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Background: The role of patient participation and representation during crises, such as the COVID‐19 pandemic, has been under‐researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID‐19 pandemic. Methods: The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. Results: We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision‐making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision‐making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. Conclusions: The struggle for patient representation during pandemic decision‐making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision‐making offer lessons for future representation activities. However, adaptations to the crisis decision‐making structure are also needed to enable patient representatives to play their role. Patient Contribution: We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co‐authored this paper. [ABSTRACT FROM AUTHOR]

Background: Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. Methods: Using Q‐methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow‐up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by‐person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. Results: Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision‐making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. Conclusions: Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. Patient or Public Contribution: An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications. [ABSTRACT FROM AUTHOR]

Background Study: Technology‐supported learning environments, act as significant observational and enabling indicators for evaluating and encouraging the digital revolution of education, are of vital importance in current educational research. Keeping track of the dynamics of technology‐supported learning environment research allows for the enrichment of theoretical studies and a prompt innovation of talent‐training environments. Objectives: The present study carried out a bibliometric analysis of the core collection of WoS database over the last two decades. Method: This study is a bibliometric research. We applied CiteSpace and VOSviewer for co‐occurrence and evolution analysis. In addition, we extracted the fundamental ideas and thoughts through reading and analysis. Results: First, the study found that technology‐supported learning environment research is in a growth phase, with core journals such as Interactive Learning Environments or Computers & Education. The findings show that a core research team comprised of such scholars as Hwang Gwo‐Jen, Lester James C. and Wong Lung‐Hsiang. Key nations of publishing and research strength are from China, the United States, the United Kingdom and the Netherlands. Second, the hot topics in research on technology‐supported learning environments were virtual learning environments, technology‐enabled learning environments and interactive learning environments. Nine study specifics were derived from these three topics such as moulding function, generating scenario, stimulating sensation, effect verification, design idea, research reflection, inquiry and research, virtual community, and mixed environment. Lastly, the frontier evolution offers a pattern of development from enhancing performance to changing mode to incorporating experience. Conclusion: Looking ahead, our research recommendations for the field of technology‐supported learning environments include a multifaceted approach. We should aim to enhance research designs and methodologies, develop contemporary guiding theories and strive for a balanced representation across various educational domains, expanding our scope to encompass all academic disciplines. In terms of practical application, it is imperative to focus on the design and implementation of technology‐supported learning environments from three critical perspectives: "change‐demand," "student‐learning" and "online‐offline." These approaches will collectively ensure that technology‐supported learning environments are both innovative and responsive to the diverse needs of the educational landscape. Lay Description: What is already known about this topic: Technology‐supported learning environments are currently a focal and hot research topic in the field of education.Although numerous studies have been conducted on the learning environment of technical support, there has yet to be a systematic and comprehensive review of the related research. What this paper adds: This study provides a comprehensive review of research on the technology‐supported learning environments over the past two decades.This study primarily presents an overview of research on the technology‐supported learning environments over the past two decades, focusing on main literature, research strength, hot topics and frontier evolution. Implications for practice and/or policy: Researchers need to further advance research on technology‐supported learning environments by enriching research designs and methods, constructing up‐to‐date guiding theories and achieving a balance across different educational domains while extending the reach to all disciplines.Educational practitioners need to pay attention to the design and implementation of technology‐supported learning environments from the three viewpoints of "change‐demand," "student‐learning" and "online‐offline." [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is an interactive process. Yet, instructional needs are usually identified with isolated componential tests. This study examined whether a dynamic approach, in which componential abilities are measured within the same text and global text comprehension is facilitated via feedback, can help in understanding variation in children's reading comprehension. Objectives: With a pretest‐posttest control group design, componential abilities before and after feedback were related to growth in global text comprehension within the same text. Methods: At pretest, third to fifth graders read 30 short texts, each followed by one global text comprehension question. This was repeated at posttest, but additional questions were asked with feedback prior to each global text comprehension question. The vocabulary group received two vocabulary questions with feedback (n = 97). The vocabulary plus integration group received two vocabulary questions and one sentence‐integration question with feedback (n = 98). The control group (n = 98) only answered the global text comprehension questions. Results and Conclusion: Participants in the experimental conditions who needed feedback (i.e., lower‐skilled) experienced a decrease in global text comprehension, whereas this was not found for the control group and participants in the experimental groups who did not need feedback (i.e., higher‐skilled). There was also less decrease among those lower‐skilled participants who had profited from the feedback. Implications: It is concluded from explorative analyses that not feedback but the overall design caused the decrease. Conceptually, the dynamic approach is worth further research. Lay Description: What is already known about this topic: Reading comprehension is a complex interaction of several componential abilities at word level, sentence level, and text level (e.g., vocabulary and sentence‐integration).Instruction should adapt to the profile of strengths and weaknesses in componential abilities.Assessing componential abilities with isolated tests does not align with the interactive processes in reading comprehension.Measuring learning ability can help to identify children with low responsiveness to instruction. What this paper adds: Reading comprehension is profiled by asking questions on vocabulary, sentence‐integration, and global text comprehension for the same text in third to fifth graders (8–11 years olds).Feedback is provided after a mistake in a vocabulary and sentence‐integration question, and the feedback effect on global text comprehension is measured with a pretest‐posttest design.Children who receive feedback decrease in global text comprehension but children with higher skills in componential abilities decrease less.Explorative analyses and previous research indicate that the assessment design had a negative impact on performance, for example, via cognitive load, attention, self‐esteem, and motivation. Implications for practice and/or policy: Global text comprehension cannot always be facilitated by providing feedback on vocabulary and sentence‐integration within the same text.The design of the assessment and its influence on performance should be carefully considered by instructional designers, educators, and researchers, especially in case of young learners.It remains unclear from this study if facilitating global text comprehension via feedback with a dynamic approach is useful to understand variation in children's reading comprehension.The dynamic approach with a proper design may potentially still provide a useful insight in individual differences. [ABSTRACT FROM AUTHOR]

In this paper, we revisit this well‐established linear relationship of person‐organisation, demands‐abilities, and needs‐supply fit with job satisfaction, commitment, and OCBs, and propose that this relationship may be linear for affective work outcomes but curvilinear for behavioural ones. We test this idea in a two‐wave sample of 212 employees, with measures taken 4 weeks apart. The results support the idea that the relationship between fit and behavioural outcomes can, indeed, be curvilinear. Overall, this study contributes to a better understanding of the nature of the relationship between fit and work outcomes by challenging the long‐held 'more fit is better' logic that pervades much of the PE fit research to date. [ABSTRACT FROM AUTHOR]

Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted. [ABSTRACT FROM AUTHOR]

Background: Frailty is an important concept for risk stratification in clinical practice, but it is hardly acknowledged at all in mental healthcare settings. This paper aims to assess the impact of frailty on the course of depression and anxiety, and the impact of these affective disorders on the course of frailty. Methods: Lifelines, a prospective population‐based cohort study, evaluated 167,729 people living in the northern Netherlands. Frailty was based on the deficit accumulation model, which resulted in a 60‐item frailty index (FI) at baseline and a 35‐item FI at baseline and 5‐year follow‐up. Current depressive and anxiety disorders were assessed with the Mini International Neuropsychiatric Interview according to DSM‐IV criteria. Bidirectional associations between frailty and affective disorders were investigated using separate multivariable regression analyses in younger (<60 years) and older adults (≥60 years). Results: The FI was associated with the onset of a depressive disorder (younger adults: odds ratio [OR] = 1.12; 95% confidence interval [CI] 1.11–1.13; older adults: OR = 1.13; 95% CI 1.09–1.16) as well as any anxiety disorder (younger adults: OR = 1.10; 95% CI 1.09–1.10; older adults: OR = 1.07; 95% CI 1.04–1.09). The other way around, depressive disorder and anxiety disorders were associated with an accelerated increase of frailty over time (depressive disorder: younger adults: beta [β] = 0.03, p < 0.001; older adults: β = 0.04, p < 0.001; and any anxiety disorder: younger adults: β = 0.02, p < 0.001; older adults: β = 0.01, p < 0.142), although the effect of anxiety disorders was less equivocal among older adults. Conclusions: Affective disorders are reciprocally related to frailty. Results with respect to the impact of anxiety disorders on frailty suggest most impact at lower levels of frailty. Our results might imply that interventions to slow biological aging should be broadened towards younger and middle‐aged people as well as non‐frail older patients. To develop targeted treatment, future clinical and epidemiologic studies on the underlying pathways of this bidirectional association are needed. [ABSTRACT FROM AUTHOR]

Background: In the management of epidemics, like COVID‐19, trade‐offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision‐making. Methods: From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID‐19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed. Results: Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations. Conclusions: This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience. Patient or Public Contribution: No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate. [ABSTRACT FROM AUTHOR]

Background: Online and blended learning need an appropriate assessment strategy which ensures academic integrity. During the pandemic, many universities have chosen for online proctoring. Although some earlier examples suggest that online proctoring may reduce cheating, the potential side‐effects of proctoring are largely unknown. Objectives: Therefore, this study aims to identify the effects of proctoring on students' self‐reported temptation to cheat and potentially undesirable side‐effects, including test anxiety, perceived exam difficulty, and performance. In addition, we examine which contextual and student characteristics affect test anxiety during online exams. Methods: For this, we collected four waves of survey data throughout a year of teaching during the pandemic at one faculty of a Dutch university, resulting in a total sample of 1760 students within 105 courses. Results and Conclusions: Multi‐level analyses showed that while proctoring had no effect on the temptation to cheat, exam difficulty or performance, students reported higher levels of test anxiety. Some learning strategies, internet literacy, access to a reliable technology and a dedicated study space as well as gender and financial stress affect their test anxiety. To conclude, the decision to use online proctoring needs to consider the undesirable side‐effect on test anxiety. We discuss practical implications for university administrators, educational designers and teachers to reduce test anxiety. Lay Description: What is already known about this topic: Proctoring is often used to ensure academic integrity in online exams.Some evidence shows that proctoring reduces cheating.Little is known about the potential negative side‐effects of proctoring. What this paper adds: The use of proctoring has no effect on the temptation to cheat.The use of proctoring results in increased test anxiety.Several student characteristics and contextual factors reduce text anxiety. Implications for practice: Consider potential negative side‐effects when choosing for proctoring.Time management and internet literacy training might reduce test anxiety.Simulating the exam environment might be used to reduce test anxiety. [ABSTRACT FROM AUTHOR]

Background: Mastering fractions seems among the most critical mathematical skills for students to acquire in school as fraction understanding significantly predicts later mathematic achievements, but also broader academic and vocational prospects. As such, identifying longitudinal predictors of fraction understanding (e.g., mastery of numbers and operations) is highly relevant. However, almost all existing studies identifying more basic numerical skills as predictors of fraction understanding rest on data acquired in face‐to‐face testing—mostly in classrooms. Objectives: In this article, we evaluated whether results obtained in these previous studies generalized to data from the curriculum‐based online learning environment Bettermarks for mathematics used in schools in the Netherlands. Methods: We considered data from more than 5000 students who solved over 1 million mathematical problem sets on basic mathematical skills, fractions, but also algebra. Results and Conclusions: In line with previous findings, we found that fraction understanding was predicted significantly by more basic mathematical skills. Our analyses also indicated that algebra achievement was predicted significantly by fraction understanding beyond influences of more basic mathematical skills. Implications: Together, these findings generalized previous results based on face‐to‐face testing to the context of data from online learning environments and thus, indicate that data from such large‐scale online learning environments may well qualify to provide significant insights into the hierarchical development of mathematical skills. Lay Description: What is already known about this topic: Understanding fractions is one of the most difficult mathematical skill for students to learn in school.Longitudinal studies using face‐to‐face testing indicated that fraction understanding as well as achievements in algebra can robustly be predicted by prior mathematics skills. What this paper adds: We evaluated data from more than 5,000 Dutch students who performed over 1 million curriculum‐based mathematical problem sets in an online learning environment.Our analyses showed that fraction understanding as well as achievements in algebra and can be predicted by prior mathematics skills. Implications for practitioners: These results indicated that previous results from face‐to‐face testing generalize to data obtained from large‐scale online learning environments.Thus, these results open up a new avenue for research using online learning environments on the development of mathematical skills. [ABSTRACT FROM AUTHOR]

Background: Creating concept maps can help students overcome challenges of accurate knowledge monitoring and thus foster learning. However, students' knowledge often contains gaps and misconceptions, even after concept map creation. Theoretically, students could benefit from additional support, but it is unclear whether this might also be the case for (more practical‐oriented) secondary vocational students. Objectives: This study investigated whether the effectiveness of concept maps for learning could be improved by providing students with expert examples and reflection prompts in addition to their self‐generated concept maps. Methods: First‐year secondary vocational students (N = 91, Mage = 17.3 years) participated in this study, which utilized a pretest‐intervention‐posttest design. Regarding the intervention, students worked in two successive online learning environments, in which they had to present their knowledge in concept maps. After creation, students' concept maps were, depending on condition, supplemented with (1) an expert example with comparative feedback (a combined concept map) and related reflection prompts, (2) the combined concept map only, or (3) no combined concept map and no prompts. Results and Conclusions: Analyses based on students' domain knowledge demonstrate that students significantly increased their knowledge in all conditions. Data indicate that there was no significant difference in knowledge gain between conditions. Further analysis showed that students in the experimental conditions demonstrated higher learning gains if they consulted the combined concept map more often than their peers. Implications: Access to an example in addition to students' self‐generated concept maps seems promising in fostering their knowledge acquisition. However, secondary vocational students might need additional ways of support to guarantee higher learning gains. Avenues to increase the effectiveness of support are discussed. Lay Description: What is currently known about the subject matter: Creating a concept map can be an effective means to promote student learning by facilitating their knowledge monitoring.Students' knowledge often contains gaps and misconceptions, even after concept map creation.There is evidence that feedback is needed to realize an effect on students' learning. What is the paper adding to this: Innovative implementation of concept map feedback in a self‐directed online learning environment.Exploration of the added value of support to process concept map feedback.Focus on a generally overlooked and unique target group: secondary vocational students. What are the implications of study findings for practitioners: The adopted unique implementation of concept map feedback seems promising for increasing students' learning.When designing support for secondary vocational students it is necessary to take the unique characteristics of these learners into account. [ABSTRACT FROM AUTHOR]

In the present study, a 5‐week tablet‐based word reading efficiency game intervention (Reading Turbo) was integrated in a comprehensive phonics‐based reading curriculum. The aims of the study were to examine whether the game would advance children's word reading efficiency, and to determine the extent to which pre‐reading capacities and in‐game mechanisms could explain individual variation in responsiveness to the game. To do so, word reading efficiency scores of first graders in an intervention group (n = 132) and a control group that continued with the usual reading curriculum (n = 118) were compared prior to, directly after, and 2 months after the 5‐week intervention period. Individual variation in responsiveness was examined by relating reading precursors (i.e., phonological awareness, letter efficiency, rapid automatized naming (RAN), and verbal working memory) measured at the onset of the intervention, and in‐game accuracy and efficiency to word reading efficiency outcomes in untrained words. Results indicated that playing the word reading game significantly enhanced first graders' word reading efficiency directly after the intervention, but the effect was no longer significant 2 months after the intervention. With respect to individual variation in game responsiveness, it was found that phonological awareness, letter efficiency, and verbal working memory predicted responsiveness to the game via in‐game accuracy. In addition, phonological awareness and RAN predicted responsiveness to the game via in‐game efficiency, and letter efficiency and verbal working memory were directly related to responsiveness. The effectiveness of the word reading game thus differentiated between children with higher and lower pre‐reading capacities, and operated via in‐game child affordances. [ABSTRACT FROM AUTHOR]

Nowadays, students often practice problem‐solving skills in online learning environments with the help of examples and problems. This requires them to self‐regulate their learning. It is questionable how novices self‐regulate their learning from examples and problems and whether they need support. The present study investigated the open questions (1) to what extent students' (novices) task selections align with instructional design principles and (2) whether informing them about these principles would improve their task selections, learning outcomes, and motivation. Higher education students (N = 150) learned a problem‐solving procedure by fixed sequences of examples and problems (FS‐condition), or by self‐regulated learning (SRL). The SRL participants selected tasks from a database, varying in format, complexity, and cover story, either with (ISRL‐condition) or without (SRL‐condition) watching a video detailing the instructional design principles. Students' task‐selection patterns in both SRL conditions largely corresponded to the principles, although tasks were built up in complexity more often in the ISRL‐condition than in the SRL‐condition. Moreover, there was still room for improvement in students' task selections after solving practice problems. The video instruction helped students to better apply certain principles, but did not enhance learning and motivation. Finally, there were no test performance or motivational differences among conditions. Although these findings might suggest it is relatively 'safe' to allow students to independently start learning new problems‐solving tasks using examples and problems, caution is warranted: It is unclear whether these findings generalize to other student populations, as the students participating in this study have had some experience with similar tasks or learning with examples. Moreover, as there was still room for improvement in students' task selections, follow‐up research should investigate how we can further improve self‐regulated learning from examples and practice problems. Lay Description: What is (not) known about the subject matter: Learning new problem‐solving skills online with examples and problems is becoming more commonInstructional design principles (IDP) detail how to sequence tasks to optimize learning and motivationIt is unclear whether students spontaneously adhere to IDP when they select learning tasksNot much is known about how to support students to make better task selections What is the contribution of this paper: Students received a fixed task sequence (FS‐condition) or selected tasks themselves (SRL)Prior to SRL, SRL‐students watched a video about IDP (ISRL‐condition) or not (SRL‐condition)Results showed that (I)SRL‐students' task‐selections matched quite well with IDPThere were no differences among the FS and (I)SRL conditions in performance or motivation What are the implications of the findings: Students were quite capable of self‐regulating their learning from examples and problemsSRL was even as effective, efficient, and motivating as a fixed task sequenceWatching a video on IDP affected students' task‐selections, but did not enhance learning and motivationFuture research should examine how to further support SRL from examples and problems [ABSTRACT FROM AUTHOR]

Background: To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim: This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods: Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results: Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion: The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution: European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey. [ABSTRACT FROM AUTHOR]