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This paper presents the process of co-design, co-production, piloting, evaluation and revision of an Integrated Digital Literacy and Language Toolkit for Vulnerable Migrant Students (VMs) in Higher Education (HE). The language element focuses on academic language skills of reading, writing, listening and speaking required for effective involvement in both the host society and HE learning; the acquisition and improvement of digital literacy skills enable VMs to successfully participate in, and contribute to, university and societal collaboration, creativity and content curation. The Toolkit resulted from the co -operation and collaboration of five EU universities and was based on the ASSURE instructional design model. The Toolkit offers a self- access, self- paced, non-linear, fully online set of ten stand-alone units which offer a range of materials and activities to develop those skills pertinent to VM academic language and digital literacy needs. Evaluation by a group of VMs resident in EU countries highlight the positive impact of the Toolkit and validates the instrument as fit for purpose. Noteworthy aspects include its usefulness in supporting student autonomy, improving digital capabilities and academic language mastery,a positive experience of a flexible learning experience along with access to open resources of international scope and dissemination under the Creative Commons licence.

BackgroundIn the province of Tarragona (Spain), 24% of immigrants come from countries in the Maghreb. 40% of Maghrebis residing in Spain say their linguistic command of Spanish is inadequate, which could hinder their relationship with healthcare professionals. The use of minors as translators by health services is a fairly common practice. The suitability of using children as translators has been questioned, although there has been little specific research on the subject and most has been from the perspective of professionals. The aim of this study was to qualitatively analyze the discourse of Maghrebi adults to the use of Maghrebi minors as translators in the health services.MethodsA qualitative study using 12 in-depth interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was primary healthcare and hospital services in the area. A content analysis was performed using open coding.ResultsThe practice studied is attributed to a lack of funding for translation resources, and prioritization of adults’ work over children’s education. It is seen as a convenient solution to the community’s communication problems, although it is considered unreliable and detrimental to the rights of the child. The attitudes of healthcare professionals to the phenomenon studied varies from acceptance without any ethical concerns to concern about its effects on the child. The solutions proposed are the organization of translation resources with a proactive approach which are adapted to real needs, and a change in the focus of language training activities for the adults in the community.ConclusionsIt is necessary to reconcile access to healthcare for Maghrebi adults with the rights of children who act as translators in the healthcare context. This requires coordination between health and educational institutions, changes in the organization and provision of translation resources, and a guarantee that immigrants have employment rights under the same conditions as Spanish nationals.

Background Decision-making tools represent a paradigm shift in the relationship between the clinician and the user/patient. Some of their advantages include patient commitment, the promotion of preferences and values, and increased treatment adherence. This study protocol aims to assess the effectiveness of a decision-making tool in contraception (SHARECONTRACEPT) concerning: a) Improvement in counselling on hormonal contraception at the medical consultation, measured in terms of decreasing decisional conflict and improving knowledge of available contraceptive options; b) Improvement in adherence to treatment measured in terms of: persistence in the chosen treatment, compliance with dose or procedure of use, and ability to deal with incidents related to the use of the contraceptive method; and decreasing unwanted pregnancies and voluntary interruption of pregnancy. The SHARECONTRACEPT tool, developed by previous phases of this project, is available at: http://decisionscompartides.gencat.cat/en/decidir-sobre/anticoncepcio_hormonal/ Methods/design A longitudinal, prospective-type, randomized, controlled community clinical trial, carried out in the clinical contraceptive counselling units of 6 autonomous regions in Spain, with an experimental group and a control group. Description of the intervention: The health professionals participating will be randomly assigned to one of the two groups. Clinicians assigned to the experimental group will perform contraceptive counselling assisted by SHARECONTRACEPT, and those of the control group will follow the conventional contraceptive counselling provided in their clinical unit. It is planned to study 1708 users (control group n = 854 and intervention group n = 854), recruited from women who attend the consultations of the health professionals. The selected users will be followed up for one year. The data will be collected through ad-hoc questionnaires, and validated instruments for measuring decisional conflict and adherence to treatment. Discussion The results of this study protocol will offer evidence of the effectiveness of a shared decision-making tool, SHARECONTRACEPT, which may prove a useful tool for users and professionals to promote adherence to contraceptive methods. Trial registration Clinical Register number ISRCTN5827994 . Date: 15/04/2019 (Retrospectively registered)