Concurrent Mixed Methods Study Research Articles

"I was just a shell": Mental health concerns for women in perimenopause and menopause.

Early detection of deteriorating mental health for women who are experiencing symptoms associated with perimenopause and menopause is critical to ensure the well-being of women. Unfortunately, many women during this phase of their lives find it difficult to access relevant and timely treatment. This concurrent mixed methods study using an online survey and qualitative interviews explored Australian women's knowledge and experiences of perimenopause and menopause and specifically reports on findings associated with women's mental health. Four hundred and eleven women completed the online survey in its entirety and 25 women participated in semi-structured interviews between April and July 2022. Survey data were analysed using SPSS and, in this article, data are presented as descriptive statistics. Qualitative interviews were analysed using thematic analysis guided by Braun and Clarke (2013; 2019). Quantitative and qualitative data specific to women's mental health were integrated into three themes: (1) increased anxiety and depression, (2) a negative impact on emotions and (3) a negative impact on self-worth. Findings from this study will help to inform clinical services for women as it highlights the need to improve education about perimenopause and menopause for healthcare providers and women.

Community perception of the autodissemination of pyriproxyfen for controlling malaria vectors in south-eastern Tanzania

BackgroundThe efficacy of the autodissemination of pyriproxyfen to control malaria vectors has been demonstrated under semi field environment in Tanzania. However, the information on how best communities should be engaged for its routine and large-scale adoption are lacking. This study assessed the community’s level of knowledge, perceptions, acceptability of the autodissemination of pyriproxyfen, and the perceived risks on the safety of pyriproxyfen on the environment.MethodsThis was a concurrent mixed methods study, comprised of a community-based survey of 400 household representatives and eight focus group discussions (FGDs). The study was conducted in two villages in Mlimba district in south-eastern Tanzania between June and August 2022. For the quantitative data analysis, descriptive statistics were applied using R software, while inductive approach was used for qualitative data analysis, using NVivo software.ResultsKnowledge on autodissemination of pyriproxyfen approach was found to be relatively low among both the FGD respondents and surveyed community members (36%, n = 144). Nevertheless, when it was explained to them, the envisioned community support for the autodissemination approach was relatively high (97%, n = 388). One of the major perceived benefits of the autodissemination of pyriproxyfen was the reduction of malaria-transmitting mosquitoes and associated malaria transmission. Environmental impact of pyriproxyfen on non-target organisms and health risk to children were among the major concerns. When provided with information on the safety and its utilization particularly through autodissemination approach, 93.5% (n = 374) of the survey respondents said that they would allow the PPF-contaminated pots to be placed around their homes. Similarly, FGD respondents were receptive towards the autodissemination of pyriproxyfen, but emphasized on the need for raising awareness among community members before related field trials.ConclusionThis study indicates a low knowledge but high support for scaling up of the autodissemination of pyriproxyfen as a complementary tool for malaria control in rural Tanzania. The Findings of this study suggest that community sensitization activities are required to improve the community’s acceptability and trust of the approach before respective field trials.

Community perceptions matter: a mixed-methods study using local knowledge to define features of success for a community intervention to improve quality of care for children under-5 in Jigawa, Nigeria

ObjectivesIn this study, we used the information generated by community members during an intervention design process to understand the features needed for a successful community participatory intervention to improve child...

Preservice English teachers’ burnout levels and motivations to choose the teaching career

This study aims to investigate preservice English teachers’ motivations for choosing the teaching career, and their student burnout levels. The correlation between these variables, and the participants’ perspectives about student burnout reasons in English Language Teaching departments were examined. The sample consisted of 466 preservice English teachers at two different state universities in Türkiye. This study adopted a concurrent mixed method study design, and the data were gathered via a questionnaire, an inventory, and a structured interview. The quantitative data were analyzed through descriptive and correlation analyses, while qualitative data were subjected to qualitative content analysis. The findings suggested that the participants’ most frequent motivations for choosing the teaching career were intrinsic motivations, yet their burnout levels were high. The participants’ career motivations correlated negatively with their burnout levels. Participants mostly reported assignments, difficulty of courses, and oral presentations as their burnout reasons. At the end of this paper, the individuals desiring to study ELT were recommended to have strong motivations to study ELT and be aware of its heavy workload.

Effects of emotion coaching group programme for mothers of preschool children with smart device overdependence: a mixed methods study

BackgroundSmart device overdependence adversely affects the overall development of preschool children. This study aimed to provide an emotion coaching group programme to mothers raising preschool children who are overly dependent on smart devices and to confirm the programme’s effectiveness.MethodsThis concurrent embedded mixed methods study used a non-equivalent control group pre-post design to verify the quantitative effect of the programme, and a descriptive research design to verify the qualitative effect. The study collected data from June 2019 to March 2021 from 51 (25 experimental, 26 control) mothers raising children aged 3–6 years in South Korea. The quantitative study examined the effects of an eight-session programme, conducted once a week for two hours, on mothers’ emotional intelligence, parenting behaviour, and their children’s attachment stability and smart device overdependence using a non-equivalent control group pre-post design. The analysis used a generalized estimate equation. For qualitative research, focus group interviews were used as a descriptive research design method, and content analysis was used for analysis.ResultsQuantitatively, the results showed significant differences between the experimental and control groups in terms of changes in maternal emotional intelligence (χ2 = 14.99, p = .001), maternal positive parenting behaviour (χ2 = 9.32, p = .009), children’s unstable attachment to their mothers (χ2 = 9.49, p = .009), and children’s overdependence on smart devices (χ2 = 14.48, p = .001). Qualitatively, the study derived five themes for the experiences of mothers who participated in the programme: “hope for desirable parenting without emotional difficulties,” “feelings touched by reflection,” “warm but authoritative parenting,” “children who became responsible by gaining psychological stability,” and “changed view of my home.”ConclusionsThe emotion coaching group programme was effective in improving the emotional intelligence and parenting behaviour of mothers raising preschool children. The programme also improved preschool children’s attachment stability to their mothers and overdependence on smart devices. The programme can be useful in community practice, and the present study can be used as evidence for education and research related to device overdependence.

A mixed-methods study on the implementation of a mobile health application (mHealth app) for stroke caregivers in Malaysia: healthcare providers' perspective.

Recognizing the burden experienced by caregivers of stroke survivors, an intervention using mobile health applications (mHealth apps) has been proposed to support and empower stroke caregivers. This study aimed to assess the acceptability and expectations of healthcare providers, who play a vital role as gatekeepers in the healthcare system, to ensure the effectiveness and sustainability of the intervention. This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool. In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients. Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.

COVID-19 Stigma and Discrimination in a North Indian State: A Concurrent Mixed Method Study.

We measured COVID-19-related stigma and discrimination and its drivers using a concurrent mixed-methods design in Punjab. The simple random sampling was used to select blocks, subcenters, and urban primary healthcenters from each of the four selected districts. The systematic random sampling was used to select households. A sample of 423 adults was interviewed using a structured questionnaire and 10 in-depth interviews were conducted using an interview guide. Binary logistic regression was performed to find the predictors. Stigma prevalence was mild 18%, moderate 45%, and severe 37%. Logistic regression indicated that stigma was lower in the rural compared to the urban population (P < 0.01). Hospitalized patients faced discrimination more often compared to those who were treated/quarantined at home. People feared police (71%), testing (69%), and contracting the infection (65%). Fear of screening, disclosure of status, and transmission of the virus were the drivers of stigma and discrimination. Co-occurrence of labeling, stereotyping, and cognitive separation was observed.

Investigating students’ perceptions of dificulty in argumentative writing: a study in gender perspective

Writing difficulty and constraints have gained much attention and research locally and overseas. However, the writing difficulty EFL male and female writers perceived in developing argumentative essays was still little in literature. To fill the void, this concurrent mixed method study aimed to scrutinize the variation and frequency and explore the perceptions of being argumentative writers among 113 EFL university students in Jakarta, Indonesia. Through a survey and the framework of interpretative phenomenological analysis (IPA), online questionnaires were distributed, and the interviews were conducted concurrently. The findings illustrated that EFL male and female writers experience similar major difficulties, including argumentative text genre, language use, difficulty in source/reference, problems in the cognitive process, and other technical challenges. Further, to be argumentative writers, female writers tend to feel various combinations of feelings and apply more learning strategies. In contrast, male writers express more on the cognitive process of essay completion. However, either male or female writers become more aware of their weaknesses in the English language, such as reading skills.

"They Did Not Know How to Talk to Us and It Seems That They Didn't Care:" Narratives from Bereaved Family Members of Black Veterans.

Racial disparities in the quality of health care services, including end of life (EOL) care, are well-documented. While several explanations for these inequities have been proposed, few studies have examined the underlying mechanisms. This paper presents the results of the qualitative phase of a concurrent mixed-methods study (QUANT + QUAL) that sought to identify explanations for observed racial differences in quality of EOL care ratings using the Department of Veterans Affairs Bereaved Family Survey (BFS). The objective of the qualitative phase of the study was to understand the specific experiences that contributed to an unfavorable overall EOL quality rating on the BFS among family members of Black Veterans. We used inductive thematic analysis to code BFS open-ended items associated with 165 Black Veterans whose family member rated the overall quality of care received by the Veteran in the last month of life as "poor" or "fair." Four major themes emerged from the BFS narratives, including (1) Positive Aspects of Care, (2) Unmet Care Needs, (3) Lack of Empathy, Dignity, and Respect, and (4) Poor Communication. Additionally, some family members offered recommendations for care improvements. Our discussion includes integrated results from both our qualitative and previously reported quantitative findings that may serve as a foundation for future evidence-based interventions to improve the equitable delivery of high-quality EOL care.

Controlled autonomy: Experiences of principals under two school funding regimes in Kazakhstan

This article focuses on the experiences of the autonomy of principals to make decisions for the development of their school under two different regimes of funding. In the context of Kazakhstan, this research explores how formula-based per-capita funding (PCF) compares to historically existing incremental line-item funding concerning decision-making autonomy for meeting the needs of the school. It also examines whether these two public school funding modes lead to a different managerial accountability experience for principals. Evidence in this paper comes from a concurrent mixed methods study. Quantitative data consists of an online survey of 498 mainstream school principals representing schools with and without PCF. Qualitative data includes 15 semi-structured interviews with principals at schools with PCF. This research finds that principals at schools with PCF feel they have more freedom to make decisions about the development of their schools than their counterparts with incremental school budgets. This, however, is due to more adequate funding in the scope of PCF. Regardless of the mode of school funding, principals feel overregulated, and experience managerial accountability demands similarly. This research concludes that school principals work in the context of 'controlled autonomy'. Governmental authorities control schools by limiting funding and requiring compliance.

Understanding cardiac rehabilitation delivery in Scotland during the COVID-19 pandemic: lessons for the future

Background/Aims Cardiac rehabilitation services were disrupted during the early stages of the COVID-19 pandemic because of limitations on interpersonal contact, exercise facility closures and clinical service reorganisation. This necessitated urgent service redesign. The authors aimed to understand the changes to cardiac rehabilitation service delivery in Scotland, the impacts on staff and participant experiences, and implications for future delivery. Methods A concurrent mixed-methods study was conducted between April and December 2021. A quantitative online survey compared service provision before the pandemic (21 March 2019 to 20 November 2019) with provision after the onset of the pandemic (21 March 2020–20 November 2020). Quantitative data were analysed descriptively. Semi-structured telephone interviews were conducted with cardiac rehabilitation professionals and participants. These qualitative data were thematically analysed using the framework approach. Results Representatives (n=11) from 11 services completed the survey, while 11 staff and 17 patients completed the interviews. Services reported staffing reductions, delayed initial patient contact, replacement of face-to-face rehabilitation with telephone and online support, compromised initial assessments and reduced exit assessments. Patients relied more heavily on cardiac rehabilitation staff as a result of reduced access to other health professionals, and experienced issues with continuity of care. Technology presented remote service opportunities, but challenges around poor access to systems and technological literacy issues created barriers to service delivery. Service evaluation data were inaccessible. Conclusions Scottish cardiac rehabilitation services were adversely impacted by the COVID-19 pandemic and responded by developing remote options. These can be enhanced by screening patients to assess their access to technology and identify any literacy issues, as well as developing online educational videos and downloadable resources. Staff education is needed to encourage use of technology, including exercise monitoring via wearables. A national audit is required to assess delivery and outcomes.

Knowledge, attitudes, and practices toward seasonal influenza vaccination among healthcare workers and pregnant women in Pakistan: A mixed methods approach

ABSTRACT Vaccine hesitancy is a significant public health issue globally. We aim to document the barriers toward seasonal influenza vaccine uptake among healthcare workers (HCWs) and pregnant women (PW) in Pakistan. We performed a concurrent mixed methods study in four cities (Karachi, Islamabad, Quetta, and Peshawar) across Pakistan from September to December 2021. The quantitative component consisted of independent cross-sectional surveys for PW and HCWs, and the qualitative component comprised of in-depth interviews (IDIs) and focus group discussions (FGDs) among HCWs. Simple linear regression was used to determine the association of sociodemographic variables with knowledge, attitudes, and practices. Overall, 750 PW and 420 HCWs were enrolled. Among the PW, 44% were willing to receive the vaccine if available free of cost. Only 44% of the HCWs were vaccinated; however, 86% intended to get vaccinated and were willing to recommend the vaccine to their patients. HCWs refused vaccine due to side-effects (65%), cost (57%), and allergies (36%). An education level of secondary school and above was predictive of higher attitude and knowledge scores while having received the COVID-19 vaccine was associated with higher practice scores for both PW and HCWs. Several themes emerged from the interviews: 1) HCWs’ knowledge of influenza and its prevention, 2) HCWs’ perception of motivators and barriers to influenza vaccine uptake and 3) HCWs’ attitudes towrd vaccine promotion. We report low influenza vaccine coverage among HCWs and PW in Pakistan. Educational campaigns addressing misconceptions, and improving affordability and accessibility through government interventions, can improve vaccine uptake.

Understanding cardiac rehabilitation delivery during Covid-19; lessons for future delivery; a mixed methods study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Scottish Funding Council (additional research funding for universities 2020-21) Background/introduction Cardiac rehabilitation (CR) services were disrupted during early COVID-19 due to limited interpersonal contacts, exercise facility closures, and clinical service reorganisation to meet COVID-19 patients’ needs. This necessitated urgent service reorganisation. Purpose We aimed to understand CR delivery changes in Scotland, the impact on staff and participant experiences, and implications for future delivery. Methods A concurrent mixed methods study with data collected between April-December 2021. A quantitative online survey compared CR service provision pre-COVID-19 (21 March 2019 – 20 November 2019) with provision during early COVID-19 (21 March 2020 – 20 November 2020). Quantitative data were analysed descriptively using SPSSv26. Qualitative semi-structured telephone interviews were conducted with CR professionals and CR participants. These were thematically analysed using the framework approach. Data were integrated during study design by aligning survey and interview questions, and at the discussion stage. Results Eleven CR services completed the online survey, and 11 individual CR staff and 17 CR participants from six services completed qualitative interviews. Services reported staffing reductions, delayed initial patient contact, replacing face-to-face CR with web-based and telephone support, and a reduction in goal setting, functional capacity testing and exit assessments. Three main qualitative themes represented the challenges and opportunities of changing CR delivery during COVID-19: 1) Access to health professional support; 2) Disruption in continuity of care and 3) CR technology use (Figure 1). Conclusions Initially, Covid-19 adversely affected CR delivery. Telephone support, the provision of web-based information and exercise options, wearables and mHealth apps can enhance future CR delivery. Technological resources must be accessible, and staff require training to ensure competency.

Student Perceptions of Substance Use Disorder Stigma as a Factor for Health Disparities: A Mixed-Methods Study.

The prevalence of substance use disorders (SUDs) is an alarming problem in the United States; however, only a fraction of patients receive treatment. Stigma from both healthcare professionals and society at large negatively impacts SUD treatment. There are limited data regarding the perceptions of healthcare students on SUD stigma as a health disparity. We conducted a concurrent mixed-methods study among students enrolled in six health-related colleges at one mid-south health science center in the US over 3 months. Both an electronic survey consisting of 17 close-ended questions and researcher-led focus groups were conducted to understand their perceptions of stigma and SUDs. The research team followed the six steps recommended by Braun and Clarke regarding the data that aimed to capture associations between categories and extract and conceptualize the themes, and thematic analysis was done using Dedoose® (Manhattan Beach, CA, USA) qualitative software, which facilitated all the codes being kept organized and compared the frequency of codes across categories. A total of n = 428 students participated in the survey (response rate = 13%), and n = 31 students took part in five focus groups. Most student respondents, on average, either agreed or strongly agreed that: stigma currently exists in the healthcare field; stigma can lead to patients' not receiving the appropriate care for an SUD; and stigma can lead to lower quality care provided to patients with SUDs. Two themes were identified based on the thematic analysis: (1) additional training is necessary to better equip students for addressing SUDs in practice and (2) suggestions were formed to develop synergy between didactic and clinical rotations to improve SUD training. It is evident that students perceive the stigma surrounding SUDs as a detriment to patient care. Opportunities may exist in professional training programs to more seamlessly and intentionally weave SUD treatment and management concepts throughout the curriculum, as well as to empower students to operate in the complex regulatory scheme that exists for SUDs in the US.

Assessing predictors of students’ academic performance in Ethiopian new medical schools: a concurrent mixed-method study

BackgroundSince 2012 the Ethiopian Federal Ministry of Health and Education implemented a new medical curriculum in 13 institutions. The new curriculum introduced some questions on its admission policy: students can join with different educational backgrounds. Students’ performance on qualifying exams and grade point average are lower than desired. Therefore, the aim of the study was to investigate what factors predict the academic performance of students in the New Medical Education Initiative in Ethiopia.MethodsA concurrent mixed method of survey and qualitative was used; for the survey, a structured self-administered questionnaire was distributed to students of four randomly selected medical schools from December 2018 to January 2019. The questionnaire includes questions about socio-demographic and educational background of participants. Multiple linear regression analysis was used in order to identify the factors associated with academic performance. In-depth interviews were conducted with 15 key informants to explore qualitatively.ResultsIn the multiple linear regressions, stress was associated with lower academic performance. Students with prior education in the field of health science outperformed students with other bachelors. The cumulative grade point average of the previous bachelor degree and the score on the entrance exam to join medicine also significantly predicted performance. Although some more variables are identified from the qualitative interviews, its findings supported the survey results.ConclusionsOf the number of predictor variables analyzed in the model, only stress, prior educational degree, performance in the prior degree and entrance exam score were significantly correlated with the performance of students in their preclinical medical engagement.

Uptake and perceptions of oral HIV self-testing delivered by village health teams among men in Central Uganda: A concurrent parallel mixed methods analysis.

The World Health Organization (WHO) recommends HIV self-testing (HIVST) to increase access to and utilization of HIV services among underserved populations. We assessed the uptake and perceptions of oral HIVST delivered by Village Health Teams (VHTs) among men in a peri-urban district in Central Uganda. We used a concurrent parallel mixed methods study design and analyzed data from 1628 men enrolled in a prospective cohort in Mpigi district, Central Uganda between October 2018 and June 2019. VHTs distributed HIVST kits and linkage-to-care information leaflets to participants in 30 study villages allowing up-to 10 days each to self-test. At baseline, we collected data on participant socio-demographics, testing history and risk behavior for HIV. During follow-up, we measured HIVST uptake (using self-reports and proof of a used kit) and conducted in-depth interviews to explore participants' perceptions of using HIVST. We used descriptive statistics to analyze the quantitative data and a hybrid inductive, and deductive thematic analysis for the qualitative data and integrated the results at interpretation. The median age of men was 28 years, HIVST uptake was 96% (1564/1628), HIV positivity yield was 4% (63/1564) and reported disclosure of HIVST results to sexual partners and significant others was 75.6% (1183/1564). Men perceived HIVST as a quick, flexible, convenient, and more private form of testing; allowing disclosure of HIV test results to sexual partners, friends and family, and receiving social support. Others perceived it as an opportunity for knowing or re-confirming their sero-status and subsequent linkage or re-linkage to care and prevention. Utilizing VHT networks for community-based delivery of HIVST is effective in reaching men with HIV testing services. Men perceived HIVST as highly beneficial but needed more training on performing the test and the integrating post-test counseling support to optimize use of the test for diagnosing HIV.

Exploratory mixed methods study on care-seeking behaviors of Asian Americans with pelvic floor symptoms.

The objective was to evaluate whether younger age was associated with noncare-seeking behavior among Asian Americans with pelvic floor symptoms, and secondarily, to explore multilevel factors that may contribute to noncare-seeking behavior in this population. We performed a concurrent mixed methods study and heterogeneously sampled Asian Americans with urinary incontinence, urgency-frequency, vaginal bulge, or anal incontinence. We stratified the participants into two groups, care seekers vs noncare seekers. Using Anderson's model as the main framework, we administered validated questionnaires and conducted semi-structured interviews to explore factors associated with care-seeking behaviors. Seventy-eight surveys and 20 interviews were completed and analyzed. Most participants reported urinary leakage (67%), followed by urinary urgency-frequency (50%), anal incontinence (18%), and vaginal bulge (17%). The mean age of the study cohort was 46.1 ± 16.2years. We found noncare seekers to be younger and with an increased proportion of lifetime spent in the USA than care seekers. When controlling for age, proportion of lifetime spent in the USA, symptom severity, and individual-level resources, both younger age and increased proportion of lifetime spent in USA remained independently associated with noncare-seeking behavior. From qualitative data, we found that noncare seekers often experienced anti-Asian racism across workplace, neighborhoods, and health care settings. Additionally, noncare seekers also reported symptom minimization and decreased self-efficacy when coping with their pelvic floor symptoms. We found that one's age and proportion of lifetime spent in the USA may affect the extent of exposure to anti-Asian racism that is associated with symptom minimization, increased perceived barrier, and noncare-seeking behavior.

Dietary management of type 2 diabetes mellitus among South Asian immigrants: A mixed-methods study.

There is a high prevalence of South Asian immigrants in Australia living with type 2 diabetes mellitus, with the dietary management of the condition presenting as a key challenge. However, their current dietary patterns and barriers to diabetes self-management are unclear. Therefore, this study aims to (i) investigate current dietary patterns and (ii) explore barriers and facilitators to dietary management in this population. A concurrent mixed-methods study comprising three 24-h dietary recalls and a semi-structured interview for each self-identified South Asian immigrant adult with diabetes recruited across Victorian primary care clinics and social media to address the aforementioned two aims. Dietary recall data were converted into food groups using Foodworks, and data analysed in SPSS. Qualitative data were thematically analysed using NVivo. Among 18 participants recruited, 14, 16 and 17 participants had grain, fruit and dairy intake lower than daily Australian recommendations, respectively. These findings echoed qualitative data that participants viewed diabetes management as reducing carbohydrate intake. Participants reported difficulties incorporating diabetes-related dietary and lifestyle recommendations into their routine and a lack of knowledge about available organisational support. They mentioned challenges in receiving social support from families and friends and relied on support from health professionals. Facilitators included proficiency in nutrition information label reading and self-blood glucose monitoring skills. Enhancing the accessibility to organisational support, facilitating the adaption of dietary recommendations into individuals' routines, and strengthening support from health professionals are essential components in intervention development to improve diabetes management for South Asians.

0144 A Mixed Methods Exploration of Stigma, Discrimination, and Sleep among Individuals on Medication for Opioid Use Disorder

Abstract Introduction Many individuals who suffer from opioid use disorder (OUD) experience symptoms of insomnia. OUD-related stigma and discrimination are major concerns and represent complex, chronic stressors that lead to negative health and social outcomes. However, how OUD-related stigma and discrimination are associated with insomnia among those on Medication for OUD (MOUD) is not known. The purpose of this study is to examine the associations among OUD-related stigma, intersectional discrimination, and insomnia among patients on MOUD. Methods This concurrent mixed methods study is a sub-study (N = 120) of the NIH funded Collaboration Linking Opioid Use Disorder and Sleep (CLOUDS) study. Insomnia was measured with the Insomnia Severity Index. OUD-related stigma was assessed with the Brief Opioid Stigma Scale, and intersectional discrimination was assessed with the Intersectional Discrimination Index. Quantitative data were analyzed via Spearman correlations. A sub-sample of 25 participants participated in semi-structured interviews. Qualitative questions explored individuals’ perceptions and experiences of stigma and discrimination and their influence on sleep. Qualitative data were analyzed with thematic analysis. Results Hypotheses were partially supported. Spearman correlations revealed a small positive correlation (r = .17, p = .04) between intersectional discrimination and insomnia severity. Correlations between OUD-related stigma and insomnia severity were not statistically significant. Patterns of negative thinking and rumination were described by participants who felt their stigmatizing and discriminatory experiences affected their sleep. Conclusion Findings add to the growing literature linking discrimination to sleep deficiency in highly stigmatized populations. With larger diverse samples, future researchers should (1) utilize longitudinal designs to explore underlying pathways by which discrimination and stigma affect sleep and (2) identify intervention approaches that target multiple levels [individual, interpersonal, community, and structural] to decrease the impacts of discrimination and stigma on self-perception and sleep outcomes for those battling OUD. Support (if any)

Out-of-home life spaces valued by urban older adults with limited income.

Access to, and occupational performance in, out-of-home-life-spaces is linked to health, wellbeing and quality of life for older adults. There is little evidence of how this relates to older adults with limited resources in an African urban context. To describe the out-of-home-life-spaces accessed and valued by older adults with limited resources, living in an urban South African setting. An exploratory concurrent mixed methods study saw 84 rehabilitation clinicians conduct 393 face-to-face interviews with older adults. Clinicians produced reflective field notes and participated in focus groups. Quantitative data were analysed using descriptive statistics with SPSS Version X. Qualitative data were analysed through inductive content analysis. Older adults walked, used mini-bus taxis or private vehicles to get to places of worship, medical facilities, shops, family and friends and special interest gatherings on a weekly or monthly frequency. Lack of funds was the main barrier. Older adults aspired to travel, go on holiday and to visit out-of-town family homes. Exploring the daily lived experience of older, urban South Africans with limited resources brought to light the value they attribute to participation in activities that contribute to the wellbeing of their families and communities. Such activities are found in a variety of life spaces. Results could inform policy makers and service providers in their planning of community mobility, transportation services and health care, for older adults with limited resources.