Background: In general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle. Programs to stimulate walking activity to increase physical activity are based on the available insights into barriers and facilitators to physical activity after stroke. However, these programs are not entirely successful. The purpose of this study was to comprehensively explore perceived barriers and facilitators to outdoor walking using a model of integrated biomedical and behavioral theory, the Physical Activity for people with a Disability model (PAD). Methods: Included were community dwelling respondents after stroke, classified ≥ 3 at the Functional Ambulation Categories (FAC), purposively sampled regarding the use of healthcare. The data was collected triangulating in a multi-methods approach, i.e. semi-structured, structured and focus-group interviews. A primarily deductive thematic content analysis using the PAD-model in a framework-analysis’ approach was conducted after verbatim transcription. Results: 36 respondents (FAC 3–5) participated in 16 semi-structured interviews, eight structured interviews and two focus-group interviews. The data from the interviews covered all domains of the PAD model. Intention, ability and opportunity determined outdoor walking activity. Personal factors determined the intention to walk outdoors, e.g. negative social influence, resulting from restrictive caregivers in the social environment, low self-efficacy influenced by physical environment, and also negative attitude towards physical activity. Walking ability was influenced by loss of balance and reduced walking distance and by impairments of motor control, cognition and aerobic capacity as well as fatigue. Opportunities arising from household responsibilities and lively social constructs facilitated outdoor walking. Conclusion: To stimulate outdoor walking activity, it seems important to influence the intention by addressing social influence, self-efficacy and attitude towards physical activity in the development of efficient interventions. At the same time, improvement of walking ability and creation of opportunity should be considered
Extended Reality (XR) technologies—including virtual reality (VR), augmented reality (AR), and mixed reality (MR)—offer transformative opportunities for education by enabling immersive and interactive learning experiences. In this study, we employed a mixed-methods approach that combined systematic desk research with an expert member check to evaluate existing pedagogical frameworks for XR integration. We analyzed several established models (e.g., TPACK, TIM, SAMR, CAMIL, and DigCompEdu) to assess their strengths and limitations in addressing the unique competencies required for XRsupported teaching. Our results indicate that, while these models offer valuable insights into technology integration, they often fall short in specifying XR-specific competencies. Consequently, we extended the DigCompEdu framework by identifying and refining concrete building blocks for teacher professionalization in XR. The conclusions drawn from this research underscore the necessity for targeted professional development that equips educators with the practical skills needed to effectively implement XR in diverse educational settings, thereby providing actionable strategies for fostering digital innovation in teaching and learning.
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Physician assistants (PAs) were introduced in the Netherlands in 2002 and are now widely deployed. However, little is known about patient satisfaction with Dutch PAs. A comparative study of patient satisfaction was undertaken in the primary care setting. Patients seen by general practitioners (GPs) and PAs were surveyed using the Consumer Quality Index, a European quality survey instrument. Quality of performance indicators included patient satisfaction, effectiveness of treatment, and safety of treatment. The results found that few differences emerged, and Dutch patients appear to be as satisfied with the care received by PAs as with GPs.