Concurrent Mixed Methods Study Research Articles

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study.

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi

BackgroundPostnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 h of birth, 48–72 h, 7–14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies.MethodsA concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study was conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 h of birth, at 48–72 h, 7–14 days, and six weeks after birth were conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach.ResultsThe uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 h of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded the utilisation of PNC services. The enablers included the mother’s level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities.ConclusionOptimisation of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, time points, and services that need to be delivered to create demand for the services. There is a need to assess the contextual factors for a better response in improving the uptake of PNC services and in turn inform the development of strategies for optimizing the uptake of PNC services.

The Opaque Language of Sexuality: Medical Students' and Providers' Beliefs About Virginity.

Although virginity is not a medical term and is instead socially constructed, it remains unknown what medical providers believe about the biological basis of virginity. This study explored providers' and medical students' beliefs about virginity and the potential impact of such beliefs on healthcare. This was a concurrent mixed-method survey study of 124 medical students and 216 healthcare providers (Registered Nurse, Physician Assistant, Nurse Practitioner, and Doctor of Medicine) at Penn State Health and The Pennsylvania State University College of Medicine. Participants rated their level of agreement with common misconceptions about virginity on a six-point Likert scale. Open-ended questions gave respondents the opportunity to define virginity and to describe terms like virgin and virginal in the context of sexual experience and the medical lexicon. We identified common themes in the qualitative data using thematic analysis. Frequencies of misconceptions and statistically significant demographic associations were identified in the quantitative data. Definitions of virginity were varied and vague, most with negative connotations. A majority of respondents said that virginity has no biological basis. Many participants identified downsides to use of terms like virgin, virginity, and virginal in medicine. The most prevalent misconceptions about virginity were related to the hymen. Seventeen percent of students and 26% of providers at least somewhat agreed that it was possible to determine whether a person has engaged in vaginal intercourse through a gynecological exam. Misconceptions about virginity persist in medicine and bias, even if unintended, may impact the quality-of-care people with vaginas receive. Language around sexual health should be specific, inclusive, clinically relevant, and free from judgment. Medical education must continue to work to eliminate the concept of a biological basis to virginity.

PD14-02 WHAT INFORMS PATIENT DECISION-MAKING WHEN SELECTING TREATMENT FOR OVERACTIVE BLADDER? A MIXED METHODS STUDY OF PATIENT PREFERENCES

You have accessJournal of UrologyCME1 Apr 2023PD14-02 WHAT INFORMS PATIENT DECISION-MAKING WHEN SELECTING TREATMENT FOR OVERACTIVE BLADDER? A MIXED METHODS STUDY OF PATIENT PREFERENCES Casey Brodsky, Hannah Sitto, Daniela Wittmann, Lauren Wallner, Courtney Streur, Melissa Dejonckheere, John Stoffel, Aruna Sarma, J. Quentin Clemens, and Giulia Lane Casey BrodskyCasey Brodsky More articles by this author , Hannah SittoHannah Sitto More articles by this author , Daniela WittmannDaniela Wittmann More articles by this author , Lauren WallnerLauren Wallner More articles by this author , Courtney StreurCourtney Streur More articles by this author , Melissa DejonckheereMelissa Dejonckheere More articles by this author , John StoffelJohn Stoffel More articles by this author , Aruna SarmaAruna Sarma More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and Giulia LaneGiulia Lane More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision making (SDM). We elicited patient perspectives on what is important when selecting a therapy for OAB, to ultimately inform future patient-centered decision aids. METHODS: We conducted a concurrent triangulation mixed methods study of patients with OAB symptoms recruited from a tertiary care clinic and online health research portal. Participants completed a questionnaire and a semi-structured interview to assess health beliefs surrounding decision making and expectations for OAB treatment. The semi-structured interview guide probed qualities of OAB therapies patients valued, their process of treatment selection, and their experiences with therapies. Interview recordings were transcribed and coded, and emerging themes were developed through inductive analysis using interpretive description. RESULTS: Of 23 surveyed patients, the mean age was 58 and most were female (91%). All patients experienced urinary urgency or urge incontinence with median LURN-SI score of 12 (IQR 10-19), and 87%, 65% and 43% had tried first, second, or third line OAB therapy, respectively. In both surveys (n=23) and interviews (n=19), participants frequently cited invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting OAB therapy. Additional themes that emerged in interviews included a desire to avoid medications, wanting therapies that are natural and address the root cause of OAB, and the need to balance therapies with lifestyle (Table 1). CONCLUSIONS: The list of treatment qualities developed for the survey did not fully capture the wide range of themes shared by patients in the interview, highlighting the importance of seeking patient perspectives. Many patients discussed a balance between qualities, demonstrating that there is no single quality that drives treatment decisions, but that patients weigh pros and cons to select a therapy that best fits their lifestyle and preferences. These data support an OAB management paradigm centered around patient preference and SDM. Source of Funding: K12-DK111011-06 NIDDK UroEPI Career Development Program © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e412 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey Brodsky More articles by this author Hannah Sitto More articles by this author Daniela Wittmann More articles by this author Lauren Wallner More articles by this author Courtney Streur More articles by this author Melissa Dejonckheere More articles by this author John Stoffel More articles by this author Aruna Sarma More articles by this author J. Quentin Clemens More articles by this author Giulia Lane More articles by this author Expand All Advertisement PDF downloadLoading ...

A mixed methods study investigating the quality of urinary and faecal continence assessment and management in residential aged care: Challenges, implications and solutions.

Incontinence is one of the main reasons for institutionalisation into residential aged care. It is linked with increased falls, skin breakdown, depression, social isolation and impaired quality of life. Studies over the past decade have demonstrated poor-quality incontinence care, which has led to ongoing development of best practice guidelines and educational resources. This study investigated current practices, and staff and resident experiences with continence assessment and management, in comparison with best practice guidelines. This concurrent mixed methods study was conducted in a 120-bed residential aged care home. Secondary analysis of data from clinical records provided a snapshot of how continence was assessed and managed. Semistructured interviews with four staff and five residents explored their experiences to understand the impact of current practice on resident emotional well-being. Mixing methods allowed for comparison between quantitative and qualitative findings, enabling a deeper understanding. Findings from the two data sets were highly congruent and identified: (1) lack of communication with residents and family members about continence needs; (2) heavy reliance on product usage and limited other conservative strategies; (3) staff frustration at inability to respond to calls in a timely manner; and (4) positive staff-resident relationships protect resident emotional well-being. Current practices are not consistent with best practice guidelines, which raises the question as to why nothing has changed. We argue that a stronger focus on implementation underpinned by a relationship-centred approach is required to improve continence care practices among residential care staff, and the quality of life for adults living with incontinence.

Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia.

Healthcare workers (HCWs) can play a significant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke. To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia. A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated. 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWsbased barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) system- based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC. This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the delivery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.

Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study.

Expected rise in the demand for healthcare and a dropping supply of healthcare professionals, has generated an increased interest in the most effective deployment of healthcare professionals. Consequently, task shifting has become a common strategy to redistribute tasks between established professional groups, however, little is known about the effects of shifting tasks to emerging professional groups. The aim of this study was to evaluate a legal amendment to facilitate task shifting to an emerging profession in Dutch healthcare: Clinical Technologists (CTs). CTs were introduced and provided an Extended Scope of Practice (ESP) to perform nine 'reserved procedures' independently. A concurrent multi-phase mixed methods study was used to evaluate whether a legal amendment to facilitate task shifting to CTs was effective and efficient. The results show that CTs use their ESP frequently to perform five categories of reserved procedures independently and suggest that the ESP increased the efficiency of care delivery for those procedures. Additionally, the findings highlight that task shifting was influenced by the setting in which CTs worked, time allotted to patient-contact as well as external factors (e.g., financing). This study provides tentative lessons for policymakers on how task shifting to emerging professional groups can be improved. Providing a legal amendment to facilitate task shifting to CTs seems to be effective and efficient. However, it also poses multiple challenges. While established professional groups can face similar challenges, it is likely that these are exacerbated for emerging professional groups, particularly when shifting tasks occurs horizontally.

The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study.

Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.

A Concurrent Mixed-Methods Study of Midwestern Latino Parents Participation and Preferences for Parenting Education Programs.

Parenting programs are an important tool that can provide support for parents and families and improve family functioning. This concurrent nested QUANT + qual mixed methods study sought to better understand parenting education program participation and examine format, delivery, and content preferences for parenting programs among Latino parents in Nebraska. Results from a statewide survey (N = 173) indicated that 31.4% of parents in the sample had participated in a parenting program. Significant predictors of participation in parenting education programs included being unmarried, not working full-time, having a higher income, and having excellent or very good health. Major barriers to participation included lack of information about available programs and logistical concerns. Focus group participants discussed key program design concerns which included: (1) cultural clashes related to acculturation gaps between parents and children; (2) cultural relevance of programming; (3) logistical considerations; and (4) the inclusion of technology to enhance parenting. Overall, participants were particularly interested in group-based learning, flexible scheduling, and improving the cultural relevance of programs. Implications for program design and outreach to improve Latino parents' access and willingness to participate in parenting education programs are presented. Future research should explore the effectiveness of parenting program implementation and dissemination with Latino parents in rural communities, if there are differences in the benefits of parenting programs by Latino subgroup or level of acculturation, and assess the impact of near-peers in the delivery of parenting programs with Latinos.

Provider and Older Patient Responses to Rapid Expansion of Telehealth in an Urban Cancer Center: Mixed Methods Critical Incident Evaluation

Background Synchronous video visits (“telehealth”) were rapidly adopted by many cancer centers across the nation to facilitate provision of care during the COVID-19 pandemic; however, in many cases, there was little time to comprehensively assess patient and provider needs related to this rollout. In addition, attitudes toward telehealth use among older patients with cancer, who may face increased vulnerability to inequities in access to care due to limited digital literacy, were largely unknown at that time. Objective The objectives of this concurrent mixed methods study were to (1) assess stakeholder experiences with telehealth since its rollout during the COVID-19 pandemic at an urban comprehensive cancer center and (2) solicit suggestions to optimize workflow and enhance telehealth implementation beyond the pandemic. Methods We conducted surveys and critical incident interviews with providers, staff, and older patients (aged ≥60 years) from a comprehensive cancer center in a large urban area. Data collection occurred from December 2020 to November 2021. We analyzed survey data using descriptive statistics and qualitative data using deductive and inductive thematic content analysis facilitated by NVivo 12.0 (QSR Australia). Results We completed a total of 106 provider or staff surveys, 128 patient surveys, 20 provider or staff interviews, and 14 patient interviews. While the majority (70.7%) of surveyed providers and staff agreed or strongly agreed that the technology used to support telehealth visits at Simmons fit well within their clinical workflow, several suggestions were offered to enhance telehealth implementation, including conducting proactive, systematic training and technical assistance; making appointment scheduling and rooms flexible for in-person or telehealth conversion in real time to streamline workflow; expanding availability of telehealth to supportive care services and physically frail patients; and increasing provider engagement via telehealth meetings and conferences. Less than a third (30.8%) of providers or staff agreed or strongly agreed that the institution did a good job of preparing patients for their first telehealth encounter, and patients reported experiencing challenges with joining video visits (29%) and understanding the telehealth process (28%). Participants suggested several strategies to assist patients with limited digital literacy, including offering video tutorials of the connection process, creating “fake appointments” to practice web-based connections, and hiring a digital navigator to assist with technical difficulties and setup of the web-based portal. Despite challenges, a majority of surveyed patients (65.7%) and providers or staff (76.9%) intend to continue using telehealth after the COVID-19 pandemic passes. Conclusions Use of telehealth for cancer care was received positively by older patients and providers or staff. Taking targeted steps to support enhanced implementation post pandemic could reduce barriers to care, including among older adults and other populations with limited digital literacy, thereby promoting greater equity of access to telehealth and the potential benefits it offers.

Translating results into action: the global impact of the World Breastfeeding Trends Initiative.

The World Breastfeeding Trends Initiative (WBTi) provides a participative framework to bridge the gaps in policies and programs on breastfeeding. This concurrent mixed-methods study investigated how and why carrying out WBTi evaluations in countries influences their breastfeeding policies and outcomes. We used data from WBTi's Global Repository to evaluate performance scores in 98 countries and conducted semi-structured in-depth interviews to investigate the impact of WBTi process, using the Managing for Development Results structure and actor-network theory. Countries that conducted WBTi multiple times seem to have better breastfeeding policies and practices than countries that have assessed only once. The central feature of the process and its subsequent impact is the dialectical interaction between the technical and political elements of the WBTi exercise. We believe that WBTi's framework is a promising monitoring and evaluation tool that could be used to engage dialogue in other public health areas.

Traditional Newborn Care Practices in a Tribal Community of Tamilnadu, South India: A Mixed Methods Study.

Traditional newborn rearing practices play a vital role in neonatal morbidity and mortality. In this context, a concurrent mixed method study was conducted to identify the traditional practices in newborn care in tribal villages of Sittilingi Panchayat of Tamil Nadu, South India. The quantitative data were collected by a community-based cross-sectional study among 59 mothers of infants. Qualitative component included two focus group discussions (FGD) each with seven mothers and one traditional dai. About 38.9% of newborns received colostrum, and 61.1% had prelacteal feeds. Majority (84.7%) of newborns had received appropriate thermal care. More than two-thirds (71.2%) of newborns were given bath before umbilical cord dropped off. During bathing, 83.1% were massaged and 67.8% had their vernix removed. Practice of blowing into nostrils (45.7%), substance application on the cord (94.9%), tepid sponging during fever (28.8%), sweet flag application over umbilicus for colic (8.5%), herbal medications during diarrhea (40.6%) and cold (25.4%), exposure to sunlight (67.8%) during jaundice, oil instillation in nostrils (76.3%), and ears (32.2%) to protect against infection were reported. Majority reported approaching traditional health practitioners during illness. Similar practices were reported in the FGDs. The beliefs related to these practices were explored. Both beneficial and harmful practices in newborn care were identified. Primary health care workers like ASHAs could be trained to recognize traditional newborn practices in their field areas to deliver appropriate behavior change communication to preserve safe practices and avoid harmful practices to improve newborn health.

Teachers’ Self-Censorship of Children’s Literature in Texas—What’s Legislation Got to Do With It?

Although children’s literature has been challenged and banned for decades, some U.S. states have recently enacted legislation limiting how teachers can address such topics as race, sex, and gender in classrooms, which may influence teachers’ selection of literature. To understand this phenomenon, this exploratory concurrent mixed-methods study involved a written children’s literature course artifact and survey responses analyzed through critical literacy and self-censorship frameworks. Findings indicate that preservice teachers reported avoiding conversations about gender and gender identity more often than those about sexual orientation or race. Further, despite legislative changes, participants mostly reported self-censoring due to lack of pedagogical knowledge, lack of policy knowledge, and fear of institutional sanctions, which are long-standing reasons for self-censorship rather than new ones. Comparatively, they self-reported little desire to promote the dominant political ideology. This research indicates that topic-restrictive legislation can influence classroom practice even when teachers do not share the ideology behind such legislation.

The feasibility, acceptability, and effectiveness of the multimodal, community-based LoveYourBrain Retreat program for people with traumatic brain injury and caregivers

Purpose To evaluate the feasibility, acceptability, and effectiveness of the LoveYourBrain Retreat program using a pre-post, retrospective, concurrent triangulation mixed methods study. Materials and methods A 5-day, multimodal, residential Retreat intervention was designed to improve quality of life among traumatic brain injury (TBI) survivors and caregivers through mindfulness, movement, nutrition, art, and community-building. Eligibility included being a TBI survivor (>2 years post-injury) or caregiver, 18+ years old, independently mobile, able to communicate verbally, and a first-time participant. Self-reported quantitative and qualitative data were collected via electronic surveys pre- and post-retreat, analyzed separately, then combined. Paired t-tests assessed mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and NIH TBI/Neuro-QOL Resilience, Cognition, Positive Affect/Wellbeing, and Emotional/Behavioral Dysregulation scales. We assessed feasibility using sample characteristics and program frequency and retention, and acceptability using quality ratings. Content analysis explored perceived benefits and improvements. Results 68 People—53 with TBI and 15 caregivers—participated in one of three LoveYourBrain Retreats. Significant improvements were found in QOLIBRI-OS (6.91, 95%CI 1.88–11.94), Resilience (2.14, 95%CI 0.50–3.78), Cognition (2.81, 95%CI 0.79–4.83), and Emotional/Behavioral Dysregulation (2.84, 95%CI 0.14–5.54) among TBI survivors (n = 41). Mean satisfaction was 9.6/10 (SD = 0.64). Content analysis revealed community connection, reframing TBI experience, self-regulation, and self-care themes. Conclusions The LoveYourBrain Retreat is feasible, acceptable, and may be effective complementary rehabilitation to improve QOL among TBI survivors.

Going beyond the surface: a mixed-method exploration of infertility-related quality of life of women with endometriosis

ABSTRACT Literature about the impact of infertility and endometriosis on Quality of Life (QoL) is scarce and needs further investigation. Our aim was to deeply investigate the QoL of women with diagnoses of both endometriosis and infertility with failed Assisted Reproductive Treatments (ART). We conducted a concurrent mixed-method study composed of both quantitative and qualitative surveys. The quantitative survey included 22 women who completed the FertiQoL. The qualitative survey included 15 of them who provided written answers to open-ended questions aimed at deeply exploring their QoL. Data were initially analyzed separately and then combined in a meta-matrix. From the quantitative survey emerged that women at higher risk for low QoL were those who have experienced previous spontaneous miscarriages and that the domains of the FertiQoL related to fertility treatment (i.e. increased pain severity, disturbed daily life routine, and dissatisfaction with services) were the most critical. From the Interpretative Phenomenological Analysis (IPA) of qualitative survey, narrations about the physical, relational, social, emotional-cognitive, and behavioural impact of the diseases emerged. Mixed findings showed that the QoL of this population was scarce and that different levels (the inner world, the behaviours, the relational context, and the environmental context) are strictly connected and interact between them in influencing QoL. Multi-level preventive or supportive programs (with specific attention to pain experience, coping strategies, quality of services and governmental support) are required for this population.

Experiences with small and large numbers of protesters at abortion clinics in North Carolina

ObjectivesTo analyze the association between number of antiabortion protesters and patients’ and their companions’ experiences accessing abortion clinics in North Carolina. Study designIn this concurrent mixed-methods study conducted in 2018–2019 at two independent abortion clinics in North Carolina, the author triangulated the methods of participant observation, descriptive statistical analysis of survey data, and thematic content analysis of open-ended responses to compare experiences of respondents who observed larger (>10) versus smaller (1–10) numbers of protesters at their clinic visit. The analytic sample contained experiences of patients and companions who saw protesters during the study period. ResultsOf 1530 people approached for the survey, 886 (58%) completed the questionnaire. Overall, 655 respondents were included in the analysis. Most respondents (n = 546, 83%) saw 1 to 10 protesters, versus those who saw >10 protesters (n = 109, 17%). Respondents who saw 1 to 10 protesters had their cars stopped at higher rates (53%) than those who saw >10 protesters (40%) but reported being physically approached at similar rates (22% vs. 23%). Respondents who saw >10 protesters indicated that it was more dangerous to drive into the clinic (44% vs. 23%) and more difficult to access the clinic (65% vs. 39%), when compared with people who saw 1 to 10 protesters. Respondents who saw >10 protesters also reported that they thought about leaving more frequently (21% vs. 12%), that the protesters made them feel unsafe (44% vs. 23%), made their visit more stressful (71% vs. 59%), and protesters negatively impacted their clinic experience at higher rates (47% vs. 31%). ConclusionsRespondents experienced logistical barriers to clinic access regardless of the number of protesters, though these worsened with larger numbers of protesters. Respondents perceived larger numbers of protesters as more intimidating and felt less safe navigating into the clinic. While all respondents made it to their appointments, these perceptions about larger numbers show how clinic protesting is an intimidating force that interferes with clinic access. ImplicationsShowing the ways that the number of protesters relates to logistical and emotional barriers can help clinics in planning mitigation measures to address issues of clinic access for their patients and their companions.

Adopting social health insurance in Nepal: A mixed study.

The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence. A cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings. Of a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30-290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3-393.9) and accessibility (OR = 74.4; 95% CI, 42.5-130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts. Although enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.

Mental health, economic well-being and health care access amid the COVID-19 pandemic: a mixed methods study among urban men who have sex with men in India

Scant empirical research from Asia has addressed the impact of COVID-19 on sexual minority health. We aimed to explore and understand the impact of COVID-19 on income security, mental health, HIV risk and access to health services among men who have sex with men (MSM) in India. We conducted a concurrent mixed methods study from April to June 2020, including a cross-sectional survey and in-depth semi-structured interviews with MSM recruited from three non-governmental organisations providing HIV prevention services in Chandigarh, India. We examined the associations of sexual minority stressors (sexual stigma, internalised homonegativity), economic stressors, and stress due to social distancing, with depression and anxiety, HIV risk, and access to health services. Survey findings (n = 132) indicated that internalised homonegativity and stress related to social distancing were significantly associated with depressive and anxiety symptoms. Results also showed reduced access to condoms, HIV testing and counselling services. Qualitative findings (n = 10) highlighted adverse economic impacts of COVID-19, including loss of employment/wages and engaging in survival sex work, which contributed to psychological distress and HIV risk. The COVID-19 pandemic has resulted in considerable psychological and financial distress among low socioeconomic status MSM in India, including those involved in sex work – communities already marginalised in economic, family and healthcare sectors. Structural interventions to improve access to mental health and HIV services and decrease financial burden are critical to mitigate the impact of COVID-19.

OP24 Impact Of Patient Input On Cancer Drug Funding Recommendations In Canada

IntroductionPatient involvement in health technology assessment (HTA) has documented advantages, such as improved understanding of disease context, and increased legitimacy and transparency of the HTA process. In the absence of clear metrics, thresholds, or criteria, it is not clear how input regarding patient preferences influences HTA based recommendations of the pan Canadian Oncology Drug Review (pCODR).MethodsThis is a concurrent complementary mixed methods study. A quantitative model (logit) is used to estimate the impact of patient input and other HTA criteria on pCODR recommendations. A qualitative analysis of semi-structured interviews with Canadian HTA committee members is used to describe the mechanisms of action through which patient input influences recommendations.ResultsPatient input was considered important in providing context to the HTA discussion, but committee members were not able to explicate how any specific elements of patient submissions weighted into the committee’s recommendation. There was an element of mistrust in the patient input data. The estimated impact of patient input on funding recommendations is not statistically significant, recommendations remain driven by evidence of clinical benefit.ConclusionsThe commitment to inclusion of patient perspectives in HTA in Canada is strong, and procedurally Canada is among the leaders in this regard. The tangible impact of patient input could be increased with an improved system for collection of most relevant data, and clear guidelines about how patient input should weigh into HTA recommendations.

Faculty perception on clinical shadowing: A concurrent mixed methods study.

This mixed methods study aims to investigate faculty members' perceptions of early clinical exposure through clinical shadowing program (CSP) at one academic dental institution. After ethical approval was received, concurrent data collection using quantitative and qualitative methods was integrated for this study design. For the quantitative data, a validated instrument (Likert scale) was distributed to all basic and clinical science faculty members regarding the CSP. Qualitative semi-structured interviews of basic and clinical science faculty members were conducted to explore their perceptions of the CSP. Descriptive statistics were completed for the quantitative data, and thematic analysis was carried out for the transcribed interviews. Faculty members from basic and clinical sciences participated in this mixed methods study, 97% (n=74) participants in the quantitative and 12 participants in the qualitative. The majority of faculty (67%; n=44) strongly agreed that CSP helps predoctoral students in the application of basic science knowledge to clinical practice. All basic science respondents (n=10; 100%) and many clinical science faculty (60%; n=35) strongly agreed that CSP requires coordination between basic and clinical science educators (p=0.042). Some faculty suggested the inclusion of training for educators on the program and regular periodic student assessments of the program's effectiveness. The current study reported positive faculty perception toward the proposed method of integration. Furthermore, opportunities to foster coordination between basic and clinical science educators may be provided by administrators to strengthen the existing CSP framework.