African Journal of Health Professions Education https://www.ajol.info/index.php/ajhpe <p>The AJHPE is a journal for health professions educators. It carries research articles, short scientific reports, letters, editorials, education practice, personal opinion and other topics related to the education of health care professionals. It also features African education-related news, obituaries and general correspondence.</p>Other websites related to this journal: <a title="http://www.ajhpe.org.za/index.php/ajhpe/index" href="http://www.ajhpe.org.za/index.php/ajhpe/index" target="_blank">http://www.ajhpe.org.za/index.php/ajhpe/index</a> en-US <p><span lang="EN-US">Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it <em><span>[forthcoming].</span></em></span></p><p><span lang="EN-US"> </span></p><p><span lang="EN-US">Material submitted for publication in the <em><span>AJHPE</span></em> is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The <em><span>AJHPE</span></em> does not hold itself responsible for statements made by the authors. The corresponding author should also indicate if the research forms part of a postgraduate short report, dissertation or thesis.</span></p><p><strong><span lang="EN-US">Previously published images</span></strong></p><span lang="EN-US">If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.</span> claudian@hmpg.co.za (Claudia Naidu) publishing@hmpg.co.za (Getrude Fani) Wed, 21 Jul 2021 14:32:50 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 DRILL: An innovative programme to develop health research leadership in KwaZulu-Natal, South Africa https://www.ajol.info/index.php/ajhpe/article/view/211060 <p>No Abstract.</p> F. Suleman, D . Wassenaar, N. Nadesanreddy, P. Brysiewicz Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211060 Wed, 21 Jul 2021 00:00:00 +0000 Creating a space for interprofessional engagement in a clinical setting https://www.ajol.info/index.php/ajhpe/article/view/211061 <p>No Abstract.</p> L. Jaffer, L . Africa, F. Waggie Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211061 Wed, 21 Jul 2021 00:00:00 +0000 Legal and ethical requirements for developing a medical MOOC: Lessons learnt from the Paediatric Physical Examination Skills MOOC https://www.ajol.info/index.php/ajhpe/article/view/211062 <p>Massive open online courses (MOOCs) are increasingly being integrated into medical education. The production of a MOOC demonstrating physical examinations of children raised the issue of legal and ethical consent for the use of images and video-recordings of children. The present article shares the valuable lessons we learned around the legal and ethical consent required, and the operational issues that will be essential to comply with these legal and ethical considerations. This information may be valuable to other educators, especially those in similar resource-constrained settings,who are planning to create medical MOOCs.</p> A. George, D. Wooldridge, J. King, A.G. Giovanelli, S.G. Naidoo, M.A. Mabeba, S. Morar, S.G. Lala, Z. Dangor Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211062 Wed, 21 Jul 2021 00:00:00 +0000 A blended learning and teaching model to improve bedside undergraduate paediatric clinical training during and beyond the COVID-19 pandemic https://www.ajol.info/index.php/ajhpe/article/view/211063 <p>The 2020 COVID-19 pandemic has severely disrupted paediatric undergraduate bedside clinical training. Facing an uncertain future, we need to be able to adapt to the variable effects of the pandemic on bedside training. During severe conditions, no bedside training is possible, while limited bedside training is possible during less severe conditions. We propose a learning and teaching model for undergraduate&nbsp; paediatric clinical training during and beyond the COVID-19 pandemic to facilitate bedside clinical training in order to maximise students’ acquisition of clinical competencies.</p> S.G. Lala, A.Z. George, D. Wooldridge, G. Wissing, S. Naidoo, A. Giovanelli, J. King, M. Mabeba, Z. Dangor Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211063 Wed, 21 Jul 2021 00:00:00 +0000 Facilitators of and barriers to clinical supervision of speech-language pathology students in South Africa: A pilot study https://www.ajol.info/index.php/ajhpe/article/view/211065 <p><strong>Background.</strong> Clinical supervision plays a fundamental role in maintaining professional standards when training students of professional degrees at a university undergraduate level.<br><strong>Objective.</strong> To describe the perceptions of clinical educators regarding the facilitators of and barriers to learning when training&nbsp; undergraduate speechlanguage pathology students in underserved and under-resourced clinical contexts in Gauteng, South Africa.<br><strong>Methods.</strong> A qualitative approach, using a focus group discussion, was employed. Data were gathered from 8 clinical educators regarding their experiences of supervision of students. Themes were identified and analysed using thematic analysis.<br><strong>Results.</strong> Themes generated revealed that there were barriers in supervision due to attitudes of student clinicians, clinical educators’ preparedness and infrastructure at clinical sites. Facilitators of the supervisory process were identified as feedback from student clinicians and support given by the department to clinical educators.<br><strong>Conclusion</strong>. These findings suggested that clinical educators require additional time, support and training to assist them with clinical supervision. As clinical supervision is fundamental to the speech-language pathology curriculum and student experience, its value should not be underestimated. These findings contribute to the process of transforming the effectiveness of clinical supervision. </p> A. Mupawose, S. Adams, S. Moonsamy Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211065 Wed, 21 Jul 2021 00:00:00 +0000 Simulation in plastic surgery: Features and uses that lead to effective learning https://www.ajol.info/index.php/ajhpe/article/view/211067 <p><strong>Background</strong>. Increased competition for surgical exposure and practice, smaller teaching platforms and shorter training times have an impact on the quality of training and competence of plastic surgery registrars. Demands for accountability and minimising patient risks are the driving forces for incorporating simulation in healthcare education. We addressed the problem of whether the features and uses of simulation would enhance postgraduate plastic surgery education and training and ensure more effective learning.<br><strong>Objective</strong>. To identify and describe: (i) how simulation impacts on student learning; therefore, how the effectiveness of learning may be enhanced in postgraduate and/or plastic surgery education and training; and (ii) which features and uses of simulation have the potential to enhance learning in plastic surgery.<br><strong>Methods.</strong> A descriptive design was used for the study. Data were collected by means of semi-structured interviews with 8 national and international role players in simulation.<br><strong>Results.</strong> The results indicated a positive outcome of simulation, as it provides, e.g. a non-threatening environment for learning and improves clinical competency, ensuring an increase in patient safety. The features and uses of simulation render it an excellent method to enhance learning effectiveness at different cognitive levels and to fulfil a specific role in integrated and holistic training, while providing opportunities to practise specific skills. The lack of clinical opportunities can be addressed, and more clinical exposure and practice will result in fewer medical errors.<br><strong>Conclusion</strong>. Simulation-based education in postgraduate plastic surgery education and training proved to be an effective teaching- learning method, which provides solutions to current deficiencies, hindrances and gaps in health professions education. The research question was answered and the use of simulation is recommended to enhance plastic surgery education and training and promote safe patient care.</p> C.P.G. Nel, G.J. van Zyl, M.J. Labuschagne, Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211067 Wed, 21 Jul 2021 00:00:00 +0000 Significance of relationships in the cognitive apprenticeship of medical specialty training https://www.ajol.info/index.php/ajhpe/article/view/211068 <p><strong>Background</strong>. The cognitive apprenticeship model is universally recommended for medical specialty training and has been introduced in some clinical disciplines by consultant specialists through the personal coaching of students and participation in the community of practice. In post-apartheid South Africa (SA), transformative initiatives gave rise to significant numbers of students from disadvantaged backgrounds in higher education that led to racial and sociocultural diversity among students and their consultants. Most notably, this occurred in medical specialties, where the number of students is much smaller than in undergraduate medicine. This stimulated interest in how this landscape may influence the cognitive apprenticeship model.</p> <p><strong>Objectives</strong>. To explore how former students of a medical specialty discipline conceived the nature of racial and sociocultural diversity in their learning environment and if/how this influenced their relationships with peers and consultants.</p> <p><strong>Methods.</strong> A qualitative enquiry was conducted with 9 formal postgraduate students (registrars) from 6 universities in SA. Data collection was through in-depth individual interviews with open, semi-structured questions. Data were analysed, recognising sub-themes and themes, and interpretation was done in a social constructionist approach of epistemology, where the participants and researcher co-construct the concepts.</p> <p><strong>Results.</strong> Participants conceived the sociocultural diversity as personal differences and related their experience of not receiving one-on-one mediation or mentoring to a lack of relationship with the consultants, which was believed to be underpinned by sociocultural differences. Power-plays in departmental culture also inhibited the legitimate access and participation of postgraduate registrars in the community of practice, inhibiting their growth of professional expertise.</p> <p><strong>Conclusions</strong>. Cognitive apprenticeship in medical specialty training has specific challenges in the context where postgraduate students and consultants are from societies previously divided by inequalities. Common acknowledgement was that learning in collaboration begins&nbsp; with learning to know each other and by forming relationships. Students faced challenges seeking professional mentorship, which was conceived as a principal contributing factor in their failure to learn.</p> A.A. Khine, N. Hartman Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211068 Wed, 21 Jul 2021 00:00:00 +0000 Cognitive load theory in simulations to facilitate critical thinking in radiography students https://www.ajol.info/index.php/ajhpe/article/view/211069 <p><strong>Background.</strong> Problem solving and critical thinking are top future skills. High-fidelity simulations improve critical thinking, but also increase students’ cognitive load, possibly limiting their learning. Educators should therefore consider learning outcomes, problems that require critical thinking, the relationship between working and long-term memory, and intrinsic and extraneous cognitive loads when developing simulation scenarios.</p> <p><strong>Objective</strong>. To report on the application of cognitive load theory (CLT) and students’ responses in terms of problem solving and new&nbsp; insights during and after a simulation experience.</p> <p><strong>Methods.</strong> A high-fidelity simulation, targeting multilevel communication, teamwork and prioritisation of learning outcomes, was designed according to CLT. Eighty students participated in presimulation knowledge, skills and attitudes acquisition and 10 participated in the&nbsp; simulation. A qualitative descriptive design was followed and data were collected through video/audio recordings of the simulation and&nbsp; reflection session, supported by educator and critical observer notes. Qualitative content analysis allowed comprehensive summarisation&nbsp; of students’ problem-solving abilities and emerging new insights.</p> <p><strong>Results</strong>. Eighty second-year radiography students formed the target population, with 10 simulation participants comprising the sample.&nbsp; Communication with health professionals was good, but lacking towards patients. Intraprofessional team collaboration was suboptimal,&nbsp; but interprofessional team collaboration was good. Students were mostly unfamiliar with the prioritisation responsibility. Upon reflection,&nbsp; students came to new insights regarding teamwork and prioritisation.</p> <p><strong>Conclusion</strong>. After application of CLT, critical thinking to facilitate problem solving during simulation was suggested and post-simulation reflection facilitated new insights. The exposure of large groups to the benefits of simulation validates further investigation. </p> A. Louw Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211069 Wed, 21 Jul 2021 00:00:00 +0000 Factors influencing radiography lecturers’ perceptions and understanding of reflective practice in a newly implemented curriculum https://www.ajol.info/index.php/ajhpe/article/view/211070 <p><strong>Background.</strong> Reflective practice has become an integral component of the new Bachelor of Science (BSc) radiography programme in South Africa (SA). As a result, lecturers on the programme are required to facilitate reflective learning, and are assumed to be skilled in this. However, relevant literature indicates that health professions educators may not necessarily possess the requisite competence or experience in facilitating reflective learning. Moreover, there is a paucity in the literature on lecturers’ perceptions and understanding of reflective practice in the context of undergraduate radiography curricula, particularly in sub-Saharan Africa.<br><strong>Objective.</strong> To gain insight into BSc radiography lecturers’ perceptions and understanding of reflective practice at a selected university of technology in SA.<br><strong>Methods</strong>. This was a qualitative exploratory study in which individual semi-structured interviews were conducted with lecturers teaching on the new BSc Radiography programme. The purposively selected sample consisted of 11 participants. Interviews were audio-recorded, transcribed and thematically analysed.<br><strong>Results.</strong> Analysis of the data revealed three themes, namely diverse understandings of reflective practice among lecturers, factors&nbsp; influencing optimal facilitation of reflective learning and strategies to improve reflective practice.<br><strong>Conclusion.</strong> The findings of this study indicated that lecturers felt unprepared to facilitate reflective practice in the new BSc radiography curriculum. The need for faculty development initiatives, such as an introduction to reflective tools and educational strategies to support lecturers in facilitating reflective practice, was highlighted. Furthermore, it was found that if objectives were clearly outlined and facilitator guides available, a desired reflective practice could be established</p> H. Thomas, M. Volschenk Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211070 Wed, 21 Jul 2021 00:00:00 +0000 Research competencies for undergraduate rehabilitation students: A scoping review https://www.ajol.info/index.php/ajhpe/article/view/211071 <p><strong>Background</strong>. Research training is important for all health science professions and interlinks with evidence-based practice (EBP). Previous studies that investigated research competencies for undergraduates predominantly focused on medical and nursing professions.&nbsp; However, specific competencies may be more relevant to certain professions than others. A set of minimum core research competencies has not been defined for research methods (RM) training in the undergraduate rehabilitation curriculum.<br><strong>Objectives</strong>. To review available evidence and identify a set of research competencies for undergraduate rehabilitation students.<br><strong>Method.</strong> A scoping review was done of studies published between January 2009 and December 2018. Five databases were searched&nbsp; (November - December 2018). Articles were included if they contained statements referring to knowledge, skills, attitudes and tasks&nbsp; related to research or researchrelated EBP for rehabilitation undergraduates. Competencies were categorised into 6 research domains using thematic analysis.<br><strong>Results</strong>. Forty-five competencies were identified from research-related statements in 26 studies. No studies explicitly investigated the most important research competencies for rehabilitation. Research competencies were often derived directly from the EBP framework (n=19 studies), resulting in poor representation of competencies related to conducting research. Overall, domains related to research&nbsp; methodology and inquiry were best represented, while soft skills, dissemination, professional attitudes and ethics were poorly represented.<br><strong>Conclusion</strong>. We identified a set of research competencies that may be important for rehabilitation undergraduates. It remains unclear which of these should be prioritised in the rehabilitation curriculum. However, this preliminary set may guide future consensus statements and allow educators to identify and address gaps in current curricula.</p> M.Y. Charumbira, K. Berner, Q.A. Louw Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211071 Wed, 21 Jul 2021 00:00:00 +0000 Learner engagement as social justice practice in undergraduate emergency care education: An exploration of expectations, impediments and enablers for academic success https://www.ajol.info/index.php/ajhpe/article/view/211073 <p><strong>Background</strong>. It is uncertain how descriptions of learner experiences and expectations can influence learner engagement in prehospital emergency care education in South Africa (SA). Improved access to higher education may imply a greater diversity of life experiences and academic needs. However, neither this diversity nor the consequent disengagement-engagement differential has been documented for the emergency care student body in SA.<br><strong>Objectives</strong>. To explore the expectations of, impediments to and enablers for success in undergraduate emergency care education.<br><strong>Methods.</strong> A concurrent (embedded) mixed-methods design was employed. Through a prospective online survey, 115 of 249 emergency care learners who were registered in 2014 - 2018 were sampled. Qualitative responses were thematically analysed from a process of mind mapping and dyadic contrasting of codes.<br><strong>Results</strong>. Three propositions emerged: (i) the paradox of programme motivation and subject hindrance suggests that participants were intrinsically and extrinsically motivated for programme completion, but experienced hindrances at the subject level; (ii) there was a&nbsp; perception of insufficient academic interaction and engagement; and (iii) while there were divergent experiences and expectations, coercive contexts for premature attrition in emergency care education prevail.<br><strong>Conclusions</strong>. Sacrifices made by respondents to overcome challenges were identified as a profound loss of time, money and relationships. Extrinsic factors affecting learner success included competing demands, institutional structure/processes, teaching quality and online teaching and learning. A learner-centred approach is therefore posited, given expression through learner engagement. If engagement is to become a meaningful social justice practice, then monoculture ideation in emergency care education must be challenged.</p> N. Naidoo, R. Matthews Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211073 Wed, 21 Jul 2021 00:00:00 +0000 A capability approach analysis of student perspectives of a medical consultation quality-improvement process https://www.ajol.info/index.php/ajhpe/article/view/211074 <p><strong>Background</strong>. Research shows that person-centredness declines during medical education. This study examines the underlying&nbsp; assumptions and effects of clinical associate training interventions on person-centred practice.<br><strong>Objectives</strong>. To understand student experiences of a medical consultation quality-improvement (QI) process in terms of a capability&nbsp; approach to learning and the effects of this process on their person-centredness.<br><strong>Methods.</strong> In a randomised controlled trial students from 8 clinical learning centres (CLCs) participated in a qualitative, medical&nbsp; consultation QI process. Qualitative data (focus group discussions and reflective reports) were analysed using a capability approach to the learning framework.<br><strong>Results.</strong> Learning was triggered by disruptions to students’ abilities, knowledge, identity and relationships. Through facilitated review-read-reflectre/action scaffolded by feedback and practical assessment tools they learnt new person-centred consultation skills. The QI process functioned as a learning cycle in which students reviewed disruptions, identified areas for improvement and developed&nbsp; improvement plans. Through it, awareness of themselves developed more deeply, their relationships with peers and patients grew and they improved their knowledge and consultation skills.<br><strong>Conclusions.</strong> Students demonstrated learning through their understanding of the skills and competencies required for person-centred practice. The study found students to be at different points along the directed/self-directed learning continuum, with most of them&nbsp; developing abilities to learn independently, work in groups, give and receive feedback and apply learning across different contexts.&nbsp; Facilitation is particularly important, given the uneven development of the ‘dimensions of a person’ at an individual level. Lastly, the capability approach is useful as an analytical framework and as a way of ‘doing learning’.</p> J.M. Louw, T.S. Marcus, J.F.M. Hugo Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211074 Wed, 21 Jul 2021 00:00:00 +0000 Validation of a questionnaire evaluating the effect of a preparatory year on qualifying students for studying at health professions education faculties https://www.ajol.info/index.php/ajhpe/article/view/211075 <p><strong>Background</strong>. The preparatory year or first-year experience in higher education aims to consistently meet the needs of students,&nbsp; institutions and broader society. It aims to help students transition from high school to university, acquaint them with the various academic disciplines at university and introduce them to the university environment.<br><strong>Objectives.</strong> To validate a newly developed instrument that evaluates the effect of the preparatory year on preparing students for studying in health professions education faculties.<br><strong>Methods.</strong> A descriptive cross-sectional study was conducted at King Abdulaziz University, Saudi Arabia, on a comprehensive sample of male and female second- and third-year students who completed their preparatory year and started studying at health professions&nbsp; education faculties. Data were collected through a questionnaire newly developed by the authors. Descriptive statistics were used and statistical significance was set at p&lt;0.05.<br><strong>Results.</strong> The study showed high internal consistency of the questionnaire. Cronbach’s alpha coefficient value for the total scale was 0.94. Among the 5 dimensions of the questionnaire, the students were highly satisfied with ‘university conduct’, but less so with the ‘perception of teachers, teaching and assessment’.<br><strong>Conclusion</strong>. There was good validity and reliability of the newly developed questionnaire. From a student’s perspective, the preparatory-year programme needs to be revisited.</p> Mohammed Al-Rabia, Lana Al Shawwa, Enas Gouda, Ahmed Aldarmahi, Hani Asfour, Hani Atwa Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211075 Wed, 21 Jul 2021 00:00:00 +0000 Development of a baseline assessment tool to establish students’ foundational knowledge of life sciences at entry to university https://www.ajol.info/index.php/ajhpe/article/view/211076 <p><strong>Background</strong>. Universities in South Africa use the Grade 12 school-leaving examinations to measure whether students have the knowledge and skills needed to enter tertiary-level education. However, there is much discussion on the effectiveness of these assessments to measure the preparedness of students for their first year at university. To facilitate the appropriate teaching and learning of anatomy and physiology, there is a need to assess students’ baseline knowledge of life sciences at entry to their first year at university.<br><strong>Objectives.</strong> To develop and refine an anatomy and physiology foundational knowledge assessment (A&amp;P foundational knowledge&nbsp; assessment), which looks back to the content of the Grade 12 life sciences curriculum and forward to the first-year anatomy and&nbsp; physiology curricula.<br><strong>Methods.</strong> Three hundred and seventy-one first-year students (occupational therapy, physiotherapy and MB ChB) wrote the A&amp;P&nbsp; foundational knowledge assessment. Classic item and test analysis was done using Iteman 4.3 software (Assessment Systems Corp., USA).<br><strong>Results.</strong> The Kuder-Richardson formula 20 (KR-20) reliability score, which ranges from 0 to 1, was 0.64 for all the students. For MB ChB&nbsp; students, the KR-20 value was lower (0.57) compared with that for occupational therapy and physiotherapy students (0.66). The KR-20 scores for the 21 physiology and 16 anatomy items were 0.48 and 0.57, respectively. A KR-20 score of &gt;0.50 is considered acceptable. The mean difficulty index (range 0 - 1) for physiology was 0.60, and the mean discrimination index was 0.15. For anatomy, the mean item difficulty index was 0.57 and mean discrimination index was 0.21.<br><strong>Conclusion.</strong> Based on the acceptable reliability value, the assessment was shown to be an effective instrument to measure students’ foundational knowledge in human anatomy and physiology, which is part of life sciences. </p> L. Pienaar, R. Prince, A. Abrahams Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211076 Wed, 21 Jul 2021 00:00:00 +0000 How well do we teach the primary healthcare approach? A case study of health sciences course documents, educators and students at the University of Cape Town Faculty of Health Sciences https://www.ajol.info/index.php/ajhpe/article/view/211077 <p><strong>Background.</strong> The comprehensive primary healthcare (PHC) approach has been a lead theme in the University of Cape Town Faculty of Health Sciences(FHS) since 1994. A 2014 institutional academic review recommended that indicators be developed for monitoring and evaluating the PHC theme.<br><strong>Objective.</strong> To evaluate PHC teaching and learning of final-year health and rehabilitation sciences and medical students at three community-based education (CBE) sites of the faculty, two in Cape Town and one in a distant and largely rural district.<br><strong>Methods.</strong> Course documents were analysed for evidence and alignment of nine indicators of the PHC approach in the documented&nbsp; learning outcomes, activities and assessments of final-year health sciences students. Clinical educators and students were interviewed to identify factors that facilitate or impede PHC teaching and learning on site.<br><strong>Results.</strong> Final-year health sciences disciplines engage inconsistently with PHC principles at the CBE sites. Alignment appears to be&nbsp; strongest between learning outcomes and teaching activities, but the available data are insufficient to judge whether there is also strong alignment between outcomes and teaching, and formal graded assessment. PHC teaching and learning at the CBE sites are facilitated by good multiprofessional teamwork, educator rolemodelling and good infrastructural and logistical support. Language barriers, staff shortages and high workloads are significant and prevalent barriers.<br><strong>Conclusion.</strong> Strong faculty leadership is required to promote the PHC lead theme and to achieve better departmental and&nbsp; multiprofessional collaboration in teaching the PHC approach. This study provides evidence from well-established CBE sites to inform future work and participatory action research in promoting the PHC approach in teaching and learning in the FHS.</p> J. Irlam, M.I. Datay, S. Reid, M. Alperstein, N. Hartman, M. Namane, S. Singh, F. Walters Copyright (c) https://www.ajol.info/index.php/ajhpe/article/view/211077 Wed, 21 Jul 2021 00:00:00 +0000