeneutics research design, a sample of 19 PCBM who were able to consent for themselves were purposively included in the study and data collected through an in-depth face-to-face interview with a semi-structured interview guide. Three major themes emerged from the data analytic process.Results: Although, few PCBMs (five) sees caesarean birth as being scary, unwomanly and cause body image dissatisfaction; majority (ten) PCBM see the process as life saving for them and their baby which is the most important advantage of a caesarean birth. Hence, pregnant women should be prepared early for possibility of caesarean birth during antenatal periods and visits.Conclusion: Due to lack of physical accessibility to medical services which is an important barrier to maternal health care access; improving accessibility should be a focus of reforms.

Struggling against Internal Turmoil: Exploring the Lived Realities of Women who Suffered from Postpartum Depression

Postpartum Depression (PPD) presents a significant mental health challenge affecting numerous women globally, including a notable percentage in the Philippines. Despite extensive research on PPD's prevalence and contributing factors, the lived experiences of women navigating this condition remain underexplored, particularly among Filipino women residing in Saudi Arabia. This descriptive qualitative phenomenological study seeks to elucidate the multifaceted experiences of ten clinically diagnosed Filipino women who suffered from PPD in Riyadh, Saudi Arabia. Utilizing semi-structured interviews, this research reveals the profound struggles and adaptive mechanisms of women facing PPD. The findings are categorized into two emergent themes: "Inner Shackles" and "Adaptive Mechanisms." The "Inner Shackles" theme captures the profound emotional, psychological, and physical challenges experienced by the participants, including unmet expectations, role transitions, physiologic changes, lack of awareness about PPD, negative feelings, and longing for support. Conversely, the "Adaptive Mechanisms" theme highlights the coping strategies employed, such as strengthened spirituality, promoting self-care, and navigating relational health. The study underscores the necessity for comprehensive, culturally sensitive support systems and tailored interventions to address the specific needs of postpartum women with PPD. By understanding the subjective realities and resilience factors of these women, healthcare providers, including midwives, can enhance their support strategies, reduce stigma, and ultimately improve the well-being of mothers during the critical postnatal period. The research contributes to the existing body of knowledge by offering a nuanced exploration of the lived experiences of women with PPD, advocating for targeted and effective mental health interventions

Allied health new graduates’ voice behavior – new perspectives using realist synthesized narratives

PurposeEffective voice behavior in healthcare workers is critical for patient safety, quality improvement and workforce well-being. A review of the literature on voice behavior in healthcare highlights that little is known about the voice behaviors of new graduates in allied health and that current theory, from medical and nursing research, does not adequately apply to this sector. New knowledge about voice behavior for this sector of the workforce will support education and healthcare institutions in building and sustaining a healthy voice behavior culture.Design/methodology/approachThis paper reports on phase two of a two-phase study looking at the voice behavior experiences of new allied health graduates over one year. Using a realist perspective and narrative analysis, we uncover and illustrate what works, with whom and under what conditions.FindingsFour synthesized narratives outline the contexts and mechanisms that result in different voice behavior outcomes – speaking up effectively, speaking up with unmet expectations, not speaking up and a reduction in speaking up over time. Experiences of positive interprofessional collaboration and reflective supervision supported effective voice behavior.Research limitations/implicationsThis study used a case study approach, focusing on healthcare providers within a large New Zealand city and a cohort of 10 participants. Some researchers argue that small numbers limit the generalization of findings to different populations. Realists argue that, given the way in which knowledge is developed using realist methodologies, the resultant theory is portable. Interviews were conducted online during the COVID-19 pandemic. This may have impacted the connection between the interviewer and interviewee, causing the interviewees to not express their true thoughts. However, the interviewer did take time to connect with the interviewees and build trust over the three interviews over one year. Participants did not capture the diversity in the allied health workforce – most identified as female and none identified as Māori/Indigenous. And finally, participants could inhibit or exaggerate information due to the influence of social desirability. This does not appear to be a significant limitation in this study, given the many examples shared by the participants highlighted their challenges.Practical implicationsThis study provides an in-depth exploration of how new graduates in allied health experience speaking up. Our findings enrich the knowledge of speaking up by using synthesized narratives to provide insights into what factors can enable a healthy speaking up culture within the new graduate allied health workforce. This is new knowledge that will be of interest at the individual, team and organizational levels of healthcare. The findings will support curriculum design and new graduate support frameworks for the education and health sectors. Highlighted in this study are the importance of the following factors in supporting speaking up for allied health new graduates: the employment of reflective supervision, purposeful facilitation of team belonging and interprofessional collaboration and tailored speaking up training for allied health new graduates and leaders in healthcare.Originality/valueBy taking a realist perspective and using narrative analysis, we gain an understanding of the voice behavior experiences of new graduates in allied health and the contextual factors and mechanisms that activate effective voice behavior in sub-acute and rehabilitation settings. These findings differ from nursing and medicine and highlight the benefits of reflective supervision and interprofessional collaborative practice.