Why Students Struggle in Undergraduate Biology: Sources and Solutions.

Students' perceptions of challenges in biology influence performance outcomes, experiences, and persistence in science. Identifying sources of student struggle can assist efforts to support students as they overcome challenges in their undergraduate educations. In this study, we characterized student experiences of struggle by 1) quantifying which external factors relate to perceptions of encountering and overcoming struggle in introductory biology and 2) identifying factors to which students attribute their struggle in biology. We found a significant effect of Course, Instructor, and Incoming Preparation on student struggle, in which students with lower Incoming Preparation were more likely to report struggle and the inability to overcome struggle. We also observed significant differences in performance outcomes between students who did and did not encounter struggle and between students who did and did not overcome their struggle. Using inductive coding, we categorized student responses outlining causes of struggle, and using axial coding, we further categorized these as internally or externally attributed factors. External sources (i.e., Prior Biology, COVID-19, External Resources, Classroom Factors) were more commonly cited as the reason(s) students did or did not struggle. We conclude with recommendations for instructors, highlighting equitable teaching strategies and practices.

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries.

BACKGROUND: Achieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports. METHODS: Thirteen Gavi-supported countries were purposively selected with emphasis on Gavi's priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016-2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF's coverage and equity assessment approach - an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard. RESULTS: In total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity. CONCLUSION: Findings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and 'zero-dose' vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.