The significance of the work lies in its starting point. Rather than designing an intervention in an office and testing it on a patient population, the research team invited the end-users themselves—foreign-born individuals managing chronic conditions, the family members who help them, nurses and physicians in primary healthcare and home care, and pharmacists—into the research process from the very beginning. This participatory approach, the authors argue, is essential when the problem involves not just clinical knowledge but the everyday, lived realities of navigating a healthcare system in an unfamiliar language. The study was funded by the Swedish Research Council under grant reference 2021–06415, and it was approved by the Swedish Ethical Review Authority, with written informed consent obtained from all participants in accordance with the Helsinki Declaration.

The methodological backbone of the study is a series of focus group discussions built on the findings of the team’s previous research. These conversations explored where medication use breaks down for people with limited proficiency in the local language and what kinds of support could realistically be provided within existing structures. The qualitative data were then analysed using qualitative content analysis, a rigorous technique for identifying patterns and themes in textual material. Crucially, the researchers interpreted their findings through the sociological framework developed by Ray Pawson, organising the results across four contextual dimensions: the individual, the interpersonal, the institutional, and the infrastructural. This layered analytical structure allowed the team to see not only what support was needed but at which level of the system it needed to be delivered—a distinction that has direct implications for policymakers and healthcare managers.

The analysis revealed seven distinct areas in which support was required. The first concerns routines: patients and families need established, repeatable procedures for organising, taking, and renewing medications that reduce the cognitive burden of managing complex regimens. The second is continuity and risk assessment—patients benefit enormously from seeing the same healthcare providers over time, and clinicians need structured opportunities to identify individuals at elevated risk of medication errors before harm occurs. The third area is support for language understanding, encompassing professional interpreters, translated materials, and other communication bridges between patients and providers. The fourth involves resources, including practical aids such as pill organisers, dosage boxes, and sufficient staffing time to provide meaningful guidance. The fifth is information for patients and relatives—not only about individual medications but about the broader logic of the prescribing system, which is often opaque to people who grew up with different healthcare traditions. The sixth area is staff training, reflecting the finding that healthcare personnel themselves need better preparation to work across language barriers. The seventh and final area concerns national measures, recognising that some barriers are too large for any single clinic or pharmacy to solve alone.

One of the study’s most important conclusions is that support must operate across all four contextual levels, but that the greatest deficits lie at the institutional and infrastructural levels. Individual patients can be taught, and individual clinicians can be empathetic, but if the organisation lacks clear guidelines and regulations, or if the system provides no time for risk assessment in an overloaded primary care schedule, even well-intentioned efforts will falter. At the interpersonal level, the everyday interactions between patients and staff in healthcare centres and pharmacies emerged as critical junctures where safety is either built or undermined. A pharmacy counter conversation, a home care visit, or a brief consultation can either clarify a confusing regimen or leave a patient more uncertain than before. The researchers emphasise that these routine encounters deserve critical review and redesign rather than being treated as incidental.

From these findings, the team developed a concrete support model anchored in primary healthcare. Its core architecture involves an extended interdisciplinary team that deliberately includes two groups often left outside the formal care circle: the patient’s relatives and pharmacists. Relatives frequently shoulder the practical burden of medication management in migrant households, yet they are rarely given systematic education or support. Pharmacists, meanwhile, possess expertise in drug interactions, dosing, and practical administration that is underutilised when they are treated simply as dispensers rather than members of the care team. The model is coordinated by an accessible contact person—a named, reachable individual who serves as the patient’s stable point of entry into the system, addressing the well-documented harm caused by fragmented care and rotating providers.

The model rests on three foundational principles articulated in the study’s conclusions. First, a well-informed patient must be placed at the centre of care, which presupposes genuine two-way communication adapted to the patient’s language capacity. Second, care planning must be based on individual needs rather than one-size-fits-all protocols, since language difficulties intersect differently with each patient’s health literacy, social situation, and disease burden. Third, support must be coordinated across the individual, interpersonal, institutional, and infrastructural levels simultaneously, because deficits at any single level can sabotage gains made at the others. In practical terms, the authors call for everyday practice to be critically examined: teams should be organised so that collaboration across professions becomes the norm, schedules should allow real time for risk assessment, and patient and relative education should be systematically improved rather than squeezed into whatever moments remain.

The broader context of this research is the demographic transformation of European healthcare systems. Migration has substantially increased population diversity in Sweden and across the continent, creating persistent challenges for safe medication use. Foreign-born persons with language difficulties face a compounding set of risks: medication labels and package inserts they cannot read, verbal instructions they may only partially understand, and prescribing conventions that differ from those in their countries of origin. The consequences can include missed doses, accidental overdoses, dangerous drug interactions, and inappropriate discontinuation of therapy. Evidence about the factors driving medication-related problems among migrants has remained limited, and no previous studies had addressed support for medication use specifically in the home environment—where most medication is actually taken—or proposed models for such support.

What makes this study methodologically notable is its commitment to co-creation as a research paradigm. Participatory action research treats the people affected by a problem as co-producers of knowledge rather than passive subjects, and the co-creation variant extends this collaboration to the design of solutions. The result is a model that has been stress-tested against the realities described by the people who will actually use it. When foreign-born patients described confusion over renewal routines, or pharmacy staff described the impossibility of providing adequate counselling without interpreter support, these observations fed directly into the architecture of the final model. This grounding in lived experience increases the likelihood that the model will be implementable and sustainable, a persistent weakness of top-down interventions in health services research.

The authors are careful to note that the model cannot succeed through clinical practice change alone. Implementation, they conclude, should be accompanied by organisational and policy-level changes to enable sustainable, person-centred medication safety. That means clearer national guidelines and regulations, organisational development within healthcare providers, and a strengthening of continuity, communication, and shared responsibility across what they describe as a seamless healthcare chain. If those structural conditions are met, the researchers argue, medication-related risks for foreign-born persons with language difficulties can be substantially reduced, and patients and relatives alike can be supported in managing medications safely in the one place where medication safety matters most: the home. The study, published as an open-access article and shared early to accelerate access to peer-reviewed findings, offers health systems across Europe and beyond a tested blueprint for closing one of the most overlooked safety gaps in modern medicine.

The study showcases a unique methodology that capitalizes on the collaborative nature of learning among healthcare professionals. By involving participants in the research process, it fosters a sense of ownership and responsibility towards their education and professional development. This participatory action research paradigm effectively bridges the gap between theory and practical application, empowering nurses to actively contribute to their own learning experiences. Such engagement is crucial in a profession where adaptability and responsiveness to emerging healthcare challenges can heavily influence outcomes.

The findings of this research reveal that traditional modes of conducting continuing nursing education often fail to resonate with the needs and realities faced by practicing nurses. In a profession plagued by high turnover rates and burnout, it is essential for education programs to be dynamic and responsive to the unique contexts in which nurses operate. The participatory action research approach provides a platform for nurses to voice their concerns and perspectives, ensuring that educational interventions are both relevant and impactful.

Moreover, this study highlights the role of mentorship in continuing education. Mentorship not only facilitates the transfer of knowledge but also fosters a community of practice where experienced nurses can encourage and support their less experienced peers. By creating a supportive learning environment, nurses can share their skills and insights, ultimately leading to enhanced patient care and improved health outcomes.

The study emphasizes accountability within nursing education as well. It suggests that structures need to be created where nurses hold themselves and each other accountable for their professional development. This sense of shared responsibility can promote a culture of continuous learning and curiosity, enabling nurses to remain engaged with the latest advancements in medical care.

Through its innovative design, the study also underscores the importance of evaluating the effectiveness of continuing nursing education initiatives. Evidence-based practice is paramount in developing curricula that truly meets the evolving needs of healthcare providers. By applying rigorous research methods, the effectiveness of educational interventions can be quantitatively assessed, providing a clear pathway for improvement.

The implications of this research extend far beyond the confines of a singular educational program. As healthcare systems worldwide confront the challenges posed by an ever-evolving medical landscape, the need for adaptable and responsive education options becomes increasingly apparent. The findings from this study could inspire similar approaches in various contexts, paving the way for globally relevant nursing education models that address the needs of diverse populations and healthcare challenges.

Furthermore, implementing this participatory action research model could assist policymakers in shaping educational policies that prioritize the ongoing development of nursing professionals. By integrating the voices of nurses into the policymaking process, educational systems can be more effectively aligned with the realities of nursing practice, ultimately leading to better patient care outcomes.

While this research holds promise, it is essential to consider the challenges and barriers that may arise when adopting a participatory approach. Resistance to change within institutions, the status quo of existing programs, and the demands of full-time nursing practice may pose obstacles that need to be thoughtfully navigated. Addressing these barriers requires strategic planning, stakeholder engagement, and a commitment from educational institutions to prioritize ongoing nurse development.

In conclusion, Mohsen and Mahdi’s research presents a progressive view of continuing nursing education that is both provocative and essential. By harnessing the power of participatory action research, this work paves the way for more meaningful and impactful nursing education models that are tailored to the complex realities of the profession. Ultimately, the future of nursing education depends on its ability to evolve in tandem with the nursing practice itself, ensuring that nurses are equipped with the knowledge and skills necessary to thrive in a demanding healthcare environment.

As the nursing profession continues to grow and evolve, studies like this one are critical for informing best practices in education and professional development. The commitment to fostering a culture of inquiry and collaboration not only benefits individual nurses but also has far-reaching implications for patient care and outcomes across the healthcare system. This shift towards a participatory education model exemplifies a profound understanding of how education can drive improvement in healthcare practices, ensuring a brighter future for nursing professionals everywhere.

In an environment where change is constant, ongoing education and training must keep pace. This study serves as a rallying call for educators, practitioners, and policymakers alike to innovate and rethink traditional educational structures. The time to act is now and the potential for transformative change is within our reach.

Subject of Research: Continuing Nursing Education through Participatory Action Research

Article Title: Enhancing continuing nursing education: a participatory action research approach in Iran

Article References:

Mohsen, H., Mahdi, K.J. Enhancing continuing nursing education: a participatory action research approach in Iran.
BMC Med Educ 25, 1589 (2025). https://doi.org/10.1186/s12909-025-08195-3

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12909-025-08195-3

Keywords: Continuing Nursing Education, Participatory Action Research, Nursing Education, Professional Development, Healthcare, Iran.