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This is a report of the "European Educational Research Journal" (EERJ) Roundtable that sought to describe what national educational research programmes are doing, how they are working together, and how they might contribute to the developing European Educational Research Space. The Roundtable was an opportunity for one large consortium of national programmes to explain their intentions and create an opportunity for dialogue. Researchers from six national research programmes (United Kingdom, Finland, Sweden, Netherlands, Norway and France) have been working closely to develop a cooperative decision-making system; web-based knowledge-sharing; cooperative analyses of best practice; joint examination of common policy problems and opportunities; and pilot implementation of new approaches to research training and dissemination. The discussion, chaired by Martin Lawn ("EERJ" Editor), was introduced by short contributions from Andrew Pollard (University of Cambridge), Kirsti Klette (University of Oslo) and Hannele Niemi (University of Helsinki). A response was given by Filip Dochy (University of Leuven), President of the European Association for Research on Learning and Instruction (EARLI). There appeared to be almost universal agreement that the educational research community needs to pay greater attention to internationalisation of research processes. To this end, the collaboration of national research programmes did offer one way of achieving this through progressive interaction between partners and their associated research communities.

In this study, the variables having impact on the student motivation have been analyzed based on the articles, conference papers, master's theses and doctoral dissertations published in the years 2000-2017. A total of 165 research papers were selected for the research material and the data were collected through qualitative research techniques through document review and content analysis. According to the research results, the most important factors affecting student motivation are the fields of teacher, teachers' classroom management skills and their teaching methods. In this research, factors having less influence on the student motivation are parental communication, student characteristics and study fields. In addition, relational search type was used more than others, mostly students were selected as the study group and most researches were conducted in USA and Turkey.

This article maps the scientific production and the contents associated with the sustainable development goals and their integration with universities during the past 21 years. Although many of the topics related to sustainable development goals (SDGs) have been addressed in different studies for decades, it is since 2015 onwards that they gained greater prominence due to the inclusion of higher education as an important actor in the fulfillment of the 2030 agenda and the United Nations SDGs. For the purpose of this paper, a bibliometric analysis of 871 papers, 535 documents in Scopus, and 336 in Web of Science (WoS) from 1998 to 2019 was performed, and the Bibliometrix analysis tool was used. The objective of this mapping is to answer the following research question: Is the integration of the Sustainable Development Goals and Universities a field of study? An analysis of the network of collaborators and trend topics in Scopus and WoS allows us to identify the concurrence and relationships of some keywords, such as sustainable development, sustainability and planning, and some background words, such as humans and global health. In another analysis, the word "higher education" is related to change. This article suggests that the integration of the Sustainable Development Goals in Universities is becoming a field of study under exploration, with a peak of production in 2016 and that has remained stable in the last three years, but thanks to the leading role assigned to Universities, intellectual production should increase in the following years.

A child's disability, long-term illness, or mental ill-health is known to affect siblings' health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018–2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling–Parent Carers. Sibling Carers and Sibling–Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support. [ABSTRACT FROM AUTHOR]

Information communication and technology (ICT) has been used in various fields. The use of teleconference for teaching and learning activities is currently not a new topic in global world. In Indonesia, through IMHERE Program from Directorate of Higher Education, some universities have been connected with a network of teleconference as a medium of disseminate knowledge. However, when compare to university, the use of teleconference is not yet well-known in schools in Indonesia. This paper aims at presenting the experiences on the use of Teleconference as a medium of teaching secondary school pupils new information on different subjects they discovered in international learning environment. This activity is carried out by Indonesian students who study abroad e.g. students who study in Germany, Japan, Canada, Australia and USA. This paper will also analyse the feedback from the beneficiaries of the teleconference program, to gather opinion about the prospect, challenges in the administration, organisation, and the pedagogy implication of the use of information communication and technology in schools in Indonesia. The author will also give suggestions or recommendations on the best strategies of improving the use of information technology in schools. This is important to further promote and establish the e-Global-learning-system in Indonesia.

Seamless learning has a significance that has been increasing in recent years, and an increasing number of studies on the subject in the literature draws attention. This study aimed to examine the research on seamless learning between 1996 and 2020 with the bibliometric analysis method. The Scopus database was used in the collection of the data. After various screening processes, a total of 389 publications were included in the analysis. Descriptive analysis and bibliometric analysis were used in the analysis of the data. The distribution of publications by years, types of publications, sources, and languages were analyzed in the research. Additionally, visual maps were created with analyses of co-author, cocitation, and co-word. At the end of the study, it was seen that there has been an increase in the number of publications from the past to the present, articles and papers were predominant, and that most of the studies were carried out in English. As a result of bibliometric analysis, it was concluded that the most efficient countries in seamless learning were the United Kingdom, the United States, and Singapore. Also, it has been determined that the National Institute of Education, Center for International Education and Exchange, and Kyushu University institutions are dominant. The most frequently mentioned authors cited in studies in many different fields are M. Sharples, L.-H. Wong, and H. Ogata. According to the co-word analysis, the keywords seamless learning, mobile learning, ubiquitous learning, and mobile-assisted language learning stand out in the field of seamless learning.

Student learning outcomes assessment examines whether programs cover the material stated in their learning goals, whether students are learning the material, and the impact on student retention, graduation, post-graduation outcomes, and institutional accreditation, with the aim of providing faculty with data that can be used to help programs evolve or improve. While there is a plethora of research regarding effective methods of assessment used in the United States, little has been written regarding cross-national comparisons of assessment methodologies. This paper examines the current state of assessment in several nations and regions, and draws parallels in practices across countries. A literature search using the term "outcomes assessment" yielded 228 articles, of which, only 35 described practices outside the United States. Generally, searches on the terms "outcomes assessment" and "global" tend to return studies of outcomes assessment of teaching about global issues as it is practiced in the United States, rather than results about outcomes assessment practices used in other countries.

The paper looks at part-time higher educational services for students in the educational systems of Australia, Canada, Germany, France, Italy, Japan, The Netherlands, New Zealand, Spain, Sweden, the United Kingdom, and the United States. A comparative examination of the nature and importance of part-time higher education is then presented. (DB)

In this paper, I examine whether generalized trust and education, as well as social security policies of welfare state institutions matter for cross-national differences in subjective well-being (SWB), because knowledge on this issue is still lacking. For this purpose I integrated the insights of two sociological theories: Social Function Production theory and Actor-Centred Institutionalism. Based on these theoretical notions we derived several hypotheses, which I tested using multilevel analysis of the data from the European Social Survey (2006), in a sample of 37,237 respondents from 22 European countries. My findings indicate that various extensiveness of social security policies matter for the level of SWB, and for the impact of education on SWB. I found negative impact of low education on SWB in all countries, except in Northern and Western European countries. This might suggest that social security policies of the latter countries have diminished the negative impact of low education on SWB. Moreover, my findings indicate positive relationship between individual education and generalized trust; as well as between generalized trust and SWB in countries with all five types of social security policies.

In a period of student loan scandals and U.S. financial market instability impacting on the cost and availability of student loans, this paper looks at alternative models of higher education funding. In this context, it also considers the level of financial support that the government should provide to higher education.

Background: Data from the Programme for the International Assessment of Adult Competencies (PIAAC) revealed that countries systematically differ in their respondents' literacy, numeracy, and problem solving in technology-rich environments skills; skill levels also vary by gender, age, level of education or migration background. Similarly, systematic differences have been documented with respect to adults' participation in education, which can be considered as a means to develop and maintain skills. From a psychological perspective, motivation to learn is considered a key factor associated with both skill development and participation in (further) education. In order to account for motivation when analyzing PIAAC data, four items from the PIAAC background questionnaire were recently compiled into a motivation-to-learn scale. This scale has been found to be invariant (i.e., showing full weak and partial strong measurement invariance) across 21 countries. Methods: This paper presents further analyses using multiple-group graded response models to scrutinize the validity of the motivation-to-learn scale for group comparisons. Results: Results indicate at least partial strong measurement invariance across gender, age groups, level of education, and migration background in most countries under study (all CFI > 0.95, all RMSEA < 0.08). Thus, the scale is suitable for comparing both means and associations across these groups. Conclusions:Results are discussed in light of country characteristics, challenges of measurement invariance testing, and potential future research using PIAAC data.

The article presents a study on the impact of multimorbidity on the frequency of participation of older people in Europe in social leisure activities. Topics include the use of data from the European Project on Osteoarthritis (EPOSA), the concept of multimorbidity, and the individual and environmental factors that predict social leisure activity participation among the elderly. It also discusses the continuity theory of Robert Atchley.

Paracetamol is used widely in pediatrics because it has a high drug safety when used in therapeutic dosages. In case of overdose the majority of paracetamol is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is responsible for the severe toxic effects. The covalent connection between NAPQI and hepatic proteins leads to hepatocellular damage and possibly to severe liver failure. The antidote for paracetamol is N-acetylcysteine (NAC). It is a precursor of glutathione and aids to fill glutathione stores. The Rumack-Matthew nomogram should be used to decide on antidote treatment. Pediatric drug metabolism differs from adult metabolism. Children have a larger liver size compared to their body weight than adults, resulting in a higher metabolism rate. Young children seem to be less sensitive to acute intoxication than adults. One hypothesis to explain the lower rate refers to the larger liver size. The acute toxic dosage for children is more than 200 mg/kg body weight. There seems to be a global increase in accidental pediatric paracetamol overdose. Governmental websites of various European Union (EU) countries were searched for legal information on paracetamol availability in pharmacies and non-pharmacy stores. Various EU countries permit prescription-free sales of paracetamol in pharmacies and non-pharmacy stores. In Sweden paracetamol 500 mg may be sold in both pharmacies and non-pharmacies in a maximum pack size of 20 units. In the United Kingdom (UK) paracetamol 500 mg is listed in the general sales list with a maximum pack size of 30 effervescent tablets or 16 tablets. In Ireland paracetamol 500 mg may be sold in a maximum pack size of 12 units in a non-pharmacy. In the Netherlands paracetamol 500 mg is legal to be sold in a maximum pack size of 50 units in a drug store and with a maximum of 20 units in any other non-pharmacy. Several countries in the European Union are permitted to offer paracetamol prescription-free in pharmacies and non-pharmacy stores without legal guidance on the storage position within the store. Further research is needed to investigate whether paracetamol is located directly accessible to young children within the stores in EU countries which permit prescription-free sales of paracetamol. [ABSTRACT FROM AUTHOR]

Aims: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Methods: Health care professionals consisting of, 409GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. Conclusion: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation. [ABSTRACT FROM AUTHOR]

Different lifestyle patterns across Europe may influence plasma concentrations of B-vitamins and one-carbon metabolites and their relation to chronic disease. Comparison of published data on one-carbon metabolites in Western European regions is difficult due to differences in sampling procedures and analytical methods between studies. The present study aimed, to compare plasma concentrations of one-carbon metabolites in Western European regions with one laboratory performing all biochemical analyses. We performed the present study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort among 5446 presumptively healthy individuals. Quantile regression was used to compare sex-specific median concentrations between Northern (Denmark and Sweden), Central (France, Germany, The Netherlands and United Kingdom) and Southern (Greece, Spain and Italy) European regions. The lowest folate concentrations were observed in Northern Europe (men, 10·4 nmol/l; women, 10·7 nmol/l) and highest concentrations in Central Europe. Cobalamin concentrations were slightly higher in Northern Europe (men, 330 pmol/l; women, 352 pmol/l) compared with Central and Southern Europe, but did not show a clear north–south gradient. Vitamin B2 concentrations were highest in Northern Europe (men, 22·2 nmol/l; women, 26·0 nmol/l) and decreased towards Southern Europe (Ptrend< 0·001). Vitamin B6 concentrations were highest in Central Europe in men (77·3 nmol/l) and highest in the North among women (70·4 nmol/l), with decreasing concentrations towards Southern Europe in women (Ptrend< 0·001). In men, concentrations of serine, glycine and sarcosine increased from the north to south. In women, sarcosine increased from Northern to Southern Europe. These findings may provide relevant information for the study of regional differences of chronic disease incidence in association with lifestyle. [ABSTRACT FROM PUBLISHER]

Purpose: Biomedical data governance strategies should ensure that data are collected, stored, and used ethically and lawfully. However, research participants' preferences for how data should be governed is least studied. The Diabetes Research on Patient Stratification (DIRECT) project collected substantial amounts of health and genetic information from patients at risk of, and with type II diabetes. We conducted a survey to understand participants' future data governance preferences. Results will inform the postproject data governance strategy., Methods: A survey was distributed in Denmark, Sweden, The Netherlands, and the United Kingdom., Results: In total 855 surveys were returned. Ninety-seven percent were supportive of sharing data postproject, and 90% were happy to share data with universities, and 56% with commercial companies. The top three priorities for data sharing were highly secure database, DIRECT researchers to monitor data used by other researchers, and researchers cannot identify participants. Respondents frequently suggested that a postproject Data Access Committee should involve a DIRECT researcher, diabetes clinician, patient representative, and a DIRECT participant., Conclusion: Preferences of how data should be governed, and what data could be shared and with whom varied between countries. Researchers are considered as key custodians of participant data. Engaging participants aids in designing governance to support their choices.

Background Finite mixture models posit the existence of a latent categorical variable and can be used for probabilistic classification. The authors illustrate the use of mixture models for dietary pattern analysis. An advantage of this approach is taking classification uncertainty into account. Methods Participants were a random sample of women from the European Prospective Investigation into Cancer. Food consumption was measured using dietary questionnaires. Mixture models identified latent classes in food consumption data, which were interpreted as dietary patterns. Results Among various assumptions examined, models allowing the variance of foods to vary within and between classes fit better than alternatives assuming constant variance (the K-means method of cluster analysis also makes the latter assumption). An eight-class model was best fitting and five patterns validated well in a second random sample. Patterns with lower classification uncertainty tended to be better validated. One pattern showed low consumption of foods despite being associated with moderate body mass index. Conclusion Mixture modelling for dietary pattern analysis has advantages over both factor and cluster analysis. In contrast to these other methods, it is easy to estimate pattern prevalence, to describe patterns and to use patterns to predict disease taking classification uncertainty into account. Owing to substantial error in food consumptions, any analysis will usually find some patterns that cannot be well validated. While knowledge of classification uncertainty may aid pattern evaluation, any method will better identify patterns from food consumptions measured with less error. Mixture models may be useful to identify individuals who under-report food consumption. [ABSTRACT FROM AUTHOR]

The article presents information on the suborbital space flights with reference to national as well as international law. It discusses the legal implications regarding the commercial suborbital flights and also distinguishes between suborbital flights and space rockets. Information on the air and space law regimes signed by the five countries namely Australia, Great Britain, the Netherlands, Sweden and the U.S. is also presented.

Set against the backdrop of counter-trafficking initiatives at international level, this article draws on the findings of a comparative study that investigated (through semi-structured interviews with officials and interest groups) the merits and demerits of domestic level responses in the United Kingdom, Australia, Holland, Sweden and Italy. In a context in which trafficking in women for sexual purposes can be understood through the lens of numerous frameworks (human rights, criminality, prostitution policy, immigration, social exclusion, etc.), this article examines the extent to which these different agendas have influenced the construction and operation of the respective domestic regimes. More specifically, it illustrates the extent to which the ambiguities inherent in the United Nation's most recent Anti-Trafficking Protocol permit scope for the incorporation and/or perpetuation of discretion at domestic level. Highlighting the underlying tensions between competing immigration, human rights, policing and social services imperatives, the differential resolution of which leads to the divergence in domestic response, this article situates this complex engagement in the broader context of debates about globalization, exploitation and prostitution. [ABSTRACT FROM AUTHOR]

This interview attempts to articulate what it might mean to speak for "Padagogik" in an era where new trends in education run the risk of marginalizing "Padagogik" as an independent academic discipline. This trend can be found in several European countries and is judged by Herner Saeverot and Gert Biesta to be a development that is cause for concern. (Contains 2 notes.)

We examine gender differences in the relative poverty of men and women in eight industrialized countries. The analyses are based on data from the Luxembourg Income Study, which includes data from the United States, Canada, Australia, the United Kingdom, West Germany, Sweden, Italy, and the Netherlands. We examine the importance of the gender-specific demographic compositions of marriage, parenthood, and employment in accounting for differences in men's and women's poverty rates, both within and across countries. The cross-national comparisons suggest that the relative importance of demographic characteristics differs by country and that factors such as religion, culture, and government policies also help determine the gap between women's and men's poverty rates. [ABSTRACT FROM AUTHOR]

A key distinction in models of social policy and typologies of welfare provision has been a differentiation between residual and institutional types. However, despite the gradual elaboration of models based on this distinction, there has been little effort to apply them in empirical comparative analysis or to assess the strengths and weaknesses of the models. This article initially examines two main approaches in identifying types of welfare states and major welfare state variations. It subsequently applies severill dimensions of variation posited by the residual and institutional models in a comparison of the United States, the United Kingdom, the Netherlands and Sweden. This comparison forms the point of departure for evaluating the merits and limitations of models based on the residual-institutional distinction. [ABSTRACT FROM AUTHOR]

Cross-national comparisons generally show large differences in life satisfaction of individuals within and between European countries. This paper addresses the question of whether and how job quality and working conditions contribute to the quality of life of employed populations in nine strategically selected EU countries: Finland, Sweden, the UK, the Netherlands, Germany, Portugal, Spain, Hungary, and Bulgaria. Using data from the European Quality of Life Survey 2003, we examine relationships between working conditions and satisfaction with life, as well as whether spillover or segmentation mechanisms better explain the link between work domain and overall life satisfaction. Results show that the level of life satisfaction varies significantly across countries, with higher quality of life in more affluent societies. However, the impact of working conditions on life satisfaction is stronger in Southern and Eastern European countries. Our study suggests that the issue of security, such as security of employment and pay which provides economic security, is the key element that in a straightforward manner affects people's quality of life. Other working conditions, such as autonomy at work, good career prospects and an interesting job seem to translate into high job satisfaction, which in turn increases life satisfaction indirectly. In general, bad-quality jobs tend to be more "effective" in worsening workers' perception of their life conditions than good jobs are in improving their quality of life. We discuss the differences in job-related determinants of life satisfaction between the countries and consider theoretical and practical implications of these findings.

To achieve efficient and effective quality improvement, European universities have gradually adopted organizational strategies, structures, technologies, management instruments, and values that are commonly found in the private business sector. Whereas some studies have shown that such managerialism is beneficial to the quality of job performances of university employees, others have argued that managerialism is largely counterproductive and that it results in lower performances. The latter situation is called a "managerialism contradiction". This paper tests two lines of reasoning underlying a potential contradiction governing the relationship between managerialism and job performances, while using university employee survey data from six European countries (Belgium, Finland, Germany, Netherlands, Sweden, UK). The results tend to support the assumption that managerialism, in these six countries at least, has a positive effect, albeit a modest one, on the quality of performances. The most important conclusion is therefore that there is no managerialism contradiction at work in European universities.

The evaluation of government-financed research has become increasingly important in the last few decades in terms of increasing the quality of, and payoff from, the research that is done, reducing the cost of doing it, and lending public credibility to the manner in which research is funded. But there are very large differences throughout the world in the extent to which systems used promote these results. This paper briefly presents the dimensional results of a study designed to comparatively evaluate the national-level research evaluation models in sixteen countries on five merit-defining dimensions. (Contains 6 figures.)

Background: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator. [ABSTRACT FROM AUTHOR]

Background: Despite significant investments to support primary care internationally, income-based inequities in access to quality health care are present in many high-income countries. This study aims to determine whether low- and middle-income groups are more likely to report poor quality of primary care (PC) than high-income groups cross-nationally. Methods: The 2011 Commonwealth Fund Telephone Survey of Sicker Adults is a cross-sectional study across eleven countries. Respondents were recruited from randomly selected households. We used data from surveys conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We identified all questions relating to primary care performance, and categorized these into five dimensions: 1) access to care, 2) coordination 3) patient-centered care, and 4) technical quality of care. We used logistic regression with low and middle-income as the comparison groups and high-income as the referent. Results: Fourteen thousand two hundred sixty-two respondents provided income data. Countries varied considerably in their extent of income disparity. Overall, 24.7% were categorized as low- and 13.9% as high-income. The odds of reporting poor access to care were higher for low- and middle-income than high-income respondents in Canada, New Zealand and the US. Similar results were found for Sweden and Norway on coordination; the opposite trend favoring the low- and middle-income groups was found in New Zealand, United Kingdom, and the United States. The odds of reporting poor patient-centered care were higher for low-income than high-income respondents in the Netherlands, Norway, and the US; in Australia, this was true for low- and middle-income respondents. On technical quality of care, the odds of reporting poor care were higher for the low- and middle-income comparisons in Canada and Norway; in Germany, the odds were higher for low-income respondents only. The odds of reporting poor technical quality of care were higher for high-income than low-income respondents in the Netherlands. Conclusion: Inequities in quality PC for low and middle income groups exist on at least one dimension in all countries, including some that in theory provide universal access. More research is needed to fully understand equity in the PC sector. [ABSTRACT FROM AUTHOR]

Background: Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. Methods: In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. Results: Overall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. Conclusion: A greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed. [ABSTRACT FROM AUTHOR]