The research, led by Gürkan Özden, Öznur İpek Aslan, Ahmet Ceviz, and Sevim Dolu, was a methodological study, meaning its goal was not to test a treatment or measure a health outcome but to build and verify an instrument. The team recruited 240 nursing students in their second, third, or fourth years at a state university in eastern Türkiye. Data collection took place entirely online between November and December 2024, using a descriptive information form alongside the scale itself. Before any student could access the questionnaire, an electronic consent process required them to read an information tab describing the study’s purpose and voluntary nature and to actively select an option agreeing to participate.

Why does rights awareness matter so much in nursing education specifically? Clinical training environments differ radically from lecture halls. Students rotate through operating theatres, emergency departments, and internal medicine wards, each with its own hierarchies, pace, and hazards. In these settings, a student may be asked to perform procedures beyond their competence, work shifts that conflict with regulations, or simply endure treatment that a licensed professional would recognize as inappropriate. Without awareness of their rights, students cannot assert them; and without a valid measurement tool, educators and researchers cannot even quantify how widespread the gaps in awareness are. That measurement gap is precisely what the Turkish adaptation is designed to close.

The validation process followed the internationally recognized standards of psychometric scale adaptation. Translation and cultural adaptation come first, ensuring that each item means the same thing in Turkish as it did in the original language, and that concepts such as the right to supervision or the right to a safe working environment make sense in the Turkish clinical context. Crucially, the team obtained permission from Mi-Young Choi, the original author of the scale, before beginning the work, a step that reflects proper scientific practice in cross-cultural instrument adaptation.

Validity was assessed through two complementary approaches. First, content validity analysis asked expert reviewers to judge whether each item adequately captures the construct it targets. The results were exceptionally strong: the scale-level Content Validity Index came out at 0.95, far above the commonly recommended threshold of around 0.80, indicating near-consensus among experts that the translated items faithfully represent the domain of nursing students’ rights in clinical practice. Second, confirmatory factor analysis, a structural equation modeling technique, tested whether the data collected from the 240 students fit the theoretical structure of the original instrument. The analysis confirmed the original three-factor structure, meaning that the items cluster into the same three dimensions of rights awareness that the original scale proposed, and the three factors together explained 67.5 percent of the total variance in responses, a proportion generally regarded as very satisfactory for a multidimensional health sciences scale.

Reliability, the second pillar of the study, concerns whether the instrument produces consistent measurements. The Turkish version demonstrated excellent internal consistency, with a Cronbach’s alpha of 0.97. Alpha values range from 0 to 1, and values above 0.90 are typically considered excellent; a value of 0.97 means that the items within the scale respond in a highly coordinated fashion, so students who score high on some items tend to score high on the others as well. The researchers also evaluated temporal stability, the degree to which the instrument yields similar results when administered at different points in time under unchanged conditions, and found good stability. In addition, every item-total correlation exceeded the recommended minimum threshold, confirming that no single item behaves erratically relative to the scale as a whole, and factor loadings were satisfactory across all three dimensions.

The technical rigor of these analyses deserves some unpacking for readers unfamiliar with psychometrics. Confirmatory factor analysis works by specifying a model in advance, here the hypothesized three-factor structure, and then using maximum likelihood estimation to determine how well the observed pattern of answers could have been produced by that model. Fit statistics such as the Comparative Fit Index, the Tucker-Lewis Index, the Root Mean Square Error of Approximation, and the Standardized Root Mean Square Residual quantify the closeness of the fit, allowing researchers to state with quantitative confidence whether the translated instrument truly measures the same construct as the original. The confirmation of the three-factor structure in a different language and culture is more than a formality; it is evidence that the concept of clinical rights awareness is a coherent, cross-culturally stable construct rather than an artifact of one country’s educational system.

The practical implications reach well beyond psychometric theory. With a validated Turkish-language instrument in hand, nursing faculties across Türkiye can now systematically assess how aware their students are of their rights before, during, and after clinical placements. Nursing schools could incorporate the scale into orientation programs to identify incoming students who need targeted education on professional rights, ethics, and self-advocacy. Researchers can use it to compare awareness levels across universities, regions, and years of study, and to evaluate whether specific interventions, such as rights-focused workshops or revised clinical supervision policies, actually raise awareness over time. Over the longer term, aggregated data from such measurements could inform national accreditation standards and curricular reform in nursing education.

The study also contributes to a broader conversation in health professions education about the ethics of clinical training. Nursing, like medicine, relies heavily on apprenticeship-style learning in real care environments, and the tension between service delivery and education is inherent to that model. Students in every country report experiences ranging from being used as extra pairs of hands to facing outright mistreatment. Measurement instruments like this one are a precondition for evidence-based policy: institutions cannot fix what they cannot measure. The authors note that awareness of rights is essential precisely because nursing students train in such varied clinical settings, and the new Turkish scale gives Turkish-speaking educators the tools to quantify that essential quality.

The findings, published open access so that any educator or researcher can read and use them, mark a concrete step forward for nursing education research in Türkiye and provide a template for future adaptations in other languages. The study received no external funding, was approved by the Ethics Committee for Scientific Research and Publications of Inonu College of Health Sciences, and obtained institutional approval from the Dean’s Office of the Faculty of Nursing. For the 240 students who took part, and for the many thousands who will benefit from the instrument they helped validate, the message is clear: the rights of nursing students in clinical practice are now something that can be measured, tracked, and defended with scientific evidence rather than anecdote.

Subject of Research: Cross-cultural validation of a scale measuring nursing students' awareness of their rights in clinical practice

Article Title: Validity and reliability of the Turkish version of the nursing students’ rights awareness scale in clinical practice

Article References: Özden, G., İpek Aslan, Ö., Ceviz, A., & Dolu, S. (2026). Validity and reliability of the Turkish version of the nursing students’ rights awareness scale in clinical practice. BMC Nursing. https://doi.org/10.1186/s12912-026-05425-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05425-x

Keywords: nursing students, clinical practice, rights awareness, scale validation, psychometrics, confirmatory factor analysis, Cronbach's alpha, nursing education, Türkiye, reliability, content validity, BMC Nursing

A team at the University of Balearic Islands in Spain has now designed and validated a practical instrument for exactly that task. Olaya Álvarez-García, Mireia Costa-Bisquerra, and Antoni Cerdà-Navarro, all based in the Department of Applied Pedagogy and Educational Psychology, set out to build a tool that can both identify deceptive practices and assess the overall quality of environmental education projects and programs offered to schools. Their work, published in the Journal of Environmental Studies and Sciences, responds to a growing body of evidence that environmentally damaging companies are increasingly targeting education systems as a channel for reputation management.

The methodological backbone of the study is the Delphi method, a structured consensus technique widely used when direct observation or experimentation is impractical. Rather than surveying a random sample, the researchers convened a panel of ten experts in environmental education and environmental communication. The panel worked through two iterative rounds of questionnaire-result-questionnaire consultation. In each round, experts rated proposed criteria and indicators; the aggregated results were fed back to the panel, allowing participants to reconsider their judgments in light of the group’s collective response. This feedback loop, a hallmark of Delphi design, progressively narrows disagreement and builds content validity, meaning the extent to which an instrument genuinely measures the concept it claims to measure.

The raw material for the criteria came from established theoretical frameworks on greenwashing and on quality in environmental education. The greenwashing literature offers a rich taxonomy of deceptive techniques, from selective disclosure and symbolic actions to vague, unsubstantiated environmental claims. Classic analyses, including the well-known ‘sins of greenwashing’ reports and subsequent systematic reviews, describe how organizations emphasize minor green attributes while obscuring far larger environmental footprints. Quality frameworks in environmental education, meanwhile, developed by bodies such as the North American Association for Environmental Education and various Spanish and Catalan agencies, specify what sound programs should contain: scientific accuracy, pedagogical rigor, clear objectives, and alignment with learners’ developmental needs.

After two Delphi rounds, the panel converged on a final instrument comprising eight criteria and forty-three indicators. Each criterion represents a dimension along which an environmental education program can be judged, and each indicator is an observable signal that evaluators can look for when reviewing program materials, funding arrangements, and stated objectives. The indicators span both poles of the problem: they flag red-warning features associated with greenwashing, such as promotional content that diverts attention from a sponsor’s environmental record, and they certify positive quality markers, such as accurate treatment of ecological concepts and the absence of covert advertising. Agreement statistics, including interrater measures commonly reported with Cohen’s kappa, supported the coherence of the panel’s judgments across rounds.

Why does this matter for schools? The researchers point to investigative journalism and prior scholarship documenting how some of the companies with the largest carbon footprints in Spain have entered classrooms to deliver climate education. Studies of what has been termed ‘petro-pedagogy’ describe how fossil fuel interests obstruct climate justice in public education by framing curricula around individual responsibility rather than systemic change. Experimental research further shows that greenwashing can measurably improve public attitudes toward corporations’ sustainability initiatives, even when those initiatives are hollow. Children, who lack the advertising literacy and background knowledge to interrogate a program’s funding or framing, are particularly receptive audiences, and teachers rarely have the time or resources to audit every free program that arrives at their door.

The new tool is designed to change that calculus. By giving teachers and educators a structured checklist grounded in expert consensus, it converts a diffuse suspicion, something feels off about this program, into a systematic evaluation. A teacher can ask whether a program’s environmental claims are substantiated, whether the sponsor’s own practices align with the messages being taught, whether the materials promote critical thinking or brand loyalty, and whether the pedagogy meets recognized quality standards. The authors emphasize that the instrument is also intended for professional development, helping pre-service and in-service teachers build the evaluative skills needed to navigate an increasingly crowded market of externally provided educational content.

Conceptually, the study makes a second, broader argument: that detecting greenwashing in education requires an interdisciplinary lens. Greenwashing has traditionally been studied in marketing and corporate communication, where researchers analyze advertising claims, stakeholder perceptions, and reputational strategy. Environmental education research, by contrast, focuses on learning outcomes, curriculum design, and teacher competence. The Balearic Islands team deliberately bridges these fields, importing the analytical vocabulary of greenwashing research into educational evaluation. The result is a tool that treats an environmental education program not just as a pedagogical artifact but as a communication product with a sponsor, a message, and potentially a hidden agenda.

The timing is significant. European survey data show strong public concern for the environment, and international frameworks, from the Paris Agreement to UNESCO’s Berlin Declaration on Education for Sustainable Development, position education as central to the sustainability transition. Yet the same visibility that makes environmental education a policy priority also makes it an attractive target for image-conscious polluters. As pressure to demonstrate climate action grows, so does the incentive to sponsor lessons that simulate action. Instruments like the one developed here offer a modest but concrete defense: a way for the education sector to distinguish genuine learning opportunities from sophisticated public relations, and to insist that what enters the classroom serves students rather than sponsors.

The researchers acknowledge that their panel of ten experts, while sufficient for establishing content validity through the Delphi process, represents a starting point rather than an endpoint. Future work will need to test the tool’s reliability and usefulness in real-world school settings, across different national contexts and program types. Still, the study delivers something the field has lacked: a validated, expert-consensus framework that names the criteria deceptive programs fail and quality programs meet. In a media environment saturated with green claims, giving educators the means to verify before they trust may prove one of the most quietly consequential contributions of environmental education research this year.

Subject of Research: Design and validation of a Delphi-based tool to identify greenwashing and assess quality in environmental education programs offered to schools

Article Title: Greenwashing and quality in environmental education: Design of a tool to identify deceptive practices through the application of the delphi method

Article References: Álvarez-García, O., Costa-Bisquerra, M., & Cerdà-Navarro, A. (2026). Greenwashing and quality in environmental education: Design of a tool to identify deceptive practices through the application of the delphi method. Journal of Environmental Studies and Sciences. https://doi.org/10.1007/s13412-026-01142-8

Image Credits: AI Generated

DOI: 10.1007/s13412-026-01142-8

Keywords: greenwashing, environmental education, Delphi method, sustainability education, corporate influence in schools, education quality assessment, climate education, teacher training, environmental communication, content validity, school programs, University of Balearic Islands

The research, conducted between October 2022 and May 2023, emerged from a well-recognized problem in surgical oncology. Health literacy, defined as a patient’s ability to obtain and interpret basic health information in order to make appropriate decisions, is a decisive factor in surgical outcomes. Patients who understand their procedures tend to prepare better, comply more fully with preoperative instructions, and engage more actively in their own recovery. Conversely, poor health literacy has been associated with avoidable complications, delayed recoveries, and heightened anxiety. The researchers, led by Cassiane de Santana Lemos of São Paulo State University’s Botucatu Medical School, argued that well-designed educational materials, validated both by experts and by the patients who actually use them, can accelerate health learning and support recovery in this vulnerable population.

The project unfolded in two distinct methodological stages. In the first stage, the team designed the content and visual layout of the educational material, drawing on established instructional design principles to ensure that the final product would be readable, logically organized, and visually accessible. In the second stage, the material entered formal validation. Specialist nurses were recruited to evaluate the content using the Health Educational Content Validation instrument, a standardized tool for judging the accuracy, relevance, and clarity of patient-facing health materials. Simultaneously, a group of patients who had already undergone colorectal surgery assessed the material using the Suitability Assessment of Materials, known in the literature as the SAM instrument, which scores educational resources on factors such as readability, graphic design, cultural appropriateness, and self-efficacy support.

The resulting product was named the “Patient Guide – Colorectal Surgery,” a 24-page booklet organized into 14 topics that follow the patient’s chronological journey through the surgical experience. The guide covers the preoperative period, hospital admission, and postoperative care, walking readers through what to expect at each stage. This trajectory-based structure reflects a deliberate instructional choice: rather than presenting fragmented medical facts, the guide mirrors the lived sequence of surgery, allowing patients to anticipate each phase and prepare questions for their care teams. The authors credited the Hollister company for assistance with the artistic production of the material, an element they treated as central to the guide’s usability rather than a cosmetic afterthought, since layout, typography, and illustration all factor directly into SAM scoring.

The expert validation phase involved six nursing professionals, whose agreement rates exceeded 80 percent, with particularly strong consensus in the domains of relevance and objective. These figures carry real technical meaning in psychometric terms. Content validation instruments measure the extent to which a panel of judges independently agrees that each item of a material is pertinent and aligned with its intended purpose, and agreement levels above 80 percent are conventionally interpreted as strong evidence that the content is appropriate for its target population. The Content Validity Ratio, a statistic that quantifies the proportion of judges endorsing each item while correcting for the level of agreement expected by chance, was used to analyze concordance between the judges, giving the validation process a quantitative backbone that distinguishes it from informal expert review.

The patient assessment phase provided the second and arguably more important half of the validation evidence. Eleven individuals who had undergone colorectal surgery evaluated the guide, and the majority of them, 45.45 percent, had experienced rectosigmoidectomy, the surgical removal of the rectosigmoid portion of the bowel. Across every domain of the SAM instrument, the guide scored either adequately or in the superior range, meaning that the very people for whom the material was designed judged it readable, understandable, motivating, and actionable. Perhaps most strikingly, the patient ratings achieved an overall reliability of Cronbach’s alpha equal to 0.89, a coefficient indicating high internal consistency. In plain terms, the patients responded to the guide’s qualities in a coherent and stable way, suggesting that their positive assessments were not the product of random variation but of genuine, shared perceptions of the material’s quality.

The significance of this dual validation extends beyond the 24 pages of the guide itself. Educational materials in clinical settings are frequently produced without any systematic evaluation, relying on the intuition of the clinicians who write them. The Brazilian team instead applied a psychometric framework, treating the patient guide as an instrument whose properties could be measured, quantified, and verified before deployment. This approach aligns with growing international interest in enhanced recovery after surgery, or ERAS, protocols, which depend heavily on patient engagement and preoperative education to shorten hospital stays and reduce complications. A validated guide of this kind, the authors note, can be used both inside and outside the hospital by health professionals, embedding itself across the entire perioperative continuum rather than serving a single moment of care.

The study also carries a broader philosophical ambition. The authors describe their goal as helping the surgical patient become “a protagonist in their self-care,” a framing that recasts patient education as empowerment rather than mere information delivery. When patients understand the operations they will undergo, the sensations they should expect, and the warning signs that demand attention, they transition from passive recipients of care to active participants in their own recovery. That shift has measurable clinical consequences: engaged patients are more likely to perform breathing exercises, mobilize early, adhere to dietary guidance, and report problems before they escalate. The ethics approval for the study came from the Research Ethics Committee of the Faculdade de Medicina de Botucatu, and all participants signed informed consent forms, underscoring the study’s adherence to formal research governance.

The research was supported financially by the Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP, under process number 2022/12950-2, reflecting institutional investment in health services research as a lever for improving surgical care. The team included researchers from the Nursing Department of São Paulo State University’s Botucatu campus and the School of Nursing at the University of São Paulo, a collaboration spanning two of Brazil’s major public universities. The corresponding author, Cassiane de Santana Lemos, and her colleagues, including Mayara Spin, Raquel Rondina Pupo da Silveira, Eduarda Cruz de Oliveira, Daniel de Santana Barreto, Arethusa Neves da Silva, Gabriela Crespan Sarzi, and Vanessa de Brito Poveda, declared no competing interests, and the article was published as open access under a Creative Commons Attribution 4.0 license, making the methodology and findings freely available to clinicians and researchers worldwide.

For the estimated millions of patients worldwide who undergo colorectal surgery each year, the study offers something concrete: evidence that a carefully constructed, formally validated patient guide can deliver reliable health education at scale. The authors concluded that the material is valid and suitable for use in patients undergoing colorectal surgery, and that it can support health professionals in hospital and community settings alike. As health systems worldwide grapple with aging populations, rising cancer burdens, and chronic shortages of time in clinical consultations, tools that transfer understanding efficiently from clinician to patient are likely to become increasingly valuable. This study demonstrates that such tools can be built to standard, measured with statistical precision, and trusted by the people who matter most: the patients themselves.

Subject of Research: Construction and validation of educational material for patients undergoing colorectal cancer surgery

Article Title: Construction and validation of educational material for patients undergoing colorectal cancer surgery: a psychometric study

Article References: de Santana Lemos, C., Spin, M., da Silveira, R. R. P., de Oliveira, E. C., de Santana Barreto, D., da Silva, A. N., Sarzi, G. C., & de Brito Poveda, V. (2026). Construction and validation of educational material for patients undergoing colorectal cancer surgery: a psychometric study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15241-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15241-3

Keywords: health literacy, patient education, colorectal surgery, psychometrics, perioperative nursing, health communication, educational technology, validation study, SAM instrument, content validity, surgical recovery, patient self-care

The study, conducted by Marcelo Leonel Peluso, Angela Donato Oliva, and Luiz Fellipe Dias da Rocha at the State University of Rio de Janeiro, describes the construction and content validation of the Therapist Communication Skills Inventory – Patient Version, abbreviated in Portuguese as the IHCT-P. Rather than asking therapists to rate themselves or relying on expert observers watching recorded sessions, the instrument puts the evaluation in the hands of the people with the most ecologically valid vantage point: the patients themselves. This choice reflects a growing consensus in the field that patient reports are less biased than therapist self-perceptions or observer judgments, particularly when the goal is to understand the interpersonal fabric of therapy.

The theoretical foundation of the work rests on the concept of social skills, and more specifically communication skills, which psychologists define as the linguistic and paralinguistic behaviors that make clear, positive, and attuned interpersonal relationships possible. The researchers adopt a competence-based view of psychotherapy, one that sees effectiveness not as loyalty to a theoretical tradition but as the therapist’s ability to enact specific, observable interpersonal behaviors that facilitate change. Within this framework, communication skills are not a stylistic flourish; the authors argue they are foundational mechanisms of therapeutic action, tied to the strength of the therapeutic alliance, the expression of empathy, and ultimately to treatment outcomes.

To give the construct a measurable structure, the team organized therapist communication skills into three dimensions. Verbal skills cover the therapist’s choice and structuring of words: asking and answering questions, requesting and providing feedback, opening and closing sessions, and making empathic verbalizations. Non-verbal skills encompass facial expressions, posture, gestures, eye contact, and other bodily cues that signal presence and emotional resonance. Paraverbal skills, the third dimension, involve the features of speech that sit outside the literal content: tone, pace, volume, rhythm, latency, and fluency. These channels are distinct but complementary, and empirical work on clinical communication has consistently treated them as separable yet interacting routes through which therapists convey attunement and intent.

The construction of the inventory began with a narrative review of the literature, drawing on Portuguese and English-language books and articles indexed in SciELO and Google Scholar, searching for concepts linking communication, skills, and therapy while excluding work focused on patient-directed communication or non-clinical settings. From seven reviewed sources, the authors identified recurring skill clusters and translated them into items. The preliminary version of the IHCT-P contained 40 items, with 17 covering verbal skills, 13 covering non-verbal skills, and 10 covering paraverbal skills. Each item then went through internal discussion among the authors regarding clarity, spelling, length, adequacy, and scope before facing external scrutiny.

That scrutiny came in two phases. In the first, five professionals with clinical and empirical expertise in the topic evaluated every item on three criteria: language clarity, practical pertinence, and theoretical relevance, each rated on a five-point scale. The researchers computed a Content Validity Coefficient for each criterion, applying a widely used threshold requiring values above 0.8. The results were strong across the board: 0.945 for practical pertinence, 0.930 for theoretical relevance, and 0.927 for language clarity. Even so, the judges’ comments drove substantial refinement. Three items were cut, fourteen were revised to sharpen clarity and precision, and two new items were added, leaving the instrument with 39 items. For its response format, the judges unanimously favored a five-point Likert scale ranging from ‘it does not apply at all’ to ‘it applies almost all the time.’

The second phase tested whether ordinary people, including those with limited formal education, could actually understand what the items were asking. Thirty adult participants, evenly split between women and men and aged between 19 and 42, with an average age of 28.3, assessed each item for clarity and comprehension rather than answering it. Here the coefficients were even higher: 0.980 for language clarity and 0.981 for comprehension. No items were removed at this stage, though three items fell below a 90 percent approval threshold on the need for change and were reworked in line with participants’ suggestions, while two others were modified based on feedback from both phases. The instrument’s instructions, rated at the maximum for both language and understanding, survived unchanged. The study received ethics approval from the State University of Rio de Janeiro, and informed consent was obtained from all participants.

The authors are candid about the limitations of what they have built. Although the scale was designed to be usable by people with lower educational attainment, the pilot sample was predominantly well-educated, with 63.3 percent holding complete higher education, a mismatch that could limit generalizability. Patient-reported measures also inherit the quirks of the respondent: individuals with personality disorders may struggle to form a stable alliance, coloring their judgments of the therapist’s communication, and the stage of therapy at assessment may shape perceptions. To blunt these biases, the team plans to have at least two patients per therapist complete the questionnaire in future studies, averaging out idiosyncratic views.

Why does this matter beyond psychometrics? The researchers position the IHCT-P as a practical tool with several clinical applications. Therapists can use it for self-assessment by inviting patients to complete it, gaining a window into how their communication actually lands with each individual. Because the instrument itself models a core communication skill, requesting feedback, its use reinforces collaborative empiricism and gives patients a structured, potentially less intimidating channel for critical or negative feedback than face-to-face conversation. In psychotherapy supervision, particularly during clinical internships, the scale can help trainees monitor their own practice and help supervisors spot gaps, while its items can serve as prompts for reflective discussion. It could also anchor intervention studies, since social skills training programs typically require pre- and post-intervention measurement to demonstrate gains.

The work is explicitly a first step rather than a finished product. The authors state that upcoming studies will pursue additional sources of validity evidence under the Standards for Educational and Psychological Testing, including exploratory and confirmatory factor analyses of the internal structure, convergent and divergent validity against established measures of therapeutic alliance and outcomes, and internal consistency and test-retest reliability. They also plan to develop and validate a therapist-report version, enabling comparisons between how therapists see themselves and how patients perceive them. Those studies are already underway, with completion expected within 18 to 24 months. If they succeed, the field will gain something it has long lacked in Brazil: a validated, patient-centered yardstick for one of the quiet but decisive ingredients of effective psychotherapy, the everyday communicative craft of the person in the therapist’s chair.

Subject of Research: Development and content validation of a patient-report psychometric inventory assessing therapists' communication skills in psychotherapy.

Article Title: Therapist’s Communication Skills Inventory – Patient Version: Construction and Content Validity

Article References: Peluso, M. L., Oliva, A. D., & Rocha, L. F. D. D. (2026). Therapist’s Communication Skills Inventory – Patient Version: Construction and Content Validity. Trends in Psychology. https://doi.org/10.1007/s43076-026-00531-w

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00531-w

Keywords: psychotherapy, communication skills, psychometrics, content validity, therapeutic alliance, patient-reported outcomes, test construction, social skills, verbal communication, non-verbal communication, clinical psychology, Brazil

The motivation for the work stems from a persistent gap in education systems worldwide. Governments and educational administrations increasingly call for the identification and dissemination of good practices with digital technologies in order to improve teaching quality, and international repositories such as the European School Education Platform and the UNESCO ICT in Education Repository collect and share such experiences. Yet defining what actually counts as a good practice has remained surprisingly elusive. Previous literature reviews have highlighted criteria such as effectiveness, transformative effect, sustainability, legitimacy and replicability, while regional agencies in Spain have emphasized features including curriculum integration, institutional support, improved outcomes, interdisciplinarity, inclusion and the involvement of the educational community. Without clear, observable criteria, judgments about quality risk being subjective and inconsistent.

To anchor the instrument in a coherent theoretical framework, the research team, based at the Department of Pedagogy of Universitat Rovira i Virgili, turned to Activity Theory, a cultural-historical framework originally developed by Vygotsky, Leontiev and Engestrom. Activity Theory conceives educational practice as an intentional, object-oriented action involving students and teachers working toward a common goal, mediated by physical and sociocultural tools. The theory models an activity system through its core components, including the subject, tools, community, rules, division of labor and object, and it emphasizes the dynamic, dialectical interactions among these elements. This holistic view aligns closely with the structure of a learning situation and allows observers to detect tensions, contradictions and disruptions within the classroom activity system, which the researchers see as essential to understanding how digital technologies are actually integrated into teaching and learning.

The study adopted a Design-Based Research approach, a methodology structured around iterative cycles of analysis, design, development and evaluation. The first cycle began with a systematic literature review following the PRISMA 2020 model, searching databases including Web of Science, Scopus, ERIC, SciELO and Dialnet for publications from 2013 to 2023 describing educational practices with digital technologies at any educational level. From an initial pool of 718 publications, 27 studies were selected for full content analysis using ATLAS.ti software. This analysis identified 26 variables linked to the seven components of Activity Theory, each operationally defined with its theoretical meaning, the type of evidence required for observation and its intended use within the guideline, forming the initial prototype of the instrument.

Validation proceeded through the Delphi method, a structured technique for aggregating expert judgment over successive rounds. The team formed a coordinating group and recruited a panel of experts across four professional profiles: teachers from early childhood, primary and secondary education; university professors; researchers; and professionals involved in educational management. Thirty-two experts were invited and 26 completed the competence questionnaire, which calculated an Expert Competence Index combining self-assessed knowledge and the quality of argumentation sources. Twenty-three experts scored at or above the 0.8 threshold denoting high competence and continued into the Delphi rounds, a panel size consistent with established guidance that Delphi studies typically require between 15 and 35 participants.

The three Delphi rounds progressively sharpened the instrument. In the first round, 23 experts ranked the variables derived from each Activity Theory component, and the researchers computed a Relative Importance Index to convert the rankings into interpretable percentages, selecting the two highest-priority variables per component to yield 14 variables and 14 indicators. In the second round, 20 experts rated the clarity and relevance of the proposed indicators, with most indicators exceeding 85 percent positive validation and five achieving unanimous acceptance; all indicators met the Content Validity Index threshold of at least 78 percent, the criterion the team used to classify indicators as excellent. In the third round, nine experts assessed their satisfaction with the revised indicators, and mean scores rose while standard deviations fell, with two indicators reaching a perfect average of 4.00 with zero variability, confirming that the iterative refinements had addressed the panel’s concerns.

With the validated prototype in hand, the team moved to pilot testing in authentic educational settings, an essential step for establishing external validity and feasibility. The pilot involved eight educational practices distributed across four stages, early childhood, primary, secondary and higher education, with two practices per stage, all hosted by different public institutions that had previously collaborated with the university. Sessions lasted one hour in the school stages and two hours at university, with class sizes ranging from 28 students in early childhood settings to as many as 80 university students. Researchers observed each practice simultaneously using individual copies of the guideline and then jointly interviewed the observed teachers with a complementary 13-question semi-structured interview guide, allowing triangulation of the observational data.

Reliability analyses during the pilot demonstrated that different observers could apply the instrument consistently. Weighted Cohen’s Kappa values ranged from 0.64 to 1.00 across the 14 indicators, with 10 of the 14 indicators exceeding 0.80, indicating substantial to almost perfect agreement according to commonly accepted interpretive benchmarks. Intraclass Correlation Coefficients, calculated under the two-way random-effects absolute-agreement model, ranged from 0.67 to 1.00 for single measures, while the global ICC reached 0.89 for single measures and 0.94 for average measures. These figures confirm that the guideline is robust, internally coherent and replicable across observers and contexts, a critical property for any instrument intended to support fair evaluation of teaching quality.

The pilot also generated concrete improvements to the instrument’s design and usability. The researchers added a new section capturing contextual information such as the observed teacher’s name, type of session, school type and dimensions, and technological devices used, reoriented the layout from horizontal to vertical for easier field use, reorganized indicators so that all indicators for each component appeared on the same page, expanded the open-observation field from three to seven lines, and moved illustrative examples directly into the guideline itself. One indicator was reworded to replace a conjunction with a disjunctive form, broadening its scope to capture situations in which community resources or external agents are identified but not necessarily used. Post-pilot analysis showed that 58 percent of the modifications involved new sections, 32 percent design adjustments and 10 percent content changes.

Beyond its immediate technical achievement, the instrument carries significant practical potential. The authors note that teacher training has traditionally emphasized technical mastery of digital tools rather than their pedagogical integration, and the observation guideline is well positioned to serve as a formative assessment tool, a self-reflection resource in mentoring programs, or an evidence-based component in departmental evaluations of technology-enhanced teaching. Its flexible design allows adaptation to different disciplines, educational levels and modalities, including hybrid and virtual environments. The authors caution that further research is needed, including criterial and convergent validation, sensitivity testing to detect changes in teaching practice over time, assessment of transferability across educational systems, and development of an English-language version, but the validated guideline already represents a substantial step toward making the evaluation of good digital teaching practices systematic, transparent and grounded in direct evidence from real classrooms.

Subject of Research: Design and validation of an Activity Theory-based observation instrument for identifying good educational practices with digital technologies through direct classroom observation

Article Title: Good educational practices with digital technologies: validation of an instrument for direct classroom observations

Article References: Good educational practices with digital technologies: validation of an instrument for direct classroom observations. (n.d.). https://doi.org/10.1007/s44322-026-00065-0

Image Credits: AI Generated

DOI: 10.1007/s44322-026-00065-0

Keywords: digital technologies, educational practices, classroom observation, Activity Theory, Delphi method, instrument validation, teacher digital competence, Design-Based Research, educational research, inter-rater reliability, content validity, teaching and learning

The research team, led by Maojie Zhang of the First Affiliated Hospital of Guizhou Traditional Chinese Medicine University and including collaborators at Universiti Sains Malaysia, began with a simple but consequential observation. Existing instruments for assessing infection prevention and control competence were largely imported from international frameworks such as those of the World Health Organization and the Association for Professionals in Infection Control and Epidemiology, or drawn from Chinese national guidelines, but none had been systematically adapted and validated for the realities of Chinese provincial hospitals. Without a sound measurement tool, hospital administrators could neither identify skill gaps among their practitioners nor design training programs with any confidence that those programs addressed genuine weaknesses. The consequence is a workforce whose professional development proceeds largely by intuition rather than evidence.

To build the questionnaire, the researchers followed a four-phase instrument development and validation strategy that reflects the gold standard in psychometric science. In the first phase, they generated an initial pool of 55 items by combining a systematic review of the literature, relevant international competency frameworks, Chinese national guidelines on infection prevention and control, and structured discussion among experts. Each item was written to capture a specific competency domain, from foundational microbiological knowledge to the leadership skills required to drive change across entire hospital departments. This triangulation of sources was deliberate: by drawing on global standards and local policy simultaneously, the team aimed to produce an instrument that was both internationally comparable and locally meaningful.

The second phase subjected the draft items to a two-round modified Delphi consultation, a technique in which a panel of experts independently rates the relevance and importance of each item over successive rounds, with anonymous feedback between rounds allowing the group to converge toward consensus. After the first round, the scale-level content validity index, calculated using the averaging method, stood at 0.87, a figure already considered acceptable in survey methodology. Expert qualitative comments were collected alongside the quantitative ratings, and items that scored poorly or attracted persistent criticism were revised or removed. By the end of the second round, the questionnaire had been trimmed from 55 items to 44, and the scale-level content validity index for the retained items had risen to 0.89, indicating strong expert agreement that the questions measured what they were intended to measure.

The third phase tested whether real practitioners could actually understand and complete the instrument. Face validity assessment and pilot testing were carried out among eligible HAIPCPs working in Guizhou Province, who evaluated the comprehensibility of each item and the overall feasibility of the questionnaire in a busy clinical setting. The scale-level face validity index reached 0.98, an exceptionally high figure suggesting that practitioners recognized the questions as sensible, relevant, and clearly worded. This step matters more than it might appear: a questionnaire that is statistically elegant but confusing to respondents produces unreliable data no matter how sophisticated the analysis, so demonstrating that frontline infection control staff found the instrument intuitive was essential to its credibility.

The fourth and decisive phase involved the main survey, in which 209 HAIPCPs completed the 44-item questionnaire. The researchers first confirmed that the data were suitable for factor analysis: the Kaiser–Meyer–Olkin measure of sampling adequacy was 0.957, far above the conventional threshold of 0.60, and Bartlett’s test of sphericity was highly significant at P less than 0.001, indicating that the items shared sufficient common variance to reveal an underlying structure. Principal component analysis then extracted a five-component solution that the investigators labeled basic knowledge, advanced infection prevention and control competency, environmental hygiene, leadership, and professionalism. Together these five dimensions explained 75.34 percent of the total variance, and component loadings ranged from 0.49 to 0.84, indicating that nearly every item aligned cleanly with one of the identified domains.

Internal consistency, the degree to which items within each dimension and across the whole scale measure the same underlying construct, proved equally impressive. The overall Cronbach’s alpha coefficient was 0.986, and the coefficients for the five individual dimensions ranged from 0.885 to 0.983, all comfortably above the 0.70 benchmark generally regarded as acceptable. The resulting instrument has been named the Competency Evaluation Index for Healthcare-Associated Infection Prevention and Control Practitioners, or CEI-HAIPCPs. In practical terms, the questionnaire now offers hospital managers in China a validated 44-item tool that can be administered to infection control staff to produce a structured profile of strengths and weaknesses across five distinct competency domains.

The significance of this work extends well beyond Guizhou Province. Healthcare-associated infections impose an enormous burden on health systems, prolonging hospital stays, driving antimicrobial resistance, and costing lives that rigorous prevention could save. The COVID-19 pandemic made painfully clear that infection prevention and control is not a bureaucratic afterthought but a core clinical discipline, and it exposed wide disparities in the training and readiness of the practitioners who carry that responsibility. A validated competency instrument transforms workforce development from guesswork into measurement: training curricula can be aligned with the five identified domains, certification schemes can reference objective standards, and individual practitioners can receive targeted feedback on where their skills need reinforcement. The authors caution, appropriately, that the instrument was validated in a single provincial sample and that further testing in broader and more diverse populations is needed before generalizing its use across China or beyond.

Nevertheless, the study offers a template for other regions facing the same problem. Its phased design, combining literature synthesis, modified Delphi consensus, face validity testing, and psychometric evaluation, is reproducible in any jurisdiction that needs a locally grounded assessment tool. The high content validity, robust factor structure, and near-ceiling internal consistency reported here suggest that the CEI-HAIPCPs is a sound foundation on which competency-based professional development for infection control practitioners can finally be built. For the largely unseen professionals who guard every catheter, ventilator, and surgical wound against infection, the study provides something they have long lacked: a credible way to demonstrate, and improve, the expertise on which patient safety depends.

Subject of Research: Development and psychometric validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners

Article Title: Development and validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners in Guizhou Province, China

Article References: Development and validation of a competency assessment questionnaire for healthcare-associated infection prevention and control practitioners in Guizhou Province, China. (n.d.). https://doi.org/10.1186/s12913-026-15495-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15495-x

Keywords: healthcare-associated infections, infection prevention and control, competency assessment, questionnaire development, modified Delphi technique, psychometric validation, principal component analysis, Cronbach's alpha, content validity, patient safety, China, health services research

Adaptive learning systems adjust content, instructional sequences and assessment to individual learners, drawing on decades of theory from constructivism, scaffolding and self-regulated learning. Moodle, the world’s most widely used open-source learning management system, was never designed as an adaptive platform, yet its modular architecture, conditional activities, quiz engine and plugin ecosystem make it capable of supporting adaptive approaches when thoughtfully implemented. Prior studies have shown that Moodle outperforms other open-source systems in adaptivity features, and recent plugins and AI-based integrations have demonstrated measurable engagement and performance gains. Nevertheless, surveys of student opinion consistently report a perceived lack of personalization in Moodle courses, and existing readiness frameworks target institutions or platforms rather than individual courses. ALRAF was designed to fill precisely that gap: a course-level, quantitative diagnostic operationalizable entirely from standard Moodle reporting data.

The framework rests on the ICAP framework of Chi and Wylie, which distinguishes Passive, Active, Constructive and Interactive modes of cognitive engagement and predicts better learning as engagement deepens. Each candidate dimension had to satisfy two constraints: it must be scoreable from observable course components alone, without classroom observation or instructor interviews, and it must map onto a recognized ICAP engagement category. Literature synthesis initially yielded five dimensions: Content Variety, capturing the breadth and quantity of resource types; Interaction Diversity, covering the range of collaborative and individual activities; Assessment Flexibility, reflecting varied and formative assessment options; Learning Path Personalization, anchored in conditional access and branching components such as Lesson and SCORM; and Feedback Mechanisms, spanning forums, surveys and dedicated feedback tools. Each dimension is scored on a 0-to-20 interval using explicit formulas combining breadth, capped quantity and diversity terms, producing a total readiness score that can be normalized to a 100-point scale divided into Low, Moderate, High and Very High bands.

The most methodologically novel element of the study is its validation protocol. Rather than convening a conventional Delphi panel of human experts, the team introduced the Multi-LLM Synthetic Expert Consensus, or MLSEC, procedure: a pre-registered, two-round content-validity exercise conducted with a stratified panel of 40 synthetic experts, generated by pairing eight large language models from eight different providers with five expert personas, including an adaptive-learning researcher, an instructional designer, a psychometrician, a Moodle developer and an AI-in-education specialist. Items were rated on relevance, clarity, comprehensiveness and theoretical alignment, with falsifiable retention thresholds locked in advance: an item-level content validity index of at least 0.78, Aiken’s V of at least 0.70 and modified kappa of at least 0.74. A deliberately off-topic poison-pill item, concerning font sizes in PowerPoint files, served as a quality-control audit, and the panel unanimously rejected it, demonstrating that synthetic raters did not endorse items uncritically.

The synthetic panel did more than ratify the researchers’ initial design. In free-text responses, 33 of 38 panelists, spanning all eight base models, independently proposed a sixth dimension belonging to the artificial intelligence and learning-analytics family. The team formalized this as AI and Data-Driven Adaptivity Integration, or ADAI, which scores whether a course contains the infrastructure needed to plug into the contemporary adaptive ecosystem: LTI external tool gateways, learner-data collection tools, and SCORM or xAPI-compatible content. The new dimension achieved a perfect content validity index of 1.00 for its definition and component mapping in the second round. A runner-up candidate on learner agency and self-regulation attracted only three endorsements and was rejected, confirming that the pre-registered decision rules were genuinely falsifiable rather than rigged toward a predetermined outcome. The authors are careful to frame MLSEC as a transparent, ordinal-ranking validation step rather than a substitute for human expertise, explicitly citing the cautionary literature on synthetic respondents, including their tendency to under-represent variance relative to human samples.

When the validated six-dimensional framework was applied to 985 Moodle 3.8.2 courses delivered between 2020 and 2022, the institutional profile proved conservative. No course reached the Very High readiness band and only 14, or 1.4 percent, reached the High band, while roughly 54 percent fell in the Low band. The dimensional breakdown was even more revealing. Content Variety dominated with a mean of 10.76 out of 20, driven largely by structurally light resources such as URLs, pages and labels, yet only 4 percent of courses used all five common resource types. Feedback Mechanisms followed at 7.90, almost entirely on the strength of near-universal forum presence rather than richer channels. Assessment Flexibility was moderate at 5.90, Interaction Diversity weak at 3.57, while Learning Path Personalization averaged just 0.28 and ADAI an almost nonexistent 0.02. Only 22 of 985 courses used any branching or sequencing component, and just 7 contained any LTI external tool.

Perhaps the most counterintuitive finding concerns grades. The total readiness score correlated negatively with the proportion of high grades, Pearson r equal to minus 0.22, and positively with the proportion of failing grades, r equal to plus 0.22, both highly significant. The authors resist any suggestion that adaptive structures harm learning. Instead, they argue, the pattern confirms that ALRAF measures structural capability rather than pedagogical enactment: courses rich in Moodle scaffolding may assign more demanding, interactive work that spreads grade distributions, and instructors who invest in infrastructure may grade more strictly. The correlation, they contend, strengthens the case for treating the framework as a capability-surface index rather than a predictor of student success. A multiple regression controlling for educational level, form of education and faculty fixed effects explained 18 percent of variance in high-grade share, with Assessment Flexibility the only individually significant dimension, retaining the negative sign.

Disciplinary differences were robust. A one-way analysis of variance across nine faculties yielded F of 10.26 with a small-to-medium effect size, eta squared of 0.078. The faculties of Geography, Tourism and History, and Pedagogical Education led the readiness distribution, while the Faculty of Arts trailed consistently, a pattern the authors attribute partly to studio-based pedagogy that Moodle component counts intrinsically fail to capture. Robustness checks comparing the original five-dimensional score with the validated six-dimensional version showed rank-order correlations above 0.9 and band agreement in over 80 percent of courses, confirming that the substantive conclusions do not depend on the specific dimensional structure, even though the added ADAI dimension and quality-weighted scoring shift absolute values systematically downward.

The practical implications are direct. The near-zero Learning Path Personalization scores point to an urgent need for faculty development on conditional activities, restriction sets and the Lesson module, the structural prerequisites for branching pathways. The near-zero ADAI scores expose a widening institutional gap on the AI frontier, at precisely the moment Moodle’s newer releases support LTI-Advantage AI plugins, connections to OpenAI, Gemini and self-hosted models, and machine-learning-driven adaptive assessment. The authors recommend a phased implementation strategy that builds on existing strengths in content and feedback before tackling personalization and AI integration, alongside discipline-sensitive judgments about what reasonable readiness looks like in fields where pedagogy is not naturally mediated by the LMS. They caution that readiness scores should diagnose capability gaps, not forecast grades.

The study’s limitations are candidly enumerated: a single-institution sample, a single Moodle version, missing conditional-restriction metadata that forced a proxy measure, correlational rather than causal design, course-level grade aggregation, heteroskedastic regression residuals, and the inherent caveats of a synthetic expert panel. Future priorities include multi-institutional validation, cross-version testing against Moodle 4.x and 5.x, direct querying of restriction data through the Web Services API, and pairing structural scores with behavioral learning-analytics variables such as time on task and navigation paths. Within those bounds, the researchers deliver something the field has lacked: a transparent, replicable, theory-anchored index of where, exactly, an institution’s adaptive learning infrastructure stands, and where the next investment should go as artificial intelligence redraws the map of personalized education.

Subject of Research: A validated course-level framework for assessing the adaptive learning readiness of Moodle courses

Article Title: Development and validation of an adaptive learning readiness assessment framework for Moodle courses

Article References: Semerikov, S., Nechypurenko, P., Vakaliuk, T., Mintii, I., & Fadieieva, L. (2026). Development and validation of an adaptive learning readiness assessment framework for Moodle courses. Journal of New Approaches in Educational Research, 15(1), Article 19. https://doi.org/10.1007/s44322-026-00069-w

Image Credits: AI Generated

DOI: 10.1007/s44322-026-00069-w

Keywords: adaptive learning, Moodle, readiness assessment, higher education, large language models, synthetic expert panel, content validity, AI integration, personalized learning, learning management systems, Development, validation