Researchers Gerard R. M. Scholten and Jeroen D. H. van Wijngaarden of the Erasmus School of Health Policy and Management at Erasmus University Rotterdam examined how Value-Based Health Care, commonly abbreviated as VBHC, is implemented in Dutch hospitals. Their findings, published in BMC Health Services Research, come from a qualitative multiple-case study conducted across four Dutch hospitals, drawing on 68 semi-structured interviews with people working at every level of the hospital hierarchy, from board members to frontline clinicians. The interviews were analysed using the widely used thematic analysis approach developed by Braun and Clarke in 2006, allowing the researchers to identify recurring patterns in how the concept was understood and enacted.

The central discovery is stark: there is a fundamental mismatch between what VBHC assumes and what Dutch hospitals can actually do. The original concept, developed in the United States, presumes that hospitals can measure the total costs of care for individual patients across the full cycle of their treatment. That measurement capability is the cornerstone of the model, because only when costs per patient are known can they be linked to health outcomes and used to calculate value. Yet the Dutch researchers found that hospitals in the Netherlands largely lack both the organizational structures and the financial systems required to perform this patient-level costing. Activity-based costing, the accounting machinery that makes cost-per-patient measurement possible in the American context, is simply not in place.

Despite this structural gap, enthusiasm for the concept at the top of the organizations was remarkably strong. Hospital boards endorsed VBHC wholeheartedly and wanted to see it implemented. But rather than driving the change themselves through formal managerial programs, the boards placed doctors and nurses at the forefront of the implementation process. The expectation was that clinical professionals would act as informal leaders, bridging the traditional divide between professional and managerial logics and carrying the concept into everyday practice. This reflects a distinctive feature of Dutch health care culture, in which physicians and nurses are seen as the natural agents of change in hospitals and managerial imposition is often viewed with suspicion.

However, the professionals who were assigned this pivotal role found themselves operating under conditions that made success nearly impossible. Doctors and nurses received limited resources to support their work, unclear mandates about what exactly they were supposed to lead, and little organizational support to help them translate the abstract concept into concrete practice. The researchers describe this as a prominent but unsupported role: clinicians were expected to spearhead a demanding management transformation while being given neither the tools nor the authority to do so. The gap between expectation and support became a decisive force shaping what happened next.

What happened next was a radical adaptation. Freed from the structural anchors of cost measurement and competitive benchmarking, and led by clinicians whose primary concern is patient care rather than market positioning, VBHC in Dutch hospitals evolved into something Porter and his followers would scarcely recognize. Instead of emphasizing the relationship between health outcomes and costs, hospitals reinterpreted the concept as an approach focused on shared decision-making and improved communication between professionals and patients. The competitive logic at the heart of the original model, in which hospitals vie to demonstrate superior value, essentially evaporated.

Nowhere is this reinterpretation more visible than in the fate of patient-reported outcome measures, or PROMs. In the original VBHC framework, PROMs are instruments for systematically capturing patients’ own assessments of their health status, intended to enable benchmarking between providers and the kind of cost-outcome evaluation that fuels competition on value. In the four Dutch hospitals studied, PROMs were instead used mainly to support clinical conversations. Questionnaires about patient outcomes became conversation starters between doctors and patients, tools for understanding individual experiences and tailoring care, rather than instruments for comparing performance across institutions or driving market discipline.

The Dutch experience offers a fascinating case study in what organizational scholars call the translation or hybridization of management concepts. Ideas that circulate internationally, such as VBHC, total quality management, or lean thinking, are never simply copied. They encounter local institutional arrangements, legal frameworks, financial systems, and professional cultures that either accommodate or resist their assumptions. When the fit is poor, the concept bends. In the Netherlands, the bending was so substantial that the researchers characterize it as a radical adaptation: a management model built around outcomes, costs, and competition was transformed into a patient-centred communication approach built around dialogue and shared decision-making.

The study’s most striking conclusion concerns the role of professional expectations. The authors argue that the way Dutch hospital boards positioned doctors and nurses, as prominent leaders who were nonetheless left without resources, clear mandates, or organizational backing, played a decisive role in reshaping the imported concept. Rather than producing the intended integration of professional and managerial perspectives, this arrangement allowed the clinical perspective to dominate, steering VBHC away from its economic foundations and toward its humanistic ones. The findings suggest that when health systems import management models, the expectations placed on professional groups, especially doctors and nurses, may matter more than the design of the model itself.

For policymakers and hospital leaders internationally, the message is sobering and illuminating in equal measure. A concept that appears universally applicable may in fact be deeply dependent on context-specific structures such as patient-level cost accounting and competitive market dynamics. Transplanting it into a system with different financial architecture and a strong tradition of professional self-governance may yield not implementation but reinvention. Whether the Dutch version of VBHC, with its emphasis on shared decision-making, delivers real benefits to patients is a question the study raises but does not resolve. What is clear is that the global travel of management ideas is a story not of faithful diffusion but of continuous adaptation, and that the professionals on the front lines ultimately hold the pen.

Subject of Research: The adaptation of the Value-Based Health Care management concept in Dutch hospitals

Article Title: The radical adaptation of the Value-Based Health Care management concept in Dutch hospitals: an exploratory multiple-case study in four hospitals

Article References: The radical adaptation of the Value-Based Health Care management concept in Dutch hospitals: an exploratory multiple-case study in four hospitals. (n.d.). https://doi.org/10.1186/s12913-026-15560-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15560-5

Keywords: Value-Based Health Care, Dutch hospitals, management concepts, shared decision-making, patient-reported outcome measures, hospital management, health services research, implementation, hybridization, doctors and nurses, qualitative case study, health care costs

The research team, led by Chanda Mwamba and Tikulirekuti Banda of the Centre for Infectious Disease Research in Zambia, together with collaborators from the Zambia National Public Health Institute, the Ministry of Health, Unity Health Toronto and the World Health Organization’s Alliance for Health Policy and Systems Research, evaluated the implementation of Zambia’s Multisectoral Cholera Elimination Plan, or MCEP. The plan, running from 2019 to 2025, aims to reduce cholera-related mortality by ninety percent, in line with the global roadmap. To understand how the plan moved from paper to practice, the researchers applied six phases of the Knowledge-to-Action framework, a widely used implementation science model that tracks how evidence is adapted to local contexts, how barriers are assessed, how interventions are put in place, and how knowledge use is monitored, evaluated and sustained over time.

The study combined several qualitative methods to build a layered picture of implementation. The researchers independently reviewed the MCEP document itself, examining how global guidance had been contextualized for Zambian conditions. They then triangulated this documentary evidence with 24 key informant interviews involving policy-makers and implementers at national, provincial, district and facility levels, 12 in-depth interviews with cholera survivors, and four focus group discussions with 28 members of community-based neighbourhood health committees. Fieldwork took place between April 2020 and May 2021 in two contrasting cholera hotspots: Mpulungu District, a swampy lakeside setting, and Lusaka District, a densely populated periurban environment. Thematic analysis, guided by the Knowledge-to-Action domains, was used to organize and interpret the data, and findings were cross-checked across sources to strengthen credibility.

Zambia’s vulnerability to cholera is well documented. Between 1977 and 2018, the country endured 29 cholera emergencies, with recorded cases ranging from 14 to 13,500 and case fatality rates between 0.5 and 9.3 percent. These outbreaks occurred chiefly in periurban areas and fishing camps that share waters with the Democratic Republic of Congo, Mozambique, Tanzania and Zimbabwe, and are characterized by poor sanitation, inadequate water supply, deficient drainage and weak solid waste management. Rapid urbanization intensifies these pressures, while high cross-border movement with cholera-prone neighbours complicates control efforts. The 2017 to 2018 outbreak that preceded the study period affected seven of Zambia’s ten provinces, producing 5,905 suspected cases and 98 deaths, an experience that sharpened political attention on the elimination agenda.

The document review revealed that the MCEP strategically targets twelve identified cholera hotspots for oral cholera vaccine campaigns, aiming for quick, visible results and public confidence before embarking on larger infrastructure and behaviour-change projects. These hotspots were identified through epidemiological, geographical and contextual analyses, encompassing areas with recurrent outbreaks, poor water, sanitation and hygiene services, transit points, slums, flooding, fishing camps and refugee influxes. The plan rests on a decentralized multisectoral governance structure anchored in national frameworks such as Vision 2030 and the Seventh National Development Plan, and it operationalizes its strategy through technical working groups covering water, sanitation and hygiene, case management, surveillance and laboratory capacity, community engagement and vaccination. Local adaptations emerged as well: in Mpulungu, revitalized community-led total sanitation projects target open defecation around lakeshores, while in Lusaka, interventions included installing pipes and drainage systems, burying shallow boreholes, and creating designated rubbish collection points after outbreaks.

Despite this thoughtful design, the study uncovered formidable barriers that have produced fragmented implementation. Perhaps the most consequential is the absence of a dedicated budget line for the MCEP, which left financing dependent on ministries with different priorities and vulnerable to redirection, particularly during the COVID-19 pandemic. Participants described how funds arrived late and flowed toward temporary emergency measures, such as water tanks during outbreaks, rather than durable infrastructure. ‘Cholera is seen as health rather than a development issue,’ one non-governmental organization actor explained, noting that funding only materializes during outbreaks, which is expensive and diverts resources from developmental activities. Underfunding of water, sanitation and hygiene infrastructure shaped how communities received cholera guidance, since hygiene recommendations are difficult to follow where piped water, sewerage and drainage simply do not exist. Community health volunteers, meanwhile, reported demotivation stemming from a lack of allowances, protective equipment and transport.

Knowledge translation emerged as another critical weak point. National and provincial health leaders demonstrated solid understanding of the MCEP’s strategic direction, but facility-level implementers and non-governmental actors, particularly in Mpulungu, knew far less about the plan itself, with one participant admitting they were ‘learning of that document today’ despite being familiar with district and provincial cholera taskforces. Stakeholders even disagreed about whether implementation was fundamentally bottom-up or top-down, revealing inconsistent internal communication. Coordination also faltered because the response was perceived to be driven predominantly by the Ministry of Health, leaving other sectors with variable responsibility and resources. Participants consistently argued that stronger accountability, commitment and shared ownership across ministries were essential, and some pointed to the COVID-19 response, with its rapid policy-making and enforcement, as a model for how cholera guidelines might be more effectively communicated and upheld.

Nevertheless, the study documents meaningful progress. The appointment of a national cholera elimination coordinator and the formation of multisectoral technical working groups improved coordination and strengthened the case for investment in laboratory capacity, vaccines and infrastructure. Zambia became one of the first four countries to receive Global Task Force on Cholera Control funds in recognition of its elimination efforts, and the leadership team continues to lobby parliamentarians for inclusion of the MCEP in the national budget. Each level of the health system now maintains emergency preparedness plans, and a monitoring framework with strategic and programmatic indicators tracks case fatality, early detection, coordination, financing and vaccine coverage. Encouragingly, Zambia has recorded no cholera outbreak since 2019, which national informants attribute to high vaccine uptake in hotspot areas during and after the 2017-2018 outbreak, intensified environmental cleaning, and increased community knowledge about chlorine use and preventive measures.

The sustainability of these gains, however, is not assured. The researchers found gaps in evidence synthesis for knowledge users, limited monitoring and evaluation capacity, and no earmarked funds for locally determined operational research. The National Health Research Authority, which is responsible for knowledge synthesis, was integrated into technical working groups only after the MCEP was developed and is still building its systems. Drawing comparisons with Zimbabwe and Ethiopia, where multisectoral cholera elimination plans similarly face large funding gaps, the authors caution that global attention and resources diverted to COVID-19 may further threaten resource mobilization. The authors conclude that a multisectoral approach can generate the momentum and efficiencies needed to eliminate cholera in Zambia, but only if stakeholders are fully committed and funding is secured. They call for comprehensive advocacy, national and international budget commitments, robust monitoring and evaluation, and an adaptive collaborative strategy embedded within national guidelines that genuinely includes target communities in local translation and adaptation of the elimination agenda.

Subject of Research: Translating global cholera elimination guidelines into national multisectoral policy and local implementation in Zambia

Article Title: Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia—a qualitative case study

Article References: Mwamba, C., Banda, T., Mazaba, M., Mukonka, V., Malama, K., Hamweemba, E., Syulikwa, M., Chilengi, R., Sharma, A., Fahim, C., Marten, R., Yangchen, S., Straus, S., & The RAISE Project (2026). Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia—a qualitative case study. Health Research Policy and Systems, 24(S1), Article 71. https://doi.org/10.1186/s12961-026-01464-7

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01464-7

Keywords: cholera elimination, Zambia, multisectoral approach, Knowledge-to-Action framework, Global Task Force on Cholera Control, oral cholera vaccine, water sanitation and hygiene, health policy implementation, knowledge translation, qualitative case study, sub-Saharan Africa, community engagement

The study, conducted by Naji Kortam and Soheer Nabil-Hanna of the Biology Education Department at the Academic Arab College for Education in Haifa, was designed as a single-site interpretive qualitative case study. The researchers worked with a kindergarten class of 35 children, from whom 20 focal participants were selected for closer observation. Over the course of a researcher-facilitated, inquiry-oriented learning-garden unit, the team gathered data through semi-structured group interviews and through both participant and non-participant observations conducted before, during, and after the unit. This triangulated approach allowed them to track not just what children said about plants, but how their talk and actions changed as the garden unit unfolded.

The analytical engine of the study was inductive, interpretive qualitative content analysis, focused on three interlocking dimensions: plant-related sensemaking, inquiry practices, and curiosity episodes. Rather than testing a predefined hypothesis, the researchers let patterns emerge from the data, coding children’s explanations, questions, predictions, and moments of wonder as they appeared in transcripts and field notes. This methodological choice matters, because curiosity research in early childhood has long suffered from a definitional problem. As earlier work by Jirout and Klahr famously noted, children’s scientific curiosity has been an elusive concept in search of an operational definition. By watching curiosity happen in real time, in a real garden, Kortam and Nabil-Hanna offer one of the most concrete answers yet.

The findings are striking in their specificity. As the garden unit progressed, the children’s explanations of how plants live and grow became measurably more sophisticated. Early in the unit, explanations tended to be generic and vague. By the end, children were grounding their accounts in specific growth conditions: soil, air, heat, and season. A child who might once have said simply that plants need water could now articulate that a seedling in shaded soil grows differently from one in full sun, or that seasonal temperature changes affect what the garden can produce. This shift from generic to evidence-referenced reasoning is exactly the kind of conceptual development that early science educators hope to see, and it emerged not from formal instruction but from sustained, hands-on engagement with living things.

Equally important, the study documented how genuine inquiry practices became visible in children’s everyday talk and action. The researchers identified four signature behaviors: making predictions about what would happen in the garden, asking child-initiated why and how questions, comparing outcomes across different conditions, and taking simple measurements. These are not trivial accomplishments for five-year-olds. Prediction requires holding a mental model and committing to its consequences. Comparison requires recognizing that conditions can be varied deliberately. Measurement, even in its simplest forms, introduces the idea that claims about the world can be quantified. The garden, in other words, functioned as an authentic laboratory where the core epistemic practices of science arose naturally from the task of keeping plants alive.

Curiosity itself, the study’s central construct, showed up in three observable forms. Children displayed overt wonder, moments of visible surprise and delight at what the garden revealed. They sustained their engagement with uncertainty, returning repeatedly to questions they could not immediately answer rather than abandoning them. And they connected their garden experiences to prior experiences and to information resources, drawing on family gardening, books, and conversations to make sense of what they observed. This tripartite picture gives researchers and teachers something they have lacked: a practical rubric for recognizing curiosity when it happens, rather than merely assuming it exists because children seem engaged.

The study’s design principles may prove to be its most immediately useful contribution. Kortam and Nabil-Hanna distilled their findings into three design principles for inquiry-oriented kindergarten science. First, planned contrasts across conditions: children should encounter plants growing in deliberately different circumstances, such as sun versus shade or watered versus dry soil, because contrast makes causal variables perceptible. Second, repeated revisits over time: because plants change slowly, children need multiple encounters with the same garden across days and weeks, allowing their predictions to be tested against unfolding evidence. Third, open-ended questioning supported by simple tools: adults should ask questions that invite exploration rather than recall, and children should have access to simple instruments such as rulers and magnifiers that extend their senses. None of these principles requires expensive equipment or specialist training, which makes them genuinely scalable.

The theoretical stakes of the work extend beyond the kindergarten fence. Curiosity has become a hot topic in cognitive science, with recent reviews in outlets such as Nature Reviews Psychology cataloguing how curiosity drives learning across ages and contexts. But most of that literature studies curiosity in controlled settings, far from the messy environments where children actually live. This study flips the perspective, asking not how curiosity can be measured in the lab but how it is enacted in the wild of everyday classroom activity. The answer, it turns out, is that curiosity is deeply social and deeply situated. It depends on talk with peers and adults, on materials that invite manipulation, and on questions that remain genuinely open rather than leading to predetermined answers.

The choice of a learning garden as the research site is also significant within a growing international movement. Garden-based learning has attracted increasing research attention, with studies examining everything from teacher roles in kindergarten foraging activities to the connections between risky nature play and science learning in Australian bush kinders. What this new study adds is a fine-grained account of the cognitive and epistemic work happening beneath the surface of garden activity. Where earlier research often emphasized affective and social benefits, such as connection to nature and well-being, Kortam and Nabil-Hanna demonstrate that a garden can be a site of rigorous scientific sensemaking, provided it is organized as structured small-group inquiry rather than free play alone.

For educators and policymakers, the message is both encouraging and demanding. Encouraging, because the study shows that the foundations of scientific literacy, evidence-based explanation, prediction, comparison, and measurement, can be built in ordinary kindergartens with nothing more exotic than seeds, soil, and thoughtful adult questioning. Demanding, because those outcomes did not appear spontaneously. They required deliberate design: contrasts planned into the garden layout, schedules that allowed revisiting, and facilitators skilled at keeping questions open. Curiosity, the study suggests, is not a fixed trait that some children bring to school and others lack. It is a practice that environments either nourish or starve. In a sunlit patch of ground in an Israeli kindergarten, twenty children showed what nourished curiosity looks like: wonder in their eyes, evidence in their explanations, and questions that kept pulling them back to the garden day after day.

Subject of Research: How five- to six-year-old children enact scientific curiosity, inquiry, and plant-related sensemaking in a kindergarten learning garden.

Article Title: Enacting Scientific Curiosity in a Kindergarten Learning Garden: Children’s Inquiry, Talk, and Plant Sensemaking

Article References: Enacting Scientific Curiosity in a Kindergarten Learning Garden: Children’s Inquiry, Talk, and Plant Sensemaking. (n.d.). https://doi.org/10.1007/s10643-026-02348-9

Image Credits: AI Generated

DOI: 10.1007/s10643-026-02348-9

Keywords: scientific curiosity, kindergarten science, learning garden, early childhood education, inquiry-based learning, plant sensemaking, garden-based learning, science education, qualitative case study, children's inquiry, preschool learning, wonder and exploration

The study, conducted by Perıhan Tugba Seker and Ozge Savas of Uşak University’s Department of Preschool Education, followed 21 children aged 60 to 72 months attending a public kindergarten in central Uşak during the 2020–2021 academic year. The research adopted a qualitative single-case study design, a methodology chosen precisely because it allows researchers to examine a bounded, real-life classroom phenomenon in depth without manipulating children’s natural behavior. Ethical approval was granted by the Uşak University Social and Human Sciences Scientific Research and Publication Ethics Committee, and informed written consent was obtained from parents before data collection began.

Crucially, the topic of investigation was not selected by the researchers or the teacher. During an outdoor recess in early November, a small group of children noticed ants carrying breadcrumbs toward a soil mound and their questions multiplied rapidly: Where were they taking the crumbs? Did ants freeze in the rain? How did they find their way without getting lost? Was there a giant city beneath the soil? The researchers documented these spontaneous exchanges in anecdotal records and recognized in them the authentic spark of curiosity that would anchor the project. This genesis matters methodologically: rather than imposing an externally designed unit, the team traced how children’s pre-existing interests could be channeled into structured, multidimensional scientific inquiry.

The project was organized around the three canonical phases of the Project Approach as articulated by Katz and Chard and later developed by Helm and Katz. In the initiation phase, spanning the first two weeks, children’s prior knowledge and misconceptions were elicited through free drawing and collaborative discussion, and co-constructed concept maps were used to visualize initial hypotheses about ant anatomy, behavior, and ecology. The fieldwork phase, from weeks three to five, formed the analytical core of the intervention: children conducted guided nature walks, observed ants through magnifying glasses and digital microscopes, documented findings through field mapping, and collaboratively designed and built model ant farms, embedding engineering design and mathematical measurement of movement patterns and distances into authentic contexts. The finalization phase in weeks six and seven centered on reflection and public sharing, with children revising their concept maps and preparing a community exhibition of their work.

Sessions ran three days per week for 45 to 60 minutes, totaling approximately 21 structured project sessions, and were mapped deliberately onto the constructivist, child-centered Turkish National Preschool Education Program. The educators’ role was carefully calibrated. Rather than lecturing or dispensing answers, the teacher functioned as facilitator and co-investigator, deploying open-ended questions—such as asking what might happen if the texture of an ant’s path changed—to stimulate prediction and solution design, while enriching classroom learning centers with magnifiers, tweezers, field journals, and art supplies as the project’s needs evolved.

The most dramatic findings concerned the dismantling of anthropomorphic misconceptions. Before the project, interviews and drawings revealed that children largely interpreted ant biology through the lens of human life. They imagined ant families with mothers, fathers, and children, insisted that ants never sleep because they always work, and variously credited the insects with anywhere from two to seven legs. After the intervention, post-project interviews documented a profound conceptual shift: children correctly deployed scientific terminology including colony, larva, and maze-like chambers, and described accurate biological structures and behaviors. The researchers argue this demonstrates that preschoolers can master genuinely complex scientific vocabulary and concepts when those concepts are explored deeply rather than treated superficially.

Procedural skills evolved in parallel. Early in the project, children could perceive no diversity within the insect world, claiming there were only black ants or inventing fictional species such as ants made of iron. By the finalization stage, they had progressed from global descriptions to fine-grained, attribute-based classification, accurately distinguishing ecological and behavioral roles such as queen ants, worker ants, carpenter ants, and wood ants based on physical form and function. Children’s understanding of the antenna underwent a particularly striking transformation. Initially described as the thing that runs the television or simply as ears, the antenna was reconceptualized after the project as a multifunctional sensory organ through which ants find their way, avoid danger, hear, and taste—a shift the researchers interpret as evidence of transition from passive questioning to causal, evidence-based explanation.

The integrated STEAM design proved central to these gains, and the authors emphasize that the arts functioned as far more than decoration. When presented with a design challenge inspired by the temperature-regulated architecture of ant nests, children used salt ceramics to sculpt intricate, interconnected three-dimensional models of warehouse systems, verbally attributing functions and names to each component. This artistic modeling acted as a cognitive and symbolic language, allowing children to translate abstract biological findings into tangible engineered products, and to test and communicate mental models that verbal language alone could not yet carry. Robot designs inspired by ant body structure, antennae, and legs further extended the engineering dimension of the inquiry.

Collaboration and communication developed alongside cognitive skills. Because workshop tasks such as constructing interconnected colony pathways were too complex for any single child, cooperative problem-solving became a practical necessity, and the researchers observed a marked reduction in egocentric behavior as children negotiated design choices and built consensus. The culminating public exhibition, for which each child’s artifacts were systematically labeled, saw children confidently explaining their work and every structural detail to an audience, reinforcing scientific communication and metacognitive reflection. A spontaneous home-school learning loop also emerged: children carried their inquiries into daily life, identifying and naming real ants encountered outdoors according to their morphological traits, and sharing their observations with parents—an authentic cross-contextual transfer of knowledge that turned family involvement into an active support mechanism for early scientific literacy.

The authors acknowledge limitations, including winter weather that constrained outdoor observation of ants and forced some sessions to rely on simulated ant farms and digital resources, as well as administrative constraints that prevented families from physically attending the final exhibition, which had to be shared through photographs and video. Even so, the study concludes with a clear message for educators, teacher-training programs, and policymakers: when long-term, interest-driven projects are integrated with a STEAM framework and supported by responsive adult scaffolding, young children are fully capable of fine-grained observation, attribute-based classification, higher-order causal questioning, and collaborative engineering design. The lowly ant, it turns out, was all the invitation these preschool scientists needed.

Subject of Research: Development of scientific inquiry skills in preschool children through a project-based STEAM investigation of ants

Article Title: Preschool children develop scientific inquiry skills through STEM based investigations

Article References: Preschool children develop scientific inquiry skills through STEM based investigations. (n.d.). https://doi.org/10.1007/s44217-026-02127-z

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02127-z

Keywords: early childhood education, STEM education, STEAM, project-based learning, scientific inquiry, preschool, curiosity, science misconceptions, ants, Uşak University, qualitative case study, Discover Education

Drama in Education, often abbreviated as DiE, is a process-oriented approach in which children and teachers step into imagined roles and explore a story or problem from within. Pioneered by educators such as Dorothy Heathcote and Gavin Bolton, the method treats the classroom as a shared fictional world where learning emerges through participation rather than instruction. In China, where early childhood classrooms have traditionally been shaped by Confucian-influenced norms of teacher authority and structured repetition, imported pedagogies of this kind have often been viewed with scepticism. Previous scholarship has suggested that Western-originated approaches may encounter resistance or superficial adoption in Chinese contexts, raising the question of whether children genuinely engage with such methods or simply comply with them outwardly.

To answer that question, the research team turned to Ochs and Phillips’s educational policy borrowing theory, a framework that traces what happens when educational ideas travel across borders. The theory describes a cycle of borrowing that includes justification, translation, and, crucially, internalisation, the stage at which an imported practice becomes embedded in local understanding. Most studies of policy borrowing focus on teachers, administrators or official documents. This study is unusual in that it asks whether internalisation can be observed in the children themselves, treating five- and six-year-olds as capable interpreters of a borrowed pedagogy rather than passive recipients of it.

The researchers adopted a qualitative case study design centred on a single Drama in Education activity in a mainland Chinese early childhood classroom. Rather than relying solely on adult observation, they used a draw-and-tell approach, a well-established technique in early childhood research in which children produce drawings and then explain them verbally. Because young children’s thinking often exceeds their writing ability, drawing combined with self-narration provides a developmentally appropriate channel for them to express how they understood an experience. After the drama activity concluded, the children drew pictures related to what they had experienced and talked through their drawings with the researchers, offering accounts of what the drama had meant to them.

The resulting dataset, consisting of children’s drawings alongside their verbal explanations, was subjected to thematic analysis, a systematic method for identifying recurring patterns of meaning across qualitative data. The analysis revealed several distinct forms of creative understanding among the participating children. Some children revisited the drama by depicting key moments and characters, demonstrating that they had retained the narrative structure of the experience. Others went further, interpreting the events of the drama and connecting them to situations from their own lives. A third pattern involved reconstruction and extension: children added new characters, altered outcomes, or invented scenes that had never occurred in the classroom drama, effectively continuing the story on their own terms.

This last finding carries particular weight for the debate over pedagogical transfer. If the children had merely reproduced the drama, their drawings would have mirrored the classroom activity closely, suggesting surface-level engagement. Instead, the evidence points to a deeper cognitive process. The children integrated their personal experiences, prior knowledge and imaginative capacities into their retellings, transforming the drama into something partly their own. In the language of the study, they did not simply reproduce the drama but reconstructed and extended it. That behaviour is precisely what theories of creative learning would predict when a pedagogy genuinely takes hold, and it suggests that Drama in Education can be meaningfully enacted within a local Chinese classroom rather than remaining an imported ritual.

The study also contributes an exploratory conceptualisation of children’s internalisation within educational policy borrowing theory. By treating children’s creative understanding as evidence of internalisation, the researchers extend a framework normally applied at the level of institutions and systems down to the level of individual learners. This move has practical implications. Policymakers and curriculum designers who import Western pedagogies into East Asian contexts often measure success through teacher training, curriculum documents or observable classroom behaviours. The present study suggests that children’s own artefacts and narratives, such as drawings and accompanying explanations, can serve as an additional and arguably more direct indicator of whether an imported approach has genuinely been absorbed.

The findings arrive at a moment of heightened policy interest in creativity across China. National education outlines issued over the past fifteen years have repeatedly emphasised innovation and creative talent, and recent scholarship has debated why Chinese schooling has historically struggled to cultivate creative thinking alongside strong foundational skills. Drama in Education has been promoted in Chinese early childhood literature as a vehicle for developing language, emotional understanding, peer interaction and creativity, and several recent case studies have explored its use with picture books in kindergartens. However, much of this literature evaluates outcomes from the adult perspective. By centring children’s voices, the new study addresses a methodological gap and provides the children’s perspective on how a Western-originated pedagogy may be internalised in Chinese early childhood education.

The researchers are careful to frame the work as a single qualitative case study rather than a generalisable experiment. The data, which are not publicly available due to ethical restrictions but can be requested from the authors, come from one classroom and one drama activity, and the study was approved by the institutional ethics committee of Universiti Kebangsaan Malaysia with informed consent obtained from all participants and their parents or legal guardians. Nevertheless, the case offers a counterexample to the assumption that Confucian-influenced classrooms inevitably resist Western pedagogies. The children’s responses indicate that when a drama activity is enacted locally, young learners can engage with it in ways that support creative understanding, revisiting, interpreting and rebuilding the experience through their own symbolic and narrative resources.

For educators, the study underscores the value of listening to children after an activity, not just during it. The draw-and-tell method demonstrates that even five-year-olds can articulate sophisticated understandings of a learning experience when given an accessible medium. For researchers of educational transfer, it suggests that the internalisation stage of policy borrowing is visible at the classroom floor level, in crayon drawings and children’s spoken explanations, and not only in ministry documents or teacher interviews. And for advocates of Drama in Education, the evidence provides reassurance that the approach can travel: transplanted into a Chinese kindergarten, it did not lose its essence but was taken up by children who made the drama their own, extending its storylines with the raw material of their own lives and imaginations.

Subject of Research: How five- to six-year-old children in a Chinese kindergarten internalise Drama in Education experiences through creative understanding, examined via a draw-and-tell qualitative case study.

Article Title: Children’s Creative Understanding in Drama in Education: Evidence from Draw-and-Tell in a Chinese Early Childhood Context

Article References: Children’s Creative Understanding in Drama in Education: Evidence from Draw-and-Tell in a Chinese Early Childhood Context. (n.d.). https://doi.org/10.1007/s13158-026-00551-8

Image Credits: AI Generated

DOI: 10.1007/s13158-026-00551-8

Keywords: Drama in Education, creative understanding, early childhood education, educational policy borrowing, draw-and-tell method, China, kindergarten, qualitative case study, children's drawings, pedagogy transfer, creativity, thematic analysis

The research, led by Ifeoma Cecil Okechukwu-Uzoechi of the STADIO School of Education in Durban, South Africa, together with colleagues at Rajamangala University of Technology Krungthep in Bangkok, set out to address a persistent weakness in teacher preparation. Conventional programs transmit valuable skills, from curriculum planning to classroom management, but often leave graduates stranded between educational theory and the messy realities of the classroom. Reflection is routinely prescribed as the remedy, yet it is frequently left unstructured, producing what the authors describe as superficial rather than transformative understanding. Their aim was to give reflection an explicit architecture, and an emotional foundation to match.

The theoretical scaffolding rests on three pillars. Donald Schön’s classic model of the reflective practitioner distinguishes reflection-in-action, the on-the-fly adjustment of judgment during teaching, from reflection-on-action, the more deliberate analysis that follows. Lev Vygotsky’s sociocultural theory contributes the insight that reflection is not a solitary act but a socially mediated one, deepened by dialogue and by the Zone of Proximal Development, the space between what learners can do alone and what they can achieve with support. Ron Ritchhart’s Visible Thinking Approach supplies the operational bridge: structured routines such as See-Think-Wonder, I Used to Think… Now I Think, Compass Points, Step Inside, Claim-Support-Question and Think-Puzzle-Explore, which externalize cognitive processes and make them available for inspection and discussion. Contemplative practice, in turn, was expected to supply the inner conditions, calm, self-awareness, and emotional regulation, that allow such routines to do their work.

The study took the form of a qualitative case study conducted at a teachers’ training college in South Africa between January and March 2025. From an initial pool of twenty-six final-year pre-service teachers aged twenty-two to thirty, twelve participants, eight women and four men, met the inclusion criteria of informed consent, full attendance at VTA sessions, and completion of pre- and post-practicum reflection activities. Each VTA routine ran as a structured, instructor-led activity of roughly thirty to forty minutes embedded in weekly seminars. Crucially, before each routine, participants spent three to five minutes on a brief mindfulness exercise such as breath awareness, performed in small groups, followed by whole-class debriefs.

Data came from three triangulated sources: individual semi-structured interviews of about forty-five minutes with each participant, two focus group discussions of roughly an hour each, and bi-weekly reflective journals responding to structured prompts. Thematic analysis, following Braun and Clarke’s iterative procedure, produced a hierarchical coding tree that reached both code and meaning saturation after about two-thirds of the corpus had been analyzed, with the remaining data confirming rather than extending the emerging patterns. Rigor was reinforced through member checking, peer debriefing, reflexive journaling by the research team, and an audit trail, while ethical clearance came from the KwaZulu-Natal Research Ethics Committee under reference HSS/1915/0166 M.

Four interlocking themes emerged. The first, metacognitive growth, was the most pervasive. Participants repeatedly described how See-Think-Wonder disrupted habitual, often deficit-oriented readings of learners. One participant, identified as Ms. N, wrote that when she first saw a photograph of a noisy class she immediately judged the students as disrespectful, but the routine revealed how quickly she jumped to conclusions, and she now forces herself to list only what she actually sees before interpreting. Another participant said the routine slowed down his teacher brain, replacing blame with the question of what else could be happening. The journaling routine I Used to Think… Now I Think prompted some participants to revise entrenched beliefs about discipline and classroom control, although not everyone transformed dramatically; one participant still held that discipline must come first, yet conceded the routine opened a door to trying something different.

The second theme concerned emotional and professional identity. Participants reported that short breathing exercises reduced anxiety before presentations and created small moments of calm that helped them articulate their thinking. Contemplative pauses appeared to ground them, making the cognitive routines feel less mechanical and more personal. Yet identity development proved nonlinear and sometimes uncomfortable. Several participants confessed persistent imposter feelings, with one writing that despite learning a great deal, she still did not feel teacher enough when comparing herself to others. The authors interpret this through identity frameworks that see teaching identities as negotiated between internal self-perception and external expectation, with contemplative practice creating the space for that negotiation and VTA routines providing the language for it.

The third theme, social-constructivist learning, highlighted the Vygotskian heart of the intervention. Working through the routines in groups generated a shared professional vocabulary, with terms like evidence, interpretation and wonderings entering everyday conversation. Disagreement, initially experienced as irritating, turned out to be pedagogically productive: participants reported that having to justify their interpretations to skeptical peers pushed them into their collective zone of proximal development, converting polite consensus into genuine critical thought. One participant noted that although she felt annoyed when her idea was brushed off, she later realized the friction had helped her think more rigorously. The routines thus functioned as cultural tools mediating social learning, exactly as Vygotsky’s framework would predict.

The fourth theme, contemplative integration, captured how mindfulness reshaped engagement with the thinking routines themselves. Some participants initially found the practices strange, with one admitting it felt odd to close her eyes in a teacher education class. Within two to three weeks, however, attitudes shifted, and participants reported that the mindfulness breaks slowed them down and allowed more honest engagement with what they were observing. The authors caution that this receptivity was not automatic; novices may experience discomfort or resistance before recognizing the professional value of contemplative practice, echoing recent scholarship noting that such practices require careful scaffolding.

The study’s practical implications are concrete. The authors recommend sequencing VTA routines developmentally, beginning with observational routines like See-Think-Wonder and progressing toward interpretive and critical forms such as Claim-Support-Question, so that reflection deepens in stages. They further suggest embedding brief contemplative practices before and after thinking routines to enhance emotional regulation and openness to perspective-taking, and deliberately designing group-based reflection to normalize cognitive conflict as a learning resource. Teacher education programs adopting the framework are advised to provide professional learning for teacher educators in both visible thinking facilitation and basic contemplative techniques.

The authors are careful about the limits of their claims. The sample was small and self-selected, drawn from a single institution, and participants were not tracked into their early careers, so the findings are context-specific rather than generalizable. Future research, they suggest, could employ larger mixed-methods or longitudinal designs to test whether VTA-plus-contemplative frameworks influence later classroom practice, teacher wellbeing, and ultimately learner outcomes. Nor do they claim the integration transforms teacher education outright. Rather, they argue, it created fruitful conditions in which novice teachers could experiment with new ways of seeing, feeling and making sense of their practice. In an era when education systems face upheaval on multiple fronts, the study makes a case that preparing teachers is as much about cultivating metacognitive insight, emotional presence and social responsibility as it is about technical competence, and that a few minutes of mindful breathing before a structured thinking routine may be one of the simplest, most teachable ways to begin.

Subject of Research: An integrated visible thinking and contemplative learning framework for fostering reflective practice in pre-service teacher education

Article Title: Integrating visible thinking and contemplative learning to foster reflective practice in pre-service teacher education

Article References: Okechukwu-Uzoechi, I. C., Anyanwu, C. C., Rakthin, C., Songsiengchai, S., Vorawattanachai, P., & siripala, W. (2026). Integrating visible thinking and contemplative learning to foster reflective practice in pre-service teacher education. Discover Education, 5(1), Article 902. https://doi.org/10.1007/s44217-026-02158-6

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02158-6

Keywords: visible thinking approach, contemplative learning, reflective practice, pre-service teachers, teacher education, mindfulness, metacognition, professional identity, Vygotsky, Schön, Project Zero, qualitative case study