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Background: Behavioural intention (BI) has been predicted using other variables by adopting the technology acceptance model (TAM). However, few studies have examined whether BI can predict learning performance. Objectives: The present study used an extended TAM to investigate whether students' BI is a predictor of their listening learning performance (LLP) through vocabulary learning performance (VLP) in the context of mobile vocabulary‐assisted listening learning by using two mobile learning tools. Methods: A total of 129 college students with a pre‐intermediate level of English were recruited as participants, and a 10‐week mobile vocabulary‐assisted, listening‐learning course was conducted in 2022. In each task of this course, the students had to learn target words from a listening passage on Quizlet and then engage in listening activities on Randall's ESL Cyber Listening Lab. Quantitative responses obtained through an online questionnaire were analysed through partial‐least‐squares structural equation modelling. Results: The analysis results indicated that BI significantly predicted LLP through VLP. Perceived ease of use (PEU) and perceived usefulness (PU) were significant antecedents of BI. However, PEU did not significantly predict PU because of the difficulty of navigating between the two technological tools used in this study. The extended model demonstrated its effectiveness in explaining listening learning performance, as evidenced by an explained variance (R2) of 69%. Conclusion: The extended model validates the influence of BI on learning performance and it can also draw teachers' focus toward the significance of enhancing students' BI to improve their listening learning performance. Pedagogical implications based on the results are provided in this paper. Lay Description: What is already known about this topic?: TAM was used to study learners' acceptance of mobile‐assisted language learning.TAM incorporates latent variables to explore mobile‐assisted language learning.Investigating factors influencing BI is a primary research focus in extended TAM literature.Mobile tools could improve listening learning and vocabulary retention. What this paper adds to that: Learning performance was considered as a dependent variable in an extended TAM.BI might predict students' learning performance in vocabulary and listening in an extended TAM.Teachers used two mobile tools to design mobile vocabulary‐assisted listening tasks.Pre‐learning the target words facilitate students' listening learning performance. Implications for practice and/or policy: We show the importance of BI on predicting listening learning performance.The impact of BI on other factors became another focus of TAM research.Results highlight pre‐learning target words' importance for better listening performance.Existing mobile tools improve listening performance, avoiding new system development. [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]

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]

Online search involves multitasking and may demand better working‐memory capacities (WMC) and additional cognitive aids. Given the constraints of human cognition, we tested the effectiveness of note‐taking strategies on university students' online search performance. Also examined were the profile configurations of WMC tests in silence and in irrelevant speech as well as its interaction effects with note‐taking strategies on online search performance. Among the participants of 60 university students, we found a four‐group WMC profile composition that differed significantly across WMC scores in both silence and irrelevant speech. Results showed that WMC profiles, note‐taking groups and their interaction effect were significant factors on online search performance. Both Free Note and Matrix Note were beneficial for the students in low silent WMC profile groups. Study results have both theoretical and practical implications, advancing our understanding of the interrelationship of WMC under different conditions and informing instructional practice of online search performance. Lay Description: What is already known about this topicWorking memory capacity is fundamental to multitasking ability.Online search is a typical multitasking behavior that requires constant switching between different information sources.Students who take note perform better than those who do not while reading materials with seductive but irrelevant information.What this paper addsStudents working memory capacity is examined under silent and irrelevant speech conditions.Students exhibited different profile patterns in their working memory capacity under silent and irrelevant speech conditions.Taking note, either in matrix form or free form, can significantly improve students' online search performance for those with high WMC ONLY in irrelevant speech or for those with low WMC in both silent and irrelevant speech conditions.Implications for practiceNote‐taking as auxiliary support may facilitate students' integration and evaluation of the online information across multiple sources during their online search.Instructions on how to self‐construct matrix note are needed to help students develop advanced note‐taking skills for their learning involving online search. [ABSTRACT FROM AUTHOR]

Previous studies on the interactive response system (IRS) have generally adopted the lecture method to facilitate teaching and learning, while few have made efforts to investigate the learning effects of instructional methods and IRS activities on learning and teaching. The purpose of the present study was therefore to explore whether the use of the IRS with two different teaching methods would affect students' learning performance. A quasi-experimental design was employed, with the teacher conducting the course using the learner as leader strategy in the experimental group (E.G.) and the teacher leader strategy in the control group (C.G.). The experiment was conducted over a period of 15 weeks (a semester), and questionnaires were administered at the beginning, in the middle and after the experiment to elicit the learners' views on the IRS application. The results support previous research which found that using the IRS improved learners' engagement and interaction. They also provide further evidence that the use of the IRS with both teaching strategies not only had a short-term learning effect but could also be a tool for sustaining students' learning motivation and self-directed learning for long-term learning purposes. Besides, the use of the learner as leader strategy contributed to enhancing discussion in groups, especially for the leading groups. The use of the IRS with the learner as leader strategy benefited those who acted as leaders in taking the initiative to learn the course content, and also engaged the students who acted as learners in concentrating on the course because it was their classmates who were leading. Lay Description What is already known about this topic The interactive response system (IRS) facilitates course interaction, and increases course attendance and learning performance, Most studies have integrated the IRS with lectures to facilitate teaching and learning, What this paper adds The paper explored the effectiveness of using the IRS with two teaching methods on students' learning for a semester., The use of the learner as leader strategy with IRS benefited the learners who acted as leaders in taking the initiative to learn the course content, and engaged the students who acted as learners in concentrating on the course., Implications for practice and/or policy Students are benefited in taking the initiative to learn the contents through hosting the IRS activity., Teachers could adopt both lectures and learner as leader strategy with IRS to sustain students' learning motivation and self-directed learning for long-term learning purposes. [ABSTRACT FROM AUTHOR]

This research develops a web‐based model, entitled the "intuitive claim, peer‐assessment, discussion, and elaborate claim argumentation training" (IPadE) model, and embeds with a Web‐based Interactive Argumentation System to enhance undergraduate students' socioscientific argumentation abilities. This research adopts a quasi‐experimental research design; the sample comprised 131 undergraduate students from two classes (69 in the experimental group and 62 in the control group). The socioscientific issue discussed were related to global health. This study collected and analysed quantitative and qualitative data, including the pretest and posttest of students' knowledge test scores and argumentation abilities questionnaire. The results generally confirmed the effectiveness of the IPadE model. First, in a comparison of the content knowledge and argumentation skills, the experimental group have statistically significantly improved than the control group. Second, regarding the number of reasoning modes proposed, the experimental group could propose multiple reasoning modes and reasoning levels on rebuttals increased after training. Lay Description: What is already known about this topic: In the traditional classroom setting, it is difficult to obtain a fair expression of opinions because dominant students lead the debate. With internet and communication technology (ICT) rapid development, that has been emerging as a useful supplement to traditional methods. Web‐based interactive learning environments have recently become a popular and effective tool in the education field worldwide.Argumentation skills are the critical reasoning abilities that a modern citizen should possess. Regrettably, the researchers have consistently demonstrated that adolescents' and young adults' insufficient competencies regarding argumentation, constructing weaknesses of two‐sided arguments, and difficulty justifying evidence in support of their claims (Brem & Rips, 2000; Driver, Newton, & Osborne, 2000; Kuhn, 1991, 2003; Naylor, Keogh, & Downing, 2007; Voss & Means, 1991). Students' inadequate knowledge of science and judgment capacity can cripple their competency to make satisfactory decisions and be responsible citizens in society (Fowler, Zeidler, & Sadler, 2009).The integration of argumentation activities into science‐related curriculum is currently upheld as a core factor for a successful science program. In addition, HIV/AIDS is a prominent global health problem in Taiwan. Research based on global health‐related content knowledge and argumentation is rarely.Most of the literature has focused on the learning of elementary and middle school students (Fowler et al., 2009; Jimènez‐Aleixandre, Rodriguez, & Duschl, 2000; Keselman, Kaufman, Kramer, & Patel, 2007; Lin & Mintzes, 2010; Wu & Tsai, 2007; Zohar & Nemet, 2002) and has rarely investigated pre‐service and in‐service teachers and undergraduate students. (Osborne, Erduran, & Simon, 2004; Chang & Chiu, 2008). What this paper adds: Research based on global health‐related content knowledge and argumentation is rarely. We develop the IPadE argumentation model with Web‐based Interactive Argumentation System to enhance argumentation abilities of undergraduate students toward globe health problem.We develop three research instruments, including HIV/AIDS knowledge test (HKT), Open‐ended SSI argumentation ability questionnaire (SAAQ), and Argumentation ability checklist (AAC).We added the metacognitive supports interface designs "context viewer" function of WIAS; on the left is the initial argumentation context of the user, in the middle is the Lakatos' argumentation model, and on the right is the peer assessment score. Students can view their own initial argumentation context and reflect upon it after interacting with their peers and group discussion to obtain a sounder argumentation in the argumentation stage (Figure 5). Implications for practice: Development of HIV/AIDS knowledge: The results confirm that experimental group students in the semester program using the IPadE model with WIAS performed better and significantly improved HIV/AIDS knowledge.Development of argumentation skills: The results confirm that undergraduate students using the IPadE model with WIAS performed significantly better than those in the control group.Changes in students' use of arguments modes: The majority of the reasons proposed by participants were science‐and‐technology‐oriented arguments, followed by law‐oriented and social‐oriented arguments in the PH. Additionally, the students' use of the major argument modes were proposed as law‐oriented in the NH and rebuttal; however, the number of students in the experimental group that could propose multiple argument modes in the PH, NH, and rebuttal increased after training.Design of online discussion boards: The students used the discussions to assess peer learning by looking at peers' viewpoints and ideas. Comparison of face‐to‐face classroom, the WIAS can provided students with opportunities at anytime and anywhere through asynchronous discussions board to record their thoughts then make peer learning. This study suggest that a well‐designed web‐based argumentation system is a critical part of the higher education experience when the goal is to improve students' argumentation ability. [ABSTRACT FROM AUTHOR]

Because the microworld can create a learning environment that allows learners to interact with the real world, the view of the microworld has been widely used in education and training. In this study, the simulated transactional interactive concurrent system (STICS) was used to provide an environment that simulates the stock market trading of the Taiwan Stock Exchange; the goal is to explore the effectiveness of using STICS in enhancing the financial literacy of students. This study adopts a quasi‐experimental design approach and divides students into two groups. The intervention group was made up of 42 students who learned financial knowledge aided by STICS, with a comparison group consisting of 43 students who learned with traditional lecturing and dictating methods. The study found that learners who used the STICS as an aid to learn financial knowledge had significantly better learning effectiveness than those who did not use STICS, in terms of motivation, attitude, and achievement. The intervention group also made significant improvements in average scores in learning motivation and achievement after 8 weeks of experimental teaching and learning. Lay Description: What is already known about this topic This study employs the microworld perspective as a learning scaffold which simulates the real financial environment through computer assistant learning.By means of the computer assistant learning pattern of STICS, it not only enhances the financial literature of learners, but also increases the happiness and fun in the learning process. What this paper adds This allows learners can free from the barrier of insufficient investment funds by using STICS computer assistant learning.The STICS computer assistant learning system have the potential of promoting interactivity between learners and instructors, and improving the students' financial achievements. Implications for practice and/or policy The benefits of the STICS computer assistant learning are not only to enable students to deepen their understanding of the content of the textbook, but also to experience practical trading environment, such as profitability, risk, delivery and payment, long‐buying and short‐selling, etc.From this study, it is known that improving students' financial literacy not only contributes to personal wealth, but also avoids the recurrence of financial turmoil.In the future, we should devote ourselves to teach students how to apply knowledge to the real environment in an immersive learning, without being out of reality. [ABSTRACT FROM AUTHOR]

Suppose learners use their free time to go online to review course materials, and they do so by taking optional tests that consist of multiple‐choice questions (MCQs). What will happen if, for every practice question, there is always a choice (out of four possible choices) that is marked as "the (current) hot choice?" Will this make any difference in learning effects? To answer this question, an educational experiment was conducted. It was found that "hot designations" helped the experimental group perform significantly better in both the immediate post‐test exam and a delayed post‐test exam and that learners with higher levels of initial knowledge benefited more from this review strategy. From the results of a follow‐up questionnaire and one‐on‐one interviews, it was found that the proposed review strategy promoted a more thorough thinking style in subjects of the experimental group. Lay Description: What is already known about the subject matter: There are good reasons why multiple‐choice questions (MCQs) are a popular choice for tests.E‐learning such as game‐based/mobile learning often uses MCQs for formative assessment.The main "problem" with MCQs is that MCQ tests tend to encourage rote learning.It is desirable to use MCQ tests to promote meaningful learning.What this paper adds to the subject matter: An HMCQ is an MCQ with one of its four choices being marked as "the (current) hot choice."The proposed review strategy requires learners to use their free time to do online tests.Learners taking HMCQ tests better retained knowledge than learners taking MCQ tests.Learners with higher levels of initial knowledge benefited most from the HMCQ review strategy.Implications of study findings for practitioners: It should be worthwhile to use HMCQ tests to help learners review course materials.The effect of "hot" designations (in MCQs) on learning still needs to be clearly delineated.Are there other approaches that also go well with "hot" designations (in MCQs)? [ABSTRACT FROM AUTHOR]

Objective: We aimed to examine the factors associated with treatment outcomes in patients with Alzheimer's disease (AD) after 1 year of acetylcholinesterase inhibitors (AChEI) treatment. Method: We obtained electronic medical records from a medical center in Southern Taiwan between January 2015 and September 2021. Participants aged ≥60 who were newly diagnosed with AD and had been prescribed AChEIs were included. Cognitive assessments were performed before the AChEIs were prescribed and at the 1 year follow‐up. Cognition progressors were defined as a Mini‐Mental State Examination decline of >3 or a Clinical Dementia Rating decline of ≥1 after 1 year of AChEI treatment. The relationship between the baseline characteristics and cognitive status after follow‐up was investigated using logistic regression analysis after adjusting for potential confounders. Results: A total of 1370 patients were included in our study (mean age, 79.86 ± 8.14 years). After adjustment, the body mass index (BMI) was found to be significantly lower in the progressor group [adjusted odds ratio (AOR): 0.970, 95% confidence intervals (95% CIs): 0.943 to 0.997, P = 0.033]. The usage of antipsychotics was significantly higher in the progressor group (AOR: 1.599, 95% CIs: 1.202 to 2.202, P = 0.001). The usage of benzodiazepine receptor agonists also tended to be significantly higher in the progressor group (AOR: 1.290, 95% CIs: 0.996 to 1.697, p = 0.054). Conclusion: These results suggest that patients with AD who receive 1 year of AChEI treatment and have a lower BMI or concurrent treatment with antipsychotics and benzodiazepine receptor agonists are more likely to suffer from cognitive decline. [ABSTRACT FROM AUTHOR]

Learning a foreign language requires interaction with language input while involved in a task. Given that problem‐based learning (PBL) offers hands‐on application in realistic contexts, and that virtual reality (VR) enables learners to interact with multiple modalities of information, this study examines how the integration of VR technology into PBL contexts affects students' motivation for, problem‐solving during, and vocabulary acquisition in learning English as a foreign language (EFL). A total of 84 engineering majors who enrolled in a course of English for specific purposes were randomly assigned to either an experimental group or a control group. Students in the experimental group participated in a VR‐assisted PBL context, in which they were to view a PBL scenario using VR technology and then to create VR videos about solving the given problems. Those in the control group participated in a PBL context without the use of VR technology for viewing and solving the identical scenario. After the intervention, all the students wrote a problem‐solving analysis, took a vocabulary knowledge test, completed a learning motivation questionnaire, and participated in individual interviews. The results showed that the students in the experimental group significantly outperformed those in the control group in terms of vocabulary acquisition, and were more motivated to learn English related to their future careers, whereas there was no significant difference in the problem‐solving performance of the two groups. Implications of these findings highlight the value of engaging EFL learners in immersive environments for contextualized learning through the integrated use of VR and PBL. Lay Description: What is already known about this topic?: Virtual reality (VR) technology has been shown to enhance students' knowledge and skills in STEM fields.Problem‐based learning (PBL) has been widely used in medical education but not so much in foreign language education.English as a foreign language (EFL) students usually have very limited access to the target language beyond the classroom, thus lack a motivating reason for them to learn English after graduation. What this paper adds?: The VR‐assisted PBL approach proposed in this study was found to significantly enhance the EFL students' specialized vocabulary knowledge.The VR‐assisted PBL approach was found to motivate and sustain the EFL students' interest in career English.Exposing the EFL students to PBL contexts was capable of developing their problem‐solving performance, regardless of VR integration. Implications for practice and/or policy: The proposed approach has the potential to facilitate student learning in EFL education, particularly English for occupational purposes.EFL educators may apply the VR‐assisted PBL approach to narrow the gap between language classrooms and workplace contexts by immersing students in authentic contexts that were relevant to their occupational knowledge and workplace English. [ABSTRACT FROM AUTHOR]

To promote maternal and infant health, there is a need to optimise the dietary pattern of pregnant women to reduce perinatal depression. This prospective cohort study was conducted from June 2020 to February 2022, 300 women from a medical center were interviewed during late pregnancy and at 4–6 weeks postpartum. Dietary patterns were derived by factor analysis using a semiquantitative food frequency questionnaire. Symptomatic depression was defined using the Edinburgh Postpartum Depression Scale (EPDS, ranged 0–30). Their dairy, vegetable and fruit intakes were below the Taiwanese recommendations for pregnant women. Symptomatic depression (EPDS ≥10) affected 31.3% in the third trimester and 35.7% postpartum. Pre‐ and post‐EPDS scores were positively correlated (r = 0.386, p < 0.001). Approximately 55% of those depressed before delivery were also depressed postpartum. For late pregnancy, four dietary patterns were identified ('Good oil', 'Vegetables and fruits', 'Omnivorous' and 'Refined‐grain and organ meats'). Dietary patterns were classified according to quartiles (Q). Higher omnivorous pattern scores reduced the risk of depression. For prenatal depression, with Q1 as a reference, the risk was reduced by 38% for Q2, 43% for Q3 and 59% for Q4 (p for trend = 0.068). These findings became evident postpartum (reduced risk by 68% for Q2, 69% for Q3 and 70% for Q4 (p = 0.031; p for trend = 0.0032). The association between dietary patterns and depression encourages the routine nutritional management of pregnant women. Key messages: Perinatal women have a higher prevalence of symptomatic depression, and more than half of women with antenatal depression also have postpartum depression.Pregnant women often face challenges in trying to achieve a healthy diet, as reflected in our findings on low vegetable and fruit intake.An omnivorous pattern was found to protect against symptomatic depression in late pregnancy, which persisted into the early postpartum period.Through effective nutritional counselling, paying attention to the risk of depression in perinatal women is expected to reduce women's pregnancy anxiety. [ABSTRACT FROM AUTHOR]

This paper presents a study on implementing the ASR-based CALL (computer-assisted language learning based upon automatic speech recognition) system embedded with both formative and summative feedback approaches and using implicit and explicit strategies to enhance adult and young learners' English pronunciation. Two groups of learners including 18 adults and 16 seventh graders participated in the study. The results indicate that the formative feedback had a positive impact on improving the learners' speaking articulation, and the summative feedback aided the learners' self-reflection and helped them to track their speaking progress. Furthermore, the implicit information such as model pronunciation with full sentences and audio recast benefitted the adult learners, whereas the young learners preferred the explicit learning information such as textual information of individual words for self-correction. In addition, the results of this study also confirm that learners have different perceptions of the media modalities designed with implicit and explicit strategies in the feedback. Feedback with audio modality is more suitable for adults, whereas juxtaposed textual and audio modalities are better for young learners. [ABSTRACT FROM AUTHOR]

This paper aims to investigate how a gamified learning approach influences science learning, achievement and motivation, through a context-aware mobile learning environment, and explains the effects on motivation and student learning. A series of gamified learning activities, based on MGLS (Mobile Gamification Learning System), was developed and implemented in an elementary school science curriculum to improve student motivation and to help students engage more actively in their learning activities. The responses to our questionnaire indicate that students valued the outdoor learning activities made possible by the use of a smartphone and its functions. Pre- and post-test results demonstrated that incorporating mobile and gamification technologies into a botanical learning process could achieve a better learning performance and a higher degree of motivation than either non-gamified mobile learning or traditional instruction. Further, they revealed a positive relationship between learning achievement and motivation. The correlation coefficient for ARCS dimensions and post-test shows that the ARCS-A (attention) is greater than ARCS-R, ARCS-C and ARCS-S. This means that the attention (ARCS-A) of this system is an important dimension in this research. The results could provide parents, teachers and educational organizations with the necessary data to make more relevant educational decision. [ABSTRACT FROM AUTHOR]

For the past 4 years, undergraduate students from the Faculty of Health, University of Newcastle, Newcastle, Australia, have undertaken a two week cultural study tour in Thailand, being exposed to a broad range of cultural interactions, health settings in rural and remote areas, and health-treatment approaches, including traditional and complementary therapies. Student evaluations and reflections were collected after the 2010 and 2011 study tours. This paper reports on findings following thematic analysis of the data, which identified central themes, including connectivity to others, 'awakenings', 'embodiment', and looking to the future. Findings included a recognition by students of a growth in awareness and change in perspective, which they felt would impact on their future approach in caring for patients from culturally- and linguistically-diverse backgrounds. We conclude that the study tour provided an effective way of sensitizing students to cultural differences and promoting cross-cultural awareness. [ABSTRACT FROM AUTHOR]

Aim Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods Data of the I- Lan Longitudinal Aging Study ( ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36-45. [ABSTRACT FROM AUTHOR]

Abstract: With the increased use of digital materials, undergraduate writers in English as a foreign language (EFL) contexts have become more susceptible to plagiarism. In this study, the researchers designed a blended English writing course with an online writing tutorial system entitled DWright. The study examined the effectiveness of the online writing tool for helping a group of EFL sophomores in Taiwan develop plagiarism avoidance knowledge, paraphrasing skills, and citation abilities. Mixed‐method data included pretest, posttest, and delayed test, a feedback sheet, writing assignments, interviews, and a post‐course questionnaire, which reported increased awareness on plagiarism avoidance with evidence such as qualitative paraphrasing improvement and positive feedback on the use of DWright for developing plagiarism avoidance knowledge and citation competence. Pedagogical implications for researchers and instructors interested in blending online writing tutorials into their courses for plagiarism avoidance were also discussed. [ABSTRACT FROM AUTHOR]

Aim: To develop and test a mobile application that supports the disease self‐management of adolescents with type 1 diabetes during their transition to early adulthood. Design: A sequential mixed‐methods design was employed. Methods: The application content was designed according to previously identified care needs and expectations, followed by application development on the Android operating system. From the outpatient clinic of the Department of Paediatric Endocrinology and Metabolism at a medical centre in northern Taiwan, 35 individuals aged between 16–25 years participated in application testing. Results: The overall median score of the QUIS was 4–5, most of the 25% quartile was 4–5, and all of the 75% quartile was 5, indicating adequate user interaction satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID‐19) pandemic. Design and Methods: This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first‐graders before and after school closure. Paired t‐test and the general linear model were applied to data analysis. Results: Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p =.029) and less delayed sleep‐wake patterns in their children. Practical Implication: Sleep is an indicator that reflects children's behavioral changes in response to the COVID‐19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Affective tones abound in work teams. Drawing on the affect infusion model and social identity theory, this study proposes that team affective tone is related to team performance indirectly through team identification and team cooperation. Data from 141 hybrid-virtual teams drawn from high-tech companies in Taiwan generally supported our model. Specifically, positive affective tone is positively associated-while negative affective tone is negatively associated-with both team identification and team cooperation; team identification is positively associated with team cooperation; and team cooperation is positively associated with team performance. Managerial implications and limitations are discussed. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Patient‐centred e‐health (PCEH) focusses on the interaction between patients and physicians. However, only a limited number of studies have focussed on the design of physician–patient value cocreation mechanisms in the PCEH context. Thus, we extend Grönroos' concept of value cocreation to understand how PCEH might improve the quality of care. Objectives: This study proposes a theoretical framework to embody PCEH‐supported value cocreation and presents some empirical validation. We expect that PCEH‐supported value cocreation should comprise capabilities for patient empowerment, intention for information sharing, complementation for checking and verifying information, and interaction for shared understanding. Methods: This study surveyed a small group of patients that have used PCEH, 'My Health Bank' in Taiwan. The questionnaires were delivered to patients in hospitals (n = 167 questionnaires, 98% response rate). Results: Results indicate that certain PCEH‐supported value cocreation mechanisms—capabilities for patient empowerment and interaction for shared understanding—affect the perceived quality of medical care. Limitations: The survey only considered patient perceptions of value cocreation. Conclusion: This study shows the patient perception of value cocreation in patient‐centred e‐Health. Further research needs to validate the framework for health professionals and in other e‐Health record information sharing settings. [ABSTRACT FROM AUTHOR]

Background: Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. Aims and Objective: To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. Design: A descriptive qualitative study with in‐depth face‐to‐face semi‐structured interviews. Methods: Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. Results: The core theme describing the phenomenon of family caregivers of a patient with delirium was "Sailing in a sea of perplexity," which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. Conclusion: "Sailing in a sea of perplexity" underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. Relevance to clinical practice: Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation. [ABSTRACT FROM AUTHOR]

Various writing assistance tools have been developed through efforts in the areas of natural language processing with different degrees of success of curriculum integration depending on their functional rigor and pedagogical designs. In this paper, we developed a system, WriteAhead, that provides six types of suggestions when non-native graduate students of English from different disciplines are composing journal abstracts, and assessed its effectiveness. The method involved automatically building domain-specific corpora of abstracts from the Web via domain names and related keywords as query expansions, and automatically extracting vocabulary and n-grams from the corpora in order to offer writing suggestions. At runtime, learners' input in the writing area of the system actively triggered a set of corresponding writing suggestions. This abstract writing assistant system facilitates interactions between learners and the system for writing abstracts in an effective and contextualized way, by providing suggestions such as collocations or transitional words. For assessment of WriteAhead, we compared the writing performance of two groups of students with or without using the system, and adopted student perception data. Findings show that the experiment group wrote better, and most students were satisfied with the system concerning most suggestion types, as they can effectively compose quality abstracts through provided language supports from WriteAhead. [ABSTRACT FROM AUTHOR]

Blogs have been increasingly used to supplement traditional classroom lectures in higher education. This paper explores the use of blogs, and how student attitudes towards online peer interaction and peer learning, as well as motivation to learn from peers, may differ when using the blog comments feature, and when students are encouraged to read and comment on each other's work. We contrast two ways blogs affect learning engagement: (1) solitary blogs as personal digital portfolios for writers; or (2) blogs used interactively to facilitate peer interaction by exposing blogging content and comments to peers. A quasi-experiment was conducted across two semesters, involving 154 graduate and undergraduate students. The result suggests that interactive blogs, compared with isolated blogs, are associated with positive attitudes towards academic achievement in course subjects and in online peer interaction. Students showed positive motivation to learn from peer work, regardless of whether blogs were interactive or solitary. [ABSTRACT FROM AUTHOR]

This paper reports an investigation into the effects of collaborative concept mapping in a digital learning environment, in terms of students' overall learning gains, knowledge retention, quality of student artefacts (the collaboratively created concept maps), interactive patterns, and learning perceptions. Sixty-four 12-year-old students from two 6th grade classes (32 from each class) participated in the study. Guided by the methodology of quasi-experimental research, group scribbles 1.0 was adopted in which students carried out collaborative concept mapping activities for social studies in two different settings: (1) 1:1 (one-device-per-student) - students working in pairs with one Tablet PC assigned to each of them; and (2) 1:m (one-device-to-many-students) - multiple students sharing a Tablet PC. Both settings were evaluated and the interactional patterns of the student groups' concept mapping were identified. The results indicated that in both 1:1 and 1:m settings, students had improved their learning results and retention. Nevertheless, while 1:1 groups had demonstrated more consistency in group participation, improved communication and interaction, the 1:m groups had instead generated superior artefacts as all the notes were well discussed among the group members. The findings suggest that a higher quality of collaborative processes does not necessarily lead to improved student artefacts. [ABSTRACT FROM AUTHOR]

In this study, we aimed to determine whether forms of victimization influence internalizing and externalizing behavior problems differently and whether these relationships are mediated by self‐esteem. This study included 2321 Taiwanese adolescents aged 11−21 from a previous case‐control study. Six forms of victimization, self‐esteem, and seven behaviors were measured. Gender, age, group (justice‐involved vs. high‐school adolescents), and family dysfunction were covariates in generalized linear models and path analysis. Different forms of childhood victimization were associated with different internalizing and externalizing behavior problems. Additionally, psychological abuse and psychological neglect were negatively associated with self‐esteem, which itself was associated with all internalizing and externalizing behavior problems. Significant indirect effects of psychological abuse and psychological neglect on all internalizing and externalizing behavior problems (mediated by self‐esteem) were also identified. Due to the limitation of measurement, the interpretation about the influence of victimization patterns could not be made. Findings suggest that different forms of childhood victimization may lead to different mechanisms for internalizing and externalizing behavior problems in adolescents. Further research is needed to identify the mechanisms underlying different forms of childhood victimization and to clarify the effects of victimization patterns to develop effective interventions. [ABSTRACT FROM AUTHOR]

Background: Lack of evidence regarding whether a useful examination instrument such as an multiple choice question (MCQ) quiz is reliable for assessing delirium care knowledge. Aim: To develop and psychometrically test a MCQ‐based quiz for assessing the delirium care knowledge in critical care nurses. Design Instrument development and psychometric evaluation study. Methods: The development and validation process consisted of two phases. The first Phase focused on the quiz development, which was achieved through the following steps: (a) generation of an initial 20‐item pool; (b) assessment of content validity; (c) assessment of face validity; (d) conduction of a pilot test, involving the collection of data from 217 critical care nurses through an online survey; and (e) item analysis and item elimination according to item difficulty and discrimination indices. The MCQ quiz was finalized through the development process. The second phase emphasized quiz validation through estimation of the internal consistency, split‐half and test–retest reliability, and construct validity using parallel analysis with exploratory factor analysis (EFA). Results: A final 16‐item MCQ quiz was emerged from the item analysis. The Kuder–Richardson formula 20 coefficient for the overall quiz indicated good internal consistency (0.85), and the intraclass correlation coefficient with a 30‐day interval also indicated that the questionnaire had satisfactory stability (0.97). EFA confirmed that the quiz had appropriate construct validity, and four factors could explain 60.87% of the total variance. Conclusion: In this study, the MCQ, and single best answer quiz for assessing delirium care knowledge was developed, and its reliability and validity for this purpose were demonstrated. Relevance to clinical practice: This study introduced an evidence‐based quiz designed for future use in delirium care research and education that has significant implications for MCQ‐based knowledge assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To determine if there are long‐term effects of a self‐management intervention guided by self‐regulation theory for adults with knee osteoarthritis at 6 and 12 months after completing the intervention. Design: This long‐term follow‐up study used a longitudinal quasi‐experimental design with repeated measures. Methods: A convenience sample of 127 patients with knee osteoarthritis who were 45 to 64 years of age were recruited from outpatient clinics in Taiwan. The Self‐Management Needs of Knee Osteoarthritis Scale was used to assess self‐management needs at enrollment (baseline). To evaluate the long‐term effects, participants were reassessed at 6 and 12 months after the intervention using the following questionnaires: The Knee Injury and Osteoarthritis Outcome Score, Healthcare Outcomes, and the Short‐Form Health Survey. Generalized estimating equations compared assessments at baseline with scores at 6 and 12 months following completion of the intervention. Multiple regression was used to examine significant factors associated with the assessments. Findings: Participants had moderate levels of self‐management needs. When assessments at 6 months were compared with baseline, scores for knee symptoms and physical function and quality of life showed significant improvements; significant reductions were seen in body mass index, unplanned medical consultations, and pain medication doses. Assessments at 12 months compared with baseline measures indicated these improvements were maintained. These improvements were significant from baseline measures at both 6 months and 12 months after adjustments were made for time and other significant variables. Conclusions: Twelve months after completion of the intervention, the significant improvements seen at 6 months were maintained. Our findings demonstrate that the self‐management intervention had significant long‐term effects on knee symptoms and physical function, body mass index and pain medication doses, and overall quality of life for patients with moderate self‐management needs of knee osteoarthritis. Clinical Relevance: Clinical care of knee osteoarthritis that includes a self‐regulation theory–based self‐management intervention could provide long‐term benefits to patients. [ABSTRACT FROM AUTHOR]

Purpose: To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. Design: A cross‐sectional descriptive design was employed. Methods: A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. Results: Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self‐identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. Conclusions: Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. Clinical Relevance: This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients. [ABSTRACT FROM AUTHOR]

Background: The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan. Purpose: Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings. Design and Methods: A cross‐sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire. Results: A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found. Conclusion: The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals. [ABSTRACT FROM AUTHOR]

The aim of this longitudinal study was to explore reciprocal relationships between work/family pressure, work/family interference, and work/family satisfaction among Taiwanese employees (N = 310). All study variables were assessed three times. We found that within the work domain, earlier work pressure caused later work-to-family conflict (WFC), while earlier WFC reduced later job satisfaction. We also found that earlier WFC caused later work pressure, while earlier job satisfaction reduced later WFC. Similarly, we found that within the family domain, earlier family pressure caused later family-to-work conflict (FWC), while earlier FWC reduced later family satisfaction. We also found that earlier FWC caused later family pressure. In addition, family pressure and family satisfaction had reciprocal relationships over time. Together these longitudinal and reciprocal relations strongly support our hypothesized feedback loops linking pressure, work and family conflict, and role satisfaction, within each of the work and family domains. We made specific suggestions on breaking these vicious cycles to effectively manage both the work and family roles. [ABSTRACT FROM AUTHOR]

Purpose: The views of butch‐ and femme‐identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study. Methods: A total of 208 Taiwanese lesbians (134 butch‐identified lesbians and 78 femme‐identified lesbians) completed an online survey. Results: Butch‐identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self‐examinations when compared with femme‐identified lesbians. Conclusions: Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities. Clinical Relevance: The results can be employed as evidence for promoting lesbians' breast health, particularly butch‐identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians. [ABSTRACT FROM AUTHOR]

In long‐term care facilities (LTCFs), nurses are key healthcare providers for older residents who have depressive symptoms or depression; therefore, they need accurate knowledge of late‐life depression, positive attitudes towards depression, and confidence in providing depression care. This cluster‐randomized trial was designed to examine the effectiveness of multiple, face‐to‐face, brief training sessions in improving nurses' knowledge, attitudes, and confidence in providing late‐life depression care in LTCFs. Nine LTCFs were included in the study. In total, 30 nurses from the four LTCFs assigned to the intervention group received three 30‐min training sessions and 36 nurses in the five comparison group LTCFs did not. A self‐report questionnaire was administered before and after the intervention. There were significant differences between groups concerning improvement in nurses' knowledge of late‐life depression, attitudes towards depression, and confidence in providing depression care. The effect size (Cohen's d) was 1.55 for knowledge, 1.38 for attitudes, and 0.89 for confidence. This training program was effective in improving LTCF nurses' knowledge, attitudes, and confidence in providing depression care. On the basis of these findings, we recommend that nurse managers and directors implement similar training programs for nurses in LTCFs to enhance the care quality for older residents. [ABSTRACT FROM AUTHOR]

Rationale and Aims: Scholars have progressively promoted shared decision making (SDM) as an optimal model of treatment decision making in clinical practice. Nevertheless, it is unclear whether health care professionals (a) understand SDM well, (b) believe that SDM is helpful in their daily practice, and (c) are willing to practice SDM during their daily activities. These are crucial research topics; however, such research is still limited. The aim of this study was to apply the knowledge‐attitude‐behavior (KAB) model to probe health care professionals' perceptions of SDM. Methods: A questionnaire was delivered to health care professionals working in various hospitals in southern Taiwan from 9 November 2018 to 8 January 2019. In addition to KAB constructs, this study explored the barriers to SDM practice and willingness to practice SDM among health care professionals. Predictive variables were subjected to multiple linear regression analysis to investigate health care professionals' views of SDM. Results: Valid respondents numbered 400, including physicians, pharmacists, nurses, and other health care professionals. The characteristics of these health care professionals significantly affected the mean scores of the KAB model. A correlation analyses indicated that the KAB constructs were positively correlated with each other. The top three barriers reported were lack of time (57.50%), lack of knowledge (38.25%), and difficulty of developing patient decision aids (37.75%). Respondents who were willing to practice SDM opined that SDM can provide the best health care for patients (81.62%), can maintain and improve individual clinical expertise (77.38%), and can meet patient and social expectations (48.40%). Conclusions: Continuous emphasis on education regarding SDM and continuous promotion of a positive attitude of SDM acceptance can influence the behaviour of practicing SDM among health care professionals. Further study is required to assess the SDM practices of various health care professionals in different settings. [ABSTRACT FROM AUTHOR]

Strategic participation is important for HR professionals who wish to have increased influence in their organizations. While a number of previous studies have suggested a link between strategic human resource management and firm performance, few have explored the specific factors enabling HR strategic participation. This study examines the impact of HR service quality and expectations of HR contributions on HR strategic participation. A total of 244 survey responses were received from 42 companies in Taiwan. All hypotheses were supported, thus signifying significant relationships between HR service quality, expectations of HR contributions, and HR strategic participation. The study results also indicate that HR professionals are able to proactively increase the value of HR in organizations by enhancing HR service quality and addressing potential internal customers' needs accordingly. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: To promote sexual health in adults with an intellectual disability (ID) in Taiwan, sexual health programmes were provided to adults with ID, their parents and service workers. This study evaluates the impact of these programmes that involved the parents and service workers. Methods: Intervention and participatory research paradigms were applied to develop, implement and evaluate programmes that address the challenges that relate to the sexual rights of adults with ID. Additionally, the programmes fostered open dialogue among the participants concerning the sexual health of people with ID. In total, 57 parents and 164 service workers were involved in the programmes. A quasi‐experimental design and standardised questionnaires (Attitudes to Sexuality Questionnaire – Individuals with an Intellectual Disability), as well as in‐depth interviews, were used to collect both quantitative and qualitative data on the programmes' effectiveness and participants' experiences between April 2012 and July 2015. Results: The findings revealed that after the programmes were implemented, attitudes towards the sexual rights of people with ID were significantly more positive among both the parents and service workers. Participation in the sexual health programmes facilitated constructive dialogue by revealing hidden concerns and by transforming the perspectives of the parents and service workers from viewing sexuality as a social problem to understanding the sexual rights of adults with ID. Conclusions: Both the quantitative and qualitative results demonstrate that the programmes had a positive impact on the parents and service workers in terms of their attitudes towards the sexual rights of people with ID. Open dialogue and reciprocal interaction strategies caused transformations in the perspectives of parents and service workers on sexual health. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed to assess the willingness to receive prenatal influenza vaccine and explore its associated factors among pregnant women in Taiwan. Design and Sample: The study population included pregnant women who received prenatal care from five private hospitals/clinics during 2017–2018 influenza season. Measurements: Collected data, including demographics, health‐relevant factors, as well as knowledge and attitudes regarding influenza and its vaccine, were analyzed using chi‐square tests, Fisher's exact test, and multivariate logistic regression analysis. Results: A total of 498 pregnant women completed the questionnaires, 321 (64.5%) intended to receive prenatal influenza vaccine. Among those who were unwilling to be vaccinated, most (88%) had concerns about the adverse events of the vaccine. Four factors were independently associated with willingness, including hospital/clinic (aOR=6.57, 95% CI=1.96–22.04), previous influenza vaccination history (aOR=9.44, 95% CI=5.63–15.83), knowledge (aOR=2.64, 95% CI=1.25–5.55) about, and attitude (aOR=5.99, 95% CI=2.40–14.92) toward influenza vaccination. Conclusions: Pregnant women with insufficient knowledge, negative attitudes, or no experience of influenza vaccination, and in remote areas were less willing to receive maternal influenza vaccine. The adverse events and uncertainty regarding the safety of vaccines were the most important factors. The health‐care providers should promote or explain risks and benefits of maternal influenza vaccination during prenatal care or outpatient consultation. [ABSTRACT FROM AUTHOR]

Purpose: Nurses are exposed to a poor psychological work environment; this may cause poor mental health, which is a risk factor for suicidal ideation. We investigated the association between psychological work environment and suicidal ideation among hospital nurses in Taiwan. Design: We conducted a cross‐sectional survey in Taiwan female nurses using stratified sampling by region (north, central, south, and east) to select representative centers for this study. Methods: A self‐report questionnaire including items on demographic data, the psychological work environment, and suicidal ideation was sent to nurses working in hospitals. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of the psychological work environment on suicidal ideation. Findings: A total of 2,734 eligible questionnaires (76.8%) were returned. The prevalence of suicidal ideation was 18.3%, and higher risk was found to be associated with the educational level of junior college or below, higher personal burnout, higher client‐related burnout, and always feeling stressed at work. Estimation of population attributable risk showed that higher personal burnout, client‐related burnout, and always feeling stressed at work were the most crucial factors among nurses, accounting for 19.4%, 8.6%, and 10.5% of suicidal ideation, respectively. Conclusions: A considerable proportion of nurses developed suicidal ideation. A poor psychological work environment was a relevant factor for suicidal ideation. Clinical Evidence: This study provides relevant knowledge for nursing management levels in preventing the development of suicidal ideation among nurses. Not only for nurses' mental health, but for patient safety and care quality, further studies in improving nurses' psychological work environment are warranted. [ABSTRACT FROM AUTHOR]

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression. [ABSTRACT FROM AUTHOR]

Sleep disturbance is a significant problem affecting around 50% of cancer patients. Non‐pharmacological interventions can be used to improve sleep quality in cancer patients, but little is known about the feasibility, acceptability, and effectiveness of auricular point acupressure (APA) to reduce sleep disturbance in women with ovarian cancer undergoing chemotherapy. A pilot randomized controlled trial was conducted at a publicly funded hospital in southern Taiwan. Fifty‐five eligible women were approached and 47 women participated. Women randomly assigned to the control group (n = 24) received sleep hygiene practices alone. Women in the intervention group (n = 23) received sleep hygiene practices and APA treatment which involved gentle fingertip pressure at acupoints on the external ear. The Pittsburgh Sleep Quality Index (PSQI) was completed at four time points. Forty women completed the trial giving a retention rate of 85%. Women receiving the intervention reported a 65% reduction in sleep disturbance according to PSQI global scores from Time 1 (mean = 13.2) to Time 2 (mean = 4.65) after 4 weeks of APA treatment. There was a further 10% decrease in PSQI scores at Time 3 (mean = 4.21) after 6 weeks of APA treatment. Compared to controls, women receiving APA had significantly lower PSQI mean global scores at both Time 2 and Time 3 (p < .001). APA treatment for women with ovarian cancer produced significantly improved sleep. Participants found the procedure easy to perform. Pilot findings support the feasibility of a longitudinal study with a larger, representative sample. [ABSTRACT FROM AUTHOR]

Is abdominal muscle exercise (AME) an effective alternative therapy to treat urinary incontinence (UI)?. Pelvic floor muscle exercise (PFME) is a conservative and conventional treatment for UI. In recent decades, another innovative method of incontinence rehabilitation involving abdominal muscles exercise, namely AME, was proposed to achieve better UI care. However, the effectiveness of AME is unclear. A quasi‐experimental pilot study with a 12‐week intervention period compared AME with PFME. Women aged ≥45 years with at least one episode per month of stress or mixed UI were enrolled. Informed consent was obtained before participation in the study. Women from each region were considered a cluster and were randomly allocated into the AME or PFME groups. All exercise sessions were accomplished at citizen activity centres. With 20 women in each group, the primary outcomes were to compare the score changes in the Incontinence Severity Index (ISI), 1‐hour pad test, and 3‐day voiding diary whereas the secondary outcomes compared the scores between the pre‐ and post‐tests. The ISI, 1‐hour pad test, and 3‐day voiding diary improved significantly after the interventions within each group; however, no significant difference was found between the groups. The effectiveness of AME was similar to that of PFME. Nevertheless, health care providers should understand the effectiveness of different strategies for treating or preventing UI. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships. METHODS: This study adopted a cross‐sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent. RESULTS: Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions. CONCLUSION: Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction. [ABSTRACT FROM AUTHOR]

Abstract: This study examines differences in English listening comprehension, cognitive load, and learning behaviour between outdoor ubiquitous learning and indoor computer‐assisted learning. An experimental design, employing a pretest‐posttest control group is employed. Randomly assigned foreign language university majors joined either the experimental group (outdoor ubiquitous learning), with 80 participants (26 males and 54 females), or a control group (indoor computer‐assisted learning), with 80 participants (27 males and 53 females). The experiment lasted 3 weeks. Both groups were administered a test of English listening proficiency before and after the experiment along with a questionnaire of cognitive load postexperiment. Prior English listening proficiency forms a covariate for the multivariate analysis of covariance. Results show (a) students in the experimental group exhibit significantly better English listening comprehension after the experiment compared to the control group; (b) students in the experimental group reported significantly lower cognitive load than the control group; (c) English listening comprehension and cognitive load exhibited a statistically significant negative relationship; and (d) outdoor ubiquitous learning enhanced self‐reported learning interests and interactions more than indoor computer‐assisted learning. Contributions and significances of this study are presented based on these results. Finally, implications for teaching practices are proposed. [ABSTRACT FROM AUTHOR]

Background While the impact of burnout on organisational commitment has been widely observed, its impact on nursing professional commitment has not previously been investigated. The literature has clarified that professional commitment has three distinct components: affective, continuance and normative. Aims This study aims to investigate the relationships between burnout and the three components of nursing professional commitment. Methods This was a cross-sectional study using questionnaires to collect data in one large medical centre. Responses from 571 nurses were used for regression analysis. Among the sampled nurses, 90.9% had <15 years of nursing experience. MBI- HSS was used for measuring burnout. Three components of nursing professional commitment came from Meyer et al. (J Appl Psychol, 78, 1993 and 538) a formally validated instrument. Results Analytical results indicated that burnout is negatively related to affective and normative professional commitment (B ≤ −0.09, p < 0.01), but not related to continuance professional commitment (B = 0.05, p > 0.05). Linking evidence to action Nurse managers aiming to improve nurses' professional commitment should consider reducing nurses' burnout, for example improving nursing optimism and reducing administrative tasks, as suggested by the literature. [ABSTRACT FROM AUTHOR]

Background The recurrence of menstrual symptoms markedly interferes with the daily life, social functioning, work disability and quality of life of women. Patient perception of healthcare services is underexplored but crucial for understanding how to efficiently develop healthcare practices. Aims To identify and describe the different patterns of treatment expectation and physician-patient relationships perceived by women receiving traditional Chinese medicine treatment for menstrual symptoms. Methods A two-stage data collection design was used. In the first stage, in-depth interviews with 40 participants were conducted; the interview data were used for content analysis. Q statements were developed on the basis of the content analysis results. In the second stage, a series of Q sorts was performed by 60 other participants to subjectively rank the Q statements. Results The results of factor analysis revealed that four factors retained in the final model accounted for 56% of total variance. Women associated with Factor 1 had experienced few negative physician-patient interactions; these women were relatively young (31.6 years) and had mild perimenstrual mood discomfort (6.4). Women who loaded on Factor 2 preferred physician guidance and encountered few barriers to adherence; these participants were older (38.6 years) and had the most severe perimenstrual mood discomfort (9.5) among the four groups. The women in agreement with Factor 3 tended to patiently wait for treatment effects; these participants had the highest scores for both cyclic pelvic pain (4.9) and perimenstrual physical discomfort (8.8). The women associated with Factor 4 demanded effective treatment and had the lowest scores for both cyclic pelvic pain (3.8) and perimenstrual physical discomfort (6.8). Conclusions The exploration of clustering patients according to their perspectives could influence healthcare providers to acknowledge patient expectations and enable effective communication between physicians and patients. [ABSTRACT FROM AUTHOR]

Background Despite the impact of medication literacy ( ML) on patients' safe use of medications, existing instruments are mostly for general health literacy measurement or designed for specific disease populations, with few specifically designed for ML. Objective To develop and validate the first Chinese medication literacy measure (Ch MLM). Methods The Ch MLM was developed by a multidisciplinary and bilingual expert panel and subsequently pilot-tested. The final version had 17 questions in four sections: vocabulary, non-prescription drug, prescription drug and drug advertisement. Face-to-face interviews were administered in a convenience sample of adults with diverse sociodemographic characteristics. Internal consistency was assessed by Cronbach's alpha. Content validity was confirmed by the expert panel, and hypothesis testing was performed to assess construct validity. Results A total of 634 adults were interviewed. The mean ( SD) total Ch MLM score was 13.0 (2.8). The internal validity was acceptable (Cronbach's alpha=0.72). Nine of the ten a priori hypotheses were fulfilled. Younger age, higher income and higher education levels were significantly associated with a higher Ch MLM score. Furthermore, higher scores on the Ch MLM were associated with higher confidence or less difficulty in writing, reading, speaking and listening abilities in a health-care encounter. No association was found between Ch MLM total scores and frequency of doctor's visits. Conclusion The Ch MLM is a valid and reliable ML measure. It may help pharmacists and other health-care providers to target patients and problem areas that need interventions with the ultimate goal of preventing medication errors and harm. [ABSTRACT FROM AUTHOR]

Cardiac disease and type 2 diabetes are prevalent diseases globally. Cardiac rehabilitation and diabetes self-management programs empower patients' self-management to improve their health outcomes. However, inappropriate delivery modes and continuing low participation rates indicate some programs are less than optimal. A previous study demonstrated the feasibility of incorporating telephone and text messages into a cardiac-diabetes self-management program in Australia; however, the program did not specifically address patients' cultural backgrounds. This current study used a randomized blocked design to evaluate short-term efficacy of the cardiac-diabetes self-management program incorporating telephone and text-messaging across different cultural contexts in Australia and Taiwan in comparison to usual care. No significant differences between groups were observed for outcomes of self-care behavior, self efficacy, knowledge and health-related quality of life, with patients in both groups demonstrating improvements. Patient-reported outcomes indicated some evidence of an interaction effect between country of origin and group allocation. Findings indicated an improved tendency of outcome measures between the baseline and follow-up assessments within usual care and intervention groups. Further research is required to clarify components of the program work for each cultural group. [ABSTRACT FROM AUTHOR]