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Background: In the field of intellectual disabilities (ID), the quality of life concept has been developing rapidly in Chinese societies including Hong Kong, mainland China and Taiwan. However, there is a lack of locally validated instruments to measure the quality of life of people with ID. The study reported in this paper attempted to validate the Chinese Quality of Life Questionnaire-Intellectual Disabilities adapted from the Quality of Life Questionnaire developed by Schalock & Keith. Methods: People with mild/moderate ID aged 15 years or above were recruited from special schools, skills centres, community service units and residential units in different regions of Hong Kong. A number of procedures were followed including reliability tests, factor analysis, content validity and construct validity. Results: A total of 359 participants were recruited for the study. Factor analysis was conducted according to the rotated component matrix method, in which 23 items were extracted from the original 40-item version of the Quality of Life Questionnaire and three domains (renamed satisfaction, competence and daily choice making/interpersonal relations) were observed. The items in each domain were shown to have factor loadings ranging from 0.42 to 0.90. Construct validity tests indicated the positive nature of the relationship between earnings, and that self-determination and social interaction increase with more independent living environments and less segregated work environments achieving higher scores (P less than 0.000, P less than 0.01 and P less than 0.05 respectively). The scale also achieved a good degree of reliability (Cronbach's alpha = 0.79). Conclusions: Initial validity tests indicated that the Chinese Quality of Life Questionnaire-Intellectual Disabilities may be a useful instrument for measuring the quality of life of Chinese people with ID. Cultural issues are discussed and recommendations for future research and service development are made. (Contains 5 tables.

Objectives: This paper reports on the prevalence of student victimization by teachers in junior high schools in a Chinese cultural context (Taiwan) and examines how student demographic variables (gender, grade level, and family socioeconomic status) and school social experiences (student-teacher relationships and involvement with at-risk peers) are associated with such victimization. Methods: Data were obtained from a large-scale random sample of 1,376 junior-high students (grades 7-9) in the city of Taichung, Taiwan. Students were given an anonymous structured questionnaire, including items regarding basic demographics and school social experiences. Results: Overall, 26.9% of students reported having been maltreated by teachers at least 1 time in the previous semester. Hitting, beating, or slapping was the most common maltreatment, and the most vulnerable students were boys and senior students. Students who perceived that student-teacher relationships were poor, and those who were involved with at-risk peers, were more likely to report victimization. Conclusion: Although there are clear guidelines and regulations prohibiting teacher aggression against students, Taiwanese students are still exposed to high levels of maltreatment. The findings provide empirical evidence to support school social workers and policymakers in taking immediate action to educate politicians, the general public, and the media about the severity of student victimization by teachers as well as to build up mechanisms to supervise the government's enforcement of regulation. These findings clearly imply that promoting positive social experiences for students is crucial for successful intervention. (Contains 4 tables.)

This paper aims to investigate the current XML-related courses available in 96 LIS schools in South East Asia and Taiwan's 9 LIS schools. Also, this study investigates the linkage of library school graduates in Taiwan who took different levels of XML-related education (that is XML arranged as an individual course or XML arranged as a section unit in courses) and their professional qualification. Research questions include what is the availability of XML-related courses in countries in Taiwan and South East Asia? What are Taiwan LIS graduates' views on degree of XML-related courses satisfaction, cognition of learning XML technology, and views of XML-related courses? What is the linkage of Taiwan LIS graduates who studied different levels of XML-related education and their professional qualifications? This study applies 3 research methodologies: information gathering from the internet; questionnaire surveys; in-depth interviews. Results of the analysis show that LIS schools should provide optional XML-related courses with practical sessions, and library associations should provide regular XML-related continuing education to enhance LIS students' professional qualifications. (Contains 1 figure and 1 table.)

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this population. We used purposive sampling to recruit 54 institutional managers who care for people with intellectual disabilities in Taiwan. The present study employed a cross-sectional design using a self-administrative structured questionnaire that was completed by the respondents in November 2009. The results showed that more than 90% of the respondents agreed with earlier onset aging characteristics of people with ID. However, nearly all of the respondents expressed that the government policies were inadequate and the institution is not capable of caring for aging people with ID, and more than half of them did not satisfy to their provisional care for this group of people. With regard to the service priority of government aging policy for people with ID, the respondent expressed that medical care, financial support, daily living care were the main areas in the future policy development for them. The factors of institutional type, expressed adequacy of government's service, respondent's job position, age, and working years in disability service were variables that can significantly predict the positive perceptions toward future governmental aging services for people with ID (adjusted R[squared]=0.563). We suggest that the future study strategy should underpin the aging characteristics of people with intellectual disabilities and its differences with general population to provide the useful information for the institutional caregivers. (Contains 7 tables.)

This paper investigated the gender differences in junior high school students' Internet self-efficacy and their use of the Internet. A total of 1080 eighth graders were randomly selected from all junior high school students in Taiwan. The Internet Self-Efficacy Scale (ISES) was developed and used to examine students' Internet self-efficacy in two dimensions: "online exploration" ("explorative ISE") and "online communication" ("communicative ISE"). A survey including the ISES instrument was administered to all the subjects and finally 936 valid questionnaires (from 466 males and 470 females) were returned for data analyses. No significant gender difference was found in students' total ISE and explorative ISE; however, a significant gender difference was found in students' "communicative" ISE. Surprisingly, the girls had significant higher communicative ISE than had the boys. In addition, there was no significant gender difference in students' Internet using experience and computer ownerships; however, there were significant gender differences in their Internet using purpose and intensity. In spite of the boys showed a significantly higher Internet use intensity than did the girls, the boys were more exploration-oriented Internet users and the girls were more communication-oriented Internet users. And this orientation played a significant role in their Internet self-efficacy. These results suggested that the gender gap may no longer exist in young students' confidence in using the Internet. However, boys and girls used the Internet for significantly different purposes suggesting that the Internet played different roles for boys and girls in Taiwan. With a large scale examination by using a valid and reliable instrument, this study provided representative results for further related studies. (Contains 12 tables and 3 figures.)

Learning to program is difficult for novices, even for those undergraduates who have majored in computer science. The study described in this paper has investigated the effects of game strategy and preference-matching on novice learners' flow experience and performance in learning to program using an experiential gaming activity. One hundred and fifteen novices participated in the experimental activity. Two types of game strategy were employed: the matching-challenging strategy and the challenging strategy. Participants were categorised into one or other of the two groups based on individual preferences. The results of the study showed that: (1) the challenging group had higher flow experiences than the matching-challenging group; (2) participants' performance was enhanced with the use of the matching strategy; and (3) a compensation effect existed among the preference-mismatched learners who performed better in the challenging game-play. (Contains 4 tables and 4 figures.)

The work described in this paper explores the feasibility of using of a wireless handheld system (WHS) that supports the individual and co-operative reading activities of students and helps teachers implement reading strategy instruction in Chinese language classes. The experimental findings demonstrate that the WHS benefits students applying reading strategies and improves co-operative learning in relation to small reading groups. (Contains 5 tables and 7 figures.)

There is little information of hepatitis B vaccination coverage for people with intellectual disabilities (ID). The present paper aims to examine the completed hepatitis B vaccination coverage rate and its determinants of children and adolescents with ID in Taiwan. A cross-sectional questionnaire survey, with the entire response participants was composed of 495 primary caregivers of children and adolescents with ID (age 3-24 years) who studying in 3 special education schools in Taiwan. The results showed that coverage rate of completed hepatitis B vaccination was 74.34% in children and adolescents with ID. Although hepatitis B vaccination is a universal health policy in Taiwan, the uncompleted coverage rate of our study subjects was 2 times of the Taiwan general population at the same age. In the logistic regression analysis of hepatitis B vaccination coverage, we found that the factors of household income and ID individual's age were variables that can significantly predict they did not accept a completed vaccination. The present study suggests that parents and providers should routinely review immunizations of children and adolescents with ID. (Contains 7 tables.)

The adoption of standardised English Language Proficiency (ELP) tests as a tool for assessing students' English competence for graduation is becoming more and more common in higher education in Taiwan. This paper focuses on university undergraduate students and uses data from a questionnaire survey to investigate their views of the application of standardised ELP tests as the graduation benchmark. The results of this study show that standardised ELP tests are viewed as insufficient to reflect what is learnt and taught in a foreign language classroom and likely to make English instruction become test-driven. The researchers conclude that the adoption of standardised ELP tests as an assessment tool should be determined on the basis of students' English competence and learning situations, and implemented in the context of overall curriculum planning and needs analysis. While finding that standardised ELP tests may place much pressure on students' English learning, the researchers also conclude that motivation rather than pressure is the key to determining whether the new assessment policy of the graduation benchmark requirement can succeed in promoting the quality of foreign language education in the institutions of higher education in Taiwan. The researchers suggest that standardised ELP tests should become an optional assessment tool to encourage more and more students to take them voluntarily for graduation. (Contains 3 tables.)

In this study, the hierarchical model of achievement motivation [Elliot, A. J. (1997). Integrating the "classic" and "contemporary" approaches to achievement motivation: A hierarchical model of approach and avoidance achievement motivation. In P. Pintrich & M. Maehr (Eds.), "Advances in motivation and achievement" (Vol. 10, pp. 143-179). Greenwich, CT: JAI Press] is used to investigate the motivational mechanism behind the relationship between fear of failure and self-handicapping adoption. A cross-sectional design was employed. The participants were 691 college students enrolled in physical education in Taiwan. Students completed the Performance Failure Appraisal Inventory (PEAI-S; Conroy, D. E., Willow, J. P., & Metzler, J. N. (2002). Multidimensional measurement of fear of failure: The performance failure appraisal inventory. "Journal of Applied Sport Psychology," 14, 76-90), the Chinese 2 x 2 Achievement Goal Questionnaire for Physical Education (CAGQ-PE; Chen, L. H. (2007). "Construct validity of Chinese 2 x 2 achievement goal questionnaire in physical education: Evidence from collectivistic culture." Paper presented at the 5th conference of the Asian South Pacific Association of Sport Psychology. Bangkok, Thailand) and the Self-Handicapping Scale (SHS; Wu, C. H., Wang, C. H., & Lin, Y. C. (2004). The exploratory and confirmatory factor analysis of self-handicap scale for sport. "Journal of Higher Education in Physical Education," 6(1), 139-148). Structural equation modeling was conducted. Generally, the results showed that mastery-avoidance and performance-avoidance goals partially mediated the relationship between fear of failure and self-handicapping. The results are discussed in terms of the hierarchical model of achievement motivation, and its implications for physical education are also highlighted. (Contains 2 figures and 2 tables.)

The paper describes the integration of web resources and technology as instructional and learning tools in oral history projects. The computer-mediated oral history project centred around interviews with community elders combined with new technologies to engage students in authentic historical inquiry. The study examined learners' affective attitudes and cognitive perceptions in grades 5 to 11 in order to understand the challenges and opportunities that students faced in the project. Data were collected using interviews with students and teachers, electronic group projects on the web, the researcher's observations, and a subjective-qualitative questionnaire. Qualitative analyses consisted of categorical and thematic analysis. With respect to categorical analysis, the excerpts of students' responses were categorised using two codes based on whether they related more to the challenges or advantages of the project. These multiple categories were then aggregated into larger analytic themes. The study showed that from this computer-mediated oral historical project, students were provided opportunities to develop better insight into the past, better historical thinking, and more positive attitudes toward the elders. The project challenged learners to conduct historical inquiry with technology while facilitating the development of historical thinking, honing interview skills, enhancing computer literacy, sharpening critical thinking, and problem-solving, as well as nurturing interpersonal and teamwork skills. Some challenges to the implementation of computer-mediated historical projects are discussed. (Contains 2 notes and 1 table.)

Using the theories of critical reflection and community of practice, the aim of this paper was to explore the use of blogs as a reflective platform in the training processes of English as a Foreign Language (EFL) student teachers, who were learning to teach English for future employment in Taiwan. They made use of blogs as a platform to critically reflect on their learning processes as well as to gauge the impact of blogs on their own professional growth. Forty-three student teachers in two teacher-education programs at two science and technology institutions in central Taiwan participated in this study. Two instructors created a blog for use as a discussion forum so that the student teachers could engage in and examine their own reflection process. The data collected was qualitative in nature, consisting of student teachers' posting messages and comments on the blog, surveys on the student teachers' reflective experiences using blogs as reflection tools, and group reflective dialogues recorded by instructors in class meetings over the implementation of blogs during the course. The results showed that the student teachers actively discussed teaching theories and their implications through blogs. All of the 43 teachers who took part in this study were reflective, and some critically reflected on their thoughts and made significant comments; and the participants considered technology a useful platform for reflecting and communicating with each other. The positive implications for the use of blogs as a medium to provide and promote critical reflection for EFL teachers are discussed. (Contains 2 tables.)

The paper illustrates an English for Specific Purposes design for English listening and speaking for students in hospitality fields, accompanied by an educational inquiry into its implementation in a bid to hold accountability to the course takers. The subject was 82 juniors and seniors at a national hospitality college in Southern Taiwan. Questionnaires, achievement tests and classroom observation were research instruments in the inquiry. The statistical evidences of the study have demonstrated the effectiveness of the ESP listening and speaking course. This ESP class, characterized by a synthesis of language-oriented, skills-oriented and learning-oriented approaches to ESP syllabus design is harvested with fruitful achievements: incremental gain in their ESP content knowledge and skills (the outcome of the language-oriented syllabus), strengthening the ability of searching for and organizing information for conducting English presentations (the outcome of the skills-oriented syllabus) and, above all, the achievement in cooperative team spirit build up (the outcome of the learning-oriented syllabus). The study also provides valuable reference for subsequent design and implementation of related ESP courses in the future. (Contains 5 tables and 6 notes.)

With the proliferation of the Internet and World Wide Web applications, people are increasingly interacting with government to citizen (G2C) eGovernment systems. It is therefore important to measure the success of G2C eGovernment systems from the citizen's perspective. While general information systems (IS) success models have received much attention from researchers, few studies have been conducted to assess the success of eGovernment systems. The extent to which traditional IS success models can be extended to investigating eGovernment systems success remains unclear. This study provides the first empirical test of an adaptation of DeLone and McLean's IS success model in the context of G2C eGovernment. The model consists of six dimensions: information quality, system quality, service quality, use, user satisfaction, and perceived net benefit. Structural equation modeling techniques are applied to data collected by questionnaire from 119 users of G2C eGovernment systems in Taiwan. Except for the link from system quality to use, the hypothesized relationships between the six success variables are significantly or marginally supported by the data. The findings provide several important implications for eGovernment research and practice. This paper concludes by discussing limitations of the study which should be addressed in future research. (Contains 4 figures and 5 tables.)

The development of constructivism has resulted in teaching modifications in the science classroom. While the majority of the literature has focused on the promising outcomes of the teaching reform, the present study reports various minor but persistent criticisms. This paper qualitatively analyzes skeptical students' criticisms regarding the author's teaching from 2000 to 2004, in her first year university physics classes in Taiwan. An open-ended questionnaire survey was administered seven times during the five-year study. In 2000 and 2001, investigations were conducted twice, during and post each academic year. Different groups of students filled in the survey in different years, giving a total of 618 students who participated in the study. The major concerns of these skeptical students include the increase of cognitive difficulty and learning responsibility, the effectiveness of the teaching performance, and the standards of the course. Many of the criticisms form an opposing opinion to the positive appraisal from their peers. Based on the findings, teaching practitioners might face challenge in grasping the optimal points between enhancing the majority of the students' expectations and alleviating the skepticism of a minority of students. (Contains 2 tables and 1 figure.)

Toastmasters is a widely recognized international club that aims to develop and enhance the art of public speaking by offering participants educational programmes and chances to speak before groups. This article reports on the integration of the Toastmasters approach to an EFL oral-communication class in Taiwan. As both the author of this study and the teacher of an EFL course, I organized the course content and the course delivery that this paper describes. At the end of the semester, the participants completed a written questionnaire that asked their opinions about the effectiveness of this unorthodox teaching approach. Students enthusiastically reported that they had improved their proficiency in public speaking and that they had made gains in various skill areas. Drawing on these experiences, this article addresses the value of a Toastmasters approach to foreign-language curricular design. (Contains 7 tables and 2 figures.)

The reasons that the current tutorial system (CTS) does not produce significant effects include the budgets and policies of schools, the greater independence of students, and the infrequent interaction of tutors with students. To reduce the deficiencies of the current tutorial system, this paper proposes a network tutorial system (NTS) and discusses the feasibility of the NTS. We use factor analysis to find the emphasized key factors of tutors, the counselors of student counseling centers (abbreviated as counselors), and students, respectively, about the feasibility of the NTS. Also, we use t test to check whether the mean opinion of male students and that of female students have significant difference with respect to each evaluation item of the feasibility of the NTS. Taiwanese universities and colleges are used as the research subjects. The empirical results show that the most emphasized factor of the tutors and students is "privacy esteem." The most emphasized factor of the counselors is "the efficiency enhancement of counseling due to the NTS." The gender differences of students do not influence the evaluation results of them for the feasibility of the NTS. (Contains 4 figures and 7 tables.)

Purpose: To study the quality in higher education in Cambodia and explore the potential factors leading to quality in Cambodian higher education. Design/methodology/approach: Five main factors that were deemed relevant in providing quality in Cambodian higher education were proposed: academic curriculum and extra-curricular activities, teachers' qualification and methods, funding and tuition, school facilities, and interactive network. These five propositions were used to compare Shu-Te University, Taiwan with the top five universities in Cambodia. The data came in the forms of questionnaire and desk research. Descriptive analytical approach is then carried out to describe these five factors. Findings: Only 6 per cent of lecturers hold PhD degree and about 85 per cent never published any papers; some private universities charge as low as USD200 per academic year, there is almost no donation from international organizations, and annual government funding on higher education sector nationwide in 2005 was only about USD3.67 million; even though there is a library at each university, books, study materials etc. are not up-to-date and inadequate; 90 per cent of the lecturers never have technical discussion or meeting and about 60 per cent of students felt that their teachers did not have time for them to consult with. Originality/value: A useful insight was gained into the perceived importance of quality in higher education that can stimulate debate and discussion on the role of government in building the standard quality in higher education. Also, the findings from this research can assist in the development of a framework of developing human resource. (Contains 2 tables and 1 figure.)

The international marketing of higher education is a global phenomenon in which more than 50 countries compete. USA enjoys the largest market share. However, the market place is highly competitive with many players seeking a place in the international club. Increasing competitive practices calls for increasing market research especially in the area of consumer behaviour and student motivations. In this research area this paper explores the differences in behavioural motivations of international students choosing an overseas university in which to study. The method used in the research is Fishbein's and Ajzen's multi-attribute Theory of Planned Behaviour model. From a sample of Taiwanese students, representing the Chinese Diaspora countries, the intentions of students to study in USA, UK and Australia are examined. Three research questions are explored and the outcome demonstrates the usefulness and the insights that can be gained from the application of the model of Theory of Planned Behaviour in a higher education marketing context. (Contains 5 tables and 2 figures.)

This paper sets out to examine the impacts of schooling and health knowledge on the level of obesity in Taiwan. The results obtained from a sample of Taiwanese females support the hypothesis of Grossman that schooling has a direct positive effect on health by reducing the likelihood of a person being obese. The awareness of obesity-disease relationships and the intake of fiber are negatively associated with obesity; however, the observed schooling-obesity correlation cannot be attributed solely to any differences existing between the health knowledge and awareness of different individuals. Furthermore, in common with the developed nations, the stigma attached to the obesity of women is also found to be widespread within Taiwanese society. (Contains 10 notes.)

A web-based learning system has been developed to facilitate question-posing, peer-assessing, item-viewing and drill-and-practice learning activities. In this paper, the pedagogical basis underlying the design and development of the system is explained in the light of information-processing theory, social construction of knowledge theory and social modelling theory. A preliminary study to evaluate the instructional potential of the system has been conducted; this has also identified the factors that influence students' use of the system. Results taken from questionnaires and open-ended questions revealed that by enabling students to play various roles such as composers, critics and adapters, the system was perceived as a cognition-enhancing and motivational learning tool by the participants. Data analysis further indicated that various factors worked together to influence the performance of question-posing.

The purpose of this study was to develop a questionnaire that measures students' motivation toward science learning (SMTSL). Six scales were developed: self-efficacy, active learning strategies, science learning value, performance goal, achievement goal, and learning environment stimulation. In total, 1407 junior high school students from central Taiwan, varying in grades, sex, and achievements, were selected by stratified random sampling to respond to the questionnaire. The Cronbach alpha for the entire questionnaire was 0.89; for each scale, alpha ranged from 0.70 to 0.89. There were significant correlations (p is less than 0.01) of the SMTSL questionnaire with students' science attitudes (r = 0.41), and with the science achievement test in previous and current semesters (r [superscript p] = 0.40 and r [superscript c] = 0.41). High motivators and low motivators showed a significant difference (p is less than 0.01) on their SMTSL scores. Findings of the study confirmed the validity and reliability of the SMTSL questionnaire. Implications for using the SMTSL questionnaire in research and in class are discussed in the paper.

School principals have difficulty embracing the competing demands of school restructuring. These demands include being accountable for the outcomes of other decision-making groups within, or external to, the school community; having strong views while making decisions collaboratively; and using group processes without wasting the time, commitment, motivation and goodwill of those involved. The three sets of tensions were named the accountability, autonomy, and efficiency dilemmas, respectively. This paper outlines the development of an instrument to determine the saliency of particular domains of decision making in which these dilemmas are experienced by school principals. The instrument was trialled in Australia and New Zealand using Rasch analysis to check the fit of items. The instrument is currently being applied in The Netherlands, Australia and Taiwan, with other countries to follow. (Contains 7 figures and 3 tables.)

Aim: This quasi‐experimental study aimed to explore effects of walking exercise on disease activity, sleep quality, and quality of life among individuals with systemic lupus erythematosus. Methods: After recruiting people with systemic lupus erythematosus from a hospital in Taiwan between October 2020 and June 2021, participants were free to opt to receive one walking exercise programme plus standard care for 3 months or to membership of a control group receiving routine care. Primary outcomes included Systemic Lupus Erythematosus Disease Activity Score, the Pittsburgh Sleep Quality Scale, and a quality‐of‐life scale for patients with systemic lupus erythematosus, namely, LupusQoL. These scales were administered first, at baseline and later, within 1 week following completion of the intervention. Between‐group effects were compared using generalized estimating equations with adjustment for baseline variables. Results: The experimental and control groups each included 40 participants. Multivariate analysis indicated that adding the walking exercise programme into routine care elevated sleep quality and LupusQoL (the latter in the subscales of physical health, planning, and intimate relationships), except for disease activity. Conclusion: Findings of this study supported the addition of walking exercise as part of routine care for people with systemic lupus erythematosus and may be a reference in the provision of adequate care for these patients. Summary statements: What is already known about this topic? Systemic lupus erythematosus is a lifelong autoimmune disease that affects any organs throughout the body, thus insidiously causing negative impacts on the affected patients.Today, use of exercise programmes such as walking exercise has been studied as a remedy for many medical conditions, but its effectiveness in minimizing the symptoms of distress among people with systemic lupus erythematosus is unknown. What this study adds? Participants with systemic lupus erythematosus who opt to receive the walking exercise programme for 3 months in addition to routine care experience improved sleep quality and quality of life compared with those receiving routine care alone. The implications of this paper: In accordance with the belief that "an ounce of prevention is worth a pound of cure," early implementation of an exercise programme should be considered in addition to routine care for patients with systemic lupus erythematosus.Evidence from this research could provide empirically informed and robust data for healthcare policymakers and in turn might help to reduce the incidence of morbidity among patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Today, the various abilities that nurses require to meet patients' healthcare needs adequately are all affected by AI-enabled systems. This research used an experimental study design in which 60 subjects were randomly assigned to either an experimental (AI image e-book guidance) group or a control (text paper guidance) group after meeting the admission conditions and agreeing to participate in the study. It was proven that providing AI image e-book guidance before surgery significantly changed the behavior of patients and promoted relief of urinary catheter discomfort through self-efficacy to reduce urinary catheter pain after surgery (p < 0.001). It was found that providing AI image e-book guidance can shorten the time for health education and provide patients with repeated medical education and familiarity with health guidance, which can help to address the important clinical service demand issue and the shortage of nursing staff. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to explore the effectiveness of a mobile app to support oral mucositis care to improve the nutritional status and reduce the occurrence of oral mucositis of patients with head and neck cancer undergoing concurrent chemoradiotherapy. Background: Concurrent chemoradiotherapy is the optimal treatment for head and neck cancer, but oral mucositis and malnutrition are common complications. Design Quasi‐experimental study using a pre‐post design was used in this work. Method: Participants were recruited from a major regional hospital in Taiwan from July 2018 to July 2020. There were 32 participants in each group: the mobile app group (Intervention Group) or routine care (Control Group). The primary outcome measure was Patient‐Generated Subjective Global Assessment (PG‐SGA). We also collected data on grade of oral mucositis, painNnumeric Rating Scale (NRS), weight loss, haemoglobin (Hb), albumin and quality of life (QoL). Result: The PG‐SGA score was significantly lower in the intervention than the control group at all three time points. Hb and albumin decreased less significantly in the intervention than the control group after 2 months. The oral mucositis grade was significantly less severe in the intervention than the control group at all three time points; for the NRS, at T2 and T3. Conclusion: Using the mobile app effectively improved nutritional status, alleviated the side effects, and improved the QoL of head and neck cancer patients with concurrent chemoradiotherapy. Summary statement: What is already known about this topic? Oral mucositis leads to malnutrition and hinders treatment in cancer patients.An oral health care mobile application ('app') is an easy‐to‐access health care resource What this paper adds? A mobile app improved oral mucositis, pain sensation score, nutrition status and QoL for patients with head and neck cancer undergoing concurrent chemoradiotherapy.A mobile app could increase the accessibility of a large amount of care information to patients. The implications of this paper: A mobile app could be used to establish an efficient communication platform; to provide feedback for patient self‐management to alleviate the feeling of suffering, and could enhance patients' competency to manage their oral mucositis. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non‐ventilated intensive care unit patients. Methods: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6‐sulfatoxymelatonin levels, relaxation responses measured using the Richards–Campbell Sleep Questionnaire, liquid chromatography‐mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. Results: Overall, 28.03% of participants showed virtually no 6‐sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6‐sulfatoxymelatonin and vital signs. Conclusions: The effects of using earplugs alone on sleep quality, urinary 6‐sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality. Summary statement: What is already known about this topic? Excessive noise exposure causes numerous adverse health outcomes, which not only contributes to noise‐induced stress and hearing loss but also affect patients' sleep.Wearing earplugs might be a practical nonpharmacological strategy used by nurses to improve ICU patients' quality of sleep. What this paper adds? Wearing earplugs alone did not affect patients' urinary 6‐sulfatoxymelatonin level in the ICU.Wearing earplugs alone did not increase patients' subjective sleep quality in the ICU. The implications of this paper: The findings of the present study on the effects of using earplugs alone on sleep quality, urinary MT6s level and vital signs in ICU patients extend the literature, particularly with respect to the limited research on using earplugs alone.Prolonged effect of earplug intervention on sleep quality is unknown. A longer intervention may help elicit any difference in sleep quality. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is a serious global health issue. Limited studies previously analyzed health literacy components in patients undergoing smoking cessation interventions. This study focuses on individuals enrolled in smoking cessation services and investigates the distribution of health literacy in three domains (health care, disease prevention, and health promotion) and four abilities (access, understand, appraise, and apply health information). The study also explores the correlation between background factors (age, BMI, etc.) and health literacy, as well as the differences in health literacy levels among different background variables (gender, etc.). Methods: 228 individuals completed the health literacy questionnaire. Descriptive statistical analysis, Pearson Correlation, and a Chi-Squared Test were employed to investigate the various health literacy levels and background variables. Results: 68% had excellent or sufficient health literacy. A total of 32% were considered problematic or to have inadequate health literacy. Of the three domains of health literacy, participants performed better in the healthcare domain. More than one-third were problematic in accessing and appraising information. Conclusions: this paper, being the pilot study in providing an analysis of health literacy components in individuals undergoing smoking cessation, could serve as a useful reference for devising interventions for different population groups in trying to maximize successful cessation rates. [ABSTRACT FROM AUTHOR]

Background: Weight control is a widespread phenomenon among young adults, especially in women. Aim: This study aimed to determine the prediction factors of weight control intention in a young Chinese sample. Methods: A cross‐sectional study was conducted with 963 (276 male and 687 female; mean age 21.8 ± 4.4 years) adult students from a university in Taiwan. The data were collected from October 2016 to January 2017. Body mass index (BMI), the Chinese version of the Weight Self‐Stigma Questionnaire, the Body Areas Satisfaction Scale and the Media Influence Questionnaire were used as data collection instruments. Results: The participants with weight control intention had higher BMI, weight self‐stigma and media influence scores and lower body satisfaction scores than those without the intention. Female sex, BMI, weight self‐stigma, body satisfaction and media influence were significant predictors of weight control intention for all participants. Conclusion: Before conducting weight loss programmes, the perception of weight self‐stigma and the influence of social media on body image should be confirmed, particularly in women with intention to lose weight. SUMMARY STATEMENT: What is already known about this topic? Weight loss is a popular issue in the health field, owing to the effect of obesity on multiple aspects of life.Females have a higher intention than males to control their weight.People with obesity are more likely to internalize weight stigma from public attitudes and influences and are more dissatisfied than others with their body appearance. What this paper adds? Females have a higher perception of weight self‐stigma and are more dissatisfied than males with their body and the influence of social media on body image.The Chinese young adults with weight control intention had a higher body mass index, weight self‐stigma, body dissatisfaction and media influence than adults without weight control intention.Weight self‐stigma, body dissatisfaction, influence of mass media and body mass index may play synergistic roles in triggering weight control intention in Chinese young adults, particularly in women. The implications of this paper Nurses should pay attention to young adult females with normal BMI and intention to lose weight.Nurses and other healthcare professionals who conduct weight loss programmes should confirm with young adults, particularly with women, their perception of weight self‐stigma, body dissatisfaction and social media influence.Healthy and non‐prejudiced advice should be included in weight loss consultation. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Aims: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. Methods: A cross‐sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5‐year junior college programme in south Taiwan. Results: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. Conclusion: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause–effect relationship of the bullying and social support on health among students during clinical practicum SUMMARY STATEMENT: What is already known about this topic? Nurses' exposure to workplace bullying will result in their health problems. What this paper adds? Student nurses' exposure to bullying during clinical practicum and low social support might impact on their health status. The implications of this paper: Establishing supportive practicum environments is important to help nursing students prevent bullying incidents during clinical practicum programmes.Nurse educators might include the results of this study into the contents of the educational programmes to increase students' knowledge on student nurses' bullying and its risks. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore nurses' demographic data, assertiveness, psychosocial work condition, and workplace bullying, and find the predictors of workplace bullying. Methods: This study adopted a cross‐sectional design. A stratified sample comprising 241 nurses from a regi onal teaching hospitals in Taiwan was selected from the 10th to the 23rd September, 2018. Data were analysed by using the SPSS Statistics 17.0. Descriptive statistics (frequency, percentage, mean, and standard deviation), one‐way Anova, t test, Pearson's correlation, and multiple linear regressions were used. Results: The results showed that the participants with "past bullying experience," "lower self‐assertiveness," "higher work psychological demands," "lower workplace justice," "lower labour participation," and "lower overall social support" are more likely to experience workplace bullying. Conclusions: Hospital managers should pay attention to the problem of nursing workplace bullying. First of all, hospital managers should encourage curriculum on nursing workplace bullying and incorporate nursing workplace bullying prevention training courses in curriculum planning. SUMMARY STATEMENT: What is already known about this topic? Workplace bullying can cause physical and psychological disorders in nurses and affect patients' safety.Understanding the affecting factors related to workplace bullying may be beneficial for decreasing the incidence of workplace bullying in nurses. What this paper adds? Past bullying experience, self‐assertiveness, work psychological demands, workplace justice, labour participation, and overall social support were predictors of workplace bullying. The implications of this paper: The establishment of a friendly workplace environment is important, such as, building up justice policies and involving nurses' opinions whilst setting up all policies.Nurse managers may provide educational programs to nurses in order to improve their knowledge and skills to deal with workplace bullying. [ABSTRACT FROM AUTHOR]

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

Aim: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full‐term normal childbirth in southern Taiwan. Methods: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State‐ Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. Results: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. Conclusion: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions. SUMMARY STATEMENT: What is already known about this topic? Recurrent miscarriage is considered a major life event and, for some, a failure to fulfil a core responsibility for the family lineage.Research about the differences between genders in both the type and degree of emotional response to a miscarriage is limited. What this paper adds? Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than women without recurrent miscarriage.The key predictors of depressive symptoms among women of childbearing age were anxiety, stress, social support and history of recurrent miscarriage, accounting for 62.9% of the variance. The implications of this paper: This study highlights the need to increase healthcare professionals' awareness of the importance of evaluating stress, anxiety and depressive symptoms in women with recurrent miscarriage.It is recommended that future studies develop and test supportive care protocols for couples experiencing recurrent miscarriage. [ABSTRACT FROM AUTHOR]

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. [ABSTRACT FROM AUTHOR]

Background: Taiwan's higher education institutions prioritize interdisciplinary knowledge and cultural competence in cultural design, emphasizing the value of immersion in the local environment to develop cultural competence. However, challenges arise from the disappearance of traditional local lifestyles and limitations of traditional outdoor lectures such as group size and learning environment. Mobile augmented reality technology serves as a personal learning tool to overcome these challenges, enabling learners to uncover hidden knowledge in scenic locations and improving learning efficiency. Objective: The study utilized learning analytics to investigate the impact of using mobile augmented reality on enhancing learners' cultural competence. Methods: The study used both qualitative and quasi‐experimental quantitative research to evaluate the effects of mobile augmented reality on cultural competence. A total of 78 third‐year university students participated in the study, with 37 of them using mobile augmented reality to learn about culture. The researchers utilized both the Mann–Whitney U test and interviews to compare the effectiveness of mobile augmented reality with that of a 'real' tour guide in field courses. Results: The experimental results indicate that learners were able to continuously seek and find information about local culture through field exploration with mobile augmented reality, resulting in similar effects to those of attending a live lecture. Conclusions: It showed that incorporating mobile AR into field visits can create gamified and active learning scenarios that enhance immersion and drive active learning in local culture. The results in greater cultural knowledge and understanding, leading to the development of cultural competence in students. Lay Description: What is already known about this topic: There is a heightened emphasis on cultivating and demonstrating cultural competence across various fields due to the significantly grow of cultural and creative industries.Relying solely on traditional classroom teaching for learning about local culture may result in a diminished impact, as a comprehensive understanding of culture necessitates a keen sense of life.To address the limitations of traditional classroom lectures, educators continuously strive to enhance teaching methodologies by developing innovative approaches, such as experiential learning and community‐based learning, which involve hands‐on activities and real‐world engagement to foster increased learning motivation and improved effectiveness.Augmented reality (AR), a technology that overlays virtual images onto real scenes in real time, has gained extensive usage in diverse fields such as medicine, national defence, education, and entertainment, offering interactive gaming experiences and providing an opportunity to experience the culture and past lives of locals in the field, enhancing learners' understanding of cultural history and creating immersive encounters during visits.Particularly in digital learning, the integration of AR enables learners to engage with additional content through mobile devices, fostering an immersive and gamified learning experience. What this paper adds: The use of the AR app for learning about the local culture yielded comparable outcomes to traditional guided tours.Participants actively engaged in self‐directed learning and demonstrated a sense of initiative while utilizing AR.The flexibility and autonomy provided by field learning, which extended beyond the course period, allowed participants to revisit the field and explore at their own pace using AR.Demonstrates that participants took control and responsibility for their own learning, leading to an enhancement in learner autonomy.Participants who utilized the Roaming Jingliao AR system to explore cultural scenarios exhibited enhanced knowledge and attitudes regarding cultural competence, specifically in areas such as cultural understanding, rice food cultural knowledge, Songjiang folk arts, and skills and practices, which can be attributed to the immersive and autonomous nature of AR‐based knowledge learning in outdoor guided courses, minimizing the influence of external environmental factors and facilitating a deeper understanding of the content compared to traditional guided tours. Implications for practice and/or policy: The findings of this study highlight the importance of considering the limitations associated with a relatively small sample size when conducting research within a university curriculum. To enhance the validity and reliability of future studies, practitioners and policymakers should prioritize the inclusion of larger and more diverse samples, enabling a more comprehensive understanding of the impact of AR technology on cultural learning and informing evidence‐based practices and policies.The study's focus on a specific group of participants and their contextual background highlights the need for future research to include participants from diverse educational settings and cultural backgrounds, ensuring that the findings are more applicable and relevant to a broader population. Practitioners and policymakers should consider the importance of inclusivity and diversity when designing and implementing cultural learning interventions using AR technology.The recognition of technological limitations highlights the importance of considering the specific AR system used in cultural learning interventions. Practitioners and policymakers should be cautious when adopting AR technologies and recognize that different AR systems or platforms may yield different outcomes. Future research should focus on evaluating the effectiveness of various AR systems and platforms to inform decision‐making regarding the selection and implementation of AR technologies for cultural learning initiatives. [ABSTRACT FROM AUTHOR]

Background: Many gamification applications (apps) have been designed to motivate students to learn particular content. Based on the brain activation approach, the present study adapted an app, named Shaking‐On, which requires students to shake their mobile devices to send their answers to multiple‐choice questions to the teacher. Students then learn from their performance. Objectives: To understand how this approach can stimulate participants' emotions when achieving their learning goals, the present study compared Shaking‐On to Kahoot! by checking participants' gameplay anxiety, learning interest, perceived learning value, and learning achievement while learning the Taiwanese language. Methods: The students were divided into two groups to play with one of the two apps, Shaking‐On or Kahoot!, as part of a quasi‐experimental study in which they used the assigned app six times in 6 weeks. Moreover, a questionnaire was distributed to participants and 151 useful responses from the Shaking‐On group, and 148 from the Kahoot! group were returned. Results and Conclusions: After statistical analysis, the results of this study revealed that besides no difference in gameplay anxiety when comparing the two groups of students, there were significant differences in game interest, flow experience, perceived learning value, and learning achievement, further indicating that Shaking‐On with hands‐on shaking outperformed Kahoot!. Lay Description: What is already known about this topic: The adoption of technology in learning pedagogies should enable students to interact with their technological devices in a fun way and there needs to be interested during the learning process.Different designs of e‐learning platforms have different functions for students to interact that promote in them different psychological outcomes, by shaping their learning behaviours and enhancing their motivation and engagement. What this paper adds: The present study adapted an app, named Shaking‐On, which requires students to shake their mobile devices to send their answers to multiple‐choice questions to the teacher, students will then learn from their performance.To understand how this approach can stimulate participants' emotions in achieving learning goals, the present study compared Shaking‐On to Kahoot! by checking participants' gameplay anxiety, learning interest, perceived learning value, and learning achievement when learning the Taiwanese language. Implications for practice and/or policy: The research on the application of CATML to education is increasing, but there has been less research in the field of Taiwanese languages.The studies related to digital game‐based learning, there are few studies that compare games with different operation movements. Therefore, this study can be used as a reference for the application of cognitive and affective theories of multimedia learning to study the field of learning other native and disappearing languages. [ABSTRACT FROM AUTHOR]

Background: Collaborative computer simulations are available on some online platforms which support students at distributed locations to synchronously collaborate on the simulations to learn sciences. However, how students collaborate with each other in collaborative simulations is not clear. Objectives: The aim of this study was to investigate whether functional interdependency would influence learning. Methods: Two collaborative learning models with different functional interdependencies were examined (the synchronous model and the distributed accountability model). Multiple data sources obtained from 64 students were collected and analyzed. We discuss the collaborative learning with two levels of factors: the individual‐level factors (i.e., individual perceptions of teamwork quality, visual attention and learning performance before and after a simulation activity) and the pair‐level factors (i.e., discourse data and joint attention). Given that the pair‐level factors in the collaborative learning environment may affect the individual‐level factors, we further discuss the interactions of the two levels of factors in different collaborative learning models with hierarchical linear modeling (HLM) analysis. Results and Conclusions: The analytical results of the individual‐level factors found participants in the distributed accountability model demonstrated more frequent and longer attention to the learning activity. Furthermore, the results indicated that the two simulation learning activities would enhance the participants' learning performance except in Q2. For the pair‐level factors, the results demonstrated that the participants in the distributed accountability model showed more active discourse segments but similar joint attention patterns in the learning activity. The results of the HLM analysis indicated that the students in the distributed accountability model had to collaborate with their partners through more constructive dialogue, and focused on the same areas of interest to enhance their learning performance, as the complexity of the distributed accountability design was implemented in a simulation learning activity. Major takeaways: We found that the increase of functional interdependency cannot guarantee students' learning effect in collaborative learning and may hinder the communication that is needed during collaboration. Researcher may need to consider other collaboration tools to enhance the reciprocal reflection. Lay Description: What is already known about this topic: Collaborative simulations are helpful in making the learning process cohesive.The learning effects of functional interdependence in collaborative learning are under debate. What this paper adds: We examined collaborative learning models with different functional interdependencies.We discuss the collaborative learning with the individual‐, the pair‐level factors and their interactions Implications for practice and/or policy: The importance of decreasing cognitive load induced by simulation with high functional interdependency.It is necessary to increase participants' transactive and constructive engagement in collaborative models. [ABSTRACT FROM AUTHOR]

Background: Performance goal orientations are influential motivational factors for predicting learning performance. However, a lack of attention has been paid to investigating the effects of performance goal orientations on learning performance and in‐game performance in the context of digital game‐based learning. Objectives: This study implemented a game‐based English vocabulary learning system and investigated how performance goal orientations affected learners' learning performance and in‐game performance. Methods: A total of 59 non‐English major university students participated in this study, divided into performance‐approach learners (PAPL) and performance‐avoidance learners (PAVL) based on their performance goal orientations. The English vocabulary listening test and log data were collected for conducting quantitative analyses. Results and conclusions: The results showed that the PAPL outperformed the PAVL in learning performance, whereas the two groups demonstrated similar gain scores and overall in‐game performance. Moreover, the results showed that the PAVL's learning performance was strongly associated with all aspects of in‐game performance in the learning activities. Conversely, the PAPL's learning performance was only associated with two aspects of in‐game performance in the competition activities. Implications: The findings of this study suggest that performance goal orientations play significant roles in both learning performance and in‐game performance, which could benefit the PAVL's in‐game performance, which is a substantial factor in promoting their learning performance via DGBL. Lay Description: What is already known about this topic: Digital game‐based learning (DGBL) has been widely adopted in various subject areas.DGBL is an effective learning approach for language learning.Performance goal orientations are influential motivational factors in predicting learning performance.Relevant empirical research on performance goal orientations in DGBL is scarce and inconclusive. What this paper adds: A game‐based English vocabulary learning system was developed based on the considerations of different characteristics of performance goal orientations.This study provides understandings of the impact of performance goal orientations on both learning performance and in‐game performance in DGBL.Performance‐approach learners outperformed performance‐avoidance learners, whereas the two groups demonstrated similar gain scores and overall in‐game performance.Performance‐avoidance learners' in‐game performance is a substantial factor in promoting their learning performance via DGBL. Implications for practice and/or policy: Educators should consider adopting game‐based assessment to reduce the gap between learners with different performance goal orientations.DGBL can be a potential approach to supporting different performance goal orientations, but it is particularly beneficial to learners with performance‐avoidance goals.Learners with different performance goal orientations need different types of learning activities to achieve better performance.A personalized DGBL system should be developed to accommodate the needs and preferences of learners with performance‐approach and performance‐avoidance goals. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation.Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. What the paper adds to existing knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression.Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one‐point increase in meaning in life score was associated with 0.47‐point decrease in depression score and 0.13‐point decrease in suicidal ideation score, respectively. What are the implications for practice: Logotherapy is a meaning‐centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression.Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. Introduction: Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim: To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method: A cross‐sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results: The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p <.03), and meaning in life had a direct negative association with depression (β = −0.51, p <.01) and indirect association with suicidal ideation through depression; this indirect association was −0.21 (p <.01). Discussion: Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice: Logotherapy is a meaning‐centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation. [ABSTRACT FROM AUTHOR]

No quantitative study has explored the influence of attention on learning English as a foreign language (EFL). This study investigated whether computer-detected attention is associated with EFL reading and listening and reading and listening anxiety. Traditional paper-based English tests used as entrance examinations and tests of general trait anxiety, reading, listening, reading test state anxiety, and listening test state anxiety were administered in 252 Taiwan EFL college students who were divided into High Attention (Conners' Continuous Performance Test, CPT < 50) and Low Attention (CPT ≥ 50) groups. No differences were found between the two groups for traditional paper-based English tests, trait anxieties, general English reading anxiety scales, and general English listening anxiety scales. The Low Attention group had higher test state anxiety and lower listening test scores than the High Attention group, but not in reading. State anxiety during listening tests for EFL students with computer-detected low attention tendency was elevated and their EFL listening performance was affected, but those differences were not found in reading. [ABSTRACT FROM AUTHOR]

INTRODUCTION The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression. METHODS We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed. RESULTS Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96- 1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97- 2.56). CONCLUSIONS Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women. [ABSTRACT FROM AUTHOR]

This experimental study investigated long-term effectiveness of two educational methods on knowledge, attitude, and practice (KAP) about palliative care consultation services (PCCS) among nurses, recruited from a medical center located in Northern Taiwan in 2015, using a stratified cluster sampling method, with 88 participants in multimedia (experimental) and 92 in traditional paper education (control) group. Data were collected using KAP-PCCS questionnaire before education, immediately after, and 3rd and 6th month after education. Results showed that both K-PCCSI and P-PCCSI significantly increased immediately after, and at the 3rd month after education for the experimental group; the K-PCCSI remained significantly higher for the experimental group at the 6th month. The highest increase in scores for both K-PCCSI and P-PCCSI was observed at the 3rd month. There was no significant change in A-PCCS in both groups after follow-up periods, when compared before education. Therefore, using multimedia every 3 months to continue strengthening their knowledge may increase the referrals of terminal patients to PCCS. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals.Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge?: To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan.Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families.Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation.LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Introduction: Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim: This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method: A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results: Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion: Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice: Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]