Edited by: Ricardo Gusmão, University of Porto, Portugal
Reviewed by: Emma Kathryn Grigg, University of California, Davis, United States
Temple Grandin, Colorado State University, United States
†These authors have contributed equally to this work and share first authorship
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In England, dog-assisted interventions (DAIs) are increasingly used to support the health and wellbeing of individuals with mental and physical health conditions. Although research in this area is increasing, little is known about the national prevalence and characteristics of DAIs in practice. Advancing knowledge is important to inform development of research, policy and practice in the field.
An online survey of DAI providers in England was conducted to collect data on DAI service provision, including target populations, session content and structure, implementation challenges, and best practices in dog selection, training, and welfare monitoring.
Of 72 invitations sent to DAI organizations and therapists, 31 participants completed the survey (response rate: 41.3%). DAIs were primarily used to support individuals with mental health and neurodevelopmental conditions (e.g., anxiety, depression, autism) across the National Health Service (80.6%), private healthcare (61.3%), and educational settings (41.9%). Respondents estimated delivering DAIs across 7,679 institutions. Interventions included structured therapeutic sessions (61.3%) and spontaneous activities (51.6%), mostly delivered individually (90.5%) rather than to groups. Over half reported delivering dog-assisted therapy, but 38.7% were unsure whether sessions had individualized goals. Session frequency and duration varied; most lasted 31–60 min (54.8%) and occurred weekly (45.2%). Key challenges included limited access to delivery spaces (35.5%), infection control concerns (32.3%), and difficulties “matching” dogs to service users (22.6%). Dog selection relied on temperament assessments (100%). While 54.8% of handlers received formal training, content varied. Some were trained in dog body language and risk assessment; others were not. Welfare monitoring primarily depended on handler observation (90.3%) and access to basic resources such as water.
DAIs are now implemented in thousands of health, care and educational settings across England, serving diverse clinical populations of all ages, especially those with mental health and neurodevelopmental conditions. Interventions range from structured, goal-oriented sessions (e.g., supporting mental, emotional, or physical health) to spontaneous interactions (e.g., community programmes, social events, recreational activities). Participant responses highlight substantial variation in DAI characteristics and delivery. These findings underscore the clear need for standardized good practice guidelines encompassing aspects related to outcome reporting, dog selection and welfare monitoring, and provider training.
In England and many other countries worldwide, demand, provision and research of animal-assisted interventions (AAIs) to improve human health and wellbeing has been rapidly growing (
Despite the expanding interest and research activity surrounding DAIs, there remains a limited understanding of the prevalence, nature, and characteristics of DAI provision within England. While health and safety guidelines for implementing DAIs have been developed across multiple sectors (e.g., healthcare, education, voluntary organizations) (
Understanding current practices and standards of DAI provision is critical not only for effective implementation and the safe and ethical delivery of these interventions, but also for enhancing the quality and transparency of research in this field. While a growing body of literature demonstrates the potential benefits of DAIs across diverse clinical populations and age groups (
Understanding more about the landscape of DAI provision in England will also facilitate international comparisons and the exchange of best practices, ensuring a more cohesive and informed approach to intervention development and evaluation. Therefore, the aim of the reported study was to undertake a survey of DAI service provision and practice in England.
A cross-sectional online survey was distributed to DAI providers in England.
The survey was released in Qualtrics survey software (Qualtrics, Provo, UT, USA). Organizations specializing in the provision of DAIs in England (e.g., Dogs for Good, Pets as Therapy) were identified based on the researchers' multi-sector networks and extensive internet searches. These searches were conducted using Google with combinations of key terms such as “dog-assisted therapy,” “dog-assisted activity,” and “animal-assisted interventions” and restricted to results in England. We also manually reviewed directories and public listings of third-sector and healthcare organizations known to deliver or promote DAIs. Additionally, the British Association for Counseling and Psychotherapy Therapist Directory was searched to identify therapists with registered expertise in delivering DAIs. Personalized email invitations were sent to organizations and therapists, with up to two follow-up reminders. For organizations, only one participant was permitted to complete the survey on behalf of each organization to avoid duplication. Participants were asked to self-nominate or be nominated by their organization as the most appropriate person to complete the survey based on their familiarity with DAI delivery practices. To be eligible to participate, participants were required to be affiliated with an organization delivering DAIs in England, rather than those involved in the placement of assistance dogs.
Prospective participants were invited to follow a link to the survey where they were presented with a Participant Information Sheet (PIS) and consent form. Consent to participate was indicated by ticking an online check box. The PIS described a survey incentive being offered (opportunity to enter a prize draw with three participants randomly selected to win shopping vouchers). Screening questions required participants to confirm their involvement in DAI delivery and residence in England. All data were stored on the Qualtrics server of the University of York.
The survey opened for recruitment on September 2nd, 2024, and closed on January 13th, 2025. Approval for this research was granted by the Health Sciences Research Ethics Committee at the University of York, UK, on 29th September 2023 (Ref: HSRGC/2023/586/E).
A bespoke survey was developed to enable collection of data most relevant to understanding the types and characteristics of DAI service provision in England. It was piloted by an expert group comprising a multi-disciplinary team of academics (
Demographic information was gathered about participants' age (in ranges), gender (male/female/non-binary), their primary role/position within their organization (e.g., professional/paid animal handler, director, volunteer, occupational therapist, clinician, teacher, social worker), and number of years' experience of providing DAIs.
Information was gathered about the respondent's affiliated DAI organization. If the participant worked at more than one organization, they were asked to answer questions with their primary DAI-providing organization in mind. Information was collected on organization type (e.g., third sector/charity organization, local authority/council, NHS organization, private hospital, residential care and nursing home, hospice, school, nursery or pre-school); the number of paid and volunteer dog handlers registered at the organization, and not-for-profit status (yes/no).
Information was collected regarding the settings in which organizations currently delivered DAIs. Options included NHS mental health settings (e.g., adult mental health services, older people's mental health services, child and adolescent mental health services); NHS physical health settings (e.g., GP practices, outpatient clinics, inpatient wards, intensive care units); non-NHS health and care settings (e.g., hospices, care/nursing homes), and educational settings (e.g., nurseries, pre-schools, schools, universities). Participants were asked to provide the approximate number of settings or institutions in which their organization currently provided DAIs, and, if known, to provide this number.
Participants were also asked to identify the target populations to whom DAIs were delivered. Response options included adults and/or children and young people with physical health conditions; adults with mental health and neurodevelopmental conditions [e.g., anxiety, depression, schizophrenia, post-traumatic stress disorder, autism, eating disorders, attention-deficit/hyperactivity disorder (ADHD), intellectual disabilities]; children with mental health and neurodevelopmental conditions (e.g., anxiety, depression, emerging behavioral problems, autism, ADHD, eating disorders, trauma, attachment-related difficulties, intellectual disabilities); and adults with neurodegenerative conditions (e.g., dementia).
Based on a brief list of definitions provided within the survey, participants were asked to identify what kind of DAIs their organization provided: dog-assisted therapy (i.e., goal-directed, documented, therapeutic intervention as part of a treatment plan, delivered by specialist-trained dog-handler teams), dog-assisted activities (i.e., activities focused on spontaneous interactions that can be delivered by volunteers and untrained dogs), both, or other. Dog-assisted therapy was defined as goal-directed interactions with dogs, led by trained professionals, and dog-assisted activities were defined as spontaneous interactions with dogs, often led by volunteers. If participants indicated their organization delivered dog-assisted therapy, they were asked to specify whether these sessions had clear individualized goals for the service user. We do acknowledge the recent suggestion of the new terminology [animal-assisted services; AASs (
Participants were also asked to indicate whether DAIs are typically delivered on an individual basis or in group settings (e.g., with peers and/or family members). Additional information was collected regarding the frequency of DAI delivery (e.g., multiple times per week, once per week, more than once every 2 weeks but less than weekly, every 2 weeks, or varying by service user); the typical duration over which DAIs were provided (in weeks), and the usual length of individual sessions (e.g., 30 min or less, 31 min to 1 hour, more than 1 h but < 2, 2 h or more).
Participants were asked whether handlers within their organization received formal training (yes/no), and if so, to indicate the training received among nine pre-specified options, or to specify it themselves. The pre-specified training options included: “service user wellbeing/safety”; “dog wellbeing/safety”; “dog obedience/skill training”; “risk assessment and awareness”; “human-dog bond” (e.g., exercises to build mutual trust and responsiveness between the dog and handler, such as eye contact games or joint play activities); “dog body language”; “general mental health”; “condition/diagnosis-specific training,” and “safeguarding.”
Participants were then asked to indicate their confidence level within their role, using a ten-point Likert scale (1 = not at all confident; 10 = very confident). An option was included for participants to leave an open-ended, free-text comment to share further information on their confidence level within their role.
Participants were asked to indicate what training a dog receives prior to working, selecting from six pre-specified options, or to specify themselves. The pre-specified options included: “obedience training (e.g., leadwork, sit, down)”; “handling training (e.g., to be stroked/touched by strangers); greeting training (e.g., to greet people calmly)”; “human-dog bond”; “trick training,” or “socialization training in environments likely to work in.”
Participants were asked to indicate what type of dogs are typically involved in the DAIs using Kennel Club groups (
Participants were asked to specify how a dog is selected for work, selecting from the following options: “temperament/behavior assessment”; “pass obedience test [e.g., Kennel Club test (
Information was collected about whether the dogs needed to have any health checks passed prior to their involvement in DAIs (yes/no), and if so, to indicate the health checks among six pre-specified options, or to specify it themselves. The pre-specified health check options included: “annual vaccinations”; “regular worming programme”; “not currently receiving any veterinary-prescribed medication”; “no current health issues that have prohibited the issuing of veterinary sign off”; “regular grooming schedule,” and “not on a raw food diet.”
Information was gathered regarding how many handlers, on average, the dogs work with; how frequently a dog is involved in the DAI (daily, a few days a week, weekly, less than once a week), and whether there is a maximum number of hours a dog can work per week (yes/no). Participants were also asked to indicate whether strategies are in place to ensure the dog's welfare is monitored, and if so, to indicate the strategies among five pre-specified options, or to specify it themselves. The pre-specified options included: “handler observation”; “veterinary observation”; “using checklists or other written materials”; “access to water,” and “access to a place the dog can choose to go by themselves.”
Participants were also asked whether a formal process was in place for reporting incidents of inappropriate dog behavior or injuries to either human participants or the dog (yes/no).
Participants were asked whether they experienced barriers when delivering DAIs, and if so, to indicate the reason among seven pre-specified options, or to specify it themselves. The pre-specified barriers included: “controlling potential risk factors and infection prevention control”; “access to appropriate space for delivery”; “challenges related to monitoring dog welfare”; “challenges related to matching dogs to service users”; “working with other professions”; “lack of appropriate skills/training for dog,” and “challenges related to access to appropriate training for handler.” A free-text, open-ended box was provided for participants to identify the most important facilitators for successful implementation.
Data were analyzed in SPSS v29.0 (IBM SPSS Inc., Chicago, USA) (
Of the 72 invitations sent to DAI organizations (
Participant and organizational characteristics.
| Female | 29 (90.3) |
| Male | 2 (6.5) |
| Prefer not to say | 1 (3.2) |
| 18–25 | 1 (3.2) |
| 26–34 | 2 (6.5) |
| 35–44 | 5 (16.1) |
| 45–55 | 12 (38.7) |
| 56–65 | 9 (29.0) |
| Over 65 | 2 (6.5) |
| Clinician (e.g., consultant, psychologist, mental health nurse) | 15 (48.4) |
| Professional/paid animal handler | 5 (16.1) |
| CEO/Director | 4 (12.9) |
| Volunteer animal handler | 4 (12.9) |
| Occupational therapist | 3 (9.7) |
| < 1 year | 2 (6.5) |
| 1–3 years | 7 (22.6) |
| 4–7 years | 9 (29.0) |
| ≥8 years | 13 (41.9) |
| South East England | 9 (29.0) |
| North West England | 7 (22.6) |
| South West England | 6 (19.4) |
| West Midlands | 4 (12.9) |
| North East England | 3 (9.7) |
| East Midlands | 1 (3.2) |
| South Central | 1 (3.2) |
| Counseling/psychotherapy practice | 13 (41.9) |
| Third sector/charity organization | 12 (38.7) |
| School | 4 (12.9) |
| NHS organization | 2 (6.5) |
| No | 18 (58.1) |
| Yes | 12 (38.7) |
| Not sure | 1 (3.2) |
| 1–2 | 19 (61.3) |
| 3–5 | 2 (6.5) |
| 6–10 | 1 (3.2) |
| 11–20 | 1 (3.2) |
| Not sure | 8 (25.8) |
| 1–2 | 12 (38.7) |
| 3–5 | 2 (6.5) |
| 6–10 | 1 (3.2) |
| 11–20 | 1 (3.2) |
| 21+ | 4 (12.9) |
| Not sure | 11 (35.5) |
Most participants reported that their organizations delivered DAIs in non-NHS health and care settings (
With non-NHS settings, DAIs were most commonly reported to be provided in mental health settings (
Twenty-one participants (67.7%) reported they were aware of the approximate number of institutions (e.g., hospitals, health services, community centers) where their organization provided DAIs. Estimates ranged from 1 to 6,000 institutions, with a cumulative total of 7,679 institutions across all participants. This wide range reflects the diversity in organizational size and reach among respondents, including both smaller local providers and some of the largest DAI organizations operating nationally within the UK.
Populations served varied substantially across organizations, as DAIs were delivered to adults with a mental health or neurodevelopmental condition (
Overview of service user diagnoses.
| Anxiety and/or depression | 21 (100.0) |
| Autism spectrum condition | 19 (90.5) |
| Post-traumatic stress disorder | 18 (85.7) |
| Attention deficit and hyperactivity disorder | 17 (80.9) |
| Eating disorder | 10 (47.6) |
| Schizophrenia and/or other severe mental illness | 10 (47.6) |
| Intellectual disability | 10 (47.6) |
| Other | 5 (23.8) |
| Dementia | 13 (100.0) |
| Various (e.g., epilepsy, cancer, diabetes) | 7 (53.8) |
| Confidential/not known | 2 (15.4) |
| Acquired brain injuries | 2 (15.4) |
| Mobility related (e.g., cerebral palsy, multiple sclerosis) | 2 (15.4) |
| Anxiety and/or depression | 18 (94.7) |
| Autism spectrum condition | 18 (94.7) |
| Attention deficit and hyperactivity disorder | 18 (94.7) |
| Trauma | 15 (78.9) |
| Problems relating to attachment | 14 (73.7) |
| Emerging behavioral problems | 12 (63.2) |
| Intellectual disability | 12 (63.2) |
| Eating disorder | 10 (52.6) |
| Other | 3 (15.8) |
| Various (e.g., epilepsy, cancer, diabetes) | 7 (77.8%) |
| Acquired brain injuries | 1 (11.1%) |
| Confidential/not known | 1 (11.1%) |
The majority of participants reported their organization delivered dog-assisted therapy (i.e., goal-oriented interactions with dogs, led by trained animal-handler professionals and/or certified therapists;
Regardless of intervention type or population served, DAIs were most frequently delivered on an individual basis (
Just over half of the participants (
Dog handler training.
| Dog wellbeing/safety | 16 (94.1) |
| General risk assessment and awareness | 16 (94.1) |
| Service user wellbeing/safety | 15 (88.2) |
| Dog body language | 15 (88.2) |
| Safeguarding | 15 (88.2) |
| General mental health | 14 (82.4) |
| Dog obedience/skill training | 13 (76.5) |
| Human-dog bond | 13 (76.5) |
| Condition/diagnosis-specific training | 11 (64.7) |
When participants were asked to rate their confidence within their role on a 10-point Likert scale (1 = not at all confident; 10 = very confident), the mean score was 8.7 (range = 5–10, standard deviation = 1.26).
In addition to handler training, participants also reported a range of training activities undertaken by dogs prior to their involvement in DAIs. The most frequently reported training activities included basic obedience (e.g., leadwork, sit, down; 80.6%), handling training (77.4%), and greeting training (74.2%). Socialization in environments similar to those in which the dogs would work (74.2%) and training to support the development of the human-dog bond (67.7%) were also commonly reported. A full summary of reported training types is provided in
Training dog receives before starting DAI sessions.
| Obedience training (e.g., leadwork, sit, down, etc.) | 25 (80.6) |
| Handling training (e.g., to be stroked/touched by strangers) | 24 (77.4) |
| Greeting training (e.g., to greet people calmly) | 23 (74.2) |
| Socialization training in environments likely to work in | 23 (74.2) |
| Training related to human-dog bond development | 21 (67.7) |
| Trick training | 11 (35.5) |
Participants reported that dogs involved in DAI sessions were most commonly from the following UK Kennel Club classifications: Gundog group (e.g., Labradors, Golden Retrievers, Spaniels;
Regardless of dog type, the youngest age at which the dog would start DAI work differed across organizations. Thirteen participants (41.9%) reported the youngest age a dog would commence work was 7–12 months, whereas others reported >2 years (
When selecting dogs for DAIs, all participants (100%) reported temperament/behavior assessment as a selection criterion. Additional selection criteria were identified, including health status (passing veterinary assessment;
In addition to these selection criteria, 26 participants (83.9%) reported the type of health checks in place for dogs prior to or during their involvement (
Type of dog health checks.
| Regular worming programme followed | 26 (100.0) |
| Annual vaccinations | 24 (92.3) |
| Regular grooming schedule followed | 21 (80.8) |
| No current health issues (that have prohibited the issuing of veterinary sign off/approval for involvement in DAIs) | 19 (73.1) |
| Not on a raw food diet | 15 (57.7) |
| Not receiving any veterinary-prescribed medication | 12 (46.2) |
To monitor the wellbeing of dogs involved in DAIs, the most commonly reported strategies included handler observation (90.3%), ensuring access to water (87.1%), and providing a space the dog could choose to retreat independently (74.2%). Fewer organizations reported using tools such as checklists or written materials (32.2%) or veterinary or specialist observation (16.1%). The full set of reported wellbeing monitoring strategies are summarized in
Wellbeing monitoring strategies.
| Handler observation | 28 (90.3) |
| Access to water | 27 (87.1) |
| Access to a place the dog can choose to go by themselves | 23 (74.2) |
| Checklists/written materials | 10 (32.2) |
| Veterinary or other specialist observation | 5 (16.1) |
Lastly, the majority of participants (
While six participants (19.4%) reported no perceived barriers to DAI implementation, others reported several challenges. The most frequently cited barriers included limited access to appropriate delivery spaces (35.5%), infection prevention and control concerns (32.3%), and challenges in appropriately matching dogs to service users (22.6%). Additional issues included difficulties in monitoring dog welfare and interprofessional collaboration. A full overview of the reported barriers are presented in
Perceived barriers to DAI implementation.
| Access to appropriate space for delivery | 11 (35.5) |
| Controlling potential risk factors and infection prevention control | 10 (32.3) |
| Challenges related to matching dog(s) to service users | 7 (22.6) |
| Challenges related to monitoring dog welfare (e.g., stress, fatigue) | 6 (19.4) |
| Working with other professions | 6 (19.4) |
| Challenges related to access to appropriate training for handler | 4 (12.9) |
Facilitators reported by free text included: a highly trained dog and handler adhering to animal welfare practices, an appropriate matching process to ensure a suitable dog-service user “fit,” allowing service users sufficient time to develop a relationship with the dog, and regular evaluation throughout implementation.
To our knowledge, this survey provides the first attempt to report on the types and characteristics of current DAI practice in England. Results indicate that DAIs have been implemented in thousands of health, care and educational settings, including NHS and non-NHS health and care settings, as well as schools, and are delivered across a range of mental and physical health conditions for both children and adults. Our findings reveal substantial variation in the delivery of DAIs, particularly in the service settings, training of handlers and dogs, and approaches to monitoring both human and animal welfare. These insights contribute to the ongoing discourse on best practice and the need for standardized guidelines in the field.
The majority of participants reported implementing dog-assisted therapy (goal-orientated, structured involving clinical professionals and trained dog handlers) just over half the sample also reported using dog-assisted activities (spontaneous interaction, often no defined outcomes). This suggests that while therapeutic interventions involving dogs are prevalent, there is also a considerable focus on non-therapeutic activities aimed at enhancing general wellbeing. However, it could also be a reflection of the lack of uniformity in defining and categorizing AAIs, as highlighted in previous research (
We found that most participating providers served individuals with mental health and neurodevelopmental conditions, particularly autism, ADHD, anxiety/depression, and PTSD. This aligns with existing evidence that suggests DAIs may be particularly beneficial for these populations (
The reported frequency and duration of DAIs also varied considerably. While 45.2% of organizations provided sessions once per week, others offered multiple sessions per week or had variable schedules based on user needs. Similarly, while most sessions lasted between 31 min and 1 h (54.8%), others extended beyond 1 h or were shorter than 30 min. The findings on frequency and duration variability are congruent with a recent survey conducted in intensive care unit settings in the UK (
Comparable to previous research in the field, our findings identified Gundogs (e.g., Labradors, Golden Retrievers, and Spaniels) as the most commonly involved dog type followed by crossbreeds (
Another key issue highlighted by this study is the variability in handler and dog training. Only 54.8% of handlers received formal training. There was a lack of consistency in the breadth of essential training provided, and notable gaps in important areas such as risk assessment and understanding of dog body language. This lack of consistent and comprehensive training raises concerns about the safe and ethical delivery of DAI implementation. Given the increasing recognition of the importance of handler competency in ensuring safe and effective DAI delivery (
We established that DAIs are now implemented in many thousands of health, care and educational settings across the UK. There is clear potential for the further development and refinement of DAIs. The variability in session structure, duration, and goal-setting suggests a need for standardized guidelines to enhance consistency, ethical provision, safety, and efficacy, while allowing for individualized adaptations. Additionally, addressing reported key barriers, such as access to appropriate operational spaces, could facilitate wider implementation of DAIs. Future research should explore the long-term outcomes of DAIs for service users, as well as the impact of intervention structure and frequency on therapeutic effectiveness. Moreover, further investigation into best practices for dog assessment, welfare monitoring and handler training would contribute to the robustness, ethical and sustainable development of DAIs.
This study represents one of the first surveys focused on DAI provision in England, offering valuable insights into current practices and standards. However, several limitations should be acknowledged. Firstly, the study relied on self-reported data, which will be subject to bias or inaccuracies. Additionally, only one individual per organization was invited to complete the survey, which may have introduced variability in response quality depending on the respondent's role (e.g., director vs. volunteer). Secondly, the small sample size (
This study demonstrates an encouraging breadth and versatility of DAIs across health and care settings in England, reflecting their integration into services that support individuals of all ages and clinical backgrounds and a clear indication of high demand and acceptability. From structured therapeutic programmes to informal community-based activities, DAIs appear to be valued for their potential to enhance mental, emotional, and physical wellbeing. At the same time, our findings underscore the pressing need for more standardized and validated procedures, particularly in areas such as practitioner training and animal welfare monitoring, to ensure the safe, ethical, and effective delivery of these interventions. While previous research points to the promise of DAIs, especially for individuals with mental health and neurodevelopmental conditions, inconsistency in practice and reporting continues to present barriers to achieving reliable outcomes and scaling services. Moving forward, greater collaboration between researchers, practitioners, and policymakers will be critical to address these challenges and establish a cohesive framework for best practice. By doing so, we can ensure that the full potential of DAIs is realized, delivering meaningful and lasting impact for service users and the wider field.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving humans were approved by Health Sciences Research Ethics Committee at the University of York, UK. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
ES: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Writing – original draft, Writing – review & editing. SH: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. ERi: Data curation, Formal analysis, Investigation, Project administration, Resources, Software, Writing – review & editing. DSM: Investigation, Methodology, Supervision, Writing – review & editing. SG: Investigation, Methodology, Supervision, Writing – review & editing. DM: Writing – review & editing. QW: Writing – review & editing. CC: Writing – review & editing. ERa: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing.
The author(s) declare that financial support was received for the research and/or publication of this article. This study was funded by the National Institute for Health and Care Research (NIHR) Programme Development Grant (PDG) (Award number 205656). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ES, ERi, DM, QW, and ERa were supported by the NIHR Yorkshire and Humber Applied Research Collaboration (
We would also like to thank all participants who completed the survey.
SG is affiliated with an organization that participated in the survey. However, SG did not complete the survey on behalf of the organization and was not involved in the data analysis or interpretation of the data.
The remaining 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.
The author(s) declare that no Gen AI was used in the creation of this manuscript.
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.
The Supplementary Material for this article can be found online at: