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Background: Digital game‐based learning (DGBL) has been shown to be an effective strategy for promoting learning motivation. However, a lack of attention has been paid to investigating the effects of individual differences on elementary students' reading motivation and in‐gaming achievements in DGBL. Objectives: This study developed an educational mobile game to facilitate learners' reading activities, and investigated how prior knowledge and gaming experience affected learners' reading motivation, gaming motivation, perceptions and in‐game achievements. Methods: A total of 53 third to fifth grade elementary school students participated in this study, and were divided into the high prior knowledge (HPK)/low prior knowledge (LPK) and the high gaming experience (HGE)/low gaming experience (LGE) groups. Results and Conclusions: The HPK learners had higher reading motivation, perceptions, gaming and social achievements than the LPK learners, whereas they had similar gaming motivation and reading achievements. In addition, the HGE learners had lower reading motivation, reading and gaming achievements than the LGE learners, whereas they had similar gaming motivation, perceptions and social achievements. Moreover, correlational results showed that similarities and differences were observed between the HPK/LPK and HGE/LGE learners. Implications: The findings of this study suggest that learners' prior knowledge and gaming experience play influential roles in reading motivation, gaming motivation, perceptions and in‐game achievements. A framework is proposed for researchers or game designers to develop personalized DGBL systems to accommodate the HPK/LPK and HGE/LGE learners' individual needs or preferences in DGBL. Lay Description: What is already known about this topic: Reading motivation is a critical factor influencing reading performance.Students have difficulties developing reading skills due to a lack of reading motivation, and therefore need additional support.DGBL has been shown to be an effective strategy for promoting learning motivation.Relevant empirical research investigating the impact of individual differences on reading in DGBL is scarce. What this paper adds: A mobile game‐based reading app was developed to facilitate elementary students' reading activities.This study provides understandings of the impact of prior knowledge and gaming experience on reading motivation, gaming motivation, perceptions and in‐game achievements in DGBL.The HPK learners had higher reading motivation, perceptions, gaming and social achievements than the LPK learners, whereas they had similar gaming motivation and reading achievements.The HGE learners had lower reading motivation, reading and gaming achievements than the LGE learners, whereas they had similar gaming motivation, perceptions and social achievements. Implications for practice and/or policy: Educators should consider adopting DGBL to facilitate students' reading activities.Prior knowledge and gaming experience play influential roles in reading motivation, gaming motivation, perceptions and in‐game achievements.Learners' prior knowledge and gaming experience should be taken into account when designing learning activities in DGBL.A personalized DGBL system should be developed to accommodate the needs and preferences of the HPK/LPK and HGE/LGE learners. [ABSTRACT FROM AUTHOR]

Learning a foreign language requires interaction with language input while involved in a task. Given that problem‐based learning (PBL) offers hands‐on application in realistic contexts, and that virtual reality (VR) enables learners to interact with multiple modalities of information, this study examines how the integration of VR technology into PBL contexts affects students' motivation for, problem‐solving during, and vocabulary acquisition in learning English as a foreign language (EFL). A total of 84 engineering majors who enrolled in a course of English for specific purposes were randomly assigned to either an experimental group or a control group. Students in the experimental group participated in a VR‐assisted PBL context, in which they were to view a PBL scenario using VR technology and then to create VR videos about solving the given problems. Those in the control group participated in a PBL context without the use of VR technology for viewing and solving the identical scenario. After the intervention, all the students wrote a problem‐solving analysis, took a vocabulary knowledge test, completed a learning motivation questionnaire, and participated in individual interviews. The results showed that the students in the experimental group significantly outperformed those in the control group in terms of vocabulary acquisition, and were more motivated to learn English related to their future careers, whereas there was no significant difference in the problem‐solving performance of the two groups. Implications of these findings highlight the value of engaging EFL learners in immersive environments for contextualized learning through the integrated use of VR and PBL. Lay Description: What is already known about this topic?: Virtual reality (VR) technology has been shown to enhance students' knowledge and skills in STEM fields.Problem‐based learning (PBL) has been widely used in medical education but not so much in foreign language education.English as a foreign language (EFL) students usually have very limited access to the target language beyond the classroom, thus lack a motivating reason for them to learn English after graduation. What this paper adds?: The VR‐assisted PBL approach proposed in this study was found to significantly enhance the EFL students' specialized vocabulary knowledge.The VR‐assisted PBL approach was found to motivate and sustain the EFL students' interest in career English.Exposing the EFL students to PBL contexts was capable of developing their problem‐solving performance, regardless of VR integration. Implications for practice and/or policy: The proposed approach has the potential to facilitate student learning in EFL education, particularly English for occupational purposes.EFL educators may apply the VR‐assisted PBL approach to narrow the gap between language classrooms and workplace contexts by immersing students in authentic contexts that were relevant to their occupational knowledge and workplace English. [ABSTRACT FROM AUTHOR]

Purpose: To determine if there are long‐term effects of a self‐management intervention guided by self‐regulation theory for adults with knee osteoarthritis at 6 and 12 months after completing the intervention. Design: This long‐term follow‐up study used a longitudinal quasi‐experimental design with repeated measures. Methods: A convenience sample of 127 patients with knee osteoarthritis who were 45 to 64 years of age were recruited from outpatient clinics in Taiwan. The Self‐Management Needs of Knee Osteoarthritis Scale was used to assess self‐management needs at enrollment (baseline). To evaluate the long‐term effects, participants were reassessed at 6 and 12 months after the intervention using the following questionnaires: The Knee Injury and Osteoarthritis Outcome Score, Healthcare Outcomes, and the Short‐Form Health Survey. Generalized estimating equations compared assessments at baseline with scores at 6 and 12 months following completion of the intervention. Multiple regression was used to examine significant factors associated with the assessments. Findings: Participants had moderate levels of self‐management needs. When assessments at 6 months were compared with baseline, scores for knee symptoms and physical function and quality of life showed significant improvements; significant reductions were seen in body mass index, unplanned medical consultations, and pain medication doses. Assessments at 12 months compared with baseline measures indicated these improvements were maintained. These improvements were significant from baseline measures at both 6 months and 12 months after adjustments were made for time and other significant variables. Conclusions: Twelve months after completion of the intervention, the significant improvements seen at 6 months were maintained. Our findings demonstrate that the self‐management intervention had significant long‐term effects on knee symptoms and physical function, body mass index and pain medication doses, and overall quality of life for patients with moderate self‐management needs of knee osteoarthritis. Clinical Relevance: Clinical care of knee osteoarthritis that includes a self‐regulation theory–based self‐management intervention could provide long‐term benefits to patients. [ABSTRACT FROM AUTHOR]

Background: The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan. Purpose: Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings. Design and Methods: A cross‐sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire. Results: A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found. Conclusion: The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals. [ABSTRACT FROM AUTHOR]

In long‐term care facilities (LTCFs), nurses are key healthcare providers for older residents who have depressive symptoms or depression; therefore, they need accurate knowledge of late‐life depression, positive attitudes towards depression, and confidence in providing depression care. This cluster‐randomized trial was designed to examine the effectiveness of multiple, face‐to‐face, brief training sessions in improving nurses' knowledge, attitudes, and confidence in providing late‐life depression care in LTCFs. Nine LTCFs were included in the study. In total, 30 nurses from the four LTCFs assigned to the intervention group received three 30‐min training sessions and 36 nurses in the five comparison group LTCFs did not. A self‐report questionnaire was administered before and after the intervention. There were significant differences between groups concerning improvement in nurses' knowledge of late‐life depression, attitudes towards depression, and confidence in providing depression care. The effect size (Cohen's d) was 1.55 for knowledge, 1.38 for attitudes, and 0.89 for confidence. This training program was effective in improving LTCF nurses' knowledge, attitudes, and confidence in providing depression care. On the basis of these findings, we recommend that nurse managers and directors implement similar training programs for nurses in LTCFs to enhance the care quality for older residents. [ABSTRACT FROM AUTHOR]

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression. [ABSTRACT FROM AUTHOR]

Is abdominal muscle exercise (AME) an effective alternative therapy to treat urinary incontinence (UI)?. Pelvic floor muscle exercise (PFME) is a conservative and conventional treatment for UI. In recent decades, another innovative method of incontinence rehabilitation involving abdominal muscles exercise, namely AME, was proposed to achieve better UI care. However, the effectiveness of AME is unclear. A quasi‐experimental pilot study with a 12‐week intervention period compared AME with PFME. Women aged ≥45 years with at least one episode per month of stress or mixed UI were enrolled. Informed consent was obtained before participation in the study. Women from each region were considered a cluster and were randomly allocated into the AME or PFME groups. All exercise sessions were accomplished at citizen activity centres. With 20 women in each group, the primary outcomes were to compare the score changes in the Incontinence Severity Index (ISI), 1‐hour pad test, and 3‐day voiding diary whereas the secondary outcomes compared the scores between the pre‐ and post‐tests. The ISI, 1‐hour pad test, and 3‐day voiding diary improved significantly after the interventions within each group; however, no significant difference was found between the groups. The effectiveness of AME was similar to that of PFME. Nevertheless, health care providers should understand the effectiveness of different strategies for treating or preventing UI. [ABSTRACT FROM AUTHOR]

Background Despite the impact of medication literacy ( ML) on patients' safe use of medications, existing instruments are mostly for general health literacy measurement or designed for specific disease populations, with few specifically designed for ML. Objective To develop and validate the first Chinese medication literacy measure (Ch MLM). Methods The Ch MLM was developed by a multidisciplinary and bilingual expert panel and subsequently pilot-tested. The final version had 17 questions in four sections: vocabulary, non-prescription drug, prescription drug and drug advertisement. Face-to-face interviews were administered in a convenience sample of adults with diverse sociodemographic characteristics. Internal consistency was assessed by Cronbach's alpha. Content validity was confirmed by the expert panel, and hypothesis testing was performed to assess construct validity. Results A total of 634 adults were interviewed. The mean ( SD) total Ch MLM score was 13.0 (2.8). The internal validity was acceptable (Cronbach's alpha=0.72). Nine of the ten a priori hypotheses were fulfilled. Younger age, higher income and higher education levels were significantly associated with a higher Ch MLM score. Furthermore, higher scores on the Ch MLM were associated with higher confidence or less difficulty in writing, reading, speaking and listening abilities in a health-care encounter. No association was found between Ch MLM total scores and frequency of doctor's visits. Conclusion The Ch MLM is a valid and reliable ML measure. It may help pharmacists and other health-care providers to target patients and problem areas that need interventions with the ultimate goal of preventing medication errors and harm. [ABSTRACT FROM AUTHOR]

Aim To develop a home nursing quality scale and to evaluate its psychometric properties. Method This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. Results The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. Conclusion The scale is ready to be used to assess the quality of services provided by home care nursing organizations. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to develop and assess the reliability and validity of the Nurse Job Rotation Stress Scale (NJRS). Methods: A convenience sampling method was utilized to recruit two groups of nurses (n = 150 and 253) from a 2751 bed medical center in southern Taiwan. The NJRS scale was developed and used to evaluate the NJRS. Results: Explorative factor analysis revealed that three factors accounted for 74.11% of the explained variance. Confirmatory factor analysis validity testing supported the three factor structure and the construct validity. Cronbach's alpha for the 10 item model was 0.87 and had high linearity. Conclusion: The NJRS can be considered a reliable and valid scale for the measurement of nurse job rotation stress for nursing management and research purposes. [ABSTRACT FROM AUTHOR]

In this study, we developed a digital game-based learning (DGBL) system, called the ToES, to foster students' creativity. Fifty-one fifth-grade students from two classes in a public school in Taipei, Taiwan, were recruited and consented to participate. Both classes consisted of students with mixed abilities studying a foundation unit entitled "Electrical Science" in a natural science course. One class was chosen to be the experimental group (EG) and the other class was the control group (CG). The goal of this study was to examine how different instructional strategies (i.e., traditional instruction and instruction using digital games) affected the students' creativity and their performance on manual skills. The analytical results indicated that the students' creativity and their performance on manual skills displayed positive growth when they were involved in acquiring knowledge and resolving tasks in a DGBL environment, which fostered their creativity and facilitated the generation of flow experiences. Moreover, there were three interesting findings related to the use of DGBL: (1) the ToES was an effective learning tool for cultivating the students' creativity; (2) there was a positive effect of creativity and their performance of manual skills; and (3) the ToES accelerated the improvement of practical behaviors regarding manual skills. [ABSTRACT FROM AUTHOR]