Behavior analysts are not recognized or regulated as a distinct profession in Europe. For the most part, European behavior analysts adhered to the standards set by the U.S.-based Behavior Analyst Certification Board (BACB). However, the BACB certification has not been recognized officially in any European jurisdiction. The recent decision by the BACB to discontinue eligibility of non-U.S. residents to apply for the BCBA exam by the end of 2022 has brought the issue of professional regulation outside of the United States into sharp focus. This article offers a snapshot in time of professional recognition of behavior analysts in 21 European countries. It stems from the Erasmus+ funded EuroBA project and its Professional Advisory Group (PAG). The EuroBA project aims to develop common standards and competences for behavior analysts to facilitate national regulation and mutual recognition across Europe. The global recognition of the professional status of behavior analysis is uneven across continents. In Europe, for example, it is not recognized and practice is largely unregulated. Without professional regulation consumer protection is not guaranteed because there is no agreed definition of the parameters of scope and competence. The result is that service users have limited access to well-trained behavior analysts. In addition, there is restricted cross-border mobility for professionals, and most important, consumer safety is compromised at significant cost  are promoted without accurate reference to their scientific heritage. This has left service users confused and unable to differentiate between ABA and specific kinds of services. For example, some advocates of positive behavior support (PBS), a clinical approach to challenging behavior that is grounded in ABA  evolved as a means to define professional standards through development of a common reference frameworks thereby supporting not only good practice but also cross-border mobility. In general, in order to achieve mutual recognition, a profession needs to be recognized and regulated with a country, before mutual recognition agreements can be negotiated across Europe. The European Parliament and the Council of the European Union (2013) clarify the necessary procedures. Mutual recognition across Europe has been agreed only for a limited number of professions, including doctors, nurses, dentists, veterinary surgeons, midwives, pharmacists, and architects. Such recognition is multilateral and based on harmonized minimum training requirements, a general system for the recognition of evidence of training, and recognition of professional experience.For professions that are not eligible for automatic recognition, qualifications may be recognized under Article 45 of the Treaty on the Functioning of the European Union  or under Article 53 of the TFEU (freedom of establishment). “In these cases, the competent authority of the host Member State must compare your training with its national training by taking into account your professional experience and any further training. If the training corresponds only in part, it may ask you to make up for these differences, for example by taking a test, doing a traineeship or an additional training course, depending on the national rules” :Map the profession of behavior analysts onto the European Qualifications Framework (EQF).Describe progress in the six partner countries based on their National Qualifications Frameworks (NQF) and show how these maps onto the EQF.Produce a glossary of terms that facilitates a common language among behavior analysts.Outline key competences for EuroBA-T  and offer a guide for course developers.Outline key competences for EuroBA-M (Masters level) and offer a guide for course developers.Provide an online multimedia entry, predegree level, technician course  project in collaboration with its Professional Advisory Group (PAG). The EuroBA project is a 3-year project (September 2020–August 2023) funded through the European Commission Erasmus+ program. The project is led by Professor Mickey Keenan  and includes nine partners from seven European countries . The EuroBA project was conceived with the realization in mind, that common standards and curricula would have the potential to ease the administrative burden on countries aiming to achieve professional recognition of behavior analysts in their jurisdiction and, at the same time, eventually facilitate mutual recognition across Europe. The EuroBA project is producing six http://euroba.org).The EuroBA project will be completed at the end of August 2023 and the IOs will be freely available to any country aiming to progress professional recognition in their jurisdiction and targeting mutual recognition across Europe and further afield  was set up to ensure that European and allied countries who are not partners of the funded EuroBA project have an input to the intellectual outputs that are developed in the EuroBA project. At the time of writing, 15 additional countries were represented on the PAG. Membership of PAG is open to all counties and includes one representative per country. Each member of the PAG represents the national organization/s that lead the developments for seeking professional recognition of behavior analysts in their home country. In countries where such an organization does not yet exist, or is in an early planning stage, a designated behavior analyst is a member of the PAG.This document by no means offers the complete picture across Europe. It simply presents a snapshot in time. Countries not represented in the present article who are keen to join the PAG are welcome. The descriptions of the state of play of the 21 countries in this article are presented in alphabetical order. It will be seen that countries are at different stages of development of the dissemination of ABA, the foundation of a national association, training opportunities, and professional recognition of behavior analysts and, as a result, the descriptions reflect national similarities and differences.The situation in Austria is limited, because behavior analysts are almost nonexistent. Indeed, there are two internationally graduated BCBA psychologists in Austria as of October 6, 2021, who work with individuals with developmental disabilities; one person has completed her MSc in ABA and her PhD at Queen’s University Belfast, on applied aspects of behavior analysis with human–dog dyads.According to DeSouza and Konrad , the sitBelgium only has five BCBAs, including three at the University of Ghent (see BACB Certificant Registry). We lack the subsidies for educational practices that are common for targeting socially appropriate behavior for all people with rights to inclusion in a tolerant society. Thus, in Belgium parents of children on the autism spectrum have become increasingly isolated as they cry out for evidence-based practices for their children with autism.Recognition of the field of ABA is just emerging in Croatia. Although Croatia does not have a national association or accreditation body yet, some significant changes have occurred since 2017. The University of Zagreb was approved to provide a one-time VCS for approximately 20 students. Thanks to that opportunity, Croatia went from having no certificants to seven BCBAs and six RBTs according to the BACB Certificant Registry. Before the VCS, Croatia had two more senior certificants who moved to the country from North America in an effort to help disseminate ABA.Given that the emergence of certificants in the country occurred relatively quickly and recently , Croatia does not have a national association, recurring VCS, or an accreditation organization. Most certificants work in the public sector  with only three working privately. Certificants working in the public sector do not necessarily state openly that they provide ABA-based services, but rather work under their core professions . In addition, there are some uncertified practitioners who provide services that are neither regulated nor quality controlled. Inconsistent quality of services along with low national awareness of what ABA has contributed to misconceptions and misrepresentations of the field.In response to their membership in the PAG of the EuroBA project, certificants in Croatia have recently started to meet regularly in an effort to form a national association and possibly a chapter of the ABAI as a first step towards building awareness, increasing consumer protection, and helping to move the field along in Croatia.The science of behavior analysis has been growing steadily but slowly in Cyprus over the last 15 years. A small number of behavior analysts who had been trained in the United States and UK returned to Cyprus and started working privately by offering ABA-based services to families and children with disabilities after 2004. In 2011, the Cyprus Behavior Analysis Association (CyABA) was established as a nonprofit organization. The founding members included three BCBA certificants and one person with a PhD in ABA.The CyABA has focused on promoting the science and practice of behavior analysis as well as establishing the profession of behavior analyst. In October 2017, the Association conducted its first national conference in ABA, attracting great interest from educators, health-care professionals, and parents. Despite efforts to expand the CyABA, the number of people involved in the organization remains small. At the time of this writing, there are six active professionals certified as BCBA and one as BCaBA, who work privately by offering services to families and their children with disabilities. According to data retrieved from the BACB online Certificant Registry on April 28, 2021, there are an additional seven professionals whose status either expired or is inactive.The future of ABA in Cyprus remains uncertain but promising. Future efforts should include two main goals: (1) creating an VCS (verified by ABAI) with local universities to increase the number of ABA professionals on the island; and (2) pushing forward to establishing the profession of behavior analysis under Cyprus’s existing legislation framework.ABA has been slow to gain momentum in the Czech Republic. Prior to the fall of the Iron Curtain, behavior analysis was virtually unheard of. Behavioral science started to emerge in the late 1990s. From 2015, parents of children with autism built support for ABA by bringing together politicians and national and international academics, organizing the first major ABA conference in Brno, and arranging a parliamentary hearing in 2016  was established in 2016, followed by the foundation of the Working Group for Applied Behavior Analysis of the Czech Medical Society  has granted approvals to several continuing education courses of SLPs focused on ABA. There also has been increased interest from schools to use practices based on ABA. In fact, in 2021, the first medical facility providing behavioral interventions for children with neurodevelopmental disabilities was opened in Prague.At the same time, there was a concerted effort to translate behavior analytic materials into Czech, starting with the translation of the multimedia resource SimpleSteps  and the The situation in Denmark with regards to ABA is at an early stage. The Danish Association of Behavior Analysis (DABA) was founded in May 2003 and has 221 members. The Danish Association is driven by the demand for services among families affected by autism, but it is a small organization compared to those in most of the other Nordic countries. The Danish Association has been actively lobbying for better education for children with autism in the local and primary schools. Several professionals provide private ABA-based services for individuals with autism or other developmental disabilities in Denmark, but the educational level of these professionals is not regulated. A few professionals work in a public setting in an ABA position. As of July 4, 2022, there are only four BCBA’s in Denmark and one professional with a MSc in ABA.The positive effect of ABA-based interventions for children with autism is recognized by the Danish government, but the endorsement varies across the country. One Danish Commune is offering ABA-based interventions as an alternative to a special school and kindergarten placement. Only few schools and institutions hire ABA professionals, and no government agencies offer full ABA-based programs. There are no academic programs in behavior analysis. The lack of university programs in ABA is one of the main obstacles that impede the development of ABA in Denmark. In addition, the strict rules regarding language create barriers that makes it difficult for many to access international training resources, most of which are offered in English. Translating the technical terms into plain professional language is going to be crucial for the future development of ABA in Denmark.Together with the other Nordic countries , the Danish Association of Behavior Analysis is involved in developing quality assurance of behavior analysis within the Nordic context. This is of great importance for the future development of ABA in Denmark.ABA has been developing slowly in France over the last 2 decades, driven by the demand for services among families affected by autism but with little organization and coordination. Autism had long been considered a psychosis and as such autistic persons were considered objects of care rather than people who would benefit from education. In fact, only 30% of children and youth on the autism spectrum received any services, mostly provided in outpatient psychiatric hospitals  and the Agency for the Assessment of Quality in Social and Medico-Social Establishments (ANESM) published “Good Practice Recommendations for Autism and Other Pervasive Developmental Disorders” . Those two associations offer several sessions a year for approximately 45 students. The only public French university that provided a master’s degree in ABA was the University of Lille, which admitted 5–15 students annually since 2003. The University of Lille was a VCS provider until 2021, but for reasons that are not known publicly, it now is listed as “retired” on the ABAI website , whereas 77,89% preferred to work on creating a national organization  was officially founded in May 2020 as a nonprofit Association Loi 1901Given the limited number of ABA professionals and undergraduate and graduate programs in behavior analysis in France, gaining recognition of a new professional title is challenging. However, for the ONPAC, earning state recognition for its certificants and supporting the community of behavior analysts and the consumers remain the top priorities.The field of behavior analysis has (very) slowly been growing in Germany over the last 2 decades. It started out with one BCBA in 2004 and grew up to 52 BCBAs, one BCBA-D, and eight BCaBAs as of November 2021. The Association for Behavior Analysis Germany was founded in 2011 and has been an affiliated chapter of ABAI since 2013. Also in 2013, a certification program was launched, in cooperation with the University of North Texas, to provide coursework that enabled students to become board certified (after passing the BACB exam). Two cohorts started and most of them completed their certification process by 2019, which helped to boost the number of certified practitioners in Germany. Due to a lack of new students, the program was discontinued.As of December 2021, ABA is not yet recognized as a science or practice by German authorities. Providers can claim funding for “autism specific therapy,” which usually gets covered but there are few standards to qualify as a service provider for people with autism. The lack of university programs, let alone ones in German, is slowing the dissemination of ABA in Germany. Despite these difficulties, many people are interested in the field through participating in workshops or conferences offered in neighboring countries to reading professional books  to offer ABA courses to students studying psychology, health services, organizational management, education, and similar fields. It is hoped that this would spark interest in students in the field of ABA, both scientifically and practically and enhance consumer protection.In the Hellenic Republic, the first public university departments of psychology were established in the early 1990s, and it is in this context that the first two university courses in the Hellenic language in experimental and applied behavior analysis were established at the Department of Psychology at the University of Crete in 1996. The program moved to the Department of Psychology at Panteion University of Social and Political Sciences (in Athens) in 2006, where it expanded to a seven-semester training sequence in experimental and applied behavior analysis, in the context of its bachelor of science degree in psychology. Behavior analytic training at Panteion is supported by a comprehensive 1,000-page Hellenic-language introductory text now in its third edition Mellon, , and supWith only two qualified behavior analytic professors in the entire National University System, the establishment of a master’s degree program is not yet feasible. However, doctoral training in the field is offered both at Panteion University and at the Department of Philosophy, Pedagogy, and Psychology at the University of Athens, which also offers introductory courses in ABA in its undergraduate and postgraduate programs in developmental psychology. Courses in behavior analysis are also offered at several private colleges. Recent recognition of degrees from qualified private institutions of higher learning as equivalent with degrees from the Ministry of Education is expected to increase the number of behavior analysts engaged in tertiary education and research, and to facilitate the establishment of master’s-level training programs.The Hellenic Community of Behavior Analysis (ABA Greece) was established at the close of the 2010 Conference the European Association for Behaviour Analysis (EABA) in Rethymno, Crete, and incorporated at Panteion University in 2012. The Community has over 200 members and is currently organizing its Fifth Biannual Scientific Conference; over 100 Hellenic- and English-language presentations from past conferences have garnered thousands of views on the internet. ABA Greece is a National Member Organization of EABA.In 2015, ABA Greece hosted the inaugural Summer School of the EABA. In 2017, the organization established a 600-hour introductory outreach training program in behavior analysis; in 2019, it was incorporated in the newly established Panteion University Continuing Education Center. In 2021, this accessible overview of behavioral philosophy and its basic and applied sciences, which includes a supervised introductory practicum, was authorized by the Ministry of Education to provide continuing education, with public financial support, for all interested preschool, primary, and secondary-level educators across the country. Others who undertake this training work in fields such as psychiatry, nursing, social work, and speech therapy, and many study behavior analysis to better serve the needs of their loved ones. This outreach program has done much to increase awareness of behavior analysis and to displace misconceptions about behavioral philosophy of science in the Hellenic Republic.In the 2010s, VCSs were established in Athens at Deree College and by the Association for Training in Neurodevelopment/Monorodi day intervention center, but both programs have been retired after the BACB’s December 2019 decision to no longer certify non-U.S. based behavior analysts. According to the BACB Registry, there are 28 RBTs, seven BCaBAs, and 17 BCBAs currently working in the Hellenic Republic. Low market value due to the absence of national and European Union recognition of the BACB certification, combined with its high costs relative to local incomes, limited its pursuit among qualified behavior analysts in our country.As an independent profession, behavior analysis is not currently recognized by government authorities, and qualified practitioners must obtain positions on the basis of their training in a related field, such as psychology, speech therapy, and vocational and special education. As is true elsewhere, a substantial majority of professional behavior analysts in the Hellenic Republic work with children and adults with developmental and learning disabilities. Qualified practitioners have established more than a dozen multidisciplinary centers providing behavior analytic service in Athens, Thessaloniki, Xalkida, and Nafplio.Unfortunately, austerity programs beginning with the 2008 economic crisis and continuing with the COVID-19 pandemic have restricted both government and parental financial resources and, as a consequence, the expansion of organized centers for behavior analytic services. This has meant that many skilled behavior analysists provide low-cost, home-based and parallel school support services for struggling Hellenic families, without systematic organizational support. ABA Greece is currently developing a national certification mechanism.Like other countries, the first steps towards the dissemination of ABA in Hungary were taken by parents of children diagnosed with autism spectrum disorder (ASD). The first ABA program was supervised by professionals from Germany and established and funded by parents in 2009. This family was joined by other families in need who wanted to provide evidence-based treatment for their children. The first Hungarian Board Certified Behavior Analyst (BCBA) received certification in the United States in 2007. At the time of this writing, there are six Hungarian BCBAs, but only four of them live and practice in the country.Within the last 10 years, two foundations were established to further disseminate the science of behavior analysis. Through the support of national and international grants, services were made available for many children with autism and challenging behavior, as well as for mainstream schools integrating children with behaviors that challenge. Although Early Intensive Behavioral Intervention (EIBI) and the Early Start Denver Model (ESDM) are mentioned in official autism practice guidelines in Hungary as best practices, no board certified or trained ABA professionals have been involved in developing these guidelines.Unfortunately, there still are many misconceptions about behavior analysis in Hungary, not only among professionals working with people with autism, but in university-based special education departments as well. The small number of ABA professionals who practice in Hungary have been working on dissemination over the past 10 years. This involved establishing an ABA therapy center to provide early intervention services for 20 families with children with autism, as well as reaching more than 30 schools and hundreds of people through consultations, presentations, and workshops.www.mavee.hu) was established on January 28, 2021, and an online campaign was launched to recruit applicants for the VCS. A second postgraduate behavior-analytic course sequence was established at the University of Debrecen in 2021. Both course sequences welcomed their first cohort in September 2021, which means that the country will be enriched with 18 new behavior analysts by the summer of 2023.The first VCS in Hungary was approved by ABAI in October 2019 at Eötvös Loránd University. With the support of the 2020 International Development Grant from ABAI, the Hungarian Association for Applied Behavior Analysis . This was achieved through successful collaboration of Hungarian BCBAs and ABA practitioners both living in the home country and abroad.Work has begun on translating behavior-analytic literature into Hungarian. In fact, the outcome of the first project of the Association has been completed; the translation of behavior-analytic terms into Hungarian is now free to download from the Hungarian Association of Behaviour Analysis’s website . As a seAs in other European countries, the Irish behavior analytic community coalesced under the minimum practice standards and ethical framework provided by the BACB. Despite the lack of statutory recognition, Irish behavior analysts continued to secure positions in the education, voluntary, community, and private sectors. Their contribution to evidence-based social policy is evident in health, social care, and education policy and guidelines. Positive Behavior Support (PBS) is now on the Irish statute book, and services providing support to people at risk of challenging behavior are required to provide training in PBS . At the EGM, the DBA committed to facilitating the development of an independent organization that could represent the interest of all behavior analysts in Ireland. Over the following18 months, a consultation process was facilitated by members of the DBA and a working group of behavior analysts. This working group developed the governance structures required to form a company limited by guarantee (CLG). This CLG was inaugurated on October 6, 2021, and a board of directors was elected. This board plans to register the company name The Irish Society for Behaviour Analysis.While facilitating the development of an independent organization, the DBA continued to pursue accreditation from the PSI for the MScABA programs in the Republic of Ireland . Both of these MSc programs were accredited by the PSI and verified as course sequence by ABAI, and accept applicants without a primary degree in psychology. Accreditation provides a route to professional recognition for those with a primary degree in psychology. However, without addressing regulation for those without primary degrees in psychology, Ireland could diverge from the strategy adopted by the UK-Society for Behaviour Analysis (UK-SBA), the Behavior Analyst Certification Board in the United States and Canada, and the likely direction of European and international standards professional development. A national divergence from international standards would restrict cross-border as well as international professional mobility  will advocate for the professional regulation of ABA in Ireland and seek to align with international standards of practice as they develop. The principal objective of ISBA is to work to protect the public by advancing public accountability, promoting high standards of professional conduct, professional education and continuing professional development for behavior analysts in Ireland. In the past, the BACB provided shared ethical standards and a means of assessing minimum standards for competence in the practice of ABA. However, the lack of statutory recognition and regulation of ABA inhibited further growth in Ireland, and many talented behavior analysts left Ireland or the profession as a result. Now it is time to share ethical and practice standards internationally while addressing professional regulation nationally.2) country and includes 9.3 million people. ABA services have a relatively short history. The Israeli Association for Applied Behavior Analysis was established in 2003 and a few years later the Israeli Association for Certified Behavior analysts was founded  preparation of an Israeli examination and certification mechanism for licensed practice in behavior analysis (the exam will be based on the current BACB task list); (2) establishment and adherence to the scientific and clinical standards set by the BACB and the ABAI, with adaptations to the Israeli laws and cultural norms as needed; and (3) defining and determining the criteria for field experience of future behavior analysts based on the standards set by the BACB and ABAI, with adaptations that consider the needs and the human resources available in Israel to provide instruction and supervision.The regulation committee was composed of 19 members. They entailed an equal representation of the two professional organizations in Israel, representatives from academics who hold tenure-track positions at higher education undergraduate and graduate programs in Israel, and representatives of key health-related organizations for families with children on the autism spectrum. The state regulation committee included seven subcommittees: Criterion, practicum, examination, exam operation committee, ethics, certification maintenance, and governance coordinating committee. Each subcommittee had its defined goals and working plan that was presented and discussed within the plenum. The regulation committee commenced in December 2021 and the chairs of the two professional organizations for behavior analysts in Israel, who also led the state regulation committee, began spearheading a process of uniting into a single representative organization. To date, Israeli behavior analysts successfully accomplished the establishment of a new, united professional organization for behavior analysis in Israel. This organization is charged on executing the regulation committee recommendations at the state level as well as applying for international grants to support the national process.The word behavior analysis (and behavior modification) became known among a small group of Italian psychologists in the early 1970s, thanks to a Conference at Villa Falconieri in Frascati (Rome) attended by Fred S. Keller, among others  was established, followed by the official founding of EABA that took place in Parma 2 years later  program in behavior analysis. Some private institutions deliver postgraduate course sequences in ABA of different quality and length, at three levels  that resemble the BACB levels. The term “certification” has no status in the Italian welfare system because health professions  are ruled by state laws, whereas the Ministry of Education regulates special educators. As in other European countries, behavior analysts are not formally recognized or regulated as a distinct profession in Italy; the profile of behavior analysts is not (and perhaps cannot be) clearly defined because, in many respects, it overlaps with some functions and task lists of the psychologists.In 2011, the Higher Institute of Health  published Guideline 21 (LG 21). ISS is a public law body that, as the technical-scientific body of the National Health Service in Italy under the Ministry of Health, carries out research, experimentation, control, consulting, documentation, and training in public health. LG 21 acknowledges ABA-based procedures as evidence-supported treatment (EST). Autistic children are the main client group of child psychiatry services. It is sad to report, but few child psychiatrists are trained in behavior analysis and have the minimum knowledge to understand basic principles of behavior analysis without bias or misrepresentations . For this reason, ISS funded and organized a course sequence for them not to become behavior analysts but to make them able to distinguish whether an intervention appointed as ABA-based is well-designed, well-implemented, and effective. The third edition of this course sequence is about to start. The instructors are selected behavior analysts.https://www.abaitalia.org/), which includes 355 behavior analysts (AdC), 155 assistant behavior analysts (aAdC), and 456 behavior technicians (TAC).In 2014, the Italian Society of Experimental and Applied Behavior Analysis . The National Health Service does not officially acknowledge BCBA, BCaBA, RBT certifications.ABA is a young field in Malta with only a handful of practitioners in 2021. In April 2021, a survey was carried out within the behavior analysis community in Malta to get a clear idea of the current context. There were 14 respondents. The first BCBA achieved certification in November 2017 after completing the MSc with Cardiff University, Wales. There were two BCBAs working on the island, two RBTs, and five individuals who have completed their MScABA and are working towards BCBA certification. In December 2021, there was a significant increase and there now are nine BCBAs and eight RBTs practicing on the island, a promising progression for Malta. The University of Malta does not currently offer a VCS and all those who have completed an MSc have done so via online courses or have traveled to study and returned to the island.Practitioners support families either on a freelance basis, or through their private clinics and practices and receive supervision from overseas. At the time of this writing, there is one ABA center in Malta with an in-house BCBA that offers government-funded projects to support children on the autism spectrum. Apart from these individual projects, ABA is not funded or supported on a general basis by the Maltese government. All respondents to the survey work to support children on the autism spectrum and their families, work in school settings, offer parent training and support, and the majority have been working in the field for fewer than 6 years.The appreciation for ABA is slowly growing in Malta with referrals to ABA-based intervention being made by more professionals in recent months. The dissemination of the field among other professionals such as doctors, psychiatrists, speech, and occupational therapists is important because in Malta they typically are the first point of contact when families seek support.In 2016, a talk about ABA was given during a conference and since then ABA has been slowly making its mark on the island. This, however, is only the beginning and dissemination of ABA needs to grow more rapidly and to a high quality and standard. Working with government entities and policy makers to recognize the importance of their support is a current and ongoing journey for stakeholders in the field. It is important for Malta that an entity exists to regulate the field and that practitioners are working towards certification under a regulatory body to ensure that the standard of practice remains high, as have been the expectations under the BACB.There is no formally accredited training and/or education for behavior analysts in the Netherlands, yet a substantial number of services that use principles of ABA to support young people on the autism spectrum and their families have been founded over the last 25 years. Many of these services were set up by parent initiatives, e.g., Robertshuis , de Drooan internet search for ABA services in the Netherlands, which yielded 40 organizations;a survey that was sent to all these organizations to acquire information on structural characteristics of their organization  training, level of educational background of staff ; number and characteristics of clients, number of service locations, and type of ABA services;a search in the certificants’ registry of the Behavior Analyst Certification Board (BACB) for Dutch certified/registered professionals ; andarchival research, in which any reference to ABA in the Netherlands is extracted from (in)formal documents in education, services, and/or personal archives.In a first attempt to draw up the history of ABA in the Netherlands, four activities were initiated at the beginning of 2021:SD = 645.5). The number of clients who received ABA-based services from these agencies ranged from 4 to 7,485 clients .The (preliminary) results of activities 1–3 illustrate the relatively young history of ABA in the Netherlands. The first services claiming to provide ABA services were founded in the 1980s; however, the majority of organizations in operation have been set up since 2010 Figure . The numFigure The discrepancy between ABA services has implications for service quality and intervention fidelity  and/or professional bodies such as the Dutch Institute for Psychologists (NIP) or the Dutch Association for Educationalists and Pedagogues (NVO).In order to pave the way ahead, an ABA consortium met in 2021 to emphasize the importance of the development of nationally recognized and accredited ABA training and professionalization opportunities to meet the current and future needs of ABA service users. The aims they identified were to encourage and/or maintain high standards in ABA-based support and early behavioral intervention services; to enable future accredited ABA education and training opportunities; and to secure the future of high-quality ABA-based supports in the Netherlands.The interest in ABA in Poland has been significant for over 20 years; as of 2021, there are 22 BACB certificants, one BCBA-D, and one BCaBA. Since the 1990s, there have been many facilities that implemented ABA-based intervention for children and adults on the autism spectrum. At the time of this writing, in every major city in Poland there are kindergartens, schools, or special centers that use the ABA principles in their pedagogy. Due to such great interest, two associations were established in Poland that are affiliated chapters of ABAI:Krok za krokiem (Step by Step), which contains articles by world-renowned experts on teaching persons with autism. PABT has promoted behavioral therapy by organizing specialist trainings for a wide range of attendees . Over 1,000 participants attended such trainings in 2020.The Polish Association of Behavioral Therapy (PABT) was established in 2002. PABT is a countrywide nonprofit organization of active practitioners of behavioral therapy. PABT’s mission is to provide people with disabilities, in particular those with emotional and developmental disorders, and their families with multidirectional, comprehensive, and professional help. PATB’s main aim is promoting behavioral therapy among therapists and academics. At the time of this writing, PABT has more than 44 registered members from every significant behavioral therapy center in Poland, as well as parents of persons undergoing behavioral therapy and other concerned experts . It cooperates with a number of Polish centers and institutions focused on providing effective help to persons with autism and publishes the informational periodical The Polish Society for Behavioral Psychology (PSBP) was founded in 2002 at the Institute of Psychology of the Jagiellonian University (JU), Poland. Members of PSBP are not only psychologists and psychology students, but also representatives of related disciplines, mainly educationalists and therapists. The main objectives of PSBP are to develop and promote psychological knowledge, with special focus on behavior analysis as the science of behavior and the environmental factors that influence behavior and to propagate the idea of effective behavioral therapy as a form of psychological intervention and to disseminate knowledge about therapeutic methods and their effectiveness. PSBP strive to achieve the above goals through science, publishing, and training activity as well as through work for the community of psychologists and psychotherapists.Postgraduate studies in ABA are conducted at universities in several larger cities in Poland. University of Social Sciences and Humanities conduct studies in Warsaw, Poznań, Katowice, Sopot, and University of Gdansk in Gdańsk. Two verified courses sequences have been established: a course run by University of Social Sciences and Humanities in Warsaw applied behavior analysis, “Working with Individuals with Developmental and Behavioral Disorders,” Monika Suchowierska-Stephany, PhD, BCBA-D, BACB VCS coordinator; and a course run by University of Gdansk Applied Behavior Analysis: “Teaching Children and Youth with Autism Spectrum Disorder.” The course started in 2015. Since then, 66 students have completed the course. The third edition has finished in February 2021. Anna Budzinska, PhD, was the BACB VCS coordinator.There are three certification systems for teachers and other specialists in Poland: The Polish Behavioral Therapist License was established in 2010. The boards of two Polish chapters of ABAI  have been working on a joint program—Polish License of Behavioral Therapist—to standardize formal requirements for behavior therapists in Poland. The purpose of these activities is to consolidate and formalize professional training for behavioral therapists in Poland, and thus define the requirements for practicing therapists to make behavioral therapy clearly identifiable by the highest quality of therapeutic services. The Polish License of Behavioral Therapist runs an integrated system of theoretical and practical training to enable trainees to gain the title of behavioral therapist. At present, 229 people in Poland have been granted the title of licensed behavioral therapist, 31 people have the title of behavioral supervisor, and 4,000 are in the process of acquiring qualifications.“Teacher of a Small Child with Autism” courses are run by the Institute for Child Development (IWRD) Teacher Training Center since 2012. So far, 399 people have been awarded the certificate of “Teacher of a Small Child with Autism.” The IWRD was created through the initiative of the Foundation-Institute for Child Development in 2006. The IWRD is the first and the only institution in Poland that is fully modeled on the Princeton Child Development Institute model created by Krantz and McClannahan. The mission of the IWRD is to provide comprehensive assistance to children with autism to help them achieve the highest possible level of independence. In 2010, the Teacher Training Center was created in the IWRD. IWRD trainers share experience and knowledge by holding ABA training sessions for teachers, psychologists, pediatricians, and students from all over Poland and abroad. The IWRD Teacher Training Center is accredited by the school superintendent; 7,000 people participated in different training courses over last 11 years. The IWRD Teacher Training Center offers courses about use of ABA principles when supporting children with ASD. This is a three-step course: “ABA in Intervention for Children with ASD” is a basic course on this topic that was created by Dr. Anna Budzińska, the director of the IWRD. The “Teacher of a Small Child with Autism” certificate involves a practical internship, a continuation of the theoretical three-step training program in behavioral therapy for small children with ASD.The Behavior Analyst Certificate (CAZ) was developed in 2021 by the Institute for Child Development in Gdansk and the University of Gdansk. It is the first certificate in Poland that is fully based on postgraduate studies organized at universities. A person applying for the certificate must complete postgraduate ABA studies, 1,000 hours of practice under supervision, and pass the final practical and theoretical exams. High requirements related to obtaining the certificate ensure the education of specialists in Poland who will conduct ABA interventions at the highest level.As of 2021, there are 35 BACB certificants in Spain , most of them certified within in the last few years, which suggests that the number of certificants is finally gaining momentum. Twenty-six out of the 33 BCBA/BCaBAs (81%) in Spain are graduates from ABA España’s program. The current rate at which new candidates are becoming certified has increased by a factor of 2.5 over the last 5 years. The rate of certification lapses calculated as the number of inactive BCBA and BCaBA certificants divided by the number of active and inactive certificants is 3.4%, which suggests that certificants see value in preserving their certification after it has been acquired. In addition, Spanish nationals and residents have had a high pass rate in certification exams.The data generated through a survey conducted in 2019 by the Spanish ABAI chapter ABA España suggests that certified and uncertified professionals do not differ in their training and sociodemographic characteristics . The IBIS project has recently obtained an external grant to evaluate this adapted version involving approximately 100 schools. At Linnaeus University and Stockholm University two doctoral projects are currently studying the PAX Good Behavior Game (GBG). After a cultural adaptation to the Swedish school context, the doctoral student at Linnaeus University is coordinating a randomized controlled trial (RCT) and the doctoral student at Stockholm University is focusing on the PAX good behavior game (GBG) with students with special education needs in mainstream settings. In addition, the PAX GBG has now been taught to more than 1,000 teachers in approximately 10% of the municipalities within Sweden.The Swedish Association for Behavior Analysis (SWABA) was founded in 1996, and now has approximately 200 members of various professional backgrounds. Since 2020, after the BACB's decision to change its certification requirements, SWABA is involved in a collaboration between representatives from the Nordic countries , discussing quality assurance of behavior analysis within a Nordic context.In sum, though ABA appears to be becoming increasingly established and accepted on both grassroot and institutional levels in Sweden, neither the profession per se or the field is officially recognized. There are no formal requirements for staff at any level to have knowledge and/or competence in ABA. It is clear that in order to avoid low quality interventions, and potentially damage the reputation of the field, ensuring high levels of competence among ABA practitioners in Sweden is vital.ABA Switzerland was founded in 2011 and is the ABAI affiliated chapter in Switzerland. The majority of BCBAs in the country are members. ABA Switzerland actively collaborates with organizations in neighboring countries to work towards a future for behavior analysis in Switzerland.In 2021, there are 18 BCBAs and three RBTS working in Switzerland. In the past 2 decades many students have been trained within ABA early intervention projects and are now carrying their experience further into other areas of work. Current ABA providers in Switzerland work almost exclusively in autism. There are two public institutions and one private center offering EIBI and ABA-based services. A hospital in Lausanne (CHUV) offers evidence-based services to children on the autism spectrum, under supervision of a French BCBA.There are no university-approved courses in ABA and no VCS. There are some behavior analytic courses taught by BCBAs or ABA-trained people at different institutions as well as some RBT courses. In September 2021, a graduate level course on EIBI taught by Early Start Denver Model (ESDM) and ABA professionals was started as a collaboration between universities in Zurich, Geneva, and Ticino. There is an ABA-trained lecturer teaching ABA to future special education teachers in Fribourg.Two studies have been published in the field of behavior analysis in Switzerland. First, a study of the implementation of EIBI for children on the autism spectrum in Switzerland . There are several early intervention centers for autism approved by the Swiss government, however, only two of them are based on ABA. ABA still faces a lot of prejudice and negative sentiment in the general public and among professionals from other disciplines.Behavior analysis began to develop thanks to interested parents who organized courses in ABA, inviting the Israeli BCBA specialist Julia Ertz to teach a certified BCBA exam preparation program in Ukraine. The first graduation of specialists took place in 2012. Later, on the territory of Ukraine, training was conducted under the certified full-time training program three more times. Also, a large number of Ukrainian specialists were trained in certified training programs for the BCaBA exam in a distance-learning format. However, approximately only 20% completed their studies and among them even fewer practice. All practicing behavioral specialists are outside the scope of formal practice and work in private. It should be noted that these programs are not included in any training course of higher educational institutions and in the register of the profession of Ukraine there is no profession of a behavior analyst or a behavioral instructor. However, since 2014, behavioral therapy has been included in the roadmap for the habilitation of individuals on the autism spectrum of the Ministry of Health of Ukraine.In 2015, leading behavior analysts in Ukraine founded the Ukrainian Association of Behavior Analysts (UABA), a nonprofit organization. In 2016, the first international conference of behavior analysis was held in Ukraine. From 2015 to 2021, several workshops, webinars and two Ukrainian conferences on behavior analysis were held. In 2019, the first two BCBAs appeared in Ukraine and became part of the UABA board.Code of Ethics in accordance with the legislation of Ukraine.When BACB announced that they were going to discontinue access to certification to non-U.S. residents, they offered support to other countries in their efforts to develop a national system of certification. After detailed consultation with Dr. Neil Martin , the UABA worked out the qualifications and levels of education of specialists, and also adopted the UABA has 45 members and plans to continue to expand and conduct monthly thematic webinars for a wide range of listeners and specialists. In early 2022, there were about 10 ABA centers in Ukraine. UABA hopes to support the development of ABA in Ukraine and plans to be included in the professional community of Europe.Until 2020, the position of behavior analysts was not strictly defined in the UK. The job title was not protected or regulated. The title BCBA was used in place of adequate national registration, in fact, only a small number of jobs advertised in the UK listed BCBA or MScABA or ABA tutor as essential or desirable criteria. There are five master’s level VCSs being taught at UK universities ABAI, . A numbeIn 2013, UK Society of Behaviour Analysis (UK-SBA) was established. When, in December 2019, the BACB announced the termination of eligibility to sit the exam for non-U.S./Canada residents by end of 2022, the UK-SBA applied for a 3-year extension. The extension was granted and ends in 2025. In 2020, UK Society of Behaviour Analysis (UK-SBA) set up a voluntary register for behavior analysts with the aim to have this register accredited by the PSA. As of December 1, 2021, a total of 302 behavior analysts are registered on this register. Applicants for the register need to evidence that they have sufficient training in behavior analysis, they do not have to be BCBAs. The applications are reviewed and decisions are made by the UK-SBA board. In late November 2020, the UK-SBA applied for accreditation of this voluntary register by the PSA. At the time of writing, the PSA has not yet published their decision. In 2022 (backdated to 2020), the UK-SBA was added to Her Majesties Revenue and Customs (HMRC) list of approved professional organizations and learned societies. This step in the right direction means that members can claim tax relief on membership fees.In the meantime, the UK-SBA has set up a taskforce to develop a credentialing system for behavior analysts. The target for this taskforce is to “ensure that UK-SBA works to establish over the longer-term, a framework for the professional recognition and certification of behavior analysts across the breadth of behavior analytical practice” and to “ensure that the UK-SBA meets the education and training requirements of the PSA standards and of the UK-SBA strategic plan.”9Professional regulation and registration of practice is important for behavior analysts in Europe for many reasons, including the protection of populations served, the strengthening of higher education programs, to facilitate staff mobility across Europe, and for the growth of the discipline. Although there are records of national progress of behavior analysis in some countries (Ala’i-Rosales et al., Some behavior analysts in Europe had realized this and had begun the process of seeking national recognition for the profession in their countries, whereas others were jolted into action by the BACB decision. It is not surprising that the process of professional recognition is progressing at different speeds in each country. Once behavior analysis is a regulated profession in different countries, the next step is mutual recognition across Europe. This requires professions first to be regulated nationally and second, for the qualifications to be based on harmonized minimum training requirements and recognition of evidence of training and professional experience. The EuroBA project aims to facilitate this process by providing common standards and agreed competences. As a starting point, this article offers a snapshot in time of the situation of professional recognition of behavior analysts in 21 European countries, thus providing necessary information to help move things forward and to encourage others to take up the mantle in their own country. This is important to ensure that behavior analysts are not only knowledgeable about the conceptual, scientific, technical, and ethical basis of ABA, but also have the necessary interpersonal skills to protect the science against misrepresentation (Keenan & Dillenburger,


Workplace health promotion programmes (WHPPs) are among the most important measures to improve the health and motivation of the ageing workforce. However, they are accompanied with certain challenges, such as low participation rates and higher participation levels of the more health-conscious workers, often failing to engage those who need such interventions the most. Following the PRISMA guidelines, this scoping review examined participation rates reported in articles on WHPPs to identify potential knowledge gaps. The results are worrying: participation rates are not only infrequently reported, but also low. Of the 58 articles, 37 report participation rates, with the majority (20) reporting an average participation rate of less than 50%. Reported participation rates refer either to different target groups, the type of intervention, or to single points in time, which makes it difficult to establish consistent criteria for comparison. We argue that despite the importance of WHPP efficacy, research focus should shift to the determinants of participation, as well as the issue of standardising the reporting of participation rates, alongside the potential problem of reporting bias. According to the OECD data on retirement age, the duration of working life in most OECD countries has increased since 2000  due to sHowever, WHPPs come with certain challenges and the reality is far from perfect. Studies suggest that participation rates in such programmes are often below 50 per cent  and typiAlthough 50 to 75 per cent of workers do not choose to participate in WHPPs, the field of employees’ commitment to personal health is still fairly unexplored. Some of these challenges have been known for a long time, with the 2013 research agenda published in the American Journal of Health Promotion (AJHP) calling for more research to focus on organisational culture, incentives, and social marketing in WHPPs to address uptake issues . The queWHPP researchers and practitioners seem to forget that the problem with the overall effectiveness of WHPPs is not the effects of WHPPs as such, but rather the low participation rates to begin with. Thus, the research field may have a problem that we are not even aware of. There is a large body of research in the field of WHPPs that focuses only on individual interventions and programmes and their effects. This calls into question its usefulness, given that the real problem appears to be low participation.The only systematic review of participation rates we came across is Ryde et al., (2013) , which cIn this article, we present a scoping review of WHPP participation rates reported in research using the PRISMA model . To shedThe article is structured as follows. The following section presents the application of the PRISMA method. The methods section is followed by the analysis of the results. Next, we discuss the results and point out the limitations of our scoping review. The article concludes with suggestions for future research and implications for the WHPP field.The scoping review was based on a literature search in bibliographic databases, namely PubMed, SAGE Journals, JSTOR, and Emerald in 2021–2022. In addition, a manual search of Google Scholar was conducted to identify articles that may have been missed in the database search. The search used a combination of terms and keywords, which were adjusted and refined during the search to yield more appropriate results. The first search used a combination of terms (workplace OR worksite OR employee*) AND  AND (program* OR intervention) AND (participation) AND (motives OR factors OR determinants). As the results were not entirely suitable, we adjusted the search terms and used a new combination of terms in the second search: (workplace OR worksite OR employee*) AND  AND (program* OR intervention) AND (participation rate OR recruitment OR engagement OR attendance OR “take-up”) AND (rate). In the third search iteration, the term “take-up rate” was excluded from the search. An obstacle arose when searching the JSTOR article database, where the length and number of search terms and keywords are limited, which meant that the search terms had to be adapted again: (workplace OR worksite OR employee*) AND  AND (program* OR intervention) AND (participation OR recruitment OR engagement) AND (rate).The titles and abstracts of a total of 1374 papers were screened for relevance, and duplicates were excluded. In the next step, studies were included if the content of the abstract included WHPP intervention(s). There were no restrictions regarding the year in which the study was published, the type of research, or the type of health promotion programme. Studies involving clinical populations were excluded. Our search yielded 58 research articles, the full texts of which were examined to see if the study mentioned the participation rate or data from which we could calculate the WHPP participation rate. A total of 37 articles met this condition. The elimination process according to the PRISMA model is presented in In our scoping review, the missing participation rates were calculated as the number of employees participating in the WHPP divided by the number of employees initially invited, multiplied by 100. One third of the articles were independently reviewed by both authors to ensure the accuracy of the extracted data. The articles were then assessed for the level of employee participation, the type of programme or intervention, the target group(s) of the intervention, the type of business where the intervention took place, the strategies used to recruit or activate employees to participate in the intervention, and the study characteristics. Only a small number of articles on WHPPs were found to report the participation rate. However, the number of articles reporting on participation rates was found to have increased in recent years. Of the 58 relevant articles found in selected bibliographic databases, only 37 studies (64%) reported participation rates. In terms of the year of publication, seven articles were published before 2000, and seven articles were published between 2000 and 2010. Since 2010, the number of articles has increased significantly with 10 or more in each subsequent 5-year period. The oldest study dates from 1988, and the most recent study dates from 2020.Participation rates were found to be reported in different ways. A total of 23 studies reported the average or overall participation rate in health promotion programmes. Overall participation rates were reported for the specific programme as a whole, whereby the average participation rates were calculated across different interventions or groups. For the remaining 13 studies, average participation rates were calculated by the authors from individual participation rates associated with participant groups or interventions. However, the studies by Ott-Holland, Shepherd, and Ryan (2019)  and BrilReported participation rates range from 3% to 100%, with over half of all studies reporting the average  participation rate of less than 50% 20 studies). Two studies reported participation rates of less than 10%  studies., five stFor the programmes with the highest participation rates, we found no obvious correlation with company size, i.e., the number of employees involved. What is typical of these programmes is that employees were either enrolled or they volunteered. One of such programmes also offered a monetary prize/incentive . A closeFinancial incentives are the most common form of encouraging participation in WHPPs, but do not seem to guarantee higher participation. Financial incentives were reported in nine studies. Eight articles reported voluntary participation in the programme and two reported assigning employees to a specific programme. Seventeen studies did not report how employees joined the programme or how participation was encouraged. Incentives and their relation to participation rates are difficult to compare directly, since various incentive sizes and incentive schemes were applied—some with fixed incentives, some with variable incentives, and some with stepped incentives. When examining the used financial incentives and the respective response rates see , it appeThere is an apparent diversity in both the duration of the WHPP and the research design used. Only 13 studies reported the duration of the programme/intervention. The shortest study lasted three weeks  and the The types of interventions were found to vary widely, ranging from specific to combined interventions. Analysis revealed 17 WHPPs which specified only the general area of intervention, and 20 WHPPs which explicitly described the interventions, such as physical activity programmes that included stretching, exercise programmes, gym availability, and standard walking ,29,42,55The analysis revealed that limited information was reported about the industry and even less about the position of participating employees, but a wide variety of work settings was reported. A total of 12 articles contained no information at all about the company, while 18 articles reported only on the industry or area in which the company operated. Moreover, as only 11 studies were found to report on the specific position of employees within the company, we did not include this factor in the additional analysis.(1)The question of redirecting the research focus in WHPPs should be raised, as programme organisers/facilitators  waste valuable resources on programmes of limited general impact, given that the benefits to the target population and those who would need the interventions most may be (very) small. Considering that the scoping review showed that the focus of WHPP research avoids the burning issue of low participation rates, it is not surprising that the incidence of modern work-related diseases  continues to rise despite the abundance of programmes and funding. This raises the broader question of how the effects and impacts of WHPP interventions introduced can be considered positive when only a (relatively) small proportion of workers participate in such programmes. At the very least, the effectiveness and efficiency of such programmes are questionable, as many resources are spent on (very) limited effects, which more often than not benefit those who are already health conscious.(2)Reporting on participation rates in WHPPs should be made more consistent and comparable. In particular, it would be useful to report participation rates for each type of intervention  by target group or type of incentive, and to summarise participation rates for composite interventions. In short, it would be useful to monitor participation rates by at least the most important factors so as to obtain comparable data on uptake. We also believe that an in-depth meta-analysis focusing on the determinants of participation in WHPPs would be imperative to understand the reasons for such low participation rates.(3)Not to overreach the aim of this study, we need to highlight an issue that is often left unaddressed. While we found that participation rates were reported in a few studies, in the vast majority of articles on WHPP they were not mentioned. Our scoping review thus draws attention to the potential problem of scientific misconduct , more spThe conclusions that emerge from our analysis represent a valuable contribution to several aspects of the WHPP research (paragraphs one and two) and practice (paragraph three).Chan and Altman (2005)  list manThe following limitations may have appeared in our scoping review. First, our literature search was limited to the selected electronic article databases, where there is considerable overlap in content. It is also possible that some useful studies were overlooked, as we only focused on English language publications in scientific journals. However, we assume this does not to have a significant impact on the results. Another potential limitation is that many interventions or studies had been conducted in the field, and the results of such studies were either not evaluated or not accurately recorded in the literature.The main findings of the systematic review can be divided into three sections pertaining to the reporting of participation in the WHPP, the level of reported participation rates with the indication of trends in higher or lower participation rates, and the issue of comparability of reported rates. The proportion of appropriate studies relative to the baseline articles identified is relatively small, with research still primarily concerned with reporting the effects of interventions rather than focusing  on the circumstances of the uptake. In more than half of the studies reviewed, reported participation rates were relatively low—below 50%. There seems to be no obvious interconnection pattern between the size of the company, i.e., the number of employees involved, and reported participation rates. Higher  incentives tend to be associated with higher participation rates; however, monetary incentives do not guarantee higher participation rates in WHHPs. Lower participation rates are more striking for physical activity interventions than for those related to counselling and training. The types of WHPPs vary, from specific to composite, as do the types of research designs used to measure their impact. A great deal of variability was also found in the delivery of the programmes. Reporting on the industry and workers’ position in the company was found to be very sparse. Most importantly, reported participation rates are tied either to different target groups or to the type of intervention or to single points in time in the research. As a result, it is difficult to establish uniform criteria for comparing reported participation rates, as they are difficult to compare directly. Nevertheless, the relationship between participation rates and intervention effectiveness should also be thoroughly explored.Several implications emerge from these findings. Despite the importance of the WHPP design and its efficacy, research in the field of WHPPs should include analysing the mechanisms needed to improve WHPP participation rates, while reporting on WHPP participation rates should be made more consistent and comparable. An in-depth meta-analysis focusing on the determinants of participation in WHPPs would be imperative to shed light on the reasons for low participation rates. Although our research has only briefly touched on the (mezzo-level) determinants of participation, other possible micro-level (workers), mezzo-level , and macro-level  determinants should be thoroughly investigated. Second, the scientific community should closely examine the possibility of reporting bias in studies with low WHPP participation rates and, if identified, address it openly. Solutions to this problem are already known but do not appear to have been fully implemented, at least in the case of WHPPs. First, researchers and journal editors should ensure that complete data are made available for all studies, regardless of their values. In addition, as suggested by Richards and Onakpoya (2019) , post-st


State of Open Data Report data. Focusing on the attitudes toward Open Data, this paper reports on how African researchers view (i) data sharing, (ii) the use of shared data, and (iii) the Open Data ecosystem. The findings show that, although the attitudes of African researchers have changed over time, they are not very different from those held by their international counterparts. These findings will aid policymakers, as well as academic and research institutions, in highlighting the areas of future growth for Open Data in Africa.A key motivation for Open Science is accessibility. For researchers in resource-poor economies, this translates into access to the methods, data and publications that will foster scientific research and discovery in such communities and environments. Attitudes toward Open Science are in flux, and there is a growing awareness of the roles and responsibilities that researchers have to one another in this regard. This paper explores how African researchers approach issues relating to Open Data by reporting on the  Scientific research in the 21st century has been scaled to new practices where scientists work more collaboratively and in data-intensive environments  there is more concern about sharing datasets than ever before, (ii) there is more familiarity and compliance with the FAIR data principles than ever before, and (iii) repositories, publishers, and institutional libraries have a pivotal role to play in helping make data openly available.Through the In Africa, several researchers have explored the data sharing practices among researchers and have identified a number of barriers and opportunities. These barriers to data sharing in African research institutions are mainly associated with (i) the lack of policy and guideline frameworks at institutional and national levels, (ii) limited funding and (iii) inadequate infrastructures  Data Managers or Data Librarians, (ii) readily available data repositories for both long-term and short-term storage, and (iii) educational programs for both awareness and to help engender good data practices are needed  Network, and conducted by Digital Science, SpringerNature and Figshare. The data for the various waves, including the associated questionnaires and reports, are freely available  attitudes to sharing one's own data, (ii) attitudes to the use of shared data, and (iii) attitudes to the broader sharing ecosystem. The framework can also be viewed within the overall research landscape in Africa as to whether the correct policies, incentives and infrastructures exist to enable positive attitudes toward the advancement of science on the continent and globally. The study on attitudes toward data sharing in Africa can also be viewed in the context of the conclusions from Baždarić et al.  that thiKim and Adler  exploredResearch on data sharing practices globally and in Africa has been ongoing. Several outputs already provide details on how new approaches are being adopted or shunned globally. It is important to note what Abebe et al.  terms naGiven this wealth of information that is already available on the attitudes of African researchers toward Open Data, this article contributes by using new data to either confirm or refute existing findings.African researchers are no different from their counterparts in other regions when comparing their reported comfort levels relating to how other researchers might reuse their data. Replication, reanalysis, reinterpretation, isolated reuse, and combination reuse are globally accepted as expected forms of reusing data.African researchers share much of the same challenges that other researchers experience. The uncertainty of sharing rights, ethical considerations and other permissions are of universal concern. African researchers are less concerned with the lack of time, size of datasets, organizing data and the risk of being 'scooped', while they are more unsure about which repository to use.Motivations to share data are no different on the African continent than elsewhere. Public benefit and increased impact are given as strong circumstances that would motivate the sharing of data, which speaks to the altruistic attitudes of researchers. Additional key motivators are the recognitions, whether through full data citation, citation of research papers or co-authorships. Non-African researchers report considerably more frequently that the citation of research papers is a possible motivator . Non-African researchers give the citation of research papers as the primary motivator for sharing data, while African researchers reflect that public benefit is what motivates them.Researchers throughout the surveyed countries reported that shared data offers benefits: it (i) fosters collaboration, (ii) validates findings, (iii) complements existing data and (iv) avoids the duplication of efforts. Whether these benefits are experienced, or just a perception of potential benefits is unclear. Regardless, the survey participants indicated that those who share their data do not receive sufficient recognition for their data. If recognition is a primary motivator, as reported in the previous section, then policies that follow those climates that foster recognition would also increase the sharing of research data.A substantial majority of the respondents (79%) indicated that shared data added to the credibility of the research. As public benefit is a strong motivator, spreading the perception of shared data that is linked to research credibility would likely increase data sharing practices.When participants were asked how they determined the quality of the shared data, many factors were considered and shown to be relevant, including (i) the reputation of the source of the data, (ii) the associated peer-reviewed article, and (iii) the availability of visualizations that are consistent with the data. Non-African researchers reported that clear dataset descriptions, which provide sufficient context, are a strong indicator of quality (84%), an opinion that was not as universally held by the African respondents: only 41% of them reported this to be the case. All researchers agreed that datasets that are easy to find are more likely to be viewed as credible.There is global agreement reported from the study participants that national mandates to make research data openly available to access, reuse, repurpose and redistribute would be welcomed since a mere 7% of the respondents disagreed. There is also support for funders to mandate data sharing as part of their grant awards, with 53% being in favor and 27% being against such a policy.When asked whether making research articles open access should be common scholarly practice, the view was strongly affirmative: 93% of the African respondents and 87% of the non-African respondents agreed. The adoption of Open Data practices appears to have slightly less traction where 84% of the African respondents and 80% of the non-African respondents agreed.The participants who responded in 2017 were from varied countries, with most responses originating from the more research-active countries: Egypt, Nigeria and South Africa. More than 60% came from universities, a distribution that is essentially unchanged in 2021.what would motivate them. Only a quarter of the respondents gave being cited as a motivator, while the ease of sharing data and freedom of information request was much stronger. It would seem that African researchers have become more aware of the factors motivating the sharing of data in the past 5 years, which speaks to a greater awareness of the Open Science movement. As in the 2021 data, respondents of the 2017 questionnaire gave public benefit as a strong motivator. Furthermore, co-authorship credit as a motivator has increased considerably over the past 5 years.In the 2017 questionnaire, fewer options were given to respondents in answer to the question of How do you think the data shared by others have or could benefit you? The data comparison between the 2017 and 2021 responses shows that African researchers appear to have a greater awareness of the personal benefits of Open Data. The ambiguous phrasing of the question makes it unclear if the attitudes to the benefits resulted from a personal experience or simply a reflection of the current narrative among researchers.Only one question relating to the attitudes toward using Open Data was asked in 2017: Support for a national mandate has increased considerably. In 2017, 33% of the respondents took a neutral position, and 54% supported the statement relating to national mandates for Open Data. In 2021, those taking the neutral position had dropped to only 6%, with an overwhelming 87% supporting a national mandate.As the number of respondents doubled over that time, one can surmise that there has been an increased interest in issues relating to Open Data in the past 5 years. This increased awareness and interest is reflected in the other questions asked.This study focused on whether African researchers think differently about Open Data compared with their global peers, and whether the thinking of African researchers have changed over time. The findings reported here illustrate that, in general, research stakeholders are supportive of data sharing, with African researchers' practices and experiences not very different from their international counterparts, despite the policy differences. It is clearly highlighted that African researchers' attitudes toward data sharing have changed positively over the past decade. It is affirming to know that the impact that the global Open Science movement's message on the benefits of data sharing is spreading across the globe and to the different research communities. The changing positive attitudes by African researchers toward data sharing could be attributed to the new requirements by journal publishers and research funders that data outputs must be visible to knowledge consumers.UNESCO Recommendation on Open Science, a framework for member nations to develop their Open Science policy frameworks. Other donors and regional organizations like the Electronic Information for Libraries and the West and Central African Research and Education Network have also supported the development of national mandates that can assist researchers in participating in data sharing activities. In Southern Africa, especially South Africa, the Open Science environment has developed rapidly. South Africa has also moved a step further through a partnership with the European Union's Europe Open Science Cloud to develop its own South African Open Science Cloud framework, further supporting the about-to-be finalized South African Open Science Framework.The results further indicate that by 2021 African researchers were more supportive of their national governments' mandates to share data within and across research domains. There are growing efforts across the continent to formulate Open Science policy frameworks both at national and institutional levels. The United Nations Educational and Scientific Organisation has the This study also highlights several issues that require attention from African academic and research institutions to support researchers' data sharing practices that will enable best science advancement and societal engagement. There should be clear national and institutional policy frameworks to enable good data sharing practices to take root among African researchers. The position of international research funders, journal publishers, and inter-institutional and country collaborations need to be spelt out in future policies to ensure equitable data custodianship in African generated research. Given the attitudes of African researchers toward such policies, the time is right to put them into place.The African academic and research communities should not be left out and lose focus of the potential benefits of Open Data for reproducibility and efficiency in research, especially in poorly resourced environments that require more collaborative use of infrastructure and resources. The potential gains for further and faster benefits in advancing science and knowledge production are all too evident in coordinated data sharing activities.https://doi.org/10.6084/m9.figshare.c.4046897.v6.Publicly available datasets were analyzed in this study. This data can be found here: Figshare repository LS took the lead in the conceptualization, methods, results, and final editing. EC took the lead in introduction, literature review, and conclusion. Both authors contributed to the article and approved the submitted version.This work has been partially funded by Stellenbosch Business School.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.


Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel , as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.The online version contains supplementary material available at 10.1186/s12889-022-14940-w. Long‐term conditions  are health conditions that are currently not curable and can only be managed with medication or other therapies , 2. One Indicative evidence suggests that the risk of developing MLTCs is higher, and with MLTCs occurring at an earlier age, for people from minoritised ethnic groups than people from the majority white group , 8. StudWith ethnic inequalities evident in single health conditions, we would expect ethnic inequalities in MLTCs to follow a similar pattern. To our knowledge, there has been one previous review that has reported on ethnicity and MLTCs in the UK . HoweverIt is important to consider that there is significant variability in the way ethnicity data is operationalised, analysed and presented in the UK . These vThus, the aim of the present review is 1) to identify and describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) to summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess how ethnicity is conceptualised and operationalised. COVID-19 and the measures adopted to curb the spread of the virus during the pandemic have disproportionately affected minoritised ethnic group people. Given emerging evidence documenting the increase in ethnic inequalities following the coronavirus pandemic, we focus on the state of the evidence prior to, and during the very early stages of the pandemic. This provides a useful benchmark for future studies to measure and understand the impact on the pandemic in further exacerbating longstanding ethnic inequalities in health.As per the Preferred Reporting Items for Systematic review and Meta‐Analysis Protocols (PRISMA‐P) guidelines , we regiWe adhered to the conventions of each search engine and used search terms that captured the key concepts; Ethnicity (e.g. "Ethnic Groups"[Mesh] OR “BME” OR “BAME”), multiple health conditions (e.g. “Multiple Chronic Conditions” OR Comorbid* OR Multimorbidity), Health inequality  and the geographical location (e.g. "United Kingdom"[MeSH Terms] OR “UK”)  and comWe imported the studies retrieved from the electronic search to Endnote X8 where duplicates were removed. BH and LB screened a random sample (10%) of the titles, abstracts, and full texts. The studies were divided into 3 batches. For each batch, BH and LB double screened 10% of the studies first and compared results before BH continued to independently screen the remaining studies. Disagreements were resolved by discussion.We extracted relevant data from the included studies using a structured form with the following items: study identifier, design, setting, recruitment/data source, sample size, population description, definitions of MLTCs, type and number of MLTCs, confounders, and the results. We denoted any missing information with the acronym NR (i.e. Not Reported). BH and LB double extracted data from a random sample of studies (10%) and reconciled differences through discussion. Thereafter, BH independently extracted data from the remaining studies.The outcomes of interest were prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population.We assessed the quality of all the studies that contributed to evidence on ethnic inequalities in the prevalence of MLTCs using quality appraisal prompts proposed by Dixon-Woods and colleagues  Supplem. The proGiven the different ways in which MLTCs were conceptualised and operationalised, the different ethnic groups, and the range of conditions explored in the included studies, we conducted a narrative synthesis. We present the findings of the synthesis in themes, supplemented with tables and figures, in two sections. First, we provide an overview of the studies that documented the prevalence estimates of MLTCs across ethnic groups. Second, we present studies where the authors counted more than two long-term conditions and reported on at least age-adjusted prevalence estimates of MLTCs across ethnic groups. Thus far, we have used the term ‘minoritised’ ethnic group people to refer to people who do not self‐identify as belonging to the majority white ethnic group. This term emphasises how social positions are social constructions dependent on context rather than outcomes and practices that are fixed and inevitable . HoweverWe identified 7949 titles from the electronic search, manual search and additional sources  , hospital records (n = 14), specialist clinics/services (n = 19) and disease registers (n = 17). Fourteen used cross-sectional survey data  and cohort study data , the Millennium Cohort Study (n = 2), and UK Biobank (n = 4)) . However, other comorbidities were found to be generally more common in white patients . Baskar Owusu-Adjah and colleagues examined ethnic differences in comorbidities in patients with type 2 diabetes mellitus . They foWe identified seven studies that give insight into age-adjusted ethnic differences in the prevalence of MLTCs. The findings are indicative of ethnic inequalities in MLTCs in favour of the majority white as five of the seven studies reported that some minoritised ethnic groups have a higher prevalence of MLTCs than their white counterparts. The evidence suggests that South Asian people (three out of five studies) and Black people (two out of five studies) may be at a higher risk of MLTCs , 80, 87.The two studies that reported a lower prevalence of MLTCs in minoritised ethnic groups are recent studies which focused on people living with diabetes. This finding is intriguing and warrants further attention. In trying to understand these observations, we cannot rule out errors with measurement of ethnicity and data quality. We must also consider that Black and South Asian people in the UK not only have a higher prevalence of diabetes, but they also develop the condition at an earlier age , 107. ItGiven that few studies have assessed the prevalence of MLTCs across ethnic groups, it is difficult to ascertain the reasons behind the observed ethnic inequalities in the prevalence of MLTCs in the UK. However, based on longstanding international evidence on ethnic inequalities in single conditions, we propose a number of mechanisms. We consider the impact of racism and discrimination in explaining the observed ethnic differences in the prevalence of MLTCs as they are known to influence health . It is pWe assessed the quality of the seven studies which contributed to the evidence on ethnic inequalities in the prevalence of MLTCs and considered the studies to be of high quality. Whilst the studies were methodologically sound, we identified limitations which potentially impede a full understanding of ethnic inequalities in the prevalence of MLTCs. For example, in one study, ethnicity, deprivation, and socially-patterned risk factors were considered in isolation . RelatedIn the seven studies that contributed to the evidence of ethnic inequalities in the prevalence of MLTCs, people from minoritised ethnic groups were often grouped into broad categories; in particular, Black/African-Caribbean, South Asian/Asian/Indo-Asian, mixed, and other. In one study, the Black ethnic group was disaggregated into three different categories, but the authors did not adopt this approach for the Asian ethnic group . CategorThe availability of complete ethnicity data is crucial for studies that seek to assess ethnic inequalities not only in relation to MLTCs, but also in relation to healthcare utilisation and care . InformaAll seven studies analysed data from patient records. For individuals to be included in patient records, they need to be in contact with healthcare services. It has been reported that access to primary care health services is generally equitable for people from minoritised ethnic groups . HoweverIn presenting the state of the evidence, this review has highlighted the inconsistent ways in which MLTCs are defined and measured with the number of long-term conditions varying between studies. This lack of consensus in how MLTCs are captured has been raised by authors of other reviews of prevalence of MLTCs in the general population , 124. ThA limitation of this review is that a single reviewer initially screened the titles and abstracts, and excluded irrelevant studies given the large number of studies retrieved. It is possible that some studies may have been inadvertently excluded. However, we manually searched the reference lists of key studies and relevant systematic reviews, thereby, reducing the likelihood of missing relevant studies. A strength of the review is that we conformed to the PRISMA guidelines to help transparently report the review process , 126 (SuIn this review, we have presented the state of the evidence on ethnic inequalities in the prevalence of MLTCs in the UK prior to the COVID19 pandemic. We have identified and described the literature in this area and in doing so, illuminated the scope of work required to enhance future analyses of ethnic inequalities in people with MLTCs. With the exception of two studies that focused on diabetes, the studies identified point to the existence of ethnic inequalities in the prevalence of MLTCs. These studies also suggest that Indian, Pakistani, Bangladeshi, Black African, Black Caribbean, and people who identify as Black other, other Asian, and mixed may be at higher risk of MLTCs. Our assessment of the conceptualisation and operationalisation of ethnicity has revealed that the majority of these studies used broad ethnic categories in their analyses. They also focused on different health conditions. Further, they drew on patient records, thereby, excluding those who are not in contact with healthcare services. Thus, the results provide a partial picture of ethnic inequalities in the prevalence of multiple conditions.The COVID19 pandemic has not only exposed structural inequalities in our society but it has also exacerbated them, especially among minoritised ethnic group people . TherefoAdditional file 1.