Diabetic retinopathy (DR) is one of the major blinding eye diseases worldwide. Psychological, emotional and social problems of DR patients are prominent. The aim of this study is to explore the experiences of patients with different phases of DR from hospital to home based on the “Timing It Right” framework, and to provide a reference for formulating corresponding intervention strategies.The phenomenological method and semi-structured interviews were used in this study. A total of 40 patients with DR in different phases were recruited from a tertiary eye hospital between April and August 2022. Colaizzi’s analysis method was used to analyse the interview data.Based on the “Timing It Right” framework, different experiences in five phases of DR before and after Pars Plana Vitrectomy (PPV) were extracted. The patients experienced complicated emotional reactions and inadequate coping skills during the pre-surgery phase, increased uncertainty during the post-surgery phase, insufficient confidence and the decision to change during the discharge preparation phase, eagerness for professional support and moving forward in exploration during the discharge adjustment phase, and courageous acceptance and positive integration during the discharge adaptation phase.The experiences of DR patients with vitrectomy in different phases of disease are ever-changing, and medical staff should provide personalized support and guidance to help DR patients get through the hard times smoothly and enhance the quality of hospital-family holistic care.The online version contains supplementary material available at 10.1186/s12912-023-01206-y. Diabetic retinopathy (DR) is one of the most common microvascular complications among diabetics and the main leading cause of blindness in adults . ProlifeRegular screening and intensive glucose management can effectively delay the progression of DR , 7. HoweVitrectomy is one of the mainstays of DR treatment. However, patients are only able to recover or retain partial useful vision after surgery, and most patients continue to have psychological, emotional, and social problems , 10. MeaUntil now, many studies have focused on interventions for patients with DR and their effectiveness , 17. SomTherefore, this study aims to explore the experiences and feelings of DR patients during different disease treatment stages through in-depth interviews based on the theory of “Timing It Right”. This is helpful to provide a reference for formulating effective and sustainable hospital-family holistic care intervention programs.This study was part of a larger research project to develop a hospital-family holistic caring intervention program for patients with DR and discuss the effect of its application on DR patients through a quasi-experimental study.The primary objective of this qualitative study was to explore the experiences and feelings of DR patients at different phases and understand their relevant needs.To provide a reference for formulating the intervention program that meets the needs of these patients.This qualitative design was adopted using the Descriptive Phenomenology approach. Descriptive phenomenology emphasizes a process of “returning to the thing itself” and gives more attention to the life experience of patients, which helps to explore the experiences and feelings of patients. Since tPatients with DR were voluntarily recruited from the Fundus Surgical Department, Eye Hospital of Wenzhou Medical University, Zhejiang, China. Purposeful sampling combined with a maximum variation sampling approach was utilized. Participants with different sociodemographic characteristics were chosen when possible.Recruitment of participants continued until data saturation was reached , which oBased on the TIR framework, combined with the characteristics of DR and vitrectomy, and consulting with specialists in the Fundus Surgical Department, Endocrinology Department and other related fields, five phases were designated: pre-surgery, post-surgery, discharge preparation, discharge adjustment, and discharge adaptation. The pre-surgical period was from the time the DR patient decided to undergo vitrectomy to the time of surgery and this period usually lasted 3–7 d. The post-surgery phase was the period between the patient’s surgery and post-surgery stabilization. This period usually lasted 1–2 d. The discharge preparation phase was from the time the patient achieved medical criteria for hospital discharge to the time of discharge, and usually lasted 1 d. The discharge adjustment phase was the period from the patient’s discharge to home until 3 months after the vitrectomy. The discharge adaptation phase was the period 3 months to 6 months after the vitrectomy. According to the short hospitalization period and quick turnaround of DR patients undergoing vitrectomy, the post-surgery and discharge preparation phases were the same patient. There was no duplication in the other phases of participants. Each phase was denoted as A, B, C, and D. The staging criterion was based on the most diseased eye.A semi-structured interview guide Table  was usedPatients who were interested in participating in the study and met the inclusion criteria were informed of the purpose and significance of the study and signed an informed consent form. The interview consisted of five phases. The first interview phase occurred during the pre-hospitalization period and was conducted in the outpatient waiting room. The second and third phases were conducted during the inpatient period, the interview location was a quiet place such as a ward or duty room, and the interview time was during non-treatment and patient rest periods. Patients had returned to the community during the latter two phases and when convenient the latter two interviews were conducted in the outpatient waiting room at the time of patient review or were recorded by video. Each person was interviewed one time, and each interview lasted approximately 20–40 min. The entire interview was recorded, and the researcher listened carefully and recorded the interviewees’ expressions, movements, and emotional reactions.Ethical approval for this study was granted by the ethics committee of the hospital . Informed consent was provided and obtained from all participants before the study commenced. To protect the privacy of interviewees, the interviews were presented anonymously, and names were replaced with letters.The recordings were transcribed word by word within 24 h after the interview. Colaizzi’s seven-step method was used for data analysis [The trustworthiness of this qualitative study was ensured by maintaining the credibility, dependability, confirmability, and transferability of the data , 26. TheA total of 40 respondents were enrolled, and the number of respondents at each phase was 7, 12, 11 and 10, including 25 males and 15 females. The average duration of diabetes was 13 years. The general characteristics of the study respondents are presented in Table In DR fundus haemorrhage, the patient’s sudden blurring of vision and the floating of black shadows in front of the eyes cause the patient to experience fear, anxiety, and other negative emotions.A2: ‘One day I woke up and my eyes suddenly went blind. I didn’t realize the haemorrhage was so severe.’A5: ‘When I got up to wash my face, I found that the cobwebs inside my eyes had fallen out. I was scared to death.’Vision loss caused many inconveniences in the working lives of patients with DR, such as difficulties driving, walking, using WeChat, injecting insulin, etc. This intensified patient anxiety.A3: ‘Last time I almost hit the old lady, so I am afraid to walk alone now.’A6: ‘I can’t see with my eyes. I can’t do anything.’In the early stages of diabetes, many patients do not know or believe that diabetes can cause diabetic retinopathy, diabetic foot and other related complications, and do not realize the importance of diabetes glucose management. When vision is impaired, patients with DR begin to regret their previous behaviour.A3: ‘I didn’t know regret until something went wrong with my eyes. I regret that I didn’t look at my eyes earlier.’A6: ‘It may not be so serious if it is controlled at the beginning.’A7: ‘Why didn’t I control it before? Why was my mouth so greedy? Why was my self-control so poor?’Some patients with DR have undergone multiple panretinal photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) treatments before being treated with vitrectomy.A1: ‘The two eyes have already been injected several times, two or three times, and the PRP treatment has been done several times.’The repeated PRP treatments and the pain associated with the PRP usually cast a psychological shadow on DR patients, making them fearful of subsequent treatments.A2: ‘When I had PRP treatment before, I felt a little scared. The cloth came up in layers and just showed you an eye.’A5: ‘I’m definitely not doing PRP treatment. The eye is like being gouged out. It’s more painful than giving birth. I give up on the left eye, I’m still left with that one after this one goes blind.’The treatment of choice for DR is usually vitrectomy followed by insertion of either a gas or silicone oil tamponade. The procedure utilises local anaesthesia. After the procedure, the anaesthetic effect wears off and patients complain of eye pain.B5: ‘I want to lower my head a bit, my eyes are not very comfortable, my eyes are swollen and painful. The whole procedure is also very painful. I feel like my eye is bursting open.’B8: ‘The whole eye is going to explode, now the pressure of the eye is so heavy, as if a mountain is pressed, the eye cannot open.’Surgical trauma and elevated intraocular pressure (IOP) are the main factors causing postoperative pain. Additionally, if gas or silicone oil is filled in the eye, the patient usually needs to maintain the head-down and side-lying positions alternately after surgery. A prolonged prone position will cause pain in the patient’s head, chest, abdomen and extremities, compress the eye orbit, affect blood circulation and aggravate eye swelling .B10: ‘I never thought I would be like this after the surgery. I couldn’t eat, I want to vomit, and my blood pressure is still high. So, I am in a bad mood. I am told to sit during the day and lie on my side at night, I am so tired. My eyes are swollen and cannot be opened.’Due to the filling of gas and silicone oil, DR patients will not have a significant change in vision immediately after surgery compared to pre-surgery. Meanwhile, those who have had silicone oil injected need a second surgery to remove the silicone oil. The uncertainty of the time of the second surgery and the uncertainty of the recovery of vision will increase the patient’s uncertainty about their disease prognosis.B1: ‘I don’t open my eye. I worry whether it can open. I always expect my eyes to recover better… I’m afraid that eye still cannot see after the surgery.’B5: ‘I don’t know what the condition of my retina is, do you have the report card from the surgery? What is the condition of my eyes now? Are 800 points of laser considered too much? I am worried that I will see less after the surgery.’B11: ‘Do I get the PRP treatment next or the anti-VEGF treatment? How can I best maintain my vision?’The course of the disease with DR is long and the condition often recurs. Patients mostly need a combination of PRP, anti-VEGF and vitrectomy treatments. Treatment requires tremendous energy and financial resources, which puts heavy care and financial burdens on patients and their families.B3: ‘Last year the doctor said it would take 20,000. I only had more than 10,000 in my pocket, so I walked away. This year the eye is really no good, my brothers and sisters lent a little to me to do surgery.’B12: ‘The doctor told me to do the other eye as well. I’m not blind. I’m not doing it for now. This surgery costs more than 20,000 yuan, and my salary is only 1000 yuan a month.’In addition, the social roles of DR patients at this age are more complex, as they are both sons and daughters and parents. As sons and daughters, they need to support the elderly; as parents, they must raise their children. The multiple roles make their caregiving burden heavy and many neglect themselves.B3: ‘My two couples earn 100,000 yuan in school, the children’s school needs 50,000 yuan, the family also needs to spend money, not much money left in a year.’B9: ‘Our generation is in the situation of “the elderly above and children below”, we are very tired, so we do not have time to pay attention to our own health. It is too late once we get sick.’Most patients with DR have a short hospitalization period. They lack sufficient knowledge about eye care, handling postoperative complications and so on. As the time of discharge approaches, patients become increasingly worried that they will not be able to take good care of themselves and then develop a sense of helplessness.B7: ‘I still don’t know how to protect my eyes, for example, I want to eat melon seeds and peas, but I don’t know if I can eat them. Are these peas bad for the eyes? I’m afraid that if I don’t take good care of my eyes, they will bleed again.’B10: ‘Today the doctor said that the surgery was successful, and that post-operative infection should be prevented. But my body is too sick, my body is not immune, my immunity is not as strong as others, and I am afraid of infection when I go home.’B12: ‘The hospital in our town does not provide ophthalmology services, what should we do if we have problems after discharge? Can we add a WeChat? We can consult when we encounter problems.’After the patients experienced the inconvenience of blurred vision in their work lives and also had a more comprehensive understanding of the cause and treatment of DR, more than half (10/12) of the interviewees said they realized the importance of blood glucose management and decided to make changes.B6: ‘Before I thought that as long as the hospital was there, I would not be afraid, and I would be able to come to the hospital for treatment. After this surgery, I realize that my previous knowledge of diabetes was very inadequate, and I will put it in my mind in the future.’B9: ‘I will definitely manage my blood glucose in the future. It comes out of my eyes and directly affects my work, and I’ve got it in mind.’B11: ‘We must keep our blood glucose under control. If we don’t control it, we may have big problems with our eyes again later. Whether it is high blood glucose or high blood pressure, it may be harmful to the eyes.’DR patients treated with vitrectomy have a long recovery after surgery, while most patients have a short hospitalization period. An inflammatory response such as conjunctival hyperaemia and corneal oedema still occurs within a short period after discharge. Combined with inadequate self-care ability among DR patients, they urgently want to obtain home support services.C4: ‘I want to listen to online lectures because sometimes there is something uncomfortable in my eyes and I can learn what causes it. …The consultation channels I also need, otherwise, I am panicking when I have a problem. I want someone who knows more about it to help me.’C11: ‘I felt fine for the first two days after surgery, then I didn’t know what caused my eyes to get red and swollen, and I really wanted to ask the doctor, but I didn’t know who to ask, and I didn’t have the hospital’s phone number, so I stopped the medication.’C9: ‘I often ask my doctor in charge. We have added WeChat. I ask him any question and he answers me.’DR patients whose eyes are filled with silicone oil or gas after surgery still have poor vision. It can make the patient puzzled.C2: ‘After the surgery on this eye, I still couldn’t see clearly, so I wondered why it was the same before and after the surgery.’C7: ‘My son and my husband say that I can’t see because of the silicone oil, but I don’t know if that’s the reason.’At the same time, patients who had high expectations of the surgery before the operation and whose vision recovery was not satisfactory after the surgery will feel a greater sense of psychological disparity. They gradually lose their confidence, and their mental health is impaired.C6: ‘What is the meaning of my life when I can’t see with my eyes.’C7: ‘I’m so annoyed that the treatment cost so much money and I can’t see so well. I’m really annoyed.’C8: ‘Even if the silicone oil is removed, my eyes may still be blind…the vision recovery is so different from what the doctor said before the surgery. I can’t accept it at all.’Patients did not know how to relieve the pain of impaired vision. However, they did not want to impose it on their family either. Some patients balanced their inner helplessness by complaining about their fate.C6: ‘I don’t know what to do. I don’t know where the eye problem came from. Why God treated me this way.’Most of the respondents mentioned the importance of blood glucose management, and the vision change made them more alert. They started to explore the experience of eye protection and blood glucose management for themselves.C5: ‘I also bought a glucometer and an automated sphygmomanometer, and now I’m eating more regularly, and my eating habits have slowly adjusted.’C8: ‘Since the surgery, I’ve been drinking less, and I’ve taken care of myself. I usually sleep at 11 pm, and I don’t stay up until 2 or 3 am.’C10: ‘Do not smoke, do not touch the kitchen fumes. Cannot eat spicy and stimulating food, we must protect the eyes after surgery, do not let the sweat flow into the eyes in summer.’The effect of postoperative vision recovery in patients with DR is different. After the second surgery, some DR patients continue to have low vision, and the distress of low vision makes them reach their lowest point emotionally, showing a loss of self-worth and self-denial.D1: ‘I can’t read, I can’t write, and I can’t enjoy the scenery, so I have no interest in life.’Patients mostly emerge from their negative emotions over time. They actively adjust their mindset, seek knowledge about ophthalmology and have regular reviews. They are hopeful for the future.D1: ‘I’m lucky to be alive now.’D3: ‘You are sick, no one else is to blame. If you can be cured, it’s good, if you can’t be cured, you learn to accept it.’D4: ‘If you really can’t keep your eyes, you have to face it. I go to the endocrinology every month to draw blood and prescribe medication now. I am relieved when the doctor said it is okay.’During this period, DR patients gradually change from their previous fear and worry to positive confrontation and gratitude. Most DR patients are trying to reintegrate into their current lives and work.D5: ‘I was really lucky to meet Director Wu. We are very happy that the surgery was done well. Now I just live my life as usual, watching TV is basically no problem, and I can cook and eat by myself.’D6: ‘I was a little cranky before, but after the silicone oil was taken, my eyes can see clearly, so I am very happy now. I’m still young. After my eyes rest for some time, I’m going to catch up on my work.’The results of the study show that when DR patients have fundus haemorrhage, patients will experience sudden blurred vision, dark shadows and other subjective feelings, which often make patients feel fear and anxiety. This is consistent with the findings of Shi et al. . At the Additionally, DR patients become concerned about the surgical effect, disease prognosis and outcome in the post-surgery phase, with an increased sense of uncertainty. During the discharge adjustment period, the persistent low vision distress and the discomfort of special body positions make DR patients feel negative emotions such as anxiety and depression. Their mental health is impaired. Some DR patients in the adaptation phase after secondary surgery still have poor postoperative outcomes. They have their hopes dashed, show a loss of confidence in continuing treatment and a gradual loss of interest in life, and reach their lowest point emotionally. However, the psychology of DR patients is closely related to their self-care ability, blood glucose management and disease prognosis , 30. TheThe results of this study showed that patients mostly expressed the importance of their eyes, the inconvenience caused by their limited vision, and their determination to make changes for their eyes in the discharge preparation phase. They planned to regularly review and manage their blood glucose. This high level of self-confidence in DR patients who decide to make changes to maintain their vision is called self-efficacy. Self-efficacy has a beneficial effect on both glycaemic control and quality of life in DR patients . The stuThis study found that from the discharge preparation period, DR patients questioned their self-care ability and showed a strong desire for DR knowledge and skills guidance. During the adjustment period, some DR patients expressed the futility of seeking help and demonstrated self-care helplessness at home. They hope to receive continuous and professional care guidance through diversified forms of guidance such as WeChat, telephone, and online lectures. Studies have confirmed that DR patients are prone to complications such as bleeding, infection and increased IOP in the early postoperative period. Moreover, improper postoperative care also increases the risk of recurrent retinal detachment, late recurrent vitreous haemorrhage and related secondary surgery , 39. TheThis study found that DR patients face many difficulties in-home care, such as basic diabetic care, eye care, and mental adjustments which are aggravated by persistent impaired vision. They are very eager to receive professional help in many ways. The care of patients with DR involves multiple disciplines such as ophthalmology, endocrinology, and nutrition. A previous study implemented multidisciplinary teamwork continuity of care for patients with DR, and it improved their blood glucose levels and quality of life . TherefoThis study had several limitations. First, the interviewees were limited to one tertiary teaching hospital for collection and the results may not be generalizable. Further surveys could be selected for sampling in non-tertiary hospitals. Second, this study only interviewed DR patients, and the generalization of the results may not be comprehensive. Follow-up studies are needed to further understand the relevant experiences of healthcare professionals and caregivers of DR patients, to gain a deeper understanding of the needs of DR patients, and to provide a higher quality and more comprehensive basis for the development of relevant nursing intervention programs. Third, considering the short hospitalization period of DR patients in this hospital, the same patients were interviewed in the post-surgery phase and discharge preparation phase, which may cause some recall bias. The results can be supplemented by future studies in wards that do not use the day surgery model.Based on the “Timing It Right” framework, this study conducted in-depth interviews with 40 DR patients at different phases. We found that the feelings and experiences of DR patients were dynamic, ranging from complicated emotional reactions and inadequate coping skills during the pre-surgery period, to increased uncertainty in the post-surgery period, reflecting a strong need for emotional and informational support. From a lack of confidence in self-care during the discharge preparation period to a desire for professional support in the discharge adjustment period, reflecting a need for support for continuity of care; during the adaptation period, most patients compromised, accepted, positively transformed, and actively integrated into their current life trajectory. Therefore, nursing staff should provide appropriate psychological support and professional guidance in a phased and planned manner, especially after the patients are discharged from the hospital, to ensure the continuity of care.Below is the link to the electronic supplementary material.Supplementary Material 1


Higher education, a key driver of women’s empowerment, is still segregated by gender across the world. Agricultural higher education is a field that is male-dominated, even though internationally women play a large role in agricultural production. The purpose of this study was to understand the experience, including challenges and coping strategies, of women from 10 Latin American countries attending an agricultural university in Latin America. The participants were 28 women students with a mean age of 20.9 ± 1.8 years. Following informed consent and assurance of confidentiality, four focus group sessions (one for each year of study with a mean duration of 81 min) were conducted in Spanish. The central question was, “what has been your experience at the university?” Sessions were recorded and transcribed. Thematic coding was performed independently by two teams of researchers (from Latin America and North America), with the resulting schemas combined through mutual discussion. Member checking, auditing, and reflexivity contributed to trustworthiness of the process. Students reported that the personal qualities needed for success included determination, persistence, and self-efficacy. Many described an empowerment process, including increased discipline and self-efficacy from the first to fourth year of study. University life encompassed six themes: university structure and discipline (part of the exosystem), two supportive microsystems  as well as three challenges . Cultural influences instantiated in students’ daily experiences included familism, machismo, and religious faith. Students anticipated futures involving further education and contributions to society. We conclude that higher education in agriculture can serve as an effective means of empowering women to feed the world. Education is the key driver of women’s empowerment. Education reduces women’s poverty , allows Women play major roles in farming and agriculture around the world. Although their participation varies by region, crop, ethnicity, and economic status, women represent approximately 43 percent of the agricultural labor force internationally . CompareThe education of women in agriculture and rural development has been implemented most broadly through extension courses rather than through formal university degree programs. Extension is an educational process for rural populations that aims to improve their livelihoods rather than provide a degree or certification . ExtensiThe objective of the United Nations’ sustainable development goal 5 (SDG5) is achievement of gender equality. The provision of agricultural education to women can contribute to that goal, as well as to the elimination of poverty (SDG1), zero hunger (SDG2) and good health and well-being (SDG3). Those goals are mutually reinforcing, with education being a fundamental means to achieve them.Although Latin America is extremely diverse with respect to geography, language, culture, economic condition, and gender roles, virtually all Latin American countries have a history of colonization, high indices of Christianity, and cultures that highlight the family as the basic unit of society. In cross-cultural studies most countries of Latin America were deemed to be collectivistic . As collLatin America is a critical region of the world for women in agriculture because they are severely underrepresented; women make up about 20% of the agricultural labor force in Latin America . MoreoveThe present study was designed to document and understand the experience, including challenges and ways of meeting those challenges, of women from 10 Latin American countries attending an agricultural university in Latin America. A phenomenological approach using focus groups allowed a deep understanding of the essence of women’s experience in agricultural higher education. What obstacles did the women confront and what were their sources of strength and adaptation?Bronfenbrenner’s ecological theory was applied as a conceptual framework to structure the findings. According to that theory the environment of the individual person consists of microsystems  as well as exosystems, mesosystems, and macrosystems . BronfenThe participants were 28 women students attending an agricultural/rural development university in Central America. Their mean age was 20.9 ± 1.8 years of age. They represented all four years of study and the three scholarship statuses . See The university where the study took place enrolls students from many parts of Latin America and the Caribbean. Although it was founded in 1942, the first women (6) were admitted in 1981 and represented 3.9% of the class. In 2018, the year the data were collected, there were 397 women students at the university, representing 33.4% of the student body.After approval by the IRB of Hope College and the research office of Zamorano University, a random sample of 45 female students, drawn from the enrollment list and stratified by year in school and scholarship status, was invited to attend focus group sessions. Except for 17 students with scheduling conflicts, all those invited agreed to participate. Both informed consent and a promise of confidentiality (to protect other participants) were obtained. The research team had developed the focus group protocol and questions in meetings in which we also reviewed the procedures for conducting focus groups and coding qualitative data. Moderators of the focus groups were professional women administrators and staff from the agricultural university. Four focus group sessions, one for each year of study, were conducted in Spanish in a conference room at the university. The central question was, “what has been your experience at the university?” and follow-up questions queried about participants’ goals, challenges, perceived sources of support, and advice to women students arriving at the university. The mean duration of the sessions was 81 min. All sessions were recorded and transcribed in the original Spanish.Thematic coding (in Spanish) was performed independently by two teams of researchers, one team of six women from Latin America and a second team of three women from the United States, all fluent in Spanish. We applied thematic coding according to We engaged in a number of procedures to ensure the trustworthiness of the findings . The intThe members of the research team, all women professionals, reflected on their own positions with respect to the research process and topic. The first author, a European-American woman originally from the United States, has lived in Central America for over 20 years. She is deeply involved in documenting the experiences of women around the world and has reflected that her lens privileges the strengths of women, rather than their lack of agency. The second author is Honduran with more than 15 years of experience in the management and planning of social, recreational, and educational activities for training young people from diverse cultural backgrounds. She has worked in psychosocial intervention on issues of education, employability, youth, gender, and social vulnerability in international cooperation organizations. The third author is Honduran, passionate about education, mother of two children who, through her own experience, has witnessed the challenges that women must overcome to grow in the professional world and is a faithful witness of how education changes lives. The fourth author is Honduran, an educator for more than 25 years at different educational levels; “that experience has allowed me to know that if women are given participation and empowerment, it affects the quality of their lives and their families.” The fifth author is a Bolivian who has lived in Honduras for the last 22 years. She has raised a family in that country, has two children and dreams of making Honduras a country with many opportunities for women and their families. She has worked for many years on projects to improve the food and nutritional security of children in the Central American region. The sixth author, a Honduran with more than 15 years of experience as a Human Resources professional, wrote, “I believe that all of us have the opportunity to generate positive changes in our environment. I firmly believe in the role of women making organizations warmer and more harmonious places.”According to the Bronfenbrenner ecological model, the chronogram is an essential system to track the relation between person and environment over time. Because the participants constructed coherent narratives of the past, present, and future, significant statements and coding are presented separately for each of three time periods: before attending the university, while attending the university, and predicted/desired futures.1 “, a third-year student, explained, “my mother has always helped me and when I told her I wanted to come here, there was no hesitation, but on the contrary she encouraged me more.” Sometimes extended families made sacrifices to pay the student’s tuition. Victoria, a fourth-year student had the support of not only her parents, but also grandparents, aunts, and uncles, who even sold property to fund her education. Some messages from family members referred to greater difficulties for women in agriculture than for their male counterparts. Soraya, a second-year student said, “most people told me that [agriculture] was men’s work” and Amatista said, “my parents told me… that one would have to work and it would be more difficult for a woman.” Juliana, a third-year student said, “neither my mother nor my father helped me, they didn’t want me to be so far from home…. I had to find transportation to get here myself, but I said, ‘I’m going’ and I bought what I needed.” Thus, the primary microsystem of students before entering the university was their families, who provided both support and cautions about potential difficulties. Other challenges prior to attendance including passing the entrance exam and acquiring the finances necessary for tuition. Even before enrolling at the university, participants expressed determination. Parents were most often supportive of their daughters’ plans. ‘‘JessicaNoteworthy was the personal growth mentioned by many participants. Amatista said this most succinctly, “I think that one grows as a person during these four years.” Soraya replied, “I grew as a person…..[I became] more responsible, and accustomed to making decisions for myself without depending on others. For me this was a great leap forward.” Victoria said, “being here at the university makes you mature,” Both Rubi and Tutis expressed what has been referred to as a growth mindset , “I alwaUniversity life was the richest and most salient of the components of students’ lives, and comprised six themes, (1) university structure and discipline, (2) academic challenges, (3) institutional support from fieldworkers, instructors, and university counseling center, (4) peer support from classmates and friends, (5) peer challenges in the social environment , and (6) machismo.The strict rules and discipline imposed on students’ lives was seen as both a valuable tool for growth, and as an irritating constraint on autonomy. Stephany from the first year said, “I think I have progressed because one learns to organize one’s time. With 10 min free time one does a mountain of things. And the discipline as well, one knows what time they have to be there and at [this university] one has to arrive 5 min early.” Jeysul of the third year said, “I have learned a mountain…. discipline, that I can’t just make excuses.” “In my case I had to self-discipline better,” said Gloria. Silvana said, “studying and discipline were always a bit difficult for me.” Amatista described how her sleeping and studying routines were altered by the university rules, “I used to go to sleep at 8 in the evening and wake up at midnight to study until 4 am, and then sleep another hour and wake up again; this was my study habit and here you have to go to sleep at 11:30.” Soraya gave an example of the limits placed on laboratory use, “We want to experiment more and have the space and create our future,” but it was against the rules that dictated specific hours for laboratory work. Or phrased differently by Aysha, “I think, yes, we can make our own decisions, but based in the regulations.”Academic classes and practica (fieldwork) were sometimes a challenge, but students reported receiving help from multiple people, including instructors, other students, and fieldworkers. Rubi expressed help she received from a number of sources, “Always instructors tried to take me aside to ask if there was something I didn’t understand in class, if I had questions to take advantage of [their help] and also my classmates also help me and they ask me if I know if we have homework, and if they can help me with homework or study habits in order to understand and succeed.” Jenny described her response to difficult classes, “you have in your mind that this class is difficult [one that can lead to you failing out], and I’m going to fail it, but no, no class is that difficult, that we are all capable of learning this material.” Skarleth pointed out that if you are too embarrassed to ask the instructor something the fieldworkers answer questions, “the truth is that they are very kind and they say, ‘come’ and they begin to explain, and because they are in the fields, they know a great deal, and they explain it.” Here [at the university] they give you all the resources you need to succeed….for example, they give you the time, the hours to study, tutorials…. I think that here they give you the confidence to come and be able to achieve all your goals,” said Jenny.Faculty, staff, the counseling center, and a religious ministry provided emotional support as well as academic support to students. Jenny underwent a personal crisis while a student at the university. “People from the religious ministry, the counseling center, many times, no matter the hour, when I was crying and feeling bad, they came and opened up, we would talk, and they would try to see what I could do to feel better.” Jessica said, “I can speak to this because [two women from the counseling center] have been there in my moments of crisis; last year in a difficult moment without the help of those two, I would not have been able to control it; the help has been enormous.”Peer support from classmates, roommates, and friends was vital to students’ social and emotional well-being. Soraya claimed that her roommate was a pillar of support, “because it is with her that I share experiences and… if one feels bad in the night or begins to think about things, because one is always going to miss the family or something bad will happen that is very difficult, well, she is always there to listen. In praising help from instructors, Aysha pointed out that, “A while ago, I had a family problem and other than my roommate and three classmates that I consider my best friends [they also supported me]. So, for Aysha the primary sources of support were her roommate and friends. Ana, in her 4th year at the university, received support from a [male] friend, “well, I wasn’t friends with him in the first or second years, but when we were in the third year of studies, he saw I was having difficulties with some things, and he was very available and attentive and he has helped me a lot.” A fourth year student underscored the importance of friendship, “My best friends during these four years I suppose are [always] going to be my best friends and they are people in who I confide my experience and I don’t hesitate to ask them something I don’t know and I am not afraid to be myself.”The women sometimes faced challenges in the social environment. “[I had challenges] in social relations, relating to people, because at the beginning I didn’t know anyone, and then I came to know many people,” said Ana, a first-year student. Cultural differences were sometimes problematic, “how to live in a different country, different from your country. Even though we are all Latinas, we have differences. This is something shocking, both the food and the culture,” said Sandy. “I had to get to know new people, other cultures,” said Juana, a fourth-year student. Soyaya, in her second year, said, “[When I arrived] I was not very focused on land or agriculture, and they were making fun of me, and one of the seniors came over and said, “You can do it; if I can, why not you?” In her advice to incoming students, Jessy admonished, “Sometimes you will be bullied, and things like that, but be strong and persist.”Machismo on the part of classmates was a common experience at the university. Tutis expressed this strikingly, “Ugly as it sounds [new women students] are entering the lions’ den; they are the fresh meat.” She continued, “[My advice is] don’t let them sweettalk you, because all lions want to take advantage of you.” A milder form of machismo was reported by the first- year student, Gaby, “the boys from the other years, they view us like objects, they don’t see us as people, with feelings.” Machismo was most prevalent during fieldwork that often required physical strength. According to Aquira her male classmates would complain that she was small and thin. Skarleth pointed out that men paired with women in work groups complained, “[women] don’t work, arrive late and [men] do the work.” Sometimes tasks were assigned according to gender, “they divide us by work, girls in light work and boys in more arduous work.” On the other hand, women were sometimes preferred as co-workers for academic tasks, “I think that in the academic domain, in class, [men] give us more responsibility, because they prefer working with women…. Because they are a little more distracted let’s say, and it’s more difficult for them,” said Elizabeth. The women reported determination in confronting machismo, “We are more determined when we set a goal, it is women who give advice here to men on how to behave, how to study. Although we are a minority I think we are better,” said Sarai, a first-year student. And in response to men who said, “You women are not good for anything, not for falling in love or taking to bed,” Jeysul replied, “I came to study, not to fall in love or to go to bed with anyone.” Soraya said, “Even though we are not men, we have the same strength as them, everything depends on our willpower and the effort we make.”familismo, in Latin American culture, “I believe that the fundamental pillar in my life is my family.” In response to a question about who has helped them achieve their goals, the most prevalent answers were parents, family, and siblings. Jeysul a third-year student said, “Every time I feel like I can’t do it…… I call my mother…. It’s like ‘mamá, I feel like I can’t, I feel tired,’ and she is like, ‘lie down and sleep…. drink some sugar water;’ for me my mother is that help, she has always been that support for me.” Many students reported missing their families while attending the university. According to Soraya, “you are always going to miss your family.” “It is difficult because you don’t have your brother, even to fight with or to bother you, but you have to overcome that.” Advice from family members often took the form of proverbs: “The immensity of sacrifice matches the immensity of success,” was the pithy saying in Skarleth’s family. Being apart from one’s family could also be stressful when the family experienced problems, For Ana, in her fourth year of university, the biggest challenge was having an aunt who was sick with terminal cancer, and she feared the worst with every phone call. Tutis, also in her fourth year of studies, said, “you are part of the family problems, but at the same time not [present], so all those things, those conflicts, the news, those impulses where you can’t do anything because you’re so far away…. I’m the oldest daughter so I get four versions of the problems at home – my mother, my father, and my siblings.”Although all students resided at the university, their families continued to play a prominent role in their lives. Families provided emotional and financial support, but also were a source of stress and responsibility. Victoria expressed the centrality of family, often called Although religion was not a prominent theme, it was mentioned as a support system in each focus group. Sarai used the common phrase “primero Dios [God willing] I will graduate,” as an expression of hope. As reported above, Jenny received support from the church ministry. Gloria, a third-year student noted that going to church helped her deal with stress. And Soraya, a second-year student was grateful to God for the opportunity to study, “[it] was an opportunity that life has given us, that God has given us.”A sense of empowerment was highlighted in the students’ future goals and aspirations. Empowerment has been defined as, “the ability to exercise choice” , p. 436.Although the data for this study were collected at a single point in time, students’ reflections on their previous and anticipated experiences allow a glimpse at the process of change, labeled as the chronogram by At the university, the personal quality of persistence despite obstacles was prominent. A major theme was the expression of self-efficacy, confidence in one’s capability to carry out actions and achieve goals. Although self-efficacy, per se, was not specifically encompassed in the original Women’s Empowerment in Agriculture Index (WEAI), it was incorporated as a part of agency in a revised version of the WEAI , machismo, and religious faith were evident and as pointed out by Widely-shared cultural values are considered by Familismo or familism is a central feature of Latin American culture, defined as, “[placing] the family ahead of individual interests and development. It includes many responsibilities and obligations to immediate family members and other kin” , and are colloquialisms, rather than indicators of religiosity. For the university students, attending church was an extracurricular activity and served as a support group. These findings might reflect the current decline in religiosity, especially among middle class youth, in Latin America (per se may not have been a dominant force in students’ lives, some of the basic tenets of Christianity seemed to permeate their thinking. Many anticipated a life of service to others and described gender roles derived from Christianity.Christianity is the dominant religion among Latin Americans. In 2020, over 80% of Latin Americans claimed a Christian faith . Moreove America . NonetheThere were dynamic interactions among the ecological systems of the women students. Their roommates, classmates, friends, and instructors encouraged them in both academics and fieldwork. Instructors and fieldworkers sometimes served as proxies for parents and older siblings, dispensing support and advice. Support from others was seen as essential to women’s achievement and thriving at the university. Ana in her first year said, “I think that here in this environment I have learned that we need other people, that we need one another; on my part my classmates have helped me, have helped me a great deal, teachers also, the counseling center of the university.” Reliance on others to thrive may be a universal need, but may also be exaggerated by cultural collectivism in Latin America .Everyday experiences of differential gender roles, reciprocity, and close familial relationships reflected cultural values of Latin America. The contrast between fieldwork, where men often disparaged women’s work and the classroom, where they preferred working with women and often assigned them leadership roles may relate to the familism and gender role ideologies prevalent in Latin America. The outside fieldwork may be analogous to the public sphere where men often dominate and can assert their power, whereas the classroom may resemble the private sphere, in which Latin American women have exercised relative power . The marWith respect to their futures, the female agricultural students saw their horizons expanding. They anticipated further education, establishing their own businesses, as well as contributing to their families, communities, and countries. Some wished to travel abroad and explore other nations and continents. The women’s desire to make a contribution, both to their families and their countries may stem, in part, from the familism and marianismo values, both of which emphasize service to others.The students in our study are well-positioned and empowered for their futures. As accomplished graduates, they will be able to serve as role models for other women working in agriculture . As roleThis study documented the experiences of a group of women students attending an agricultural university, but it cannot be generalized to other situations or conditions. And despite attention to the trustworthiness of the findings and the employment of reflexivity, member checking and auditing, the investigators were prepared to notice the growth and transformation of students, rather than their mistakes and missteps. The researchers’ shared commitment to women’s empowerment may have inadvertently influenced the focus group discussions, as well as the coding and interpretation of the findings. Although a sense of empowerment was clearly expressed in the focus group discussions, the specific personal and environmental factors fostering empowerment are unknown. According to the participants, the keys to success included physical and emotional effort, maintaining a positive attitude, not trusting too readily, relying on friends and family, recognizing that this is not a “feminine” life, and keeping a focus on the future. More research is needed to further document the preconditions for empowerment and to explore the women’s future challenges and successes as professional agriculturists in Latin American cultures. In addition, to fully understand gender interactions and processes at the university, the views of men and persons who are non-binary with respect to gender should also be queried about their gender attitudes and the factors that promote equity across all gender categories.The findings have implications for university policies and initiatives. The recruitment of women students could be prioritized to achieve gender parity in enrollment. Moreover, women students relied heavily on social support from many others – including male and female classmates, faculty, and fieldworkers – to achieve empowerment. Therefore, initiatives to maintain or increase sources of support are essential. Workshops or programs on gender equity might be initiated, perhaps aimed primarily at men . UniversIn sum, a number of ways have been proposed to empower women in agriculture. Among those are initiating agricultural development projects , establijudith.gibbons@slu.edu.The datasets presented in this article are not readily available because the transcripts of the focus groups contain potentially identifiable data. Requests to access the datasets should be directed to JG, The studies involving human participants were reviewed and approved by Human Subjects Research Board, Hope College. The participants provided their written informed consent to participate in this study.JG designed the research study and wrote the manuscript, participated in the construction of the interview questions, the coding of the blinded transcripts, and the data analysis. ZE-F, AM-A, GM-F, IV-M, and AA-S participated in the construction of the interview questions, the conducting of the focus groups, the coding of the blinded transcripts, the data analysis, and reviewed the manuscript for accuracy and completeness. ZE-F led the local team with respect to the research conduct and coding. AM-A served as the liaison with the university administration. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Debate has been warranted as a meaningful activity to promote students’ higher-level thinking, such as critical thinking. However, traditional debate activities which are typically carried out in the physical classroom may meet some obstructions of limited time and space, which would result in the phenomenon that many participants act as silent watchers rather than mind exchangers. Moreover, it is hard to make a visualized record about the whole process and contents of the traditional debate activity. The current study aimed to explore the effects of argument map (AM)-supported online group debate activities on college students’ critical thinking, including their depth and phases of critical thinking, and the relationship between students’ depth of critical thinking and their number of speeches. In the study, an innovative argumentation construction way was designed. All students enrolled in a course could have a chance to attend the AM-supported online group debate activities and the whole process and outcomes of online group debate could be visualized by AM. At the same time, the effectiveness of the innovative activities was evaluated by content analysis of AM. A total of 42 sophomores in the undergraduate course named “Learning Sciences and Technology” were recruited to attend online group debate activities assisted by a web-based visualization tool named “ZJU Yuque” in 5 weeks. Newman’s framework about the depth of critical thinking and Murthy’s instrument of critical thinking phases were employed as guidelines. We found that 42 students’ overall depth of critical thinking was gradually improved in an obvious way during the five online debate activities. The most frequent phases for students in the first and second team in online group debate activities include Understand→Understand (U→U), Recognize→Understand (R→U), and Understand→Evaluate (U→E). However, students’ creating behaviors were not significantly generated. Teachers’ real-time feedback was helpful for students’ improvements of high-level thinking skills and their preparation for the next debate activity. Students’ interviews found that students highly valued such online group debate activities because every student could have a chance to express their thoughts and they had enough time to prepare debate contents. Based on the findings, some implications were proposed for the better design and implementation of online group debate activities. Critical thinking refers to the “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as an explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based” . In thisCritical thinking was closely related to the creative thinking . TherefoSuch instructional activities as dialogue, free questioning, debate, self-assessed homework, problem-based learning, and collaborative group work were proven efficient in improving learners’ depth of critical thinking . Among tArgumentation is the main activity in the process of debate , it asksSome efforts have been made to ensure that all students can participate in debates. For example, students were asked to write down their arguments, allowing them to present their opinions with more sentences than just the propositions . HoweverTo deal with such issues, the aim of this study was to design an argument map (AM)-supported online group debate activity in an undergraduate course, in which all students could attend the debate by constructing an argument map in an online learning platform. Debaters’ critical thinking was objectively evaluated by analyzing the content they wrote in AM. Before introducing the main contents of the study, the literature review was presented.An argument map is a visual representation of argumentation; in an AM, claims and evidences were represented by a diagram comprising of “colorful boxes and arrows” and indicates a claim and claim-evidence relationship, colorful boxes indicate the status of basic claims, such as claims, reasons, rebuttals, they are represented by different colors. The arrows reveal the evidence-based relationships between basic claims . An AM hvia Rational software, argument mapping via manuscript and pencil, and traditional instruction without AM) on students’ critical thinking. Result demonstrated that students showed the highest level of critical thinking when they constructed AM through Rational software.To deal with such shortcomings, computer-based AM was proposed as a better argumentation development . ConstruWhether constructed in a traditional or computer-based environment, AM focuses on the inferential structure of argumentation and require all argumentation with “boundaries” . In anotGenerally speaking, when students construct AM, their number of speeches is an important reference to reflect the engagement. The more the number of their speeches, the larger size the argument map. According to the fact that mapping  and softHowever, some studies found no difference between students’ critical thinking and their engagement , in whicMany previous studies have used the survey to evaluate students’ depth of critical thinking in computer-based AM . For exaContent analysis is an objective evaluation method; it usually codes students’ oral or written contents based on the specific theories or frameworks. For example, in the study of In addition to theories, some frameworks are also frequently used to code students’ oral or written contents. For example, in critical thinking-related studies, Newman’s depth of critical thinking framework  or MurphLiterature review has indicated that AM could be adopted to present the structure of argumentation in a clear form. Computer-based AM could provide more participants the opportunities to engage in argumentation activities. However, in previous studies, AM was usually drawn by students in a team holding the same view. Few studies explored the effects of students with opposite viewpoints to draw AM together, which was supposed to facilitate rebuttals. In the study, an innovative argumentation construction way was designed. All students enrolled in a course could have chance to attend the AM-supported online group debate activities and the whole process and outcomes of online group debate could be visualized by AM. As to the effect of AM, many previous studies have proven that AM could promote students’ critical thinking, which was normally evaluated by the survey. It remains unknown that whether or not students could practice their critical thinking by practicing more. In this study, the effectiveness of the innovative debate activities was evaluated by content analysis of AM.Based on the literature review, the study aims to design AM-supported online group debate activities to improve college students’ critical thinking skills. In the activities, two debate teams holding the opposite viewpoints could carry out online group debate through drawing AM together. To examine the effects of the activities, not only students’ depth and phases of critical thinking could be evaluated through analyzing the contents in AM, but also the relationship between students’ depth of critical thinking and the number of speeches could be explored. Specifically, the study includes the following research questions:Q1: In each debate, what are debaters’ general depths of critical thinking and their number of speeches?Q2: Is debaters’ depth of critical thinking significantly correlated to their number of speeches?Q3: What are debaters’ phases of critical thinking?Q4: How do debaters perceive the AM-supported online group debate activities?Learning Science and Technology. This course was a compulsory course for all sophomores majored in education. Among these 42 students, 38 were female and 4 were male. Their average age was 20. To attend the debate activities, these 42 students were randomly divided into five groups. Four groups had eight students and one group had ten students. There were two debate teams (pro and con) in each group, and each team had four or five members. Each debate team was randomly assigned the position (pro or con) of the debate in the group.The participants of this study were 42 sophomores enrolled in Zhejiang University (ZJU), China, which was founded in 1897 and is a top university in China. The 42 participants took the course named The course was taught in 8 weeks of Spring Semester 2021 (from 2 March to 22 April 2021). The course was twice a week (one on Tuesday and the other on Thursday). In each lesson, students needed to take two continuous classes and each class lasted 45 min. The main contents of the course include foundation of learning science, technology-supported learning, technology-supported teaching, methodology in learning science studies, learning assessment, and future learning. Students’ performance in the course was mainly assessed from these aspects: posting debate topics (10), debate activities (50), group presentation about debate activities (20), and learning reflection (20).In the first week, the instructor gave students a general introduction about course arrangement, such as course goals, outline of course contents, course schedule, guidelines for debate, and criteria for students’ performance assessment. The first 2 weeks were featured by the instructor’s lecture about the basic knowledge about learning science. From the 3rd week to the 7th week, five debates were integrated into the course, and it took place on every Thursday. In the last week, students were asked to make a learning reflection.In the first week, eight rules about the debate were presented to students: (1) all statements and responses should be expressed appropriately and respectful; (2) information should be clear, accurate, and comprehensive; (3) rebuttal should be clear, relevant, and strong; (4) facts, statistics, and literature are needed when supporting opinions; (5) contents should be organized logically, and have reasonable and orderly arrangement; (6) debaters should understand the topic clearly, and debate under the same concept; and (7) information should be presented professionally. By learning these rules, students would better understand the key points of debate.From the 3rd to the 7th week, on each Tuesday, the instructor lectured on a specific topic. Right after the instructor’s lecture, students were encouraged to propose debate topics through an online discussion board in an online platform named “Learning in ZJU.” After the debate topics were proposed, students were selected their topics through voting. The top three topics were considered as debate topics, and students chose one from the three topics. After selecting debate topics, each group consisting of one pro team (4 or 5 members) and one con team (4 or 5 members) would carry out AM-supported online debate activity through “ZJU YuQue” platform. Comparing with traditional debate activity, the activity designed in this study has obvious innovation in two dimensions. Firstly, all students could have a chance to attend the online debate activities at their own pace through “ZJU YuQue” platform. “ZJU YuQue” is an online collaboration platform that could support students to draw AM at any time. As (A)Yunnan Luquan No. 1 Middle School, one of the 248 middle schools in poverty-stricken areas, took the synchronous classes through live video with Chengdu No. 7 Middle School, which is a school with high quality of education. This had increased enrollment in poor areas and reduced the loss of local students. In 2019, all students in one class that adopted this teaching method went to key universities.(B)This is peer-to-peer supporting. The limited high quality resources could not meet the needs of all schools in poor areas.(C)This problem can be addressed through the flexible application of technology.(D)The high quality resources could be one-to-many in asynchronous class, such as massive open online courses (MOOC).(E)Some studies have explored the effect of MOOC on students’ learning. Results indicated that children from poor families showed lower participation and completion rates in MOOC.The argumentation above demonstrated that the pro side supported their viewpoint with evidence of A. Then A was rebutted by B, which was generated by the con side without evidence. C means the rebuttals to B without evidence. D was rebutted by the con side with evidence, and the evidence was shown as E.Between the 3rd and the 7th week, on each Thursday, all the five groups were asked to present the main content of their AM. The final score of each debate was decided by the instructor and the teaching assistant.In the 8th week, some students were randomly invited to share their learning reflections. After the 8th week, all students were required to submit their learning reflections to the instructor. Additionally, students’ semi-structure interview was also carried out 1 week after the 8th week.+ − X−)/(X+ + X−), and its range is between −1 and 1. The higher the value of the ratio, the higher students’ depth of critical thinking. For example, −1 means that all indicators of an individual’s viewpoints are negative information, and it implicates that the individual has no depth of critical thinking. 1 means that all indicators of an individual’s viewpoints are positive information, it implicates that the individual has a high depth of critical thinking.In this study, the content analysis framework of critical thinking developed by Additionally, the content analysis framework of critical thinking developed by Data were collected in an innovative way. Different from the survey, which was subjective, the content of AM drawn in “ZJU YuQue” platform was the most important source of data in the study. The contents were analyzed based on the analysis unit. Each rectangle was considered as an analysis unit. Guided by Newman’s depth of critical thinking framework, all analysis units were independently coded by two doctoral students majoring in educational technology.In order to know the phases of debaters’ critical thinking, the content of AMs in the first- and second-team  was analyzed. The content was analyzed based on the analysis unit. Each sentence was considered as an analysis unit. Guided by Murphy’s critical thinking phases framework, all analysis units were independently coded by two doctoral students majoring in educational technology. And then the codes were analyzed by the software of GSEQ , which is a computer program for analyzing sequential observational data.In order to understand how students perceive AM-supported online group debate activities, the semi-structured interview was conducted and it was designed by instructor and assistant. The semi-structured interview includes three questions: (1) How do you perceive the online environment? (2) How do you perceive AM? and (3) How do you evaluate instructor’s role during the debate?As to Q1 , the reliability of coding was 0.77, indicating that the coding was reliable. Content analysis found that, in five debates, debaters’ depths of critical thinking were 0.81, 0.85, 0.86, 0.89, and 0.90, respectively, which indicates a gradual upward trend . AdditioAs to Q2 , correlation analysis found that there was no significant correlation between debaters’ depth of critical thinking and their number of speeches . That isAs to Q3 , the content of AM was drawn by debaters from the first- and second team were analyzed as a sample. The reliability of the coding was 0.72, indicating that the coding was reliable. As for the number of effective single sequences, it was larger in the second- and fifth debates, with the number of 141 and 137, respectively. In these two debates, the type of debate topics was “yes or no,” while in the third and fourth debates, the type of debate topics was “choose one from two,” the former brings a wider range of discussions, while the later limited discussion scopes, which may make the argumentation challenging to carry out. While for the first debate, although the topic type was “yes or no,” students were not familiar with the AM-supported online group debate activities; therefore, the number of effective single sequences was still small.In terms of the top three effective single sequences, it could be seen that Recognize→Understand (R→U) and Understand→Understand (U→U) ranked first and second in the first and second debate, while they ranked second and first in the last three debates, indicating that the quality of debaters’ critical thinking phases was improved.As to Q4 (How do debaters perceive the AM-supported online group debate activities?), semi-structured interview was utilized to collect opinions from 20 interviewees. For the question of “How do you perceive the online environment,” interviewees showed two opposite attitudes. Some students expressed their positive attitude. They reported that online environment could provide them more time to think, allow them to engage at any time and rebut without awkwardness. This indicated that AM-supported online debate not only provided all students the flexible time to engage, but also helped them to debate freely without pressure from social relationships through rebutting anonymously. As an interviewee stated, “In online environment, I needn’t end in a specified time. I can add new content in a few days, which deepens my discussion and helps me better understand the topics.” Such statement reflected that the time was sufficient for students to debate online. However, some students expressed the negative attitude about the online environment. They thought that the online environment extended argumentation time and let them spend too much time on the activity. Sometimes, they were unable to support or rebut timely. This implied that the appropriate debating time as well as the reminder whenever students write their speeches in the AM should be set in advance. For example, an interviewee mentioned, “I feel like that I have to argue every day, which took up a lot of time away from doing other things.” Such expression suggested that the online debate was a time-consuming process.For the question of “How do you perceive the AM,” all of the 20 students expressed their positive attitudes. The reasons might be as follows. The AM helped them to get a clear picture of debate, provide topic-related supplements or rebuttals, make the evidence-based supplements or rebuttals, and organize the thoughts in a logical way. This indicates that the application of AM could not only facilitate students’ evidence-based supplements and rebuttals, but also encourage them to organize these evidences logically. An interviewee stated, “The map makes the argumentation structure and content clear. The different colors represent different means, I could see what others rebut or support my side clearly,” this statement was the indication that students understand the structure of debate in a clear way.For the question of “How do you evaluate the instructor’s role during the debate,” all the 20 students expressed their positive attitude. Students’ AM was commented and their effort was recognized by the instructor. The instructor emphasized that argumentation should be evidence-based and both teams’ argumentation should be under the same concept. Generally speaking, the instructor’s guidance helped students in gaining both argumentation skills and professional knowledge. For example, an interviewee mentioned, “Evidence-based argumentation was one of the most important words I learned from the instructor’s evaluation. That is, when making a point, we should be sure to back it up.” The sentence showed that students realized the importance of evidence in argumentation.The aim of the study was to explore the effects of AM-supported online group debate activities on college students’ depth of critical thinking. Five AM-supported online group debate activities were designed based on the platform of “ZJU YuQue.” A total of 42 sophomores majoring in education were invited to attend the debate activities. Guided by Newman and Murphy’s framework of critical thinking, content analysis of debaters’ speeches found some interesting findings.Firstly, in five debates, debaters’ general depth of critical thinking increased gradually. The result was in agreement with the previous studies , which iSecondly, debaters’ depth of critical thinking was not significantly correlated to their number of speeches. The result was consistent with Thirdly, through exploring debaters’ phases of critical thinking in the first- and second team in five debates, it was found that Understand→Understand (U→U), Recognize→Understand (R→U), and Understand→Evaluate (U→E) were the top three effective single sequences, indicating that the phases of debaters’ critical thinking were relatively low. This result could be explained from the following aspects: (1) Traditional AM is usually drawn by students on the same side at the fixed time, which is not good for triggering the rebuttals. At the same time, the effects of AM-supported argumentation activities are normally measured by the survey instrument. This study designed an AM-supported online group debate activity, which could allow all of the participants (both the con and the pro sides) to visually debate by drawing online AM together at a flexible pace. Students could not only support their own viewpoints, but also rebut the opposite sides in the same online AM. Students’ depth and phases of critical thinking could be objectively evaluated by analyzing the contents they created in the AM.Additionally, in order to know whether students’ critical thinking skills were practiced through participating debate, the relationship between students’ depth of critical thinking and the number of speeches was explored in the study. Results indicated that debaters’ general depth of critical thinking was increased gradually. Understand→Understand, Recognize→Understand, and Understand→Evaluate were the top three behaviors for students in the first- and second team usually had during the argumentation. Students’ critical thinking skills were not practiced by participating in the debate.Based on the results, some enlightenments are proposed. Firstly, the debatable and lecture-related debate topics are the premises for high-quality argumentation. Secondly, drawing AM online allows all students to think and collect debate-related evidence in sufficient time, to express their ideas at their own pace, to organize the evidence in a more logical way, and to understand the structure of argumentation in a more clearly way. Thirdly, rebutting anonymously let participants express themselves freely, for they don’t have to consider the pressure from the social relationship. Fourthly, the timely and procedural feedback from the instructor facilitates students’ gaining in professional knowledge as well as argumentation skills. Finally, in order to practice students’ critical thinking skills through their participation in debate, an evaluation criterion that emphasizes both on the quantity and the quality of debaters’ speeches is needed.Although the study found some meaningful findings, the study has some limitations. Firstly, the study was carried out in a relatively short period. Secondly, the debate teams included different number of members (4 or 5), this might affect the debate team’s overall depth of critical thinking. Thirdly, some topics were not suitable for debate; the unsuitable debate topics may also affect the debaters’ depth and phases of critical thinking.Based on the findings and the limitations of the study, some suggestions are put forward. Firstly, in AM-supported online group debate activities, to further explore debaters’ depth and phases of critical thinking, and the relationship between debaters’ depth of critical thinking and their number of speeches, more studies are encouraged in more courses from diverse disciplines. Secondly, the instructor may engage in the process of students proposing and choosing debate topics, ensuring that the topics were closely related to course content taught in class. Finally, considering the familiarity among team members may weaken their frequency of rebuttals, further studies may explore debaters’ depth and phases of critical thinking in an anonymous way.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.XC is mainly responsible for the implementation of experiment, manuscript writing, and data coding. LW is mainly responsible for data coding. XZ is mainly responsible for manuscript writing. YL is mainly responsible for the implementation of experiment and manuscript writing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Classic psychedelics have been administered in sacramental contexts since ancient times. They were of prominent interest within psychiatry and neuroscience in the 1950s to 1960s, but the association between classic psychedelics and the emerging counterculture put an end to their research. Modern research with classic psychedelics has reinitiated interest in the treatment of both cancer-related distress and addiction, with really promising results.We aim to provide a review about history and new insights regarding research with psychedelics specially as treatment of addictive disorders.A framing analysis of articles, searched on Pubmed (articles between 2010-2020) with the key words: “ psychedelics”, “psilocybin”, “substance use disorder”, “addiction”.Classic psychedelics are 5HT2AR agonists such as LSD, mescaline, and psilocybin. They were shown to occasion mystical experiences, which are experiences reported throughout different cultures and religions involving a strong sense of unity. These experiences are scientifically important because they appear to cause abrupt and sustained changes in behavior and perception, that can be very useful in the substance use disorder field. From this analysis is possible to understand that the use of psychadelics in the treatment of some addictions is currently at an early stage of research. However, they show interesting results with no clinically significant adverse events when risk individuals are excluded.In comparison to psychedelic research about cancer-related psychological distress, studies with addictions are less developed, but if they continue to suggest safety and efficacy, may be the use of psilocybin for the treatment of specific addiction can happen in a close future.