review of related literature on inclusive education

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Understanding the value of inclusive education and its implementation: A review of the literature

• Published: 07 September 2020
• Volume 49 , pages 135–152, ( 2020 )

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• Anthoula Kefallinou 1 ,
• Simoni Symeonidou 1 , 2 &
• Cor J. W. Meijer 1  

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European countries are increasingly committed to human rights and inclusive education. However, persistent educational and social inequalities indicate uneven implementation of inclusive education. This article reviews scholarly evidence on inclusion and its implementation, to show how inclusive education helps ensure both quality education and later social inclusion. Structurally, the article first establishes a conceptual framework for inclusive education, next evaluates previous research methodologies, and then reviews the academic and social benefits of inclusion. The fourth section identifies successful implementation strategies. The article concludes with suggestions on bridging the gap between inclusive education research, policy, and practice.

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Kefallinou, A., Symeonidou, S. & Meijer, C.J.W. Understanding the value of inclusive education and its implementation: A review of the literature. Prospects 49 , 135–152 (2020). https://doi.org/10.1007/s11125-020-09500-2

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International Journal of Research and Innovation in Social Science (IJRISS) | Volume V, Issue III, March 2021 | ISSN 2454–6186

Inclusive Education: A Literature Review on Definitions, Attitudes and Pedagogical Challenges

Tebatso Namanyane, Md Mirajur Rhaman Shaoan Faculty of Education Southwest University China

Abstract: This paper on inclusive education explores several diverse viewpoints from various scholars in different contexts on the concepts of inclusive education in an effort to reach the common understanding of the same this concept. The attitudes section is addressed from the perspectives of pupils, educators, and the society (parents), and it further explore the dilemmas that teachers and students with disabilities face in modern education systems. The instructional approaches focusing on how teachers plan and execute lessons with diverse students’ aptitudes from literature are also levelheadedly outlined. In conclusion, it included a broad overview focused on two models, social and medical models on which this paper is primarily based.

Key words: Inclusive Education, Attitudes, Pedagogical Challenges

I. INTRODUCTION There are several terms in the field of education that are interpreted differently depending on the reason for which they are meant. Others have been given meanings that are globally recognized, while others are interpreted differently based on the varying reasons and factors affecting them, including religion and regions, history, values, race, and resource limitations. The present paper is intended to discuss an interesting educational topic which has intrigued scholars across the globe due to its arguable definitions from different perspectives. It will also have a more comprehensive but remarkably different interpretation of these core tenets as proposed in the topic specified above, Inclusive Education: A Literature Review on Definitions, Attitudes and Pedagogical Challenges. Education is a full process of training a new generation who is ready to participate in civic life and is also a vital link in the process of human social production experience to be carried out, with special regard to the process of school education for school-age infants, young people and retired people. Generally, all things that will improve human intelligence and skills and affect people’s moral character as considered as part of education. In a narrow sense, it is primarily schooling, which is characterized as the practice of educators to impact the mind and body of the learner intentionally, purposefully and systematically according to the requirements of a specific community or class to develop them as persons they want to be. Aristotle defines education as the way to prepare a man to achieve his mission by exercising all the faculties to the fullest degree as a citizen of society.

• DOI: 10.20489/intjecse.722380
• Corpus ID: 218795647

The development of inclusive education practice: A review of literature

• N. Alzahrani
• Published in International Journal of… 30 June 2020
• Education, Philosophy

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The influence of teaching experience and professional development on Greek teachers’ attitudes towards inclusion

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Review of Literature: Inclusive Education 

This brief review of relevant literature on inclusive education forms a component of the larger Inclusive School Communities Project: Final Evaluation Report delivered by the Research in Inclusive and Specialised Education (RISE) team to JFA Purple Orange in October, 2020. 

Suggested citation for full evaluation report: 

Jarvis, J. M., McMillan, J. M., Bissaker, K., Carson, K. L., Davidson, J., & Walker, P. M. (2020).  Inclusive School Communities Project: Final Evaluation Report. Research in Inclusive and Specialised Education (RISE), Flinders University. 

https://sites.flinders.edu.au/rise  

Introduction 

Inclusive education has featured prominently in worldwide educational discourse and reform efforts over the past 30 years (Berlach & Chambers, 2011; Forlin, 2006). Inclusive schools are critical to providing a strong foundation for young people with disabilities to access, participate in and contribute to their communities and lead fulfilling lives (Hehir et al., 2016). Schools also represent a key condition for the development of thriving, inclusive communities for all citizens. Yet, as reflected in submissions to the current Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, and consistent with recent South Australian reports (Parliament of South Australia, 2017; Walker, 2017), many students living with disability (and their families) continue to report negative experiences of education. While progress has been made, traditional educational structures and practices often run counter to inclusive goals (Slee, 2013), and inconsistencies occur between theory and policy and the implementation of inclusive principles and practices in schools (Carrington & Elkins, 2002; Graham & Spandagou, 2011). In addition, both preservice and practicing teachers consistently report feeling underprepared to teach students with disabilities and special educational needs (Jarvis, 2019; OECD, 2019). 

Despite legislation and policy imperatives related to inclusive education, there remains a lack of consensus in the field about the definition of inclusion and associated models of inclusive practice (Ainscow & Sandill, 2010; Kinsella, 2020). Multiple conceptualisations of inclusion and theoretical approaches to fostering inclusion in schools may contribute to confusion and uncertainty for educators and policymakers. With schools facing growing accountability and teachers expected to educate an increasingly diverse student population (Anderson & Boyle, 2015), it is vital that the concept of inclusive education is demystified for practitioners. Against this backdrop, initiatives such as the Inclusive School Communities (ISC) project that aim to deepen understandings of inclusion and increase the capacity of school communities to provide an inclusive education, are particularly important. 

Inclusive Education 

Inclusive education is based on a philosophy that stems from principles of social justice, and is primarily concerned with mitigating educational inequalities, exclusion, and discrimination (Anderson & Boyle, 2015; Booth, 2012; Waitoller & Artiles, 2013). Although inclusion was originally concerned with ‘disability’ and ‘special educational needs’ (Ainscow et al., 2006; Van Mieghem et al., 2020), the term has evolved to embody valuing diversity among all students, regardless of their circumstances (e.g., Carter & Abawi, 2018; Thomas, 2013). Among interpretations of inclusion, common themes include fairness, equality, respect, diversity, participation, community, leadership, commitment, shared vision, and collaboration (Booth, 2012; McMaster, 2015). The United Nations Convention on the Rights of Persons with Disabilities (CRPD), to which Australia is a signatory, defines inclusive education as:  

. . . a process of systemic reform embodying changes and modifications in content, teaching methods, approaches, structures and strategies in education to overcome barriers with a vision serving to provide all students of the relevant age range with an equitable and participatory learning experience and environment that best corresponds to their requirements and preferences. (United Nations, 2016, para 11)

Consistent with this definition, inclusive education now generally refers to the process of addressing the learning needs of all students, through ensuring participation, achievement growth, and a sense of belonging, enabling all students to reach their full potential (Anderson & Boyle, 2015; Booth, 2012; Stegemann & Jaciw, 2018). Inclusion is concerned with identifying and removing potential barriers to presence (attendance, access), meaningful participation, growth from an individual starting point, and feelings of connectedness and belonging for all students and community members, with a focus on those at particular risk of marginalisation or exclusion (Ainscow et al., 2006; Forlin et al., 2013). 

Critically, the view of inclusion described above moves beyond considerations of the physical placement of a student in a particular setting or grouping configuration. That is, while physical access to a mainstream school environment is essential to maintain the rights of students living with disabilities to access education “on the same basis” as their peers (consistent with legislation and human rights principles), it is not sufficient to ensure inclusion. Rather, inclusion can be considered a multi-faceted approach involving processes, practices, policies and cultures at all levels of a school and system (Booth & Ainscow, 2011). Inclusive education is responsive to each child and promotes flexibility, rather than expecting the child to change in order to ‘fit’ rigid schooling structures. The latter approach reflects integration, and inclusion is also inconsistent with segregation, in which children with disabilities are routinely educated separately from others. 

Considerable research has focused on the implementation of inclusive school processes, practices and cultures that are sustainable over time. Although a number of frameworks to achieve sustainable inclusive practice have been proposed, key elements are consistent across approaches and well supported by research (Booth & Ainscow 2011; Azorín & Ainscow, 2020). These interconnected elements are summarised in Figure 1 and considered fundamental to the process of achieving whole-school (and systemic) cultural change towards more inclusive ways of working. Of particular relevance to the Inclusive School Communities project are the concepts of a whole school approach, leadership, school values and culture, building staff capacity, and multi-tiered models of inclusive practice. 

Inclusion as a Whole School Approach 

Adopting a whole of school approach to inclusive education is fundamental to ensure efficacy and sustainability (Read et al., 2015). The process of developing inclusive schools is complex and multi-faceted, requiring time, commitment, ongoing reflection, and sustained effort. For inclusion to truly take root in schools, changes must be made from the inside out; a strong foundation must be built from inclusive school values, committed leadership, and shared vision amongst staff to support whole school structural reforms to policy, pedagogy, and practice (Ekins & Grimes, 2009). Whilst challenging, “it is necessary to unsettle default modes of operation” in schools (Johnston & Hayes, 2007, p.376), as inclusive education requires new, more efficient and effective ways of supporting student participation and achievement. This is made possible by implementing flexible, planned whole school support structures, such  as multi-tiered systems of support (MTSS), where teachers work collaboratively with specialist staff to identify, monitor, and support students requiring varying levels and types of intervention at different times, and for different purposes (Sailor, 2017; Witzel & Clarke, 2015). This contrasts to the more traditional, ‘categorical’ and segregated approach of general educators referring identified students with additional needs to special educators, to devise and administer further education in isolation from the regular classroom (Sailor, 2017). 

Figure 1. Interconnected elements in sustainable inclusive education, derived from research.

Even at the classroom level, inclusive planning and teaching practices must be supported by school policies, practices, and culture in order to be sustainable (Sailor, 2017). Barriers to inclusive classroom practice can include lack of effective professional learning and support for teachers; teachers’ lack of willingness to include students with particular needs; attitudes that are inconsistent with inclusive practices; teacher education that fails to address concerns about inclusion; and, a lack of accountability for the implementation of inclusive teaching practices (Forlin & Chambers, 2011; Forlin et al., 2008; van Kraayenoord et al., 2014). Addressing each of these relies on targeted, coordinated support. The complexity of embedding inclusive practices such as differentiated instruction or Universal Design for Learning (UDL) into classroom work is often underestimated, and these practices have the greatest chance of becoming embedded when they are reinforced by a shared vision and collaborative effort (McMaster, 2013; Sailor, 2015; Tomlinson & Murphy, 2017). 

Sustainable, whole school change cannot be achieved via focus on a single element of inclusion in isolation, as components do not function in isolation. Rather, the core elements of inclusion including leadership, school culture, building staff capacity, and inclusive practices are parts of an interdependent system. Hence, key elements of inclusion must be considered collectively and accounted for in advanced planning to ensure they function harmoniously and are integrated into the developing inclusive fabric of the school (Alborno & Gaad, 2014). 

Leadership for Inclusion 

The importance of leadership for determining the success of school reforms or changes to practice is well established in the literature (McMaster & Elliot, 2014; Poon-McBrayer & Wong, 2013). Becoming a more inclusive school often requires significant shifts in school values, culture, practices, and organisational systems; thus, leadership is critical to ensuring sustainable inclusive change in schools (Ainscow & Sandill, 2010; McMaster, 2015; Poon-McBrayer & Wong, 2013). School leaders are highly influential figures whose values, beliefs, and actions directly affect the culture of the school, expectations of staff, and school operations (Slater, 2012; Wong & Cheung, 2009). It is critical that school leaders are committed to embodying inclusive principles, establishing and modelling a standard of behaviour that promotes the development of inclusion within the school community. 

Organisational change on the scale often required for inclusion requires leadership across multiple levels (Jarvis et al., 2016; Tomlinson et al., 2008). It is likely to be most effective when facilitated through models of distributed leadership across roles and levels within a school, and when the case for change is underpinned by a broader, shared vision specifically related to student outcomes (Harris, 2013). Research has established the relationship between distributed leadership practices and the implementation of effective, inclusive school practices (Miškolci et al., 2016; Mullick et al., 2013; Robinson et al., 2008; Sharp et al., 2020). Leaders should consider utilising inclusive styles of management, replacing hierarchical structures with leadership teams (Ainscow & Sandill, 2010; McMaster, 2015). Effective school leadership enables shared responsibility, vision, and consistency within the school community, which is vital for the successful implementation of inclusion (Poon- McBrayer & Wong, 2013). 

Fostering Inclusive School Cultures 

Developing an inclusive school culture is a fundamental component of developing sustainable inclusion in schools (Dyson et al., 2004; McMaster, 2013). The culture of a school is made up of the shared values, attitudes, and beliefs of the school community (Booth, 2012). Transitioning to a truly inclusive culture requires close attention to attitudes and general support of the inclusive values being adopted, particularly by staff, but also by students and the broader school community (Dyson et al., 2004; Forlin & Chambers, 2011). 

A whole school approach to inclusion prompts a school to reflect on and embrace values based on inclusive principles, such as equality, diversity, and respect. This process cannot be imposed, but should be a collaborative exercise with school leaders and staff, to ensure any pedagogical philosophies or practices based on outdated ideas or past assumptions are not operating by default (Johnston & Hayes, 2007; Schein, 2004). Evaluating and redefining existing school values also requires professional learning, to facilitate a collective reconceptualisation of inclusion specific to the unique context of the school; the meaning, aims, and expectations of inclusion must be clarified for the school community, to encourage a shared understanding, vision, and responsibility for supporting the inclusive changes unfolding within the school (Horrocks et al., 2008; Symes & Humphrey, 2011). Finally, it is vital that school policies and practices are regularly revised, to ensure that they reinforce the inclusive values and culture of the school; otherwise, they can act as a potential barrier to the development of sustainable whole school inclusion (Dybvik, 2004; McMaster, 2013). 

Building Teachers’ Capacity for Inclusive Practice 

Building the knowledge and capacity of teachers and other school staff is crucial to developing sustainable inclusion in schools. The evolution of an inclusive school culture depends on aligning the attitudes and behaviour of staff (McMaster, 2015). Teachers must be knowledgeable about how inclusive education has progressed over time, particularly how the meaning of inclusion has changed and what it means in their school context. Understanding the concepts and values behind inclusion can help teachers appreciate its significance, prompting reflection of their own practice and how they see their students (Anderson & Boyle, 2015; Skidmore, 2004). This can allow any unhelpful assumptions or beliefs that may have been unconsciously informing their teaching practice, particularly in relation to students living with disability, to be challenged and revised (Ashby, 2012; Ashton & Arlington, 2019). 

While attention to attitudes, values, and broad understandings is fundamental, the goals of inclusion will only be achieved when principles are consistently enacted in daily classroom practice. At the classroom level, inclusion relies on teachers’ willingness and capacity to apply evidence-informed inclusive practices, such as Universal Design for Learning (UDL) and Differentiated Instruction (Van Mieghem et al., 2020). UDL is a planning framework for learning activities designed to maximise curriculum accessibility for all students by offering multiple opportunities for engagement, representation, and action and expression (CAST, 2018; Sailor, 2015). Differentiated Instruction (DI) is a holistic framework of interdependent principles and practices that enables teachers to design learning experiences to address variation in students’ readiness, interests and learning preferences (Tomlinson, 2014). UDL is primarily focused on inclusive task design, although the model has been expanded in recent years to include greater attention to pedagogy. Differentiation encompasses elements of planning (clear, concept-based learning objectives; formative  assessment to inform proactive decision-making for diverse students), teaching (strategies to differentiate by readiness, interest and learning preference; ensuring respectful tasks and ‘teaching up’), and learning environment (flexible grouping, classroom management, establishing an inclusive culture) (Jarvis, 2015; Tomlinson, 2014). 

The application of UDL and DI principles and practices by skilled teachers enables diverse students to access curriculum content in multiple ways (Kozik et al., 2009; McMaster, 2013), at appropriate levels of challenge and support to ensure learning growth, and in ways that support motivation, engagement, and feelings of connection and belonging (Beecher & Sweeney, 2008; Callahan et al., 2015; van Kraayenoord, 2007; Stegemann & Jaciw, 2018). These complementary frameworks apply to all students and define general, flexible classroom practices that also reduce the need for individualised adjustments for students with identified disabilities and specialised learning needs. However, in inclusive classrooms, teachers must also develop the knowledge and skills to make and implement reasonable adjustments and accommodations that enable students with identified disabilities and more complex needs to engage with curriculum and assessment ‘on the same basis’ as their peers, as defined within the Disability Standards for Education (Davies et al., 2016). 

While inclusive teaching and classroom practices are non-negotiable, the challenge for some teachers to master the necessary skills and achieve the significant shift away from traditional teaching practices is often underestimated (Dixon et al., 2014; Tomlinson & Murphy, 2015). It is well-documented that teachers often find it difficult to apprehend both the conceptual and practical tools of DI and to embed differentiated practices into their daily work (Dack, 2019), particularly when they are not adequately resourced or supported to do so (Black-Hawkins & Florian, 2012; Brigandi et al., 2019; Fuchs et al., 2010; Mills et al, 2014). Perhaps related to teachers’ perceived lack of competence and confidence, the past 5-10 years have seen an enormous increase in the employment of teacher aides to work alongside students with disabilities in mainstream classrooms, despite limited evidence for its effectiveness and often in the context of inadequate planning and oversight (e.g., Sharma & Salend, 2016). 

Engagement in targeted professional learning (PL) is fundamental to supporting the shift towards inclusive teaching. Yet, traditional approaches to PL have been criticised for a lack of systematic evaluation and inadequate adherence to principles of effectiveness (Avalos, 2011; Merchie et al., 2018). Research on effective professional learning for teachers has established common principles and practices that are associated with changes in practice, and these also align with teachers’ stated preferences (Walker et al., 2018). These include: 

• professional learning is embedded in teachers’ own work contexts, and requires teachers to engage with content that is highly relevant to their daily practice, and closely linked to student learning (Desimone, 2009; Easton, 2008; Spencer, 2016; Van den Bergh et al., 2014); 
• professional learning enables teachers to learn together with colleagues, such as in communities of practice (Gore et al., 2017; Voelkel & Chrispeels, 2017); 
• professional learning activities are supported by robust school leadership and linked to broader school values and goals (Carpenter, 2015; Frankling et al., 2017; Sharp et al., 2020; Tomlinson et al., 2008; Whitworth & Chiu, 2015); 
• professional learning is provided over extended periods, is led by facilitators with expert knowledge, and includes timely follow up activities such as mentoring and coaching to embed changes in practice (Desimone & Pak, 2017; Grierson & Woloshyn, 2013; Tomlinson & Murphy, 2015). 

Multi-tiered Approaches to Whole School Inclusive Practice 

Multi-tiered system of supports (MTSS) is an overarching term for a whole school inclusive framework that can be used to structure the flexible, timely distribution of resources to support students depending on their level of need (Sailor, 2017). As reflected in the generic depiction of MTSS in Figure 2, models generally utilise three tiers of intervention and teaching, where the intensity of the support is increased with each level or tier (McLeskey et al, 2014; Witzel & Clarke, 2015). Tier 1 includes core differentiated instruction and universal, evidence-based strategies for support that all students in the class receive. Tier 2 provides additional, targeted support to certain students for a specified purpose and period of time, usually in a small group format, while Tier 3 represents the most intensive and individualised support (Webster, 2016). The MTSS approach requires assessing all students regularly to assist in the early identification of needs requiring additional support, to enable prompt delivery of targeted interventions (McLeskey et al., 2014). MTSS is concerned with supporting the holistic development of students, by targeting their academic progress, behaviour, and socio-emotional well- being (McMillan & Jarvis, 2017). 

When implemented with fidelity, MTSS is an effective whole school inclusive framework as teachers, therapists, and other support staff work collaboratively to assess, monitor, and plan interventions to support students (Sailor, 2017). Student progress is frequently monitored and data are evaluated by the support team to determine whether alternative interventions are required. MTSS additionally encourages the use of evidence-based practices to be implemented across the tiers of support. Some common examples of MTSS include Response to Intervention (RTI) and Positive Behaviour Interventions and Supports (PBIS) (Webster, 2016). RTI is focused on supporting students academically, while PBIS is concerned with emphasising behavioural expectations in a positive manner, naturally supporting the social and emotional development of students. MTSS models have also been applied in whole-school mental health promotion, prevention and intervention (McMillan & Jarvis, 2017) and inclusive approaches to academic talent development for more advanced students (Jarvis, 2017). 

MTSS approaches to contemporary inclusive practice stand in contrast to traditional, categorical models whereby students were either ‘in’ or ‘out’ of special education services. The focus is on determining and responding to what students need when they need it, as opposed to focusing on a specific diagnosis or inflexible program options. In the MTSS framework, the tiers do not represent students or their placement, but the flexible suite of supports and interventions that may be provided. The implementation of MTSS approaches fundamentally reconceptualises the role of the classroom teacher, who must work collaboratively with specialist staff and other professionals to define and address individual student needs in ongoing ways, rather than relying on a specialist teacher or even a teacher aide to take responsibility for the education of students with identified special needs. While MTSS requires substantial changes to school operations (and must therefore be supported by leadership and culture in deliberate, coordinated ways), the general framework provides an organisation and structure to support the development of sustainable, contemporary inclusive schools (McLeskey et al., 2014). 

Figure 2. Multi-tiered System of Supports (MTSS) framework. 

Conclusion 

Ultimately, developing sustainable and effective inclusion in schools is a challenging but worthwhile undertaking, requiring shared vision, commitment, ongoing reflection, and patience. Changes in practice, particularly in teachers’ daily planning and pedagogy, take time and will be supported by ongoing, well designed and embedded professional learning in the context of strong leadership and an inclusive school culture. By utilising a whole school approach, key areas including leadership, school values and culture, building staff capacity, and coordinated frameworks for inclusive practice, can be considered collectively and planned for in advance.  

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Inclusive Education: Literature Review

The education of disabled children never received such amount of consideration and special efforts by government and non-government agencies in past as in present days. The attitude of the community in general and the attitude of parents in particular towards the education of the disabled have undergone change with the development of society and civilization.

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Executive Summary In India, inclusive education for children with disability has only recently been accepted in policy and in principle. In light of supportive policy and legislation, the present paper argues for individual initiative on part of an institution and colleges to implement programmes of inclusive education for children with disabilities in their classrooms. The paper provides guidelines in a generalized mode that institutions can follow to initiate such programmes. In this context, this paper argues for individual initiative on part of institutions to extend facilities for children with disabilities within their regular school settings. The paper further provides guidelines that institutions can adopt to set up inclusive education practices. The guidelines were derived from an empirical study which entailed examining prevalent practices and introducing inclusion in a regular institution setting. It is suggested that institutions can implement inclusive education programmes if they are adequately prepared, are able to garner support of all stakeholders involved in the process and have basic resources to run the programmes. The guidelines also suggest ways in which curriculum adaptations, teaching methodology and evaluation procedures can be adapted to suit needs of students with special needs. Issues of role allocation and seeking support of parents and peers are also dealt with. The recommendations that intuitions can adopt to implement inclusive education programmes for students with special needs within their regular set ups. The recommendations have been presented in a generalized mode to permit institute to interpret, modify and adapt the guidelines based on their individual needs and characteristics. It is pertinent those institutes that initiate such programmes assess their strengths and weaknesses at the outset and ensure adequate cooperation from the school management as well as the administrative and teaching staff. It is important to state here that an inclusive education programme does not require resource overload or elaborate preparations. With policy support, opportunities for training of teachers and cooperation from parents and the peer group, inclusive practices can be effectively adopted by any school. Clarity of vision, commitment to the goal of inclusion, and a perceptible understanding of the nuances involved in such an initiative are central to the success of the programme. Emotional commitment to inclusion emerges when the intellectual understanding of the concept goes through a democratic visioning process involving all the stakeholders expressing their opinions and feelings.

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BRAC, a leading international development organization, has been working to ensure the rights of persons with disabilities to education through its inclusive education program. This article discusses the BRAC approach in Bangladesh and aims to identify its strategies that are effective in facilitating inclusion. It employed a qualitative research approach where data were collected from students with disabilities, their parents, and BRAC's teachers and staffs using qualitative data collection techniques. The results show that the disability-inclusive policy and all other activities are strongly monitored by a separate unit under BRAC Education Program (BEP). It mainly focuses on sensitizing its teachers and staff to the issue through training, discussing the issue in all meetings and ensuring effective use of a working manual developed by the unit. Group-based learning and involving them in income generating activities were also effective. The findings of the study would be usefu...

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ABSTRACT Name : Zahrien Assyifa Nur Palisma NISN : 0002223086 Title : Analysis of Inclusive Education on Children with Learning Disabilities (Case study on 4th Grade of Mutiara Bunda Elementary School, Cilegon Banten Inclusive Education is an approach that aims to change the education system by translating barriers that can accommodate every student to participate fully in education. That is, every child is entitled to a decent education, not to mention children with learning disabilities. Children with learning disabilities are interpreted as children who find it difficult to receive formal and non-formal learning because of certain psychological "disabilities". This study aims to determine how much the effectiveness of inclusive education for children with learning disabilities in Mutiara Bunda Elementary School, Cilegon. The method used by the author is the field research that is carried out on October 6th, 2017 at Bunda Mutiara Elementary School, Street. Boulevard Raya Block A2 Number.6 Taman Cilegon Indah, Sukmajaya, Cilegon Banten.The results obtained from this study are: a. Inclusive Education is the right solution for children with learning disabilities even for all children with disabilities. b. The curriculum used in inclusive schools is similar to the curriculum in public schools. There is little modification in children with learning disabilities as well as some omissions and curriculum substitutions. Keywords: Inclusive Education, Children with Learning Disabilities

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Analysis of various international documents clearly suggests that international documents have provided a significant motivation to efforts undertaken at the national level about education of children with disabilities. UN Convention on the Rights of the Child imposed a requirement for radical changes to traditional approaches to provision made for children with disabilities. One year later, the 1990 World Conference on Education for all focused attention on a much broader range of children with disabilities who may be excluded from or marginalized within education systems. Its development has involved a series of stages during which education systems have explored different ways of responding to children with disabilities and others who experience difficulties in learning. This conference declared the inclusive education is regarded as the only means to achieve the goal of "Education for All". This trend was reaffirmed by next international documents. And finally, according to the article 24 of the Convention on the rights of persons with disabilities, disabled persons should be able to access general tertiary education, vocational training, adult education and lifelong learning without discrimination and on an equal basis with others through reasonable accommodation of their disabilities. All of these documents played an important role in bringing the attention on to children with disabilities, especially on education as a vehicle for integration and empowerment. This research examines the new international trends occurring regarding the education of children with disabilities and finally results that the new trends show a movement from special education to inclusive education and moving from seclusion to inclusion and provide that solutions must focus on prevention, cure and steps to make these children as normal as possible. In this regard, States must ensure the full realization of all human rights and fundamental freedoms for all disabled people, on an equal basis with others, and without discrimination of any kind on the basis of disability.

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An Introduction to Faculty Diversity, Equity, and Inclusion for Excellence in Nurse Education: Literature Review

Affiliation.

• 1 College of Nursing and Health Sciences, Lewis University, Romeoville, IL, United States.
• PMID: 38039066
• PMCID: PMC10724810
• DOI: 10.2196/49231

Background: The diversity of the world's population is increasing, along with the health inequities of underrepresented minority populations. To provide high-quality care to all patients, nurses require an understanding of diversity, equity, and inclusion (DEI) as well as how to implement best practices. Nurse educators are the ones to lead the way for DEI education for students.

Objective: This paper aims to describe the findings of a literature review that introduces DEI concepts for excellence in nurse education and their related benefits. Best practices for actions to address DEI in nursing education will be described.

Methods: After institutional review board approval, a literature search yielded 61 articles using 15 distinct keywords in 4 global, peer-reviewed literature databases. Melynk and Fineout-Overholt's (2023) Levels of Evidence guided the process of selecting 26 peer-reviewed articles and resources.

Results: Common themes for best practices in DEI were identified. These themes included recruiting underrepresented minority nursing faculty, incorporating DEI into an institution's mission statement, addressing DEI topics in curricula, providing leadership, having a DEI strategic plan, developing education, developing data-based interventions, instilling policy change, partnering in outreach, targeting impact on hiring committees, recognizing DEI work, and providing mentorship.

Conclusions: In summary, this literature review provides several strategies to address DEI for nurse educators. Committing to DEI efforts and improving diversity in the nurse educator workforce are integral steps in improving the quality and inclusivity of nursing education and ultimately improving the health of our communities.

Keywords: DEI; allied health; curriculum; diversity; educator; educators; equity; health care education; hiring; inclusion; inclusive; medical education; nurse; nurses; nursing; nursing education; recruiting; recruitment; teacher; teachers; teaching.

©Emily Ganek, Romy Antonnette P Sazon, Lauren Gray, Daisy Sherry. Originally published in the Asian/Pacific Island Nursing Journal (https://apinj.jmir.org), 01.12.2023.

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Conflict of interest statement

Conflicts of Interest: None declared.

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Recommendations to advance digital health equity: a systematic review of qualitative studies

• Sarah Wilson   ORCID: orcid.org/0000-0001-7803-3978 1 ,
• Clare Tolley 1 ,
• Ríona Mc Ardle 2 ,
• Lauren Lawson   ORCID: orcid.org/0000-0003-0433-5214 1 ,
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• Nehal Hassan   ORCID: orcid.org/0000-0002-8302-5769 1 ,
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npj Digital Medicine volume  7 , Article number:  173 ( 2024 ) Cite this article

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The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users’ needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice.

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Introduction.

The World Health Organisation (WHO) advocates Digital Health Technologies (DHTs) to advance population health 1 . Digital health can be defined as the use of information and communication technologies within healthcare to provide healthcare users with services relating to the prevention, detection, diagnosis and management of diseases and other health conditions 2 , 3 , 4 . Examples of DHTs include smartphone applications and wearable monitoring devices that can empower people to better manage their own conditions, such as keeping track of symptoms or remotely monitoring their condition(s) over time 2 , 3 , 4 . DHTs can pick up signs of deterioration in healthcare users’ symptoms longitudinally and provide real-time data to healthcare professionals to help support tailored clinical decision making 4 . DHTs can also enable individuals with mobility issues and those living in rural areas to access healthcare. Digital health has gained global momentum due to its potential to contribute to personalised health care for patients, improved quality of care, and lower healthcare costs 5 , 6 .

However, there are growing concerns that DHTs may not lead to health benefits in all populations, with underserved groups (i.e., those typically left out of research or experience inadequate access to healthcare) at particular risk 7 . One possible factor contributing to this is digital exclusion, denoting disparities in motivation, access and use of DHTs across different demographic groups 8 . Digital exclusion can potentially create a barrier for various underserved groups, such as those who are on a low income, are not fluent in English, or homeless, thus exacerbating health inequities for these groups 9 . Individuals with visual impairment may also find on-screen reading challenging and many older adults with hearing impairments have expressed low motivation to use phone calls as a remote option to access healthcare due to their disability 10 .

Technology has advanced rapidly over recent years, with some DHTs (e.g., telehealth services, mobile phones, wearable devices, smartphone apps and other software) having greater relevance to the direct inequities underserved groups face compared to other DHTs. For example, DHTs designed to be solely used by healthcare professionals (e.g., electronic patient records) are less likely to directly impact healthcare service users, and so it is prudent to focus on DHTs that underserved groups may be asked to use. Qualitative studies gathering rich in-depth experiences from those whose voices are rarely heard (i.e., underserved groups) 11 , 12 will provide valuable insights into the facilitators and barriers regarding access, motivated and/or use of DHTs.

The WHO Bellagio eHealth Evaluation Group (2019) recognised the need to mitigate digital exclusion 13 , with organisations such as NICE (National Institute for Health and Care Excellence) requiring evidence that health inequities have been considered in the design of DHTs 2 . This includes important aspects of design, development or implementation of a DHT that support digital inclusivity, such as strategies to increase an individual’s access to suitable devices or connectivity, and educational support in digital literacy to increase DHT use 14 . To support the development of such strategies, it is vital to understand the needs of underserved groups as well as their experiences and perspectives of these strategies to identify what does and does not support digital inclusivity. However, there is currently no qualitative systematic review of key strategies conducted in this area; a key knowledge gap in the literature. To advance digital health equity, we aimed to systematically synthesise the literature on what key strategies have been used to promote digital inclusivity, and assess the facilitators and barriers to implementing and adopting these in practice based on underserved groups’ experiences and perspectives.

Study descriptions

Our search yielded 13,216 results. After removing duplicates ( n  = 2815), titles ( n  = 10,401) abstracts ( n  = 1224) and full-texts ( n  = 143) were screened. Ten papers met our inclusion criteria (Fig. 1 ). Inter-reviewer reliability was high with 99.33% agreement at title stage, 99.43% at abstract stage, and 97.89% at full-text stage. All included studies were found to have moderate- to high-quality levels (Supplementary Tables 7 and 8 ). None of the included studies measured or reported any participants’ health literacy.

A PRIMSA flow chart detailing our search and selection process applied during the article screening process.

Included studies incorporated a range of participants at risk of digital exclusion, including those from different cultural backgrounds (ethnic diversity, languages and religion) ( n  = 8) 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , those with limiting conditions (visual and hearing impairments) ( n  = 2) 21 , 22 , low educational attainment ( n  = 4) 15 , 19 , 20 , 21 , aged over 65 ( n  = 4) 16 , 20 , 21 , 22 , homeless ( n  = 2) 19 , 24 , and those who had low socioeconomic status ( n  = 5) 15 , 16 , 17 , 18 , 21 (Supplementary Table 9 ). All 10 studies used interviews 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , with two studies also conducting focus groups with participants 18 , 21 . (Supplementary Table 10 ). Inclusive digital health strategies were grouped into either outreach programmes providing educational support and/or access to devices ( n  = 2) 19 , 22 , or co-designing DHTs with underserved groups ( n  = 8) to gain feedback on the usability and acceptability of DHT to enhance inclusivity in future versions of the DHT (Table 1 ) 15 , 16 , 17 , 18 , 20 , 21 , 23 , 24 .

Our narrative thematic synthesis generated three overarching themes; user-friendly designs (e.g., software and website design elements that promoted inclusivity), infrastructure (e.g., access to DHTs) and educational support (e.g., training to develop digital literacy skills required to use DHTs) (Supplementary Table 10 ). Facilitators and barriers to the adoption of these themes are embedded in the discussion below and summarised in Fig. 2 .

Summary of the key facilitators and barriers to strategies to support digital health equity (using a user-friendly design, providing infrastructure and providing educational support) alongside the specific CLEARS groups the strategy will support.

User-friendly designs

User-friendly designs were a key theme supporting access and use of DHTs across seven studies 15 , 16 , 20 , 21 , 22 , 24 . Health-related software and websites needed to be compatible across different digital platforms, operating systems and devices including smartphones and desktops, and assistive technologies (e.g., screen reading software) to accommodate the needs of ethnically and linguistically diverse groups 17 , 18 , 22 , individuals with limiting conditions (visual and hearing impairments) 20 , 21 , older adults (+65 years) 20 , 22 , those with low educational attainment and low socioeconomic status 17 , 18 . For example, Yeong et al. noted how older adults with visual impairments and of low socioeconomic status needed websites to be compatible with different magnification levels and assistive technologies (e.g., iOS Voiceover [Apple Inc]; a screen reading software) to aid visibility 21 . The authors also noted how certain features aided navigation and minimised scrolling to help the user find information, such as tables of contents, drop-down menus, and ‘jump to top’ buttons 21 . Older adults with limiting conditions (visual or hearing) also suggested that navigation features, such as search bars and hyperlinks, needed to be of high contrast (compared to the rest of the screen) to improve visibility 20 , 21 . Yeong et al. emphasised how search features should be designed in a similar way to commonly visited search engines, like Google, to improve usability and reduce confusion 21 .

Older adults, homeless, ethnically diverse individuals and those with visual impairments all described how digital messages on software, health related websites or text messages should be simple, concise, and presented in a logical manner without time restrictions 18 , 20 , 21 , 24 . For example, older adults with visual impairments described how they did not have enough time to read the information when presented on a timed loop (i.e., rotating between different screens with information), and suggested that the user be able to manually control the timing of this loop 21 . Older adults interviewed in another study described how it would be useful if they could change the font size to improve the visibility of the text, and provide alternative languages for those who are not fluent in English 22 . Personalising information, such as allowing users to choose content that they are interested in, was felt to be one way of increasing the motivation to use health related websites and software amongst those with visual impairments 21 and ethnically diverse individuals 18 . Additionally, providing evidence that supported the key messages in healthcare information, such as the importance of reducing alcohol intake to reduce the risk of developing chronic health conditions, enhanced trust amongst ethnically diverse individuals 18 . Kramer et al. also emphasised how any communication should be culturally appropriate and avoid reinforcing stereotypes, especially for ethnically and linguistically diverse users 18 . For example, the language used to categorise different ethnicities on DHTs should avoid generic terms such as ‘men of colour’ as some ethnically diverse men found this offensive; they felt it defined them based on their skin colour and not their ethnic background. Instead, specific terminology should be used that accurately represented their ethnicities (e.g., African American for individuals with an African and American descent) 18 . Any imagery should also be inclusive to all cultural groups 18 .

It was felt that the overall user friendliness and engagement of health related software could be improved with the addition of engaging features 15 , 18 , 20 , 22 , 24 . This included interactive quiz elements 20 , notifications encouraging behavioural changes 18 , reminders about upcoming appointments (particularly for homeless individuals as this they may not have access to other reminders, like letters) 24 , ability to order a repeat prescription and schedule specific appointments (e.g., physiotherapy) 22 . Older adults of Jewish faith also suggested simplifying security features, as many found flicking between a text message with the password reset information and the screen (where the information should be entered) challenging 22 .

Infrastructure

Five studies described the need for supportive infrastructure, such as access to devices and connectivity (i.e., Wi-Fi) to support homeless individuals, ethnically and linguistically diverse groups, and individuals of low socioeconomic status 15 , 17 , 19 , 23 , 24 . For example, Howell et al. explained how community nurses in the UK provided homeless individuals with temporary access to smartphones during the pandemic so as to enable them to access vital digital healthcare support 19 . In the United States (US), homeless individuals were provided with phones (the Obama phone), credit and data plans financed through a government programme 24 . However, Asgary et al. found that some of these homeless individuals using the Obama phone plan often exceeded their limits when put on hold to schedule medical appointments 24 . They subsequently turned to friends and family for financial support to purchase credit 24 . Other homeless individuals were hesitant to accept this government support, with the authors reflecting on how this may have been due to the homeless experiencing a lack of government financial aid in the past 24 .

Homeless individuals 19 , ethnically and linguistically diverse groups 15 , 17 , 23 , and those of low educational attainment and low socioeconomic status 15 , 17 , 19 reported relying heavily on free Wi-Fi to be able to access healthcare. This included accessing free Wi-Fi in public spaces and transport systems, fast-food restaurants, clinics and families’ houses. However, they often experienced barriers to this connectivity with time limits set by the specific organisations (e.g., opening hours) 15 or restrictions placed on using shared devices (e.g., computer keyboards due to the risk of coronavirus spreading) 19 . Many participants suggested creating dedicated centres for digital health services with suitable devices and free Wi-Fi that would also include some private areas 15 . Access to these private spaces was felt to be important for some ethnic and linguistically diverse groups with low educational attainment and socioeconomic status, as they were concerned about being overheard when discussing/looking at confidential health information 17 . Many groups suggested that they would like the choice between both digital and non-digital access to healthcare, as this would help mitigate the risk of possibly excluding those with poor digital literacy skills, those who would prefer in-person consultations, or those who lack the resources to access digital healthcare 15 , 18 , 19 , 23 .

To complement infrastructural changes, ethnically diverse adults based in the US advocated for more resources to be provided by local government 15 . This included the introduction of new policies, such as reduced payment plans and regulations on the price of DHTs for lower income earners to make them affordable 15 . Older adults of Jewish faith and ethnically diverse adults with a low educational attainment and socioeconomic status also suggested that financial incentives could help promote greater access to DHTs and encourage motivation to use DHTs 15 , 22 . Alkureishi et al. highlighted how different organisations, such as hardware and Wi-Fi companies, might need to collaborate to ensure that these different components (e.g., devices, connectivity, financial aid) are jointly available to support successful implementation 15 .

Educational support

Provision of educational support was important for ethnically diverse individuals and older adults to enable their use of DHTs in five studies 15 , 16 , 19 , 20 , 22 . Ethnically diverse individuals with lower educational attainment and low socioeconomic status, and older adults of Jewish faith commonly reported asking family members to remain close during video healthcare consultations in case of technical issues 15 , or for their guidance with accessing online health information 22 . Mizrachi et al. found this support promoted independence over time as older adults’ digital skills developed through learning and they were further motivated to use DHTs on hearing positive experiences from their family and friends 22 .

Some individuals relied on educational support from professional services to use DHTs 19 . It was felt that in-person educational support from community workers or health care professionals with supplementary materials (e.g., videos and written information) would be beneficial prior to attending virtual appointments to support ethnically diverse adults (both above and below 65 years) from a low socioeconomic status and low educational attainment 15 , 16 Alternatively, Alkureishi et al. noted some participants expressed preference for accessing training classes at healthcare sites (e.g., hospitals) and community centres, where support was provided by ‘technology champions and coaches’ 15 . However, older adults of Jewish faith highlighted how advertisements to promote awareness of support services would be unlikely to reach individuals in their community and those who were socially isolated and arguably most in need of support 22 . Some studies also highlighted how certain groups (e.g., ethnically diverse adults with low socioeconomic status and low educational attainment, and older adults of Jewish faith) might also be reluctant to accept this educational support due to concerns around burdening others, feeling helpless, and/or reaffirming how they are unable to do something independently 15 , 22 .

This systematic review synthesises strategies that promote digital inclusivity and assess the barriers and facilitators to adopting these in practice. Our findings highlighted three key themes relating to user-friendly designs, supportive infrastructure, and provision of educational support. Barriers to adopting these strategies included a lack of acceptance amongst some underserved groups to receive such support, whilst facilitators included promoting trust amongst ethnically diverse groups by providing lay term friendly evidence that supports health claims.

Our findings highlighted how health-related software and websites must be interoperable across different devices to accommodate the needs of underserved groups. This form of user-friendly design is advocated by national healthcare providers and government bodies; for example, the UK and US have legislation in place which mandates that websites and software in the public sector be ‘perceivable, operable, understandable and robust’ to ensure that those with visual and hearing impairments, low reading ability (reading age of 9) and/or those who are not fluent in English can access and understand the information provided 25 , 26 . However, a recent study reported that public health authority websites in only three countries (UK, Italy, China) out of a total of 24 actually adhered to these accessibility standards when checked 27 . Additionally, the wider literature supports our findings on how the use of appropriate language and imagery can improve end-user satisfaction 18 , 28 . National bodies, such as the US National Institute of Health (NIH), have developed the ‘National Culturally and Linguistically Appropriate Services (CLAS) Standards’ to assist developers and researchers in developing culturally and linguistically appropriate services 29 . The wider literature also suggests co-designing DHTs with underserved groups at the earliest stages to help ensure that they meet the needs of all end-users 30 . This involves co-designing security features that are easy-to-use and align with the UK government ‘ secure by design principles’ , to help overcome any potential future barriers to usage 31 , 32 .

Our results also highlighted the need for supportive infrastructure to facilitate access and use of DHTs. Government schemes in high-income countries are already available; for example, the ‘Obama phone’ in the USA and the Emergency Broadband Benefits and social tariffs (reduced payment phone plans) in the UK, to support those on a low income to access smartphones and phone plans 24 , 33 . However, implementing supportive infrastructure might not be viable for low to middle income countries as they may have less suitable centres to provide devices and free public Wi-Fi spots, which high income countries already have access to 34 . Some charity organisations, such as the Good Things Foundation, have started to repurpose donated corporate IT devices and deliver them to those who are digitally excluded 35 . However, better promotion of the support available and a collaborative working environment is needed, especially by healthcare professionals, social services, and charities. Free phone numbers would also help to facilitate access to healthcare services. Some underserved groups would like the option of accessing healthcare via non digital means, thus questioning the temptation to always use technology to potentially address healthcare challenges 36 . Researchers need to consider whether a new DHT will provide an equitable solution to the healthcare problem and whether other means of accessing healthcare should also be provided within healthcare systems 37 .

This systematic review also underlined the importance of providing educational support, from family or professional services, to encourage motivation and capability to use DHTs. There is a need for effective advertising of this support to groups at particular risk of both digital and social exclusion, such as older adults and homeless individuals, in order to increase their awareness 38 . A systematic review conducted by Ige et al. 39 suggested using a combination of two or more strategies to reach socially isolated individuals, including referrals from relevant agencies (e.g., GPs, pharmacists etc), as this might be a more effective approach than relying solely on public facing methods 39 .

Previous recommendations to promote digital health equity have centred around guidance for behavioural and social science researchers with limited insight to the facilitators and barriers to implementing strategies into society and appear limited to research settings 40 . Previous reviews have applied the socioeconomic model to inform recommendations to promote digital health equity, such as providing devices (individual level support), educational support (relationship/interpersonal level support), access to connectivity infrastructure (community level support) and implementing policies (societal level support) 41 , 42 . However, there has been little consideration given to those individuals who belong to two or more underserved groups at risk of digital exclusion. Our systematic review considered this intersectionality and provides practical recommendations that focus on two main areas: collaborative working and effective advertising (Fig. 3 ). Collaborative working between the DHT developer, healthcare professionals, policy-makers, voluntary sectors, patients and public members of underserved groups is vital to help improve the co-design of DHTs and provision of support and should be embedded from the very beginning of the design and development process 30 . Effective advertising strategies are also vital to raise public awareness and ensure that those who are, or know of an individual, at risk of digital exclusion are made aware of in-person support that is available and how to access it. DHT developers and researchers should also be aware of the accessibility and inclusivity standards (e.g., government legislation and CLAS) and on how to use them to support digital health equity.

Summary of the two key recommendations to advance digital health equity, centring around adopting a collaborative working environment and using effective advertisement.

This review used a comprehensive and systematic approach to identify relevant literature. Included studies were published within the last decade to remain relevant to the current digital healthcare landscape. We opted to focus on qualitative research to gather rich detailed information on the facilitators and barriers to each strategy. Despite no geographical restrictions being placed on this search, we found that all included studies were conducted in high-income countries, which may limit the applicability of these findings to low- and middle-income countries; this also highlights the importance of further work in this area. Representation of the different religious groups and languages was limited, highlighting a gap in the literature and a need for greater diverse inclusion in research. None of the included studies reported on participants’ health literacy, which has previously been suggested to overlap with low digital literacy 43 ; this information would have aided our understanding of whether the participants included in the qualitative studies were truly representative of the groups that they were intended to represent. Future research should incorporate a standardised health literacy measure, such as the Newest Vital Sign (NVS) 44 or the Health Literacy Questionnaire (HLQ) 45 , into their methodology to provide greater detail on the participants in their study.

The appropriateness of recommendations from this systematic review could be further explored using an established framework, such as the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Size effects/safety, and Equity) 46 . This would involve seeking the perspectives of CLEARS demographic groups’ and relevant stakeholders’ (e.g., policy makers and community workers) on the practicalities of implementing these different strategies and recommendations to further advance this important area of digital health equity. The facilitators and barriers to implementing government-issued public health website accessibility standards should also be explored to further understand how to encourage use of these standards.

This systematic review identified three key themes relating to digital inclusivity, associated facilitators and barriers, and recommendations for advancing digital health equity. This information will guide individuals when designing, developing and implementing digital health interventions to ensure it is done in a digitally inclusive manner. This review also highlighted the need for further work to explore the feasibility and acceptance of implementing different strategies and recommendations to support digital health equity amongst those at risk of digital exclusion.

Identification of key groups at risk of digital exclusion

We conducted a scoping review of the literature to identify the sociodemographic factors that could put an individual at risk of digital exclusion. Based on the findings published in peer-reviewed articles 24 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , systematic reviews 61 , 62 , 63 , 64 , government reports 8 , 65 , and regulatory organisation documents 66 , we identified a number of sociodemographic factors that we complied into six groups, relating to Culture (ethnicity, language, and religion) 8 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 62 , Limiting conditions (visual and hearing impairments) 6 , 54 , 66 , Education (at or below United Kingdom (UK) government mandated level or equivalent) 52 , 55 , 56 , 66 , Age (over 65 years) 51 , 54 , 55 , 56 , 62 , 66 , Residence (rural or deprived areas [based on consensus data within a country], or homeless) 8 , 24 , 51 , 60 , and Socioeconomic status (low income [earns less than 60% of the median household annual income within a country] and unemployed individuals) 8 , 52 , 55 , 56 , 62 , 65 , 66 abbreviated to CLEARS (Fig. 4 ). These factors often intersect (i.e. intersectionality), placing an individual at even greater risk of digital exclusion 8 , 64 , 65 , 66 .

A framework which encompasses sociodemographic factors associated with digital exclusion and recognises the role of intersectionality.

Search strategy

This systematic review was registered with PROSPERO (CRD42022378199) and followed PRISMA guidelines 67 . The search string utilised terms from two relevant scoping reviews 8 , 68 , with additional relevant terms included when searching four large online databases (Medline, Embase, PsycINFO and Scopus) (Supplementary Tables 1 – 4 ). The search focused on words associated with digital technology, health inequities, and CLEARS (Table 2 ).

Eligibility criteria

The eligibility criteria followed the Population, Intervention, Comparison, Outcomes and Study design (PICOS) framework, recommended by the Cochrane Handbook for Systematic Reviews 69 , and provided an organising framework to list the main concepts in the search. The Population criteria included any group represented by our CLEARS framework (see above). The Intervention criteria focused on inclusive digital health strategies, which we defined as an action designed to alleviate the digital exclusion of individuals by promoting access, motivation, and/or use of information and communication technologies 2 , 3 , 4 , 5 . Articles needed to have discussed the facilitators or barriers associated with the inclusive digital health strategy (outcome criteria) to be included. This allowed the researchers to reflect on what currently worked or did not work to inform key recommendations. Only qualitative studies that provided rich in-depth experiences from CLEARS groups were included to aid our understanding of how a complex phenomenon, i.e., intersectionality, can affect digital exclusion 11 , 12 . Quantitative studies were excluded as they are designed to test a hypothesis or enumerate events or phenomena 11 , 12 , which was not aligned with the aim of this review. Only peer-reviewed articles published between 2012 and 2022 in the English language were included; this ensured only the latest advancements in digital technologies were considered.

Study selection

Results from each database were exported into EndNote (version 20.5, Clarivate, International) and duplicates removed. Remaining articles were uploaded to Rayyan (Qatar Foundation, State of Qatar) 70 , where titles, abstracts, and full-texts were screened independently by two reviewers (SW, LL, EB) to minimise bias. The lead author (SW) screened all articles, acting as a constant throughout the process. Disagreements were resolved by a third reviewer (RMA). The reasons for excluding full text articles were recorded (Fig. 1 ).

Data extraction and synthesis

The lead author (SW) developed a data-extraction sheet with the research team to extract and record specific study details, including participant demographics and a description of the inclusive digital health strategy under investigation (Supplementary Tables 5 and 6 ). Any measure used to record participants’ health literacy in the included studies, such as the Newest Vital Sign (NVS) 44 or the Health Literacy Questionnaire (HLQ) 45 , was also extracted. A quality assessment was carried out on the included studies using the Critical Appraisal Skills Programme (CASP) Qualitative Review Checklist 71 . Quality was measured by reporting the frequency of ‘yes’ (denoting the study met the criteria on the checklist) (Supplementary Tables 7 and 8 ).

The lead author (SW) performed a narrative thematic synthesis of the included studies. Firstly, the authors began by developing a preliminary synthesis of findings from included studies to identify the key strategies and list the facilitators and barriers to implementation. We then considered the factors that might explain any commonalities and differences in the successful implementation of these digital inclusive strategies across included studies. This involved exploring the directly reported verbatim quotations obtained from particular CLEARS groups and seeking to draw descriptive and explanatory conclusions around key themes 72 , 73 . All data management and analysis was carried out within N-Vivo (version 1.6.1, QSR International). Discussions with co-authors (SPS, RM, CT) were conducted at several stages throughout the analysis to discuss, refine and define themes to ensure a coherent narrative that reflected the data. Detailed descriptions and contextual material from the included studies was kept throughout the analysis to ensure that the trustworthiness was upheld 74 , 75 . Ethics approval was not required for this systematic review.

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

All relevant data used for the study has been included in the manuscript and supplementary information.

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Acknowledgements

We would like to thank the social sciences librarian, Karen Crinnion, at Philip Robinson Library, Newcastle University, for her help and advice regarding the search strategy, choice of databases and search keywords for this systematic review. This work has been supported by the Early Detection of Neurodegenerative diseases (EDoN) research initiative, funded by Alzheimer’s Research UK with support from Gates Ventures and the Alzheimer’s Drug Discovery Foundation through its Diagnostic Accelerator Project. This project is also funded by the NIHR, (NIHR205190). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Ríona Mc Ardle is funded by the National Institute for Health Research (NIHR) (NIHR 301677) and the NIHR Newcastle Biomedical Research Centre (BRC) based at The Newcastle upon Tyne Hospital National Health Service (NHS) Foundation Trust; Newcastle University; and the Cumbria, Northumberland and Tyne and Wear (CNTW) NHS Foundation Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

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Wilson, S., Tolley, C., Mc Ardle, R. et al. Recommendations to advance digital health equity: a systematic review of qualitative studies. npj Digit. Med. 7 , 173 (2024). https://doi.org/10.1038/s41746-024-01177-7

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DOI : https://doi.org/10.1038/s41746-024-01177-7

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Typology of informal learning spaces (ils) in sustainable academic education: a systematic literature review in architecture and urban planning.

1. Introduction

2. literature review, 2.1. informal (social) learning and sustainability, 2.2. informal learning spaces (ils) and their architecture and planning, 2.3. theoretical basis of the study, 3. materials and methods, 3.1. search strategy, 3.2. inclusion and exclusion criteria, 3.3. study selection, 3.4. data extraction and synthesis, 3.5. study quality assessment, 4.1. characteristics of the selected study, 4.2. typology of ils in academic education, 4.3. design factors of ils in academic education, 4.4. positive outcomes related to ils, 5. discussion, 5.1. limitations and future directions, 5.2. conclusion and theoretical and practical implications, supplementary materials, data availability statement, conflicts of interest.

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Salih, S.A.; Alzamil, W.; Ajlan, A.; Azmi, A.; Ismail, S. Typology of Informal Learning Spaces (ILS) in Sustainable Academic Education: A Systematic Literature Review in Architecture and Urban Planning. Sustainability 2024 , 16 , 5623. https://doi.org/10.3390/su16135623

Salih SA, Alzamil W, Ajlan A, Azmi A, Ismail S. Typology of Informal Learning Spaces (ILS) in Sustainable Academic Education: A Systematic Literature Review in Architecture and Urban Planning. Sustainability . 2024; 16(13):5623. https://doi.org/10.3390/su16135623

Salih, Sarah Abdulkareem, Waleed Alzamil, Ali Ajlan, Athira Azmi, and Sumarni Ismail. 2024. "Typology of Informal Learning Spaces (ILS) in Sustainable Academic Education: A Systematic Literature Review in Architecture and Urban Planning" Sustainability 16, no. 13: 5623. https://doi.org/10.3390/su16135623

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Review of Tasmania's education system announced following calls for system reform

• In short: The Tasmanian government has announced an independent review of the state's education system to improve poor education outcomes, following calls from the opposition and stakeholders.
• The review will be undertaken by Vicki Baylis, the former chief executive of the Northern Territory Department of Education.
• What's next? The review's terms of reference will be released in the coming weeks and will be presented to the government by the end of 2024.

An independent review into Tasmania's education system has been announced, with an eye to fixing low education outcomes that trail the rest of the country.

Education Minister Jo Palmer announced the review on Monday, which would focus on improving the education system, including literacy and numeracy outcomes over the next 10 years.

Vicki Baylis, the former chief executive of the Northern Territory Department of Education, will lead the review, in consultation with the Department of Education, Children and Young People.

The details so far are scarce, with the terms of reference and scope of the review to be released in the coming weeks, and a final report to be delivered by the end of the year.

Tasmania's education system has already drawn attention this year due to its ongoing battle with low year 12 completion rates , and the number of young people leaving the state for better tertiary education opportunities elsewhere.

Calls for political action to address the education system aren't new. The current Liberal government came to power a decade ago promising to lift year 12 retention and attainment rates.

In recent weeks, the pressure for the Tasmanian government to act has increased.

The Labor opposition called on the government to implement an independent education system review in May.

A month later, in an interview with ABC's Stateline, the University of Tasmania's vice-chancellor Rufus Black called on the government to make lifting year 12 completion rates a top priority, warning the state wasn't "ready for the future".

Ms Palmer said while the state had improved "in leaps and bounds" there were areas of "clear concern" that needed to be addressed.

"We have delivered significant change in the education system over the past 10 years, including extending high schools to years 11 and 12, and changing the law to ensure young people are in education or training," she said.

"This is paying off with 80.2 per cent of 15 to 19-year-olds in formal education or training, which is in line with the national average."

Appeal to 'remove the politics'

Independent economist Saul Eslake, demographer Lisa Denny and Emeritus Professor Michael Rowan have also been vocal supporters of educational reform in Tasmania.

Earlier this month the three penned a letter urging an independent review to "remove the politics that has undermined previous attempts to reform" the education system.

A report Mr Eslake produced earlier this month highlighted the role education would play in the state's "three Ps": population growth, workforce participation rate and economic productivity.

"The single most important reason why we are so far behind the rest of Australia on each of the 'three Ps' is our under-performing education system, which produces the worst outcomes of any state," Mr Eslake wrote.

The gap between Tasmania and the rest of the country appears to be growing.

Data from the Productivity Commission shows the number of Tasmanians completing a year 12 qualification or equivalent fell to 53 per cent in 2023 , the lowest level since 2015.

The national average is 76 per cent.

And the retention rate, the percentage of students progressing from year 10 to year 12, fell to a decade low of 69 per cent in 2022.

Highest student investment but worst outcome 

For the review to effect the desired outcome, a system-wide approach that includes the early childhood, vocational, public and university system was needed, Ms Denny said.

"I hope that this inquiry … will be about the whole system and about how it integrates with other areas of education," Ms Denny said.

"We spend more money per student and get the worst outcomes in any jurisdiction.

"That's exactly what we need to know: Why does this occur?"

Labor education spokesperson Sarah Lovell welcomed the review, noting the short turnaround for the review's publication.

"We need this to be an inquiry that is done quickly, thoroughly," Ms Lovell said.

"We've seen educational outcomes get worse and worse. That's already an entire education for some students."

The Australian Education Union (AEU) Tasmania said any cuts to education must be ruled out if the "review is to be taken seriously".

"The department doesn't currently even have the resources to engage in a review, let alone make improvements based on recommendations that may follow," AEU Tasmania president David Genford said.

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