Search Results (2,239)

Ethical conflicts are an inherent—yet often invisible—dimension of occupational therapy practice. Most available evidence remains qualitative or conceptual, and the empirical articulation of ethical conflicts in Spain is still limited. This study examines the nature, distribution, co-occurrence patterns, and meanings of ethical conflicts reported by occupational therapists in Spain. A concurrent convergent mixed-methods design was used. From a broader national sample of 596 valid responses, the analytical sample consisted of 160 practitioners (84.4% women, reflecting the gender composition of the profession in Spain) who reported having experienced ethical conflicts and provided open-text information. Data were collected via an online questionnaire combining closed items and open-ended narratives. Quantitative analyses included descriptive statistics and Jaccard-based co-occurrence estimates derived from a non-mutually exclusive thematic coding matrix. Narratives were analyzed inductively with a descriptive phenomenological orientation (Giorgi), using thematic procedures as an analytic scaffold (Braun and Clarke). Findings were integrated through joint displays and meta-inference. The most frequently selected primary conflict categories concerned professional competence and practice (19.4%), relationships with family members/caregivers (14.4%), and the user–therapist relationship (12.5%). Co-occurrence analysis indicated that conflicts rarely occurred in isolation and tended to cluster across relational, structural, and professional domains. Integration of quantitative patterns and narrative meanings supported a preliminary interpretive three-dimensional framework (relational, structural, professional) for understanding ethical tensions in practice. Across narratives, participants described experiences interpreted as consistent with moral distress, economic and workload pressures, limited professional recognition, and normative gaps. Ethical conflicts in occupational therapy practice in Spain are best understood as recurrent, situated tensions shaped by relational dynamics and organizational conditions, rather than isolated dilemmas. Supporting moral agency requires organizational supports, spaces for collective ethical deliberation, and context-sensitive ethics education. Full article

Genetic cardiomyopathies (GCMs) are chronic heart muscle disorders requiring lifelong monitoring and treatment. Although quality of life (QoL) and health-related quality of life (HRQoL) are increasingly recognized as important outcomes in cardiomyopathy care, their conceptualization and measurement remain inconsistent. This scoping review aims to (a) identify the tools most commonly used to assess QoL and HRQoL in adults with genetic cardiomyopathies and (b) map the thematic areas of existing studies, including symptom burden, psychological distress, diagnostic challenges, and the impact of medical and psychological interventions. PubMed, Scopus, and PsycINFO were systematically searched, and the final search was completed in November 2025. Seventeen peer-reviewed studies met the inclusion criteria and were included in this scoping review. The review followed the PRISMA extension for Scoping Reviews and included both quantitative, qualitative and mixed-methods designs. Most studies employed standardized tools such as EQ-5D (N = 5), SF-36/SF36v2 (N = 5), and the Kansas City Cardiomyopathy Questionnaire (N = 3), while others included the Minnesota Living with Heart Failure Questionnaire (N = 2) and disease-specific or ad hoc measures. The most frequently investigated themes included impairments in physical functioning, emotional well-being, symptom burden, psychological distress, and social participation. Several studies showed that patients’ perceived QoL was more closely associated with symptom burden and psychological adjustment than with objective clinical indicators alone. Clinical interventions showed mixed or limited effects on QoL and HRQoL outcomes, even when clinical parameters improved. Qualitative research further emphasized the lived experiences of patients and families, highlighting unmet needs in care. Less commonly addressed findings concerned caregiver perspectives, patient–provider communication, treatment adherence, socioeconomic disadvantage, healthcare costs, productivity loss, and the experiences of patients with rarer cardiomyopathy-related conditions. The results highlight how QoL and HRQoL are central but still inconsistently assessed outcomes in cardiomyopathy research. This review calls for greater conceptual clarity between QoL and HRQoL, greater standardization in measurement tools, broader inclusion of psychosocial variables, and more patient-centred research approaches to better support individuals living with cardiomyopathies. Full article

Objective: To analyze the perceived facilitators and barriers promoting and hindering the clinical application of the best evidence of clean intermittent catheterization (CIC) in patients after radical hysterectomy (RH). Methods: This study employed a convergent parallel mixed-methods design. Participants included patients undergoing CIC after RH, medical and nursing practitioners and managers in the gynecological department and outpatient clinics at a tertiary-level women’s and children’s hospital in Chengdu. They were included in both components separately. Interview data were managed using Nvivo 11.0 software and analyzed through directed content analysis. Quantitative data were analyzed using SPSS 29.0 statistical software. Results: A questionnaire survey was conducted among 156 healthcare providers and 300 patients. Qualitative interviews were conducted with 11 healthcare workers and 12 patients. At the evidence itself level, evidence meeting clinical needs and evidence lacking practical applicability, respectively, promoted and hindered clinical implementation of the best evidence. At the potential adopters’ level, healthcare professionals’ insufficient professional competence, low willingness to promote implementation, numerous concerns, and lack of autonomy and awareness regarding the importance of the task were significant barriers, but they maintained an overall positive attitude toward the application. At the practical environment level, patient-related perceived barriers predominantly hindered evidence implementation. Additionally, a supportive practice atmosphere, economic feasibility, and talent development opportunities served as key facilitators. However, existing nursing practice content and workflows directly impacted evidence adoption. Conclusions: The promotion and barriers to the clinical application of the best evidence for CIC in RH postoperative patients are multifaceted. Targeted intervention strategies must be developed to facilitate the effective translation of evidence into clinical practice. Full article

Despite the growing attention paid to sustainability education, limited quasi-experimental research has examined how metacognitive guidance can integrate cognitive, affective, and agency-oriented learning in food-related climate education. This classroom-based quasi-experimental study, complemented by student interviews, investigated a six-lesson metacognitive guidance-based unit designed to strengthen ninth-grade students’ sustainable food literacy (SFL), climate-change perceptions and attitudes, and constructive hope. Participants were 59 students from two intact classes in northern Israel; one class received the intervention, and the other received traditional instruction on the same content. Quantitative data were collected through a sustainable food and climate change knowledge test and a climate change literacy questionnaire and were analyzed using mixed-design repeated-measures ANOVA, t-tests, and multiple regression. Qualitative data were obtained from individual semi-structured interviews with students in the experimental group. Results indicated significant intervention-related gains in SFL knowledge, climate-change perceptions, climate-change attitudes, and constructive hope, with moderate-to-large time × group effects across the main outcomes (partial η² = 0.16–0.33). Climate-change perceptions emerged as the strongest post-intervention predictor of constructive hope (β = 0.92, p < 0.001). Interviews illustrated how reflective prompts, self-monitoring, discussion, and learning artifacts supported conceptual understanding, moral responsibility, perceived agency, and self-reported short-term intentions for sustainable food choices. The findings suggest that metacognitive guidance can support integrative, hope-oriented sustainability learning among adolescents. These findings should be interpreted cautiously given the small non-random sample, the use of two intact classes, the short six-lesson intervention, and the reliance on short-term self-reported outcomes. The study’s novelty lies in integrating sustainable food literacy, climate-change perceptions and attitudes, and constructive hope within a metacognitively guided food–climate unit in a culturally underrepresented Druze school context. Full article

Despite growing interest in Virtual Labs (VLs), limited research examines the factors influencing educators’ willingness to adopt them through the lens of inquiry-based learning (IBL). This exploratory pilot study evaluates educators’ interaction with the VHEalthLab VLs toolkit, examining their perceptions on usability, pedagogical value, IBL support, and intention to use. The study combines IBL, as a pedagogical lens, with the Technology Acceptance Model (TAM) within a Triple Bottom Line sustainability framework aligned with Sustainable Development Goals 4 and 10. Using an exploratory cross-sectional design with an embedded qualitative component, data were collected from seventy Biology educators across four European countries (Cyprus, Greece, Romania, Spain) through two structured questionnaires. Data analysis included descriptive statistics, Pearson correlations, directed content analysis, and joint display integration. Findings indicate that adoption intention was associated primarily with pedagogical rather than technological factors; IBL alignment showed the strongest association with intention to implement VLs (r = 0.63, p < 0.001), while perceived usefulness was most strongly associated with pedagogical materials (r = 0.65, p < 0.001). Assessment and inclusion functioned as quality criteria rather than factors associated with adoption intention. Educators consistently endorsed VLs as complements to physical laboratories, with their perceptions suggesting potential environmental, economic, and social sustainability implications within a blended model. Full article

Background/Objectives: Artificial Intelligence (AI) integration in healthcare promises improved diagnostic accuracy, patient safety, and operational efficiency. However, AI acceptance among healthcare workers remains limited due to knowledge gaps, risk concerns, and governance challenges, particularly in developing countries like Saudi Arabia, where rapid healthcare modernization faces unique infrastructure, organizational, and cultural challenges. This research investigates the factors influencing AI acceptance among medical practitioners, nurses, administrators, and students in Saudi Arabian hospitals to identify key determinants and barriers to adoption. Methods: This cross-sectional study employed an extended Unified Theory of Acceptance and Use of Technology (UTAUT) framework integrated with ethical considerations from the Model for Ethical Assessment and Analysis of AI in Medicine (MEAAM). A structured bilingual questionnaire was administered to 119 healthcare professionals and students across Saudi Arabia, measuring constructs including Awareness and Knowledge, Performance Expectancy, Effort Expectancy, Facilitating Conditions, Social Influence, Trust, Perceived Risk, Ethical Governance, and Price Value. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed for quantitative analysis, supplemented by thematic analysis of open-ended qualitative responses. Results: The PLS-SEM analysis explained 59.8% of variance in behavioral intention to adopt AI (R² = 0.598). Awareness and Knowledge emerged as the strongest predictor (β = +0.505, p < 0.001), followed by Performance Expectancy (β = +0.229, p < 0.05) and Social Influence (β = +0.123). Perceived Risk functioned as the primary barrier (β = −0.185, p < 0.05). Qualitative findings identified infrastructure gaps, regulatory ambiguities, and training deficiencies as major implementation barriers, while emphasizing opportunities in diagnostic accuracy and remote monitoring. Conclusions: AI acceptance in Saudi healthcare is primarily driven by knowledge, with perceived usefulness and peer support as secondary facilitators, while safety and accountability concerns remain substantial obstacles. Successful AI integration requires coordinated efforts in education, transparent governance frameworks, and institutional support. This study contributes theoretically by validating extended UTAUT in a non-Western healthcare context and practically by providing evidence-based strategies for sustainable AI adoption that enhance healthcare quality while respecting professional roles and ethical principles. Full article

Background: A subgroup of adolescent and young adult patients (AYAs; 18 to 39 years at diagnosis) face an uncertain or poor cancer prognosis (UPCP). Previous qualitative research identified dual coping pathways in this population: engagement in life versus the reality of premature death. This study examines whether similar psychosocial profiles can be identified through quantitative data, aiming to differentiate patient experiences and identify characteristic features of each cluster. Additionally, this study examines the association between cluster membership and social support needs to understand psychosocial disparities. Methods: Eligible participants completed questionnaires assessing physical, psychosocial, and existential outcomes related to their disease and prognosis. An ensemble clustering approach was applied, including evaluation of clustering tendency and multiple algorithms, with stable clusters identified through majority voting. Associations with social support needs were analyzed using Fisher’s exact test. Results: Data from 155 AYAs with a UPCP were included. The mean age at diagnosis was 31.2 years, with glioma (34.8%) and breast cancer (17.4%) as the most common diagnoses. Two distinct clusters were identified: one (22%) characterized by poorer functional outcomes and fewer protective factors (e.g., hope, meaning in life), and another cluster (78%) with better functioning and less frequent needs for social support (p < 0.00043). Conclusions: Findings revealed divergent psychosocial profiles within the AYA-UPCP population, highlighting the importance of early identification of vulnerable subgroups. Strengthening protective factors may enhance resilience and reduce unmet support needs. Validation in larger, external datasets is needed to confirm these pathways and guide tailored supportive care strategies. Full article

Background/Objectives: Physical inactivity is a significant public health challenge among children and young people (CYP), particularly within clinical populations. Whilst healthcare professionals (HCPs) are uniquely positioned to implement behaviour change strategies, there is little evidence of implementation in practice. This study examined the practices of, as well as barriers and facilitators experienced by, HCPs in South Wales, United Kingdom (UK), when promoting physical activity (PA) and reducing sedentary behaviour (SED) in clinical paediatric populations, together with their perceptions and proficiencies in delivering this support. Methods: A 32-item questionnaire was completed by 41 HCPs, recruited through professional and clinical networks to generate an opportunistic sample from physiotherapists (n = 22), doctors (n = 7), occupational therapists (n = 4), therapy technical instructors (n = 2), and others (n = 1 each). Quantitative responses were analysed using descriptive statistics; free-text responses underwent qualitative content analysis. Results: The findings revealed that 95% of HCPs discussed PA at some or all appointments, with similar figures reported for SED (90%) and exercise (88%). However, only 63% of participants felt PA was adequately addressed within their services. Barriers included time constraints, resource limitations, and knowledge gaps. Key facilitators included training, toolkit availability, and multidisciplinary collaboration. Conclusions: This study highlights the need for system-level changes to enable HCPs to deliver consistent, effective messaging that promotes PA and reduces SED, ultimately improving health outcomes for CYP receiving clinical input. Facilitating this approach requires embedding PA promotion into HCP training, expanding referral pathways to CYP, and strengthening multidisciplinary working. Full article

Informal waste picking and scrap collection constitute critical yet highly precarious livelihood strategies among economically marginalised women in rural South Africa. This article presents a cross-sectional mixed-methods study, guided by Sen’s Capability Approach as its analytical framework, examining the lived experiences, motivations, and livelihood outcomes of 126 Black African women engaged in scrap collection along the N2 Highway in the Eastern Cape, specifically in Mthatha, Xhora, and Qumbu. The study integrates quantitative descriptive statistics with qualitative thematic analysis derived from structured interviewer-administered questionnaires. The findings indicate that participation in scrap collection is overwhelmingly driven by structural economic constraints, including chronic unemployment, household poverty, and extensive caregiving responsibilities, rather than autonomous occupational choice. The sample is characterised by limited educational attainment, frequently disrupted by poverty, bereavement, early marriage, and early caregiving roles, which collectively constrain access to formal employment opportunities. Participants consistently described scrap collection as physically hazardous, economically insecure, and detrimental to both physical health and psychosocial wellbeing, while remaining indispensable for household survival. Through the lens of the Capability Approach, these conditions reflect severe restrictions in substantive freedoms, particularly in relation to economic security, bodily health and human dignity. Expressions of acceptance are interpreted as manifestations of adaptive preferences formed under conditions of prolonged structural deprivation rather than indicators of genuine agency. The study contributes to informal economy scholarship by demonstrating how intersecting structural inequalities constrain capability sets and limit livelihood trajectories and calls for targeted policy interventions to enhance occupational safety, income security and access to sustainable livelihood alternatives. Full article

Spanish–English bilingual learners in U.S. dual language and bilingual education programs develop Spanish orthographic competence while receiving literacy instruction across two writing systems that differ in phonological transparency, orthographic depth, and grammatical marking. This study examined experts’ perceptions of the clarity, instructional coherence, pedagogical relevance, applicability, and refinement priorities of a pedagogical framework for Spanish orthographic development in contexts where Spanish is used as a language of instruction and literacy. The framework conceptualizes Spanish orthographic decision-making as the coordinated activation of phonological mapping, orthographic–grammatical reasoning, and visual–lexical retrieval within biliteracy development. Using a qualitative evaluative design, the study analyzed open-ended questionnaire and interview data from 44 experts in bilingual education and Spanish literacy-related fields. Findings show broad convergence regarding the framework’s clarity, instructional coherence, and relevance for bilingual contexts. Participants emphasized pre-dictation preparation, explicit metalinguistic analysis, visual-memory activation and retrieval routines, and cross-linguistic comparison between Spanish and English. They also identified refinement priorities, including classroom-ready examples, clearer articulation of error and autocorrection, and stronger integration with reading, writing, and oracy practices. This study positions Spanish orthographic instruction as a cognitively guided biliteracy practice and identifies design principles for strengthening orthographic, metalinguistic, and cross-linguistic instruction in bilingual programs. Full article

AI use is associated with both cognitive relief and cognitive offloading, leading to uncertainty in how users make value judgments and decisions. This study focuses on in-class AI use and explores the perceptions of cognitive relief and cognitive offloading among university students, as well as the distinct mediating mechanisms through which these factors shape the attitudes of students. Based on questionnaire data from 287 respondents, structural equation modeling and bootstrap methods were employed to test the research hypotheses. The results show that cognitive relief exerts a complementary mediating effect between AI use and attitudes, whereas cognitive offloading functions as a competitive mediator. The two mechanisms produce opposing effects on students, with cognitive relief demonstrating a stronger overall mediating effect. These findings suggest that educators should guide students toward a more nuanced understanding of AI use to mitigate confusion and its potential negative psychological consequences. Moreover, educators and institutions should leverage AI to provide cognitive relief for higher-order learning activities, thereby enhancing the engagement, motivation, and deeper learning processes of students, while simultaneously implementing reflective and critical thinking practices to guard against the risks of cognitive offloading. This study is limited by its single-institution convenience sample and reliance on self-reported data; future research incorporating qualitative methods such as interviews and classroom observations is encouraged to further validate and extend these findings. Full article

This qualitative study examines how Orthodox and ultra-Orthodox Jewish fathers in Israel describe raising a child with autism within the everyday life of a religious family. Although research on autism and family life has expanded, fathers’ voices remain underrepresented, especially in religious families in which family routines, the Sabbat and holidays, and everyday religious practices shape parenting and participation at home. Data were collected from 127 fathers of children aged 3 to 18 through an online Hebrew questionnaire that included open-ended questions and were analyzed using qualitative content analysis. The findings suggest that religiosity shaped fathers’ caregiving not only as a source of meaning, hope, and emotional strength but also as a practical framework for everyday accommodation and belonging. Four themes emerged: (1) religiosity as an anchor for resilience; (2) paternal love as a religious practice of accommodation; (3) paternal adaptation during the Sabbat and holidays; and (4) religious authority as a basis for legitimizing care practices and preserving the child’s place within family and religious life. Together, these findings underscore the importance of culturally responsive support that acknowledges how religious meaning systems shape paternal care, family participation, and children’s inclusion, while also suggesting that fatherhood may function as an ongoing mediating process within religious family life. Full article

Given the moral barriers that hinder critical analysis of pornography, this study aims, through a qualitative approach with 15 participants, to examine its impacts on the construction of masculinity and the social relationships of men from the semi-arid region of Paraíba, Brazil. Data were collected via an online form, which included a sociodemographic questionnaire and open-ended questions on the topic. The data were analyzed using dialogical maps within the framework of discourse analysis. Results show that pornography is a constant and influential presence in the participants’ lives, often beginning at an early age and reinforced by social interaction. Its consumption goes beyond personal satisfaction, also serving as a tool for social comparison, shaping male subjectivity and relational dynamics. In sum, the study highlights the cultural impact of pornography in a context where critical discussions about sexuality remain limited due to the prevalence of traditional gender norms and male chauvinism. Full article

Students with disabilities, particularly those needing additional support or intervention to manage emotions and behaviors, build healthy relationships, and navigate social and academic demands, face heightened risks of high school pushout that can be traced back to their transition into high school. Project Elevate (PE) is a multi-component intervention that strategically invests in early coordinated student, family, and school supports to prevent barriers associated with high school pushout, such as a lack of continuity of effective services across school sites. This mixed-methods pilot study examined the implementation of PE with three 8th-grade students and their parents during their last term in middle school. This study includes quantitative pre–post descriptive analyses of multi-informant reports of students’ social, emotional, and behavioral skills, as well as descriptive analyses of weekly teacher- and parent-reported behavior and student attendance. Qualitative analysis using the Framework Method was applied to student and parent interviews and open-ended responses on a satisfaction questionnaire to understand their experience receiving PE support. Session case notes were also used as contextual data to describe implementation processes and contextualize findings. Results indicated improvements in student attendance and reductions in home-based behavioral concerns, with mixed findings across school-based outcomes. Students and parents reported high satisfaction with the intervention, highlighting the value of individualized support, goal setting, and strengthened communication with schools. Findings from this intervention development pilot study provide preliminary evidence regarding the implementation and perceived value of PE. Results also highlight the importance of culturally responsive, relationship-centered practices that affirm student strengths and support access to educational opportunities. Further investigation of PE in larger studies is warranted. Full article

Background: Respectful maternity care (RMC) prioritizes dignity, privacy, and autonomy during childbirth. In low-resource primary health centers (PHCs), the lack of delivery gown availability compromises these aspects, leading to discomfort and reduced patient satisfaction in PHCs. This study on Maathru Samman Pants (MSPs), a culturally sensitive garment designed with functional flaps, aims to enhance privacy, comfort, and dignity during labor, as well as assess the satisfaction, acceptability, and demand for MSPs among pregnant women and their birth companions in PHC settings across four Indian regions. Methods: A cross-sectional study was conducted across eight PHCs in North, South, East, and West India. A total of 80 pregnant women and 60 birth companions participated. Data were collected through structured questionnaires and in-depth interviews. The quantitative data covered satisfaction, acceptability, and demand using Likert scales, yes/no, and open-ended formats. The qualitative data were analyzed thematically. Results: Most PW (pregnant women) were aged 21–30 years, mainly Hindu, 34 (42.5%), or Christian, 27 (33.75%), with 71.25% homemakers. PW highly rated MSPs for covering the body, preventing cold, comfort, and ease of use. They felt cared for and respected, with a mean ± SD of 4.47 ± 0.57, and agreed that MSPs maintained privacy and cultural norms. Demand was strong, with 76 (95%) supporting the introduction of MSPs and 74 (92.5%) willing to use them again. Most PW, 66 (82.5%), and BCs (birth companions), 49 (81.67%), accepted MSPs positively, with a few reporting discomfort or changes. Conclusions: MSPs demonstrated high satisfaction, strong acceptability, and future demand among PW. This study addresses key gaps in respectful maternity care at the PHC level by enhancing privacy, preserving cultural norms, and improving comfort. Integrating MSPs into maternal health protocols could significantly improve birthing experiences in resource-limited settings. Full article