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Background: The role of patients in healthcare research is slowly evolving, although patient roles in the research process are limited. This paper reports on a patient‐led research project aiming to develop a musical hearing training programme for patients with a cochlear implant (CI): the Musi‐CI programme. A CI is an inner ear prosthesis that allows people with severe hearing loss to hear. However, while speech can be understood, CI users cannot fully enjoy music or feel aversion to it. The Musi‐CI programme aims to reduce this music aversion to ultimately improve music enjoyment and social participation. The development of the Musi‐CI programme was supported by a consortium of professionals in CI rehabilitation and research. The aim of this paper is to describe and evaluate the Musi‐CI programme development process and its impact on professional CI rehabilitation and research. Methods: Programme development was described using a 3‐layered process model of action research, distinguishing the CI user process, the healthcare professional process and the research process. To evaluate perceptions on the programme development process, consortium partners provided written comments and participated in a reflexive evaluation session that was video‐recorded. Reflexive evaluation aims for collective learning and strengthening collaboration among participants. Written comments and video data were analysed using template analysis. Results: The involvement of an expert by experience was perceived as challenging but rewarding for all consortium partners, opening up new perspectives on CI‐rehabilitation practice and research. Data analysis revealed two themes on the programme development process, professional space and acknowledgement, and two themes on the outcomes on CI rehabilitation and research: critical reflection and paradigm shift. Conclusion: Experts by experience represent a different knowledge domain that may contribute to change in rehabilitation and research. Patient or Public Contribution: The development of the programme was initiated by a professional musician and CI user who organized the funding, had a leading role throughout the research process, including the write‐up of the results, and co‐authored this paper. [ABSTRACT FROM AUTHOR]

Background: Self‐harm is a major public health concern. Lifetime prevalence is high, and rates of self‐harm are rising; however, available interventions do not benefit everyone, and engagement with therapy can be low. Qualitative accounts allow for a greater understanding of what is helpful to individuals. This study aimed to synthesize the experiences of interventions for self‐harm, from participants who have participated in these themselves. Methods: Participants had self‐harmed at least once and undergone an individual psychotherapeutic intervention for self‐harm. Papers not written or translated to the English language were excluded. Four databases (Medline, CINAHL, Web of Science and PsycINFO) were systematically searched and each paper was assessed using the CASP quality appraisal tool. A meta‐ethnographic approach to the synthesis was taken. Results: Ten studies encompassing 104 participants were included. Four overarching themes were developed and the importance of recognizing the person beyond the self‐harm emerged through a line of argument synthesis. Building a trusted, therapeutic relationship founded on patience and without judgement was essential for the perceived success of therapy, which was unique to each person and often went beyond reducing self‐harming behaviours. Limitations: Papers included in the study showed a lack of diversity with regard to ethnicity and gender. Conclusions: The findings illustrate the importance of the therapeutic alliance when working with self‐harm. Clinical implications of this paper include the importance of utilizing key therapeutic competencies which should be considered fundamental to change within psychotherapeutic interventions for self‐harm, with the uniqueness of each patient recognized throughout. [ABSTRACT FROM AUTHOR]

Introduction: Despite the advancements in Patient and Public Involvement and Engagement (PPIE), the voices of traditionally underserved groups are still poorly reflected in dementia research. This study aimed to report on a PPIE partnership between academics and members of the public from underserved communities to co‐design Forward with Dementia—Social Care, a resource and information website supporting people receiving a dementia diagnosis. Methods: The PPIE partnership was set up in four stages: 1–identifying communities that have been under‐represented from PPIE in dementia research; 2—recruiting PPIE partners from these communities; 3—supporting PPIE partners to become confident to undertake their research roles and 4—undertaking research co‐design activities in an equitable fashion. Results: To address under‐representation from PPIE in dementia research we recruited seven PPIE partners from Black, Asian and other minority ethnic groups; lesbian, gay, bisexual, transgender, queer+ communities; remote/rural area; religious minorities and partners living with rare forms of dementia. The partners met regularly throughout the project to oversee new sections for the study website, refine existing content and promote the website within their communities. Conclusion: Strategies can be used to successfully recruit and involve PPIE partners from underserved communities in co‐design activities. These include networking with community leaders, developing terms of reference, setting out 'rules of engagement', and investing adequate resources and time for accessible and equitable involvement. These efforts facilitate the co‐design of research outputs that reflect the diversity and complexity of UK contemporary society. Patient or Public Contribution: This study received support from seven members of the public with lived experience of dementia from communities that have been traditionally underserved in dementia research. These seven members of the public undertook the role of partners in the study. They all equally contributed to the study design, recruitment of participants, development and revision of topic guides for the interviews and development of the website. Three of these partners were also co‐authors of this paper. On top of the activities shared with the other partners, they contributed to write independently of the academic team the section in this paper titled 'Partners' experiences, benefits and challenges of the partnership'. Further, they provided input in other sections of the paper on a par with the other (academic) co‐authors. [ABSTRACT FROM AUTHOR]

Background: Online interaction in blended learning is leveraged through social presence and convergence. However, little systematic work currently exists on how researchers have explored these challenges in higher education institutions and no studies have synthesised these challenges. Objectives: The purpose of this study is to give a novel overview of social presence and convergence to improve online interaction in blended learning in higher education. The findings will be synthesised into blended learning design principles. Method: Two systematic literature reviews, one on each challenge, were carried out through the Web of Science databases and consulting cited sources in review articles. Accordingly, 28 distinct studies were selected through the guidelines of the PRISMA statement, using predefined selection criteria. Results and Conclusions: The results show that social presence in blended learning is mostly evoked through course design, introductory f2f meetings, collaborative activities, prompt online feedback, the teacher's presence, and planned facilitation. To establish convergence, it is recommended to make basic theory available online through video clips, web‐lectures, articles, followed by simple online assignments or self‐study to increase understanding, thereby creating opportunities for deep learning during face‐to‐face through discussions and collaborative activities. Implications: This paper adds to the theory on blended learning and instructional design in higher education, and further offers an elaborate set of design principles for educational practice. Future research on instructional design may investigate in particular how a target group or student factors, are affected by the blended learning environment in order to tailor designs for a specific target group. Lay Description: What is known?: Online interaction is pivotal in blended learningOnline interaction is leveraged through social presence and convergenceSocial presence prevents the online student from feeling lonelyConvergence entails deciding the best‐suited delivery mode: online or face‐to‐face What this paper adds: A novel overview and critical analysis of social presence in blended learningA novel overview and critical analysis of convergence in blended learningA synthesis of the findings on social presence and convergenceExtraction of the findings into blended learning design principles Implications for practitioners: The teacher's presence through design and accessibility fosters students' social presencePlacing concepts online leaves room for deep learning during face‐to‐faceCollaborative activities evoke social presence and facilitate deep learningBlended learning designs should be further tailored for the target group [ABSTRACT FROM AUTHOR]

Background: Both socially regulated learning and cognitive quality are important factors affecting collaborative knowledge building, but the current research lacks a joint quantified evaluation method that combines these two aspects. Objectives: Based on the existing framework, we proposed a joint evaluation method for regulated learning and cognitive quality in collaborative knowledge building, and further extracted the evaluation indicators. Methods: This study involved 74 learners enrolled in a course named 'the Application of Modern Educational Technology' as the subject of study, and made a case analysis with this method. Results and Conclusions: First, the indicators of this joint evaluation method could complement the indicators of traditional frequency statistics methods and facilitate an analysis of regulated learning and cognitive quality in collaborative knowledge building. Second, the group with a higher proportion of high‐level cognitive quality and socially shared regulation in collaborative knowledge building achieved better final scores. Finally, four types of groups were obtained through clustering: excellent, risky, mixed group, and highly collaborative group. This study introduced a joint evaluation method for regulated learning and cognitive quality in collaborative knowledge building and provides suggestions for future research. Lay Description: What is currently known about this topic?: Online collaborative knowledge building is increasingly important.Regulated learning and cognitive quality are considered very important for successful collaborative learning.Without quantitative methods, it is difficult to assess regulated learning and cognitive quality during collaborative knowledge building in a timely manner. What does this paper add?: This paper provided a joint evaluation method of regulated learning and cognitive quality (JERC) for online collaborative knowledge building.A case study was conducted to identify JERC's usefulness. Using descriptive statistics and visualization, it was determined that indicators of JERC can not only capture the state of cognitive quality and regulated learning status, but also elucidate the nature of that status (i.e., comprehensive, dynamic, cyclical).Through clustering analysis, four distinct groups were identified, each exhibiting different characteristics and moving patterns of regulated learning and cognitive quality over time. These patterns indicate that the quality of cognitive and regulatory learning cannot be determined solely by behavioural frequency. Moreover, an excessive proportion of individual regulation cannot predict better learning performance. Implications for practice: A computable representation model of regulated learning and cognitive quality was constructed to support automated perception and intervention in regulated learning and cognitive processing.With JERC, it is possible for researchers to capture, process, analyse and predict dynamic data to examine online collaborative knowledge building combined with shared physiological arousal events.The results of JERC can be used by researchers to develop advanced techniques, such as AI deep learning, for designing adaptive supports that can foster students' online collaborative knowledge building. [ABSTRACT FROM AUTHOR]

Community engagement (CE) at Rhodes University (RU) and community psychology draw on similar principles: using an asset‐based community development approach; recognising and drawing on the skills, capabilities, and knowledge of all parties, which they contribute to a partnership. Working from a strategic model of engagement, mutuality is foreground in all CE activities, where both student volunteers and community partners jointly benefit from the engagement. This paper examines CE at RU and how CE principles are translated into practise, using Siyakhana@Makana (S@M) as a case study. In S@M, a 19‐week‐long volunteer programme, community partners and student volunteers are jointly involved in planning, executing, and evaluating CE activities together. This paper illustrates how being involved in such CE activities has enabled community partners to mobilise for effective change in their communities. Community partners reflect on how they have been empowered to taken on leadership roles, addressing local challenges in collaborative ways, while drawing on the skills and knowledge that they have gained through their engagements in S@M. This resonates with the social action model of community psychology, a participatory approach that seeks to mobilise people to bring about change in the contexts in which they live. [ABSTRACT FROM AUTHOR]

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

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Introduction: Those with severe and enduring mental ill health are at greater risk of long‐term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. Methods: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. Results: This priority setting exercise guided by people's needs and lived experience has produced a set of well‐defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. Conclusions: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. Patient or Public Contribution: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops. [ABSTRACT FROM AUTHOR]

Introduction: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. Methods: The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. Findings: Patients and clinicians perceived changes to continuity in PCNs in our study. Larger‐scale care provision in PCNs required better care coordination and information‐sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. Conclusions: New practitioners need to be effectively integrated to support effective team‐based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow‐up care. Patient and Public Involvement (PPI): A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings. [ABSTRACT FROM AUTHOR]

Introduction: Involving service users in health service design and delivery is considered important to improve the quality of healthcare because it ensures that the delivery of healthcare is adapted to the needs of the users. Co‐production is a process used to involve service users, but multiple papers have highlighted the need for the mechanisms and values guiding co‐production to be more clearly stated. The aim of this paper was to evaluate the mechanisms and values that guided the co‐production approach of the Stories for Change project, which used Public Narrative as part of the co‐design process to create change in National Health Service maternity services. Methods: This study was conducted using a rapid feedback evaluation approach. Semistructured interviews (n = 16) were the main source of data, six of which were maternity service users, with observations (5 h) and documentary analysis also carried out in parallel. RREAL sheets were used for data analysis to organize data based on key topics of interest. Results: This study identified three broad mechanisms and values underpinning the co‐production approach: creating an open and safe space to share ideas, learning how to tell stories using Public Narrative and having service providers who play a key role in strengthening the health system listen to stories compelling them to action. This study identified the main areas for improvement of the Stories for Change project related to recruitment, the inclusion of participants, the co‐design process, the Skills Session and the Learning Event. Conclusion: Our study provided a deeper understanding of the co‐production approach that addresses the need to uncover the mechanism and values underlying co‐production and co‐design approaches. This study expands on the literature pertaining to the influence of storytelling in creating meaningful change in health care. We propose a co‐design methodology that uses Public Narrative as a model for service user engagement to help inform future healthcare development processes. Patient or Public Contribution: The experiences and perceptions of maternity service users and health professionals informed this evaluation. The project organizers were involved in the manuscript preparation stage by providing feedback, and service users wrote a commentary on the project from the lived experience perspective. [ABSTRACT FROM AUTHOR]

Despite a history of critique, concentrated discussion and improved assessment processes, neglect continues to be a major challenge for child protection services. This paper draws on findings from a government‐commissioned analysis of 'serious case reviews' (SCRs) in England, arising from incidents of serious child abuse in 2017–2019. There were 235 cases, for which 166 final reports were available. Alongside a quantitative analysis of the whole cohort, we undertook an in‐depth qualitative analysis of 12 cases involving neglect. A key challenge in responding to neglect in its different forms is that it can be so widespread amongst families that practitioners no longer notice its severity or chronicity – it becomes normalised. In this paper we explore two dimensions of the 'paradox of neglect' where it seems to be everywhere and nowhere simultaneously. The first is that neglect is so closely bound up with the prevalence of poverty that little action is taken to address it. The second is that the overwhelming nature of neglect can blind practitioners to other forms of maltreatment that may also be present within a family. Practitioners, now more than ever, need to recognise the dimensions of this paradox to protect children from neglect. [ABSTRACT FROM AUTHOR]

The independent review of children's social care (2022) has proposed a radical reset of England's children's services, shifting a remote, assessment heavy system towards one that works alongside communities to help prevent statutory interventions. However, notions around the harnessing of community resources to deliver Early Help are often underpinned by assumptions regarding the voluntary, community and social enterprise (VCSE) sector and the ease with which such organizations can be integrated into preventative strategies. This paper reports findings from embedded research within a unitary authority in Southwest England during remodelling of its Early Help service to work more collaboratively with local VCSE organizations. The study generated data from ethnographic observations, semi‐structured interviews and focus groups with 95 participants, including local parents, service providers, VCSE organizations and Council leaders. The findings illustrate that families value the compassionate, responsive and flexible support available within many VCSE settings. However, differences in practice cultures, regulatory pressures on statutory providers, the need to (re)build trust in communities and sensitivities around power‐sharing and resourcing meant negotiating VCSE sector integration was fraught with complexities. Few studies have gained such privileged access to a Local Authority's remodelling of Early Help services, and this paper has significant insights for the debates surrounding the independent review of children's social care (2022) and its recommendation to bring services 'closer to communities'. [ABSTRACT FROM AUTHOR]

Background: Preceptorship has been found to be effective in supporting Newly Qualified Nurses (NQNs) during their transition into challenging environments, particularly in addressing issues related to confidence and anxiety. Effective preceptorship is an element of best practice and essential to support NQNs' transition into the critical care setting. However, the impact of preceptorship on NQNs and their preceptors in critical care units is yet to be completely understood. Aim: To review the impact of preceptorship on NQNs and preceptors working in a critical care environment. Study Design: An integrative literature review of the literature. The review employed Whittemore and Knafl's (2005) five‐stage integrative review approach. Methods: Three databases (MEDLINE, CINAHL and PsycINFO) were searched for papers published between January 2010 and May 2022. The PRISMA framework was used to guide the search and screening. Thematic analysis was used to extract, organize and analyse the data. Results: Nine studies were included in this review. Reflective thematic analysis revealed three themes, with four related subthemes. Preceptorship has an impact on the development of the NQNs and preceptors' 'nurturing' relationship. NQNs develop their knowledge, competence and confidence when experiencing supportive preceptorship. Meanwhile, preceptors experience a combination of increased workload and opportunities for learning and professional development as a result of preceptorship. Conclusion: There is evidence of the impact of preceptorship on learning and professional development for both NQNs and preceptors, but this is a complex phenomenon and further research is required to understand this area more fully. Relevance to Clinical Practice: In nursing practice, it is well‐established that Newly Qualified Nurses (NQNs) often face heightened levels of anxiety and a lack of confidence when embarking on their careers, particularly in the demanding and stressful environment of critical care units. This review holds particular significance in the realm of clinical practice as it delves into the pivotal role of preceptorship in nurturing the professional growth and development of NQNs within the challenging domain of critical care. Effective preceptorship, as an essential component of best practice, plays a pivotal role in aiding NQNs' transition into critical care settings. [ABSTRACT FROM AUTHOR]

Co‐production is a collaborative way of working which emphasises the exchange of diverse forms of knowledge in an equal partnership for equal benefits. Co‐produced research is a key strategic aim of the UK Research and Innovation (UKRI) Transforming UK Food Systems (TUKFS) Strategic Priorities Fund; this research programme brings together researchers, policymakers, industry and communities to create positive change in the way food is produced, accessed and consumed. However, more generally, there are diverse understandings of co‐production and a lack of consensus on what 'good practice' looks like. Therefore, this study aimed to identify and map examples of co‐production methods employed across the TUKFS programme. Two creative workshops (n = 15 participants), conversations with TUKFS researchers and stakeholders (n = 15), and systematic analysis of project documents were used to critically explore co‐production activities within six TUKFS projects. A range of co‐production activities were identified. Findings highlighted areas of 'messiness' and complexity, challenges associated with applying co‐production approaches and practical solutions. Four key shared principles for co‐production were identified: (1) Relationships: developing and maintaining reciprocity‐based partnerships; (2) Knowledge: recognising the contribution of diverse forms of expertise; (3) Power: considering power dynamics and addressing imbalances; and (4) Inclusivity: ensuring research is accessible to all who wish to participate. Opportunities for reflection and reflexivity were considered crucial across all these areas. Findings contribute important insights towards a shared conceptual understanding of co‐production for food system transformation research. This paper makes recommendations for researchers, practitioners, academic institutions and funders working in this area of research and practice. [ABSTRACT FROM AUTHOR]

The context of this paper is family situations where young people are experiencing significant behavioural and emotional problems. Based on a qualitative study, it offers an empirical and theoretical contribution to the understanding of family‐related factors that promote or hinder behaviour change. Data were collected through face‐to‐face, semi‐structured group interviews with nine families (28 participants), all of them mandatory recipients of child welfare services in Croatia. Thematic analysis comprised primary coding designed to elicit information about individual family members' capacity for change and secondary coding of family‐level phenomena. The results indicated 10 phenomena that were judged to represent factors that helped or hindered change. The discussion section suggests three broad categories of capacity to change at family level (Goals and Priorities; Problem solving dynamics; and Development of role relationship). This analysis is offered as the basis for an examination of the concept of family capacity for change. [ABSTRACT FROM AUTHOR]

Background: Science history is a discipline that teaches the development of scientific thought and the discoveries of scientists. However, these topics can sometimes be abstract and difficult to understand. The use of technology can make the teaching of the history of science more effective, engaging, and accessible. By providing students with visual and interactive experiences, it allows them to better understand abstract concepts and closely follow the discoveries of scientists. In this way, history of science lessons can become more appealing and conducive to learning for students. Objectives: This research aims to design and develop a Mobile Augmented Reality (MAR) environment that can be used for teaching science history. Methods: The research was conducted using a design‐based research method consisting of four stages: Analysis, design, development‐implementation‐evaluation, and reporting. The research involved 10 science teachers and five secondary school students. Data were collected through focus group interviews, individual interviews, notes, audio recordings, and images, and then analysed using content analysis. Results and Conclusions: As a result of the research, a MAR application named TISAR‐3D was developed, which allows students to interactively and visually explore scientists and enrich their learning experience. Implications: The widespread use of the TISAR‐3D application in science history education is recommended, as well as the development of similar MAR applications for other topics. Lay Description: What is known about this topic: AR technology is an increasingly used technology in education.AR technology is effective in teaching the history of science.AR makes abstract concepts concrete and provides interactive experiences for students. What this paper adds: The research focuses on the development of a MAR application called TISAR‐3D.The application supports Turkish and English languages and offers voice narration.The role of scientists in the history of science is not sufficiently known.Scientists are not adequately represented in textbooks. Implications of the study findings for practitioners: Include more scientists in the app for a broader learning experience.Include more interactive activities in the app for a fun learning experience.Teachers should extend more time to accommodate the app's use in class. [ABSTRACT FROM AUTHOR]

Background: Some studies have researched the correlation between flipped learning and cognitive learning outcomes; however, there is a paucity of research elaborating on the effects of flipped language learning on cognitive load (CL). Objectives: This study investigates the effects of using flipped learning designs (student‐led, teacher‐led and collaboration‐led) on learning outcomes and CL management during out‐of‐class activities versus during‐class activities. Methods: A mixed methods research was used to concurrently triangulate different strands of data on the effects of flipped learning designs on English as foreign language (EFL) learners' learning outcomes and CL. A total of 122 EFL learners were randomly assigned to either the control or experimental group and participated in the study. The interpretations were made based on running one‐way analysis of variance between four groups. Results and Conclusion: This study evidenced the efficacy of the interactive use of collaboration‐led flipped learning design over student‐led and teacher‐led designs for improving learning outcomes and lowering CL during computer‐assisted language learning (CALL) course. Pedagogically, CALL practitioners need to develop and integrate a well‐organized combination of student‐led and teacher‐led flipped learning activities for during‐class and out‐of‐class phases with respect to the CL and learning material complexity, while also considering the specific contexts and goals of their instructional settings. Theoretically, the results indicate the necessity of merging active learning and sociocultural theories into an instructional design to take advantage of the identified affordances of flipped language learning approach in terms of psychological effects (CL management) and learning effects (CALL outcomes). Lay Description: What is already known about this topic: The flipped language learning approach involves receiving online instruction outside the classroom and is a learner‐centered pedagogy. What this paper adds: This study contributes by triangulating different strands of data on the effects of flipped learning designs on learning outcomes and cognitive load.The findings highlight the effectiveness of collaboration‐led design for flipped language learning, facilitating engagement in both out‐of‐class and during‐class activities. Implications for practice: The findings emphasize the importance of designing and implementing instructional designs that align with emerging educational technologies.Teachers should consider the flexibility, fluency and novelty of the learning material when designing flipped learning activities. [ABSTRACT FROM AUTHOR]

Background: Public involvement in health services research is encouraged. Descriptions of public involvement across the whole research cycle of a major study are uncommon and its effects on research conduct are poorly understood. Aim: This study aimed to describe how we implemented public involvement, reflect on process and effects in a large‐scale multi‐site research study and present learning for future involvement practice. Method: We recorded public involvement roles and activities throughout the study and compared these to our original public involvement plan included in our project proposal. We held a group interview with study co‐applicants to explore their experiences, transcribed the recorded discussion and conducted thematic analysis. We synthesized the findings to develop recommendations for future practice. Results: Public contributors' activities went beyond strategic study planning and management to include active involvement in data collection, analysis and dissemination. They attended management, scrutiny, planning and task meetings. They also facilitated public involvement through annual planning and review sessions, conducted a Public Involvement audit and coordinated public and patient input to stakeholder discussions at key study stages. Group interview respondents said that involvement exceeded their expectations. They identified effects such as changes to patient recruitment, terminology clarification and extra dissemination activities. They identified factors enabling effective involvement including team and leader commitment, named support contact, building relationships and demonstrating equality and public contributors being confident to challenge and flexible to meet researchers' timescales and work patterns. There were challenges matching resources to roles and questions about the risk of over‐professionalizing public contributors. Conclusion: We extended our planned approach to public involvement and identified benefits to the research process that were both specific and general. We identified good practice to support effective public involvement in health services research that study teams should consider in planning and undertaking research. Public Contribution: This paper was co‐conceived, co‐planned and co‐authored by public contributors to contribute research evidence, based on their experiences of active involvement in the design, implementation and dissemination of a major health services research study. [ABSTRACT FROM AUTHOR]

Children's participation in decision‐making remains a key focus of social work practice. Yet the protection and participation of children in our society remains a setting of tension for children, families and practitioners. Drawing on evidence from a retrospective qualitative study on Family Group Conferencing, this paper uses the lens of recognition theory to highlight the experiences of young people more broadly in the social work system. The study found social workers' attitudes affected children and young people's capacity to be 'partners' in decision‐making. Feelings of misrecognition can create barriers for how children and young people perceive and interact with social work professionals. While small, this study sheds light on the experiences of young people's struggles for recognition when involved in the social work system. Further research is needed on this topic to fully understand the implications of (mis)recognition in social work practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including relationship-based leadership; leadership literature; and organizational design.

Aim: To evaluate a year‐long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. Background: Investment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. Program evaluation: Using the logic model of program evaluation, this non‐empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. Discussion: The value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. Conclusion: This evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. Implications for nursing practice: Nurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well‐being of their workforce. Implications for nursing policy: Every nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future. [ABSTRACT FROM AUTHOR]

Background: Partnership research practices involving various stakeholder groups are gaining ground. Yet, the research community is still exploring how to effectively coproduce research together. This study describes (a) key programme developments in the creation of a 6‐year partnership research programme in Sweden, and (b) explores the hopes, expectations, and experiences of patient innovators (i.e., individuals with lived experience as patients or caregivers who drive health innovations) and researchers involved in the programme during the first years. Methods: We conducted a prospective longitudinal qualitative study spanning the first 2 years of the programme. Data consisted of meeting protocols and interviews with 14 researchers and 6 patient innovators; 39 interviews were carried out in three evenly‐spaced rounds. We identified significant events and discussion themes in the meeting protocols and analyzed the interviews using thematic analysis, applying a cross‐sectional recurrent approach to track changes over time. Findings: Meeting protocols revealed how several partnership practices (e.g., programme management team, task forces, role description document) were cocreated, supporting the sharing of power and responsibilities among programme members. Based on the analysis of interviews, we created three themes: (1) paving the path to a better tomorrow, reflecting programme members' high expectations; (2) going on a road trip together, reflecting experiences of finding new roles and learning how to cocreate; (3) finding the tempo: from talking to doing, reflecting experiences of managing challenges and becoming productive as a team. Conclusions: Our findings suggest that sharing, respecting, and acknowledging each other's experiences and concerns helps build mutual trust and shape partnership practices. High expectations beyond research productivity suggest that we need to consider outcomes at different levels, from the individual to society, when evaluating the impact of partnership research. Patient or Public Contribution: The research team included members with formal experiences as researchers and members with lived experiences of being a patient or informal caregiver. One patient innovator coauthored this paper and contributed to all aspects of the research, including the design of the study; production of data (as interviewee); interpretation of findings; and drafting the manuscript. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present the evidence shared with a citizen Consensus panel detailing key issues associated with how nursing CPD can best influence the quality of health and social care experienced by citizens and communities. It presents a summary of contemporary theory, research and evidence of the effectiveness of nursing CPD and outlines four key challenges: (i) how to strengthen the focus on patient experience as the starting point for CPD; (ii) the lack of evidence of CPD effectiveness and accountability in its transfer to practice; (iii) evaluation of CPD effectiveness; and (iv) involving citizens in targeting CPD where it is most needed. It briefly describes the methods used to facilitate public consultation through a citizen Consensus panel as part of a collaborative project with the RCN Strategic Research Alliance in 2020 and outlines 7 themes identified as important by the public for future development. The main challenge for nursing is capitalizing on the workplace as a learning resource that can integrate learning with development, improvement, knowledge translation, inquiry and innovation. This requires skilled facilitators, particularly at meso‐ levels, and systems leaders with the full skillset to develop system‐wide cultures of learning that enable everyone to flourish and create good places to work. The paper concludes that the development of CPD process measures would indicate how CPD investment contributes to person‐centred, safe and effective care and system transformation and enable commissioners and education providers to optimize CPD's full potential. [ABSTRACT FROM AUTHOR]

Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician‐specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke. Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke. Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi‐structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method. Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'. Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke. WHAT THIS PAPER ADDS: What is already known on this subject: Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variability in clinical practice. Clinician‐specific and workplace factors influence clinical practice and may contribute to variability in dysphagia rehabilitation. What this study adds: Professional relationships influence speech pathologists' clinical practice, including relationships between senior and junior clinicians, between inpatient and community settings and with peers and multidisciplinary teams. Workplace norms and hierarchies, poor continuity of care between settings and competing priorities from other disciplines can hinder dysphagia rehabilitation. However, collaborative learning, positive workplace cultures and respectful transdisciplinary care can improve the quality and consistency of clinical practice. What are the clinical implications of this work?: Flattening hierarchies in the workplace can foster a safe learning space. Further, questioning workplace norms and seeking out peer learning within and across settings can build clinical skills and confidence. Developing positive workplace cultures that support continuous development may be key for empowering speech pathologists to provide high‐quality and consistent dysphagia rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Undergraduates' collective epistemic agency is critical for their productive collaborative inquiry and knowledge building (KB). However, fostering undergraduates' collective epistemic agency is challenging. Studies have demonstrated the potential of computer‐supported collaborative inquiry approaches, such as KB—the focus of this study, and reflective assessment to foster collective epistemic agency. Objectives: This study used a quasi‐experimental design to examine the impact of reflective assessment on undergraduates' collective epistemic agency and the mechanisms of this impact. Methods: An experimental class, comprising 40 undergraduates, engaged in KB inquiry enhanced by analytics‐assisted reflective assessment, while a comparison class, comprising 41 undergraduates, engaged in portfolio‐supported reflective assessment in KB inquiry. Classroom observations, audio recordings of group discussions and reflections, and student artefacts were collected in both conditions. Results and Conclusions: The experimental class demonstrated significantly higher levels of collective epistemic agency than the comparison class, as indicated by their collective knowledge advancement and epistemic and metacognitive actions. Qualitative thematic analysis revealed that reflective assessment enhanced the undergraduates' collective epistemic agency through their collective monitoring and regulation of inquiry and ideas, negotiation and synthesis of the community's ideas, conceptualization of collective theories and identification of collective inquiry trajectories with an internal reflective structure. Major Takeaways: Higher‐level metacognitive actions are critical for productive collaborative inquiry and higher‐level epistemic agency that does not often occur naturally and should be promoted by appropriate scaffolding strategies. Students need data from learning analytics and accompanying prompt sheets to help them develop the internal metacognitive structure for agency and learning. Lay Description: What is currently known about this topic?: Undergraduates' collective epistemic agency (CEA) is critical for productive KB.Analytics‐assisted reflective assessment (AARA) are promising in fostering CEA. What does this paper add?: AARA has positive influences on students' CEAAARA helps students develop CEA through the following mechanisms.AARA supports students' collective regulation and negotiation of collective ideas.AARA enhances conceptualization and deepening of collective trajectories with an internal reflective structure. Implications for practice/or policy: Higher‐level metacognitive actions are critical for collaborative inquiry and CEAAnalytics‐assisted RA can enhance students' higher‐level metacognitive actions.Students should be provided with learning data and appropriate scaffolding strategies.These data and strategies can develop students' internal metacognitive structure crucial for agency and learning. [ABSTRACT FROM AUTHOR]

Objective: To articulate how Aboriginal community‐controlled art centres support the role of Elders and older people within an ontologically situated, intergenerational model of care. Methods: In this paper, we draw on stories (data) generated through interviews involving 75 people associated with three Aboriginal community‐controlled art centres and field notes taken during a Participatory Action Research (PAR) study. The study was undertaken in collaboration with three community‐controlled art centres and two aged care providers over almost 4 years, in diverse Indigenous sovereignties, all located in geographically remote Australian locations. Results: Engaging with decolonising and Indigenous theoretical frameworks, our analysis identified three interwoven meta‐themes. These include connection to law and culture; purpose; and healing. Each theme had important subthemes, and all were central to upholding the well‐being of older people and their families, as well as the art centre workforce, Country, and their broader communities. Conclusions: Our analysis articulates an ontologically situated model of care within Aboriginal community‐controlled art centres. The model sees that older people receive care from art centres and provide care to each other, to younger generations, to art centre staff, to Country, and to their broader communities. In this model, those in receipt of care, many of whom are older people, art centre directors, and important artists, govern how care is conceptualised and delivered. [ABSTRACT FROM AUTHOR]

Introduction: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence‐based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well‐established barriers to mental health help‐seeking and improve outcomes for this at‐risk group. Objective: This paper describes the findings of a co‐design phase informing the development of a peer (farmer)‐led approach for delivering BA for farmers living with depression or low mood. Design: This qualitative study used a co‐design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. Findings: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context—tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. Discussion: Findings suggest BA could be a contextually appropriate model of support for the farming community—given its practical and solution‐focused approach—and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. Conclusion: Insights gained through co‐design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood. [ABSTRACT FROM AUTHOR]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Child abuse and neglect is a complex problem that needs to be addressed through a multidisciplinary approach. Nurses internationally have frequent contact with children and are ideally placed to respond to children experiencing abuse and neglect. Nurses' roles can include reporting abuse to child protection services (CPS). This paper reports on one aspect of the findings of a qualitative study exploring Australian nurses' perceptions and experiences of keeping children safe from abuse. Specifically, this paper reports on the theme relating to nurses' experiences of communicating their concerns to CPS and the family when reporting abuse and neglect. This qualitative study was underpinned by social constructionism, with data collected through semi‐structured interviews with 21 nurses working with children in Australia. Key findings reported are: (1) being heard; (2) [feeling] disappointed, discouraged and disenfranchised; and (3) managing tensions between engagement and reporting. Nurses at times perceived that they were not taken seriously by CPS and felt powerless to enact change for children. Nurses subsequently had to decide how, and if, to discuss their report with families to mitigate negative reactions and maintain engagement. This study highlights the need for more effective multidisciplinary collaboration between nurses and CPS to promote change for children affected by abuse in Australia. 'This paper reports on... nurses' experiences of communicating their concerns to CPS and the family' Key Practitioner Messages: Nurses often perceived that they were not taken seriously by CPS and felt powerless to make a difference for children.Nurses experienced a tension between openly discussing their intention to report with families and minimising negative reactions such as disengagement and mistrust.This study highlights the need for greater collaboration between CPS and nurses to promote shared understanding and effective action to promote the wellbeing of children experiencing abuse and neglect. [ABSTRACT FROM AUTHOR]

This study explores perceptions of child abuse and child protection matters involving staff working in the out‐of‐school‐hours care (OSHC) sector. Quantitative and qualitative data were collected through an online survey, focus group and interviews with staff and managers employed by one organisation that provided OSHC services in Sydney, Australia. This paper reports on their perceptions about implementing mandatory reporting requirements associated with the concepts of 'significant harm' and 'reportable conduct'. The aim of this paper is to engage OSHC stakeholders, including government, in reviewing child protection policies and practices to support educators in their work with children. Key findings indicate the inadequacy of available training, and the importance of relationships and communication between stakeholders, especially OSHC and school staff. This requires systemic change including raising the status of OSHC and the critical role that these educators have in supporting children's development, learning and wellbeing during the early years of school. Key Practitioner Messages: It is important that leadership supports educators to engage in respectful partnerships with families and schools to ensure child protection, and thereby child wellbeing and learning outcomesTraining in supporting children's safety and wellbeing in OSHC is critical.There is a need for a systems approach to OSHC services which places children's development, learning and wellbeing at the forefront of professional practice. 'Explores perceptions of child abuse and child protection matters involving staff working in the out‐of‐school‐hours care (OSHC) sector' [ABSTRACT FROM AUTHOR]

Background: There is limited evidence of genuine equal partnership where power is shared with young people with mental health difficulties throughout all research stages, particularly in data collection and analysis. Objective: To describe how our qualitative study, exploring young peoples' perceptions on the feasibility of using technology to detect mental health deterioration, was co‐produced using principles of co‐production, whilst reflecting on impact, challenges and recommendations. Methods: Young people with experience of mental health difficulties were appointed and then worked with researchers throughout all research stages. The study was evaluated against the five principles of co‐production. Reflections from researchers and young people were collected throughout. Results: Seven young people formed an initial Young People's Advisory Group (YPAG); three became co‐researchers. Reflection was key throughout the process. Sharing power became easier and more evident as trust, confidence and mutual respect grew over time, particularly after a safe space was established. The safe space was crucial for open discussions, and our WhatsApp group enabled continual communication, support and shared decision‐making. The resulting co‐produced topic guide, coding framework, thematic map, papers and presentations demonstrated significant impact. Conclusions: To our knowledge, this is the first qualitative mental health study to be co‐produced using the principles of co‐production. Our rigorous assessment can be utilized as an informative document to help others to produce meaningful co‐produced future research. Although co‐production takes time, it makes significant impact to the research, researchers and co‐researchers. Flexible funding for spontaneous suggestions from co‐researchers and more time for interview training is recommended. [ABSTRACT FROM AUTHOR]

Although spiritual practices such as prayer are engaged by many to support well‐being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the "spirit" of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person‐centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity‐oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is becoming increasingly accessible and being utilized in various organizations to meet education and training needs. Despite its potential, research regarding VR applications has focused on measuring the effectiveness of VR programs relative to non‐VR programs; consequently, the ways in which VR programs are effective remain unclear. Objectives: Recognizing this research gap, this study examined whether task type‐dependent differences in training outcomes exist between VR training and non‐VR training groups. Methods: To examine the effects of VR technology for training purposes in a military setting, we conducted a quasi‐experiment focusing on how the effects vary based on task characteristics. A total of 90 military personnel were randomly assigned to either an experimental group (VR) or a control group (non‐VR). After completing their respective training, the two groups participated in four tasks simulating real battle scenarios and designed to evaluate the effectiveness of the VR‐based training. We analysed primary data collected through survey instruments and performance evaluation using a one‐way between‐group analysis of covariance (ANCOVA) and supplementary interview data using thematic analysis. Results and Conclusions: The quantitative analysis showed that the VR group performed better than the control group on three tasks in which communication, interaction and immediate situational judgements were critical. No difference was found between the two groups in the other task, which involved the routine operation of physical objects. Additional interview data revealed the extent to which trainees perceived the VR training as effective in understanding in‐situ conditions, preparing and practising their own and their team's reactions to emergent situations and in manipulating virtual objects. Implications: Our findings provide insight into VR technology's potential to enhance human performance in various training contexts. VR is specifically effective in training that aim to improve immediate judgement and group coordination. Our findings provide useful information for those seeking to design and develop training environments that maximize the effects of VR. Lay Description: What is already known about this topic: Virtual reality training is widely used to train personnel in high‐risk/cost occupations (e.g. surgeons and military personnel).Virtual reality education and training help to improve cognitive and affective function as well as psychomotor skills.The success of technology adoption depends on how well the task characteristics are aligned with technological characteristics. What this paper adds: The current study helps verify the generalizability of the TTF theory and provides an in‐depth framework that can be used to classify task types to optimize VR training.VR training programs are more effective when assigned tasks involve solving problems in groups and/or require spontaneous decision‐making than individual physical operations. Implications for practice and/or policy: When considering VR integration to an existing or new training program, the types of tasks to be designed in the program should be well‐aligned with the technological characteristics.At the organizational level, strategic adoption of VR in the training field should be initiated instead of replacing the existence of areas in current/traditional training (i.e. individual physical operation in this study). [ABSTRACT FROM AUTHOR]

Background: Formative online multiple‐choice tests are ubiquitous in higher education and potentially powerful learning tools. However, commonly used feedback approaches in online multiple‐choice tests can discourage meaningful engagement and enable strategies, such as trial‐and‐error, that circumvent intended learning outcomes. These strategies will not prepare graduates as self‐regulated learners, nor for the complexities of contemporary work settings. Objectives: To investigate whether providing only a score after formative online multiple‐choice test attempts (score‐only feedback) increases the likelihood of students to engage in self‐regulated learning compared with more directive feedback. Measurable outcomes included deeper learning, collaboration, information seeking, and satisfaction. Methods: Data in this mixed methods study were collected from nursing students through surveys, test results, focus groups, and student discussion board contributions. A quasi‐experimental design was used for quantitative data, and qualitative data were analysed thematically against domains of self‐regulated learning. Results and Conclusions: Students receiving score‐only feedback were more cognitively engaged with the content, collaborated constructively, and sought out richer sources of information. However, it was also associated with lower satisfaction. In this study, minimal feedback created states of uncertainty, which resulted in the activation of self‐regulatory actions. Implications for Practice: Providing overly directive feedback for formative online multiple‐choice tests is conducive to surface‐level learning strategies. By minimising feedback and allowing for extended states of uncertainty, students are more likely to regulate their learning through self‐assessment and problem‐solving strategies, all of which are required by graduates to meet the challenges of real‐world work settings. Lay Description: What is already known about this topic: Formative online multiple‐choice tests are widely used in higher education.Feedback is a critical element in the design of effective online multiple‐choice tests.Formative feedback should promote self‐regulated learning.Feedback types used in multiple‐choice tests facilitate strategies not conducive to self‐regulation. What this paper adds: Online multiple‐choice test feedback can influence how students self‐regulate their learning.Less feedback can result in greater self‐evaluation and performance in summative assessment.Less feedback can encourage richer help‐seeking strategies (collaboration and information seeking).However, less feedback can result in student dissatisfaction. Implications for practice and/or policy: Judicious use of feedback is required in the design of online multiple‐choice tests.Educators should consider providing less feedback to promote learner self‐regulation.Satisfaction with online multiple‐choice tests does not necessarily equate to greater learning. [ABSTRACT FROM AUTHOR]

Background: Online collaborative learning has been widely adopted in the field of education. However, learners often find it difficult to engage in collaboratively building knowledge and jointly regulating online collaborative learning. Objectives: The study compared the impacts of the three learning approaches on collaborative knowledge building, group performance, socially shared regulation, behavioural engagement, and cognitive load in an online collaborative learning context. The first is the automatic construction of knowledge graphs (CKG) approach, the second is the automatic analysis of topic distribution (ATD) approach, and the third one is the traditional online collaborative learning (OCL) approach without any analytic feedback. Methods: A total of 144 college students participated in a quasi‐experimental study, where 48 students learned with the CKG approach, 48 students used the ATD approach, and the remaining 48 students adopted the OCL approach. Results and Conclusions: The findings revealed that the CKG approach could encourage collaborative knowledge building, socially shared regulation, and behavioural engagement in building knowledge better than the ATD and OCL approaches. Both the CKG and ATD approaches could better improve group performance than the OCL approach. Furthermore, the CKG approach did not increase learners' cognitive load, but the ATD approach did. Implications: This study has theoretical and practical implications for utilising learning analytics in online collaborative learning. Furthermore, deep neural network models are powerful for constructing knowledge graphs and analysing topic distribution. Lay Description: What is currently known about the subject matter: Online collaborative learning has been widely adopted in the field of education.Learners often find it difficult to engage in collaboratively building knowledge and jointly regulating collaborative learning. What the paper adds to this: This study compared the impacts of three learning approaches, namely, the automatic construction of knowledge graphs (CKG), the automatic analysis of topic distribution (ATD), and the traditional online collaborative learning (OCL) approach.The findings revealed that the CKG approach could encourage collaborative knowledge building, socially shared regulation, and behavioral engagement in building knowledge better than the ATD and OCL approaches. Both the CKG and ATD approaches could better improve group performance than the OCL approach. Furthermore, the CKG approach did not increase learners' cognitive load, but the ATD approach did. Implications of study findings for practitioners: It is strongly recommended that the CKG approach can be employed to enhance collaborative knowledge building, socially shared regulation, and behavioral engagement in building knowledge in an online collaborative learning context. Both the CKG and ATD approaches contribute to improving group performance.Deep neural network models are powerful for constructing knowledge graphs and analysing topic distribution. [ABSTRACT FROM AUTHOR]

Introduction: In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all‐risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. Objective: The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. Design: The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. Findings: The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option ‐ it has to work'. Discussion: All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. Conclusion: This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option–it has to work'. [ABSTRACT FROM AUTHOR]

Background: The transition from teacher‐centred towards student‐centred approaches in English language teaching, accompanied by developments in educational technology, has attracted researchers' attention to reverse teaching or flipped class. The related literature asserts that this mode of instruction might influence instructors' and students' participation in the class. Objectives: To shed more light on the role of flipped class in affecting language learning strategies and skills, this study applied a sequential explanatory mixed‐methods approach to explore the impact of flipped class on English as a foreign language (EFL) learners' writing metacognitive strategies and writing skills. Methods: Forty‐six intermediate EFL learners with an age range of 21–27, studying at a private language institute, were randomly divided into two groups of 23 learners. The two groups were randomly assigned to a flipped class, which received writing metacognitive strategies and writing skills through video clips before the class time, and a non‐flipped class, which received writing metacognitive strategies and writing skills in a conventional way during the class time. Results and Conclusions: The results revealed that both flipped and non‐flipped classes improved the EFL learners' writing metacognitive strategies, writing performance, writing content, and writing organisation. Furthermore, one‐way ANCOVA analyses indicated that the flipped class outperformed the non‐flipped class in writing metacognitive strategies, writing performance, writing content, and writing organisation. Thematic analyses, which were used to help analyse individual semi‐structured interviews, uncovered a number of categories and themes, signifying the flipped learners' positive perceptions towards the flipped class, such as enhancing motivation, self‐confidence, and writing collaboration. Implications: Pedagogical implications were discussed for flipping writing metacognitive strategies and writing skills. Lay Description: What is already known about this topic?: Metacognitive strategies, including planning, monitoring, and evaluation strategies, help English language learners become more successful writers.Writing skills, including writing content, writing organisation, and language use, help learners deal with collaborative writing activities effectively.Flipped class has been shown to be an effective mode of instruction to improve English language learners' language learning strategies and skills. What this paper adds?: Flipped class improves English language learners' writing metacognitive strategies, writing performance, writing content, and writing organisation.Flipped class is more effective than non‐flipped class in improving English language learners' writing metacognitive strategies and writing skills.English language learners' motivation, self‐confidence, and writing collaboration are increased as a result of the flipped writing course. Pedagogical implications: Writing metacognitive strategies and writing skills need to be flipped in English language contexts in order to free up time for more effective in‐class collaborative writing activities. [ABSTRACT FROM AUTHOR]

Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well‐being, as well as high‐quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU). Method(s): A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. Results: Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. Conclusions: A relationship‐based model of care was crucial for both the functioning of the FMU and service users' satisfaction and may offer a compelling response to high levels of stress and burnout among midwives. [ABSTRACT FROM AUTHOR]

Background: While evidence‐based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice‐based research literature. Aims: This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice‐based evidence will be used to inform the multi‐stakeholder co‐design of an evidence‐based stuttering intervention for adults. Methods & Procedures: Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi‐structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement. Outcomes & Results: Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'. Conclusions & Implications: These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice‐based evidence to support clinical decision‐making and intervention evaluation. What this paper addsWhat is already known on the subjectEvidence‐based practice involves the synthesis of multiple forms of knowledge, including research, practice and patient evidence to support clinical decision‐making and intervention evaluation. Research evidence for stuttering intervention effectiveness is the dominant form of knowledge in stuttering literature, while other forms such as practice and patient evidence are less represented.What this paper adds to existing knowledgeThis study provides valuable practice evidence for effective stuttering intervention components, including individually tailored intervention, person‐related factors and therapeutic alliance. It highlights the need to consider multiple forms of knowledge to guide the design and evaluation of intervention.What are the potential or actual clinical implications of this work?Clinicians should adopt a person‐centred care approach when designing and evaluating an intervention for adults who stutter. Multiple factors beyond therapeutic technique influence treatment outcomes and should be incorporated into any intervention for adults who stutter. [ABSTRACT FROM AUTHOR]

Incidents of child abuse such as the Oxfam case in 2010 of sexual abuse of children by volunteers' and cases of abuse in orphanages by high‐risk overseas volunteers have highlighted the need for the development of effective safeguarding in the international context. This is of equal importance for faith‐based organisations (FBOs) who, like non‐governmental organisations (NGOs), are obligated to create safe spaces for their beneficiaries. This paper reports the findings from an online survey conducted in 2019, which was completed by 72 participants, 39 were representatives from organisations based in the UK which support individuals to engage in International Christian Work (ICW), 33 were individuals who are or have been engaged in ICW in the last three years. The online survey collected qualitative data, which was analysed using reflexive thematic analysis whilst descriptive analytical techniques were employed on the quantitative data. The findings illustrate commitment to safeguarding children and young people in ICW but also the complexities, challenges and tensions around this. The necessity to work collaboratively in local contexts with co‐production was identified as key to developing effective safeguarding practice. These findings have implications beyond faith‐based organisations to others working in the international context. [ABSTRACT FROM AUTHOR]

Background: The scope of this priority‐setting process is communication and collaboration in transitional care for patients with acute stroke. Actively involving persons with stroke and their family caregivers is important both in transitional care and when setting priorities for research. Established priority‐setting methods are time‐consuming and require extensive resources. They are therefore not feasible in small‐scale research. This article describes a pragmatic priority‐setting process to identify a prioritized top 10 list of research needs regarding transitional care for patients with acute stroke. Methods: A pragmatic priority‐setting approach inspired by the James Lind Alliance was developed. It involves establishing a user group, identifying the research needs through an online survey, analysing and checking the research needs against systematic reviews, culminating in an online prioritization of the top 10 list. Results: The process was completed in 7 months. A total of 122 patients, family caregivers, health personnel and caseworkers submitted 484 research needs, and 19 users prioritized the top 10 list. The list includes the categories 'patients and caregivers' needs and health literacy', 'health personnel's common understanding', 'information flow between health personnel and patients and caregivers', 'available interventions and follow‐up of patients and caregivers', 'interaction and collaboration between health personnel and caseworkers across hospital and primary healthcare' and 'disabilities after stroke'. Conclusion: This paper outlines a pragmatic approach to identifying and prioritizing users' research needs that was completed in 7 months. The top 10 list resulting from this priority setting process can guide future research relating to communication and collaboration during the transition from hospital to the community for patients with stroke. Patient and Public Contribution: Members of three stroke organizations participated in the advisory group. They gave feedback on the scope and the process, distributed the surveys and prioritized the top 10 list. Persons with stroke and their caregivers submitted research needs in the survey. [ABSTRACT FROM AUTHOR]

Background: Health sciences education prepares students for social‐ and healthcare by developing evidence‐based nursing, leadership and working life skills, including collaboration. Due to the changes caused by the global pandemic, health sciences education has shifted more to online and hybrid contexts, which can challenge students' competence development. Students' competence development and interaction in collaborative hybrid learning is a little researched area. Objectives: To observe and evaluate health sciences students' competence development in a collaborative hybrid learning context. Methods: This quasi‐experimental mixed‐method study was implemented by providing educational intervention. First‐year Bachelor's degree health sciences students (n = 18) of a Finnish university completed an educational intervention with synchronous online and face‐to‐face learning. Students' collaborative hybrid learning and interaction were video observed, while self‐evaluation of competence development was made with a questionnaire. Results: In the collaborative interactions, the students showed analytical thinking, problem‐ solving and communication and technology skills. Extensive knowledge of health sciences and ethics skills was not strongly visible in interaction. The students effectively used collaborative work time to perform tasks. Cognitive interaction (monitoring and evaluating learning) was observed in 85% and socio‐emotional interaction (expressions of emotions and motivation) in 53% of the data. Related to the students' learning results, the students' ability to communicate and interact with culturally different people improved after the educational intervention. Conclusion: Collaborative learning methods in hybrid learning can create opportunities for students to construct their competence in interaction. Attention should be paid to different areas of competence and the role of socio‐emotional interaction. Lay Description: What is already known about this topic: Health sciences education prepares students for social and healthcare by developing working life skills, including collaboration.Hybrid learning brings benefits but challenges the equity of students with different attention modes.Collaborative learning is widely used but has not been studied much in hybrid context.Students' competence development and interaction in collaborative hybrid learning is a little researched area. What this paper adds: The purpose was to observe and evaluate health sciences students' competence development in a collaborative hybrid learning context.Hybrid collaborative interaction encourages students to construct knowledge in health sciences.The students utilised the collaborative time appropriately.Socioemotional interactions were very visible in collaborative learning. Implications for practice: This study helps educational organisations to design hybrid model education.The design requires pedagogical and technical competence and should include collaborative methods.Attention should be paid to different areas of competence in collaborative learning.The role of socio‐emotional interaction needs more focus in hybrid learning. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study that sought to understand the experiences of frontline staff working in Oxfordshire County Council (OCC) Children's Social Care Services and their views on a new family safeguarding model (Family Solutions Plus). Focus group interviews were conducted with 20 frontline staff and managers in different teams across OCC Children's Social Care Services using video conferencing software. Thematic analysis identified three overarching themes: Preparation for the implementation of Family Solutions Plus, staff views on the implemented model, and challenges to its implementation. Staff voiced strong support for the new model, which places a much greater emphasis than previous practice on supporting the whole family, developing parenting skills and keeping children safe with their families. The challenges associated with the transition to a new model were considerable in the short term, partly due to the COVID‐19 pandemic, but there was optimism that the new model could be sustained and stabilized over time. [ABSTRACT FROM AUTHOR]

The number of disabled students enrolled in higher education institutions is increasing. Yet in disciplines such as nursing, where placements are an important part of student success, students' lived experiences, though an important and necessary aspect of promoting equity, diversity, and inclusion, has been ignored. In this paper, we respond to such issues by creating and utilizing a novel storytelling method that harnesses the antiessentialist philosophy of Deleuze and Guattari. Storytelling empowers students to both describe their experiences and inform institutions on how to better serve them, and we use concepts from Deleuze and Guattari to provide a framework for thinking about students and their pathways toward success as multiple. As we show, applying storytelling as a method through this lens offers an expansion of strategies to put students first and, therefore, promote equity at the administrative, research, educational, and practical levels. We describe how thinking rhizomatically opens new avenues of insight, allowing for the creation of institutional assemblages based on a diverse array of students' needs, enabling them to become successful in their own ways. [ABSTRACT FROM AUTHOR]

This paper reports upon the learning that emerged from a development project which aimed to facilitate improvements in multiagency work in domestic abuse and safeguarding children. The two-year project (2011-13), funded by the Department for Education and led by WomenCentre, a specialist voluntary sector organisation based in West Yorkshire, was undertaken in nine local authorities in the north of England. Activities undertaken during the project included case mapping, service user and professional engagement exercises, observation of local multiagency meetings and provision of training. An evaluative research study examined the work of the project and the learning that emerged. Drawing upon data from telephone interviews with project participants, analysis of case mapping and project reports, this paper discusses some critical issues which emerged from this project. The paper draws attention to the different understandings and priorities which shape interprofessional practice in relation to safeguarding children and domestic abuse, and the complexities of the wider interagency environment including coordination, resources and expertise. Recommendations for improving multiagency work to achieve better outcomes for women and children experiencing domestic abuse are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Multiagency working in domestic abuse and safeguarding children is complex and could be improved., The impact of professional differences in how cases are understood and managed, particularly in relation to 'risk', as well as different professional priorities and approaches to working with families should be recognised and considered within the multiagency context., Practitioners may want to consider whether 'case mapping' is pertinent to their own safeguarding practices and processes. [ABSTRACT FROM AUTHOR]

This paper presents the results of a qualitative study completed with 16 designated liaison persons (DLPs) for child protection in Ireland. The care practices and systems in place in Irish primary schools that support child protection work are the particular focus of this paper. Recent changes in legislation, following the publication of the Children First Act 2015 (Government of Ireland, Irish Statute Book; Office of the Attorney General), are considered. The Act recognises all teachers registered with the Teaching Council as mandated persons. Mandated persons are recognised as persons who work with children and young people and are required to report child abuse, above a defined threshold, which comes to their attention in the course of their professional or employment duties. Semi‐structured interviews were completed with the DLPs, and an exploratory approach using interpretative phenomenologial analysis was deemed the most suitable method of analysis for the study. Five superordinate themes emerged from the findings, alongside a number of subordinate themes; the theme 'The School Story' which focuses on the care practices that are undertaken in schools daily is illuminated throughout this paper. The findings highlight the need for formal acknowledgement of this work in schools and also for greater interagency communication and collaboration in the area of child protection. 'This paper presents the results of a qualitative study completed with 16 designated liaison persons (DLPs) for child protection in Ireland' Key Practitioner Messages: Teachers, in their day‐to‐day work in schools and through the care structures in place in schools, contribute in a significant way to the safety and protection of children.There is a need for greater communication and collaboration between schools and the Child and Family Agency to support children at risk of abuse effectively.There should be formal recognition in the evaluations undertaken by the Department of Education of the care practices that exist in schools. [ABSTRACT FROM AUTHOR]

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care. [ABSTRACT FROM AUTHOR]

Descriptive title: Parents of children with rare diseases face pervasive challenges in meeting medical and social care needs. Existing research on the parents' experience of caring for a child with a rare disease is limited. This paper offers suggestions for better supporting families living with rare disease as well as possible avenues of future research. Background: Parents of children with rare diseases face pervasive challenges in meeting medical and social care needs. Existing research on the parent's experience of caring for a child with a rare disease is limited. Methods: An interpretive phenomenological approach was applied in this inquiry. Fifteen parents of children with rare diseases participated in semistructured interviews. Results: Interpretive thematic analysis revealed that due to the rarity of the disease and an overall lack of knowledge of the disease, there is an increase in the burden on the family in relation to "rarity" in addition to "disability." Four insights were also revealed: (a) Parents often know more about the disease then Health Care providers, and this leads to entanglements in communication and collaboration as experts and parents; (b) there is lack of coordination of care between providers and services caring for children with rare diseases; (c) there is a gap in accessibility to government supports; and (d) due to fragmented care, parents must fill the aforementioned gaps by juggling multiple roles including that of advocate, case manager, and medical navigator. Conclusion: This paper offers suggestions for better supporting families living with rare disease as well as possible avenues of future research. [ABSTRACT FROM AUTHOR]