Economic Resilience and Welfare of Older Adults after the Paitua Assistance Program

The importance of teacher performance in improving achievement to determine the quality of education and school performance, This study is an Exploratory Sequential mixed method design study. aims to influence leadership, work motivation, and organizational culture on teacher performance and achievement, both partially and simultaneously with Exploratory Sequential Design . This approach combines qualitative and quantitative methods, starting with an in-depth exploration of the factors that influence the effectiveness of teacher work performance, followed by testing the quantitative model. This research was conducted at SMP Negeri 3 Numfor Barat in a remote area. To achieve the objectives of this study, the researcher applied Exploratory Sequential mixed method design research with a case study approach . In the qualitative stage, the research data was collected through observation, in-depth interviews with 1 head of educational unit and 10 subject teachers, and document analysis to identify needs, challenges, and best practices in management. The research data was processed through the stages of data collection, data presentation, data reduction, and data conclusion drawing. To ensure the validity of the research data, the researcher conducted data confirmation and credibility by involving the Education Office for the development of educational resources and school supervisors. The results of the study indicate that: (1) the teacher training management model in improving work performance that has been implemented in remote areas consists of the planning, organizing, implementing and evaluating stages. (2) The function of the teacher training management model in improving work performance that has been implemented in remote areas runs effectively and efficiently. The results of this study provide important information for the government, school supervisors, principals and teachers. leadership, work motivation, and organizational culture simultaneously have a positive and significant effect on teacher work performance.

Occupational therapists concern themselves with understanding engagement in everyday activity as a mode of facilitating wellbeing. However, there appears to be little consensus within the literature as to how engagement in meaningful activities contributes to wellbeing. Currently, there are no published evidence-based frameworks for wellbeing to support occupational therapy practitioners to address wellbeing with clients. The purpose of the study was to establish an evidence-based contemporary framework, domains and descriptive statements defining occupational wellbeing. A multiphase, exploratory sequential mixed methods design, using both qualitative and quantitative approaches was used. Two phases were identified for data collection. The first phase involved exploration of the domains of occupational wellbeing, through conducting a literature review and two focus groups. The Delphi technique was employed in the second phase to refine and corroborate the domains of occupational wellbeing with an expert panel. Six new domains of occupational wellbeing were generated in the first phase of the study, namely: Competence, autonomy, contentment and pleasure, identity, hope and belonging. In the second phase, five out of the six domains reached a consensus level of 70% or more. Hope was the only domain not to reach consensus. The framework for occupational wellbeing produced by this study was created using evidence-based, replicable methodology and garnered support from a highly regarded expert key informant group of occupational therapy and occupational science academics. Further exploration to determine whether there is widespread support and applicability for these domains with normative and vulnerable population groups is required.

Dark tourism is a concept that is primarily constructed by Western values but has become a global discipline with the potential for epistemological colonisation. In response to this academic status quo, paradigm guidance is essential to the rigorous development of decolonising tourism praxis. Addressing this academic ‘pluriversal challenge’ from a non-Western perspective requires a rigorous methodological foundation. The exploratory sequential mixed-methods enable a sequential combination of qualitative and quantitative approaches to deepen the research findings by recognising the socio-cultural and political backgrounds of the actors in question. Currently, mixed methods studies in the tourism discipline are facing challenges caused by unclear research paradigms and confusing process design. In reaction, this paper examines an exploratory sequential mixed methods study of the dark tourism experience through a reflective lens. A triadic analytical lens is proposed to highlight the potential of the exploratory sequential mixed methods design to advance research decoloniality from a methodological perspective. By operationalising the three contextual research phases, the transition phases of the exploratory sequential design are emphasised and made more concrete. Meanwhile, this paper presents practical toolkits applicable to exploratory mixed methods designs and studies guided by decolonial aims.

This chapter examines the application of exploratory sequential mixed methods design in the context of small accommodation enterprises (i.e., home-stay). This study, therefore, discusses the exploratory sequential mixed methods of data collection and analysis and provides practical illustrations based on a study of small tourism enterprise sustainability practices in Ghana. The findings demonstrate that mixed methods overcome the weaknesses of a mono-method and offer an in-depth understanding of tourism and hospitality phenomena. In addition to providing a practical guide to emerging tourism scholars, the current study highlights the ability of mixed methods to develop emerging practitioners' skills in both qualitative and quantitative data. In conclusion, the exploratory sequential mixed methods design offers pragmatic data collection techniques that are non-existent in mono-methods. Accordingly, it is recommended for exploring research questions when there is limited information and high flexibility is needed.

BackgroundAdvance care planning (ACP) is a complex process where individuals communicate decisions about their future health care before becoming incapable to participate in medical decision-making. While ACP has many potential benefits, little is known about ACP among older adults with cancer and their family caregivers. The purpose of this study is to examine holistic factors that affect ACP in older adults with cancer and how family caregivers engage in the process.MethodsThis study used explanatory sequential mixed methods design guided by Engel's Biopsychosocial model. Phase I included secondary analysis of 1088 decedents over 55years of age, using data from 2002-2016 waves of exit interviews of the Health and Retirement Study. Phase 2 included semi-structured interviews with a convenience sample of 14 family caregivers. Quantitative and qualitative findings were integrated using a joint display.ResultsQuantitative findings showed that over half of participants had all 3 types of ACP (end-of-life care discussion, durable power of attorney, advance directives) and all 3 types were significantly associated with age, race, education, multimorbidity, limitations in activities of daily living and instrumental activities of daily living, and marital status. Qualitative findings revealed that most participants had no knowledge about ACP. Integration identified points of convergence and divergence in knowledge, documentation, and factors affecting ACP.ConclusionsFuture studies are needed in a diverse sample of older adults with cancer and their family caregivers to understand and improve discussion and documentation of ACP. Findings also suggest the need for interventions to improve knowledge and awareness of ACP in this population.

The legalization of cannabis in Thailand has increased its accessibility among older adults, leading to its use for managing various health problems based on personal perceptions. However, such use may increase the risk of side effects or adverse outcomes. A sequential explanatory mixed methods design was used to explore cannabis use for healthcare purposes among older adults. A survey utilizing questionnaires on knowledge, attitude, and cannabis use behavior was administered to 180 older Thai adults in Chiang Mai Province. Then, 30 participants took part in in-depth semi-structured interviews. Descriptive statistics and the Chi-square test were used to analyze quantitative data, while qualitative data were analyzed through content analysis. The quantitative research results showed that older adults had a moderate level of knowledge about cannabis (x̅ = 11.2, SD = 1.72), a neutral attitude towards cannabis (x̅ = 3.5, SD = 0.50), and 33 older adults (18.3%) used cannabis for health maintenance. The qualitative findings revealed that older adults mainly obtained information about cannabis through online media. Although they acknowledged its benefits, they emphasized the importance of using it appropriately and in an informed manner. Alleviating health problems was the vital reason older adults used cannabis, obtaining it from sources both within and outside their community. The outcomes included effective and ineffective, leading to managing the effects of cannabis by discontinuing use and seeking information. Nurses should organize educational programs to promote accurate knowledge of the benefits and side effects of cannabis use, ensure access to reliable information sources, and monitor for potential adverse symptoms to support informed decision-making among older adults.

BackgroundThe rising burden of chronic diseases among older adults in China underscores the urgent need for an integrated and efficient health care system. Existing services are often fragmented, lacking coordination and accessibility, particularly for urban community-dwelling older adults with multiple comorbidities. There is a critical demand for person-centered integrated care that enables resource sharing, expert guidance, and the safe, continuous management of chronic conditions.ObjectiveThis study aims to extend the theoretical understanding of case-managed integrated care informed by the Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) model within urban Chinese communities. It will examine older adults’ expectations for case-managed integrated care, develop and validate a measurement instrument to quantify these expectations, and build an evidence-based framework to adapt the PRISMA model to the Chinese context.MethodsAn exploratory sequential mixed methods design will be used across 3 phases. Phase I involves qualitative interviews with community-dwelling older adults and other stakeholders to explore unmet health care needs and perceptions of case-managed integrated care. Phase II entails the development and psychometric validation of a questionnaire informed by the findings from phase I. Phase III involves a large-scale cross-sectional survey in Wenzhou, Taiyuan, and Hainan to quantify expectations for case-managed integrated care and identify associated sociodemographic factors. A data integration approach will be used to synthesize both qualitative and quantitative findings, providing a comprehensive understanding of expectations regarding the proposed integrated care.ResultsData collection is scheduled to begin in December 2025, with the study expected to last 24 months. Ethics approval has been obtained from the Institutional Ethics Committee.ConclusionsThis study seeks to evaluate the feasibility of culturally adapting the PRISMA model for case-managed integrated care to address critical gaps in existing health care service delivery. The findings are expected to inform policy formulation, guide the implementation of integrated community care strategies, and ultimately improve health outcomes and quality of life for older adults in urban China.Trial RegistrationOSF Registries 825ah; https://osf.io/825ahInternational Registered Report Identifier (IRRID)PRR1-10.2196/71394

The study adopted the explanatory sequential Mixed Method design approach. Using the proportional stratified random sampling technique, the study sampled 325 respondents made up of 260 teachers and 65 headteachers from the four categories of basic schools in the Central Region of Ghana for the quantitative phase of the study. Subsequently, 15 teachers and 5 headteachers from 4 categories of schools were sampled purposely for the qualitative phase of the study. Questionnaires and interview guides were used to collect data. The quantitative data were analysed using descriptive (Means and Standard Deviation) statistics whilst the qualitative data were analysed thematically. It was evident from the results that teachers in the improved and dynamic schools are highly empowered than their counterparts in the trapped and failing schools. The teachers in the trapped and failing schools missed elements of empowerment such as decision making, professional growth, status, self-efficacy, autonomy and impact. The study further found that teacher empowerment affects school improvement significantly. It is recommended per the findings that headteachers should invest in teachers the right to participate in the determination of school goals and policies and the right to exercise professional judgement the content of the curriculum and the means of instruction.

The study adopted the explanatory sequential Mixed Method design approach. Using the proportional stratified random sampling technique, the study sampled 325 respondents made up of 260 teachers and 65 headteachers from the four categories of basic schools in the Central Region of Ghana for the quantitative phase of the study. Subsequently, 15 teachers and 5 headteachers from 4 categories of schools were sampled purposely for the qualitative phase of the study. Questionnaires and interview guides were used to collect data. The quantitative data were analysed using descriptive (Means and Standard Deviation) statistics whilst the qualitative data were analysed thematically. It was evident from the results that teachers in the improved and dynamic schools are highly empowered than their counterparts in the trapped and failing schools. The teachers in the trapped and failing schools missed elements of empowerment such as decision making, professional growth, status, self-efficacy, autonomy and impact. The study further found that teacher empowerment affects school improvement significantly. It is recommended per the findings that headteachers should invest in teachers the right to participate in the determination of school goals and policies and the right to exercise professional judgement the content of the curriculum and the means of instruction.

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

Purpose: The purpose of this study was to examine the effects of psychosocial wellbeing status and self efficacy on health-promoting behavior of nursing students, and to explore the experiences related to health-promoting behavior. Methods: For this study, an explanatory sequential mixed method design approach was used with survey data collected from 148 nursing students. In addition, qualitative data for exploration of health-promoting behavior experience were collected from three focus-group interviews of 17 participants. Quantitative data were analyzed with SPSS/WIN 25.0 and qualitative data were analyzed by making contents analysis with Nvivo 12.0. Results: The results showed that psychosocial wellbeing status, self efficacy, grade, and regularity meal explained 43.0% of the variance in health-promoting behavior. And seven themes from the collected significant statements about experience of health-promoting behavior included the daily life going on without delay; changes in body which is felt; recognizing the necessity of health care; making efforts to increase physical activities; revising eating habit; looking for the way to relieve stress; and attempting to divert my thoughts. Conclusion: Based on the results of this study, it is necessary to develop and verify health program in order to improve nursing students’ health-promoting behavior. And university authorities and government should make an effort to improve nursing students’ health-promoting behavior.

The African Studies Curriculum at the University of Education, Winneba (UEW) has been implemented for over two decades. Its challenges include students’ motivations, cultural content, teaching methods, techniques and strategies. With a pragmatic worldview rooted in the Constructivist Learning Theory, the Self-Determination Theory (SDT), and the Expectancy-Value Theory, empirical literature within the domain of curriculum implementation in African Studies was critically reviewed. An explanatory sequential design within the mixed method approach was adopted, while the Krejcie and Morgan Table for sample size determination was employed to sample three hundred and seventy-five (375) students from a total of 12,009 first-year students offering African Studies courses in the 2022/23 academic year at the University of Education, Winneba (UEW). Nine (9) students were purposively selected from the sample size of 375 for the qualitative data. Again, five (5) lecturers from the African Studies Centre of UEW were purposively selected for the study. Instruments for data collection included questionnaires, interviews and focus group discussions. Quantitative data analysis was done by using SPSS statistics analytical software. Descriptive and inferential statistics were employed for the quantitative analysis, whilst thematic analysis was used to analyse the qualitative data. In the context of explanatory sequential mixed method design (QUAN → qual), a Directed Content Analysis (DCA) was employed. This approach aids in interpreting and explaining the quantitative results. Findings showed that even though students are motivated by a series of factors when selecting courses in the African Studies curriculum, they are influenced by external factors such as department, colleagues, and the popularity of the courses. It was concluded that some Departments choose specific courses based on relativity to their areas of specialism and future academic pursuits. It was recommended that, there is the need for course recommendation systems in physically-based university environments like the University of Education, Winneba in Ghana. This has become necessary since African Studies courses are mandatory to re-orient students' misconceptions concerning the continent and carve a positive African image. Fresh students should be oriented to alleviate the misconceptions associated with course selection.

This study explores how the cultural financial narratives connect to technology based informal accounting competencies and financial management abilities towards financial inclusion of Bottom-of-the-Pyramid (BoP) households. Our study is trying to expose such important social issues in the era of modern financial technology which is yet understudied. We select sample across rural and semi-urban areas of India, conducted with 48 qualitative interviews from 687 low-income respondents in form of survey method using sequential explanatory mixed-methods design. Quantitative analysis shows that culturally embedded financial narratives significantly predict the uptake of mobile accounting tools (r = .42, p < .001) adoption results cascading into better informal accounting competencies and advanced digital inclusion. Digital inclusion has potential to contribute and positive measurable impact on the economic resilience of households at the bottom of the pyramid (BoP). Associations of variables are unveiled through different quantitative and qualitative findings. collective narrative practices considered as an informational framework play a significant role that accelerate monetary transactions competencies, reduce financial risk, uncertainties in decision making, cultural judgment to financial behavior and foster trust in technology. Impact of technology use at the BoP is focused on access to our literacy limitations. The main challenge insights into our study are influence of digital technology for financial inclusion which needs policy intervention shaped by narratives and aligned with shared cultural values. The primary conclusion of this study is practical methods for building inclusive digital ecosystems at the BoP that develop accounting competencies, financial behavior and sustainable economic resilience in resource-constrained environments.

Recently the universities in Pakistan started replacing their old legacy systems with Enterprise Resource Planning (ERP) systems to improve their academic and administrative processes. Previously, ERP systems were used in business organizations to gain a competitive edge over competitors. The Higher Education Commission (HEC) has implemented ERP systems at eight different universities in Pakistan. The HEC has invested a significant amount of money to facilitate the integration, customization and implementation of these systems. Little research is reported to assess the impact of ERP systems in higher education institutions. Previous studies reported in the literature focus mainly on Critical Success Factors (CSFs) and risk factors in success and failure of ERP systems. To explore the research problem, various Information System (IS) success models were studied as part of the literature review. This study also presents a conceptual research model based on re-specification of the DeLone and McLean IS success model to empirically measure the impact of ERP in higher education in the Pakistani universities’ context. This research study empirically evaluated the post implementation impact of the ERP systems in higher education institutions, focusing on improvement in the academic and administrative processes. This study used a sequential explanatory mixed method design approach to meet the objectives and address the research questions. Quantitative data were collected from a survey involving 230 respondents (120 students and 110 faculty members) from two selected universities that had implemented ERP systems. The qualitative data was collected through 12 interviews (five faculty members, five heads of department and two VCs). The results of both the quantitative and qualitative findings highlight that the ERP implementation has a positive and significant impact on the improvement of academic processes such as student satisfaction, teaching quality, better communication and feedback mechanism and the higher management decision-making process in Pakistani university contexts. The research findings will help future researchers to build on the research, perhaps with different samples and methodologies and will be useful for higher education to formulate strategies for the implementation of ERP system in their respective public-sector universities. Keywords: Enterprise Resource Planning (ERP) Systems, Higher Education, mixed methods research, DeLone and McLean IS Success model

Background: The vision of the Alma-Ata Declaration sought to achieve universal health access, yet no country has fully attained “health for all.” Healthcare financing remains a persistent global challenge, with substantial differences in expenditure, insurance coverage, and out-of-pocket (OOP) payments across countries. While medical insurance has been shown to reduce OOP expenditure and improve access to healthcare services, evidence from Mbagathi Hospital and similar settings remains limited regarding how insured patients simultaneously utilize insurance and direct OOP payments. Methods: A sequential explanatory mixed-methods design was used, combining quantitative and qualitative approaches. Quantitative data were collected from 306 insured outpatients through structured questionnaires using stratified systematic sampling, while qualitative data were obtained from 50 purposively selected healthcare providers, policymakers, and departmental heads through focus group discussions and interviews. Quantitative data were analyzed using descriptive and inferential statistics, including chi-square, t-test, and ANOVA, while qualitative data were analyzed thematically. Results: The study revealed that socio-demographic factors significantly influenced the choice and utilization of healthcare financing. Age (χ² = 18.47, p = 0.024), education level (χ² = 21.89, p = 0.014), and income (χ² = 26.12, p = 0.030) were all associated with the type of financing used. Notably, out-of-pocket (OOP) expenses disproportionately burdened lower-income groups (F = 11.23, p < 0.001), reflecting a regressive effect. Awareness of healthcare financing models also significantly affected model adoption (χ² = 16.89, p = 0.002). Capitation was the most frequently utilized financing model (45%)². Overall satisfaction with financing models was moderate, with 39.4% satisfied and 37.8% dissatisfied³; satisfaction did not vary significantly across insurance providers (p = 0.9999)³. Qualitative findings indicated that higher education and formal employment facilitated effective insurance use, whereas low-income and informal sector patients often relied on OOP payments due to irregular contributions or limited understanding⁴. Conclusions: Medical insurance limits direct financial burden, but important inequities remain, particularly among low-income populations who continue to experience substantial OOP costs in Mbagathi Hospital. Policy recommendations include expanding tiered insurance schemes, improving health insurance literacy, broadening outpatient coverage, strengthening public-private partnerships, and promoting community and workplace-based schemes to enhance equity and access, which are essential for advancing universal health coverage in urban Kenya.