Concurrent Mixed Methods Research Articles

Evaluating the implementation of Nuevo Amanecer-II in rural community settings using mixed methods and equity frameworks

BackgroundThe 10-week Nuevo Amanecer-II intervention, tested through a randomized controlled trial, reduced anxiety and improved stress management skills among Spanish-speaking Latina breast cancer survivors. This paper describes the implementation and equity evaluation outcomes of the Nuevo Amanecer-II intervention delivered in three California rural communities.MethodsUsing implementation and equity frameworks, concurrent convergent mixed methods were applied to evaluate implementation (feasibility, fidelity, acceptability, adoption, appropriateness, and sustainability) and equity (shared power and capacity building) outcomes. Quantitative data were collected using tracking forms, fidelity rating forms, and program evaluation surveys; qualitative data were collected using semi-structured in-depth interviews. Respondents included community-based organization (CBO) administrators, recruiters, compañeras (interventionists), and program participants.ResultsOf 76 women randomized to the intervention, 65 (86%) completed at least 7 of 10 sessions. Participants’ knowledge (85% correct of 7 questions) and skills mastery were high (85% able to correctly perform 14 skills). Mean fidelity ratings across compañeras ranged from 3.8 (modeled skills) to 5.0 (used supportive/caring communication); 1–5 scale. The program was rated as very good/excellent by 90% of participants. Participants and compañeras suggested including family members; compañeras suggested expanding content on managing thoughts and mood and healthy living and having access to participant’s survivorship care plan to tailor breast cancer information. CBOs adopted the program because it aligned with their priority populations and mission. Building on CBOs’ knowledge, resources, and infrastructure, implementation success was due to shared power, learning, responsibility, and co-ownership, resulting in a co-created tailored program for community and organizational contexts. Building intervention capacity prior to implementation, providing funding, and ongoing technical support to CBOs were vital for fidelity and enhancement of recruiter and compañera professional skills. Two of three CBOs created plans for program sustainability beyond the clinical trial; all administrators discussed the need for new funding sources to sustain the program as delivered.ConclusionsBuilding on community assets and using equitable participatory research processes were central to the successful implementation of a peer-delivered psychosocial intervention in three rural communities among Spanish-speaking Latinas with breast cancer.

Abstract 16395: Caregiver Challenges, Needs, and Health Outcomes After Left Ventricular Assist Device Implantation

Introduction: Caregivers of patients with left ventricular assist devices (LVAD) experience significant strain in caring for patients after device implant, yet few studies have captured underlying caregiver needs and the impact on caregiver health. Aim: To describe caregiver challenges, needs, and health outcomes at three distinct time points following LVAD implant. Method: Using a cross-sectional, concurrent mixed methods design, patients were interviewed at 1 of 3 time points during LVAD recovery: at hospitalization after LVAD implant (n=3), at 1 month (n=9) , or 3 months (n=7) after returning home. Key health outcomes (measures) included caregiver Roles and Responsibilities (CRRS), mental health (SF-12 MCS), and physical function (Duke Activity Status Index, DASI). Qualitative interviews were transcribed verbatim and analyzed using thematic analysis; qualitative and quantitative findings were integrated using matrix displays across time points. Results: Caregivers (N=19) were 60.0±9.6 years old, 68% married, 88% female, 56% with 2 or more comorbidities, and 56% caring for Destination Therapy patients. Three phases of caregiving were characterized. At 1 month, caregiver burden was highest (CRRS: hospitalization after implant= 32±12.7; 1 mo = 51.6±7.8; 3 mo = 47.3±8.9); physical function lowest (DASI: hospitalization after implant = 53.7±5.3; 1 mo = 38.1±9.7; 3 mo = 42.1±15.6); and mental health highest (SF-12: hospitalization after implant = 43.4±7.8; 1 mo = 55.8±25.9; 3 mo = 48.3±26.8). Qualitative analyses validated caregiving challenges and health impact at 1 month (isolation, constant caregiving, uncertainty) and low physical function (work of caregiving, disrupted sleep), while simultaneously underscoring positive mental health effects (gratitude for a second chance, establishing routines, experiencing support). Conclusion: The characterization of three phases of caregiving after LVAD implantation provides important new insights necessary for targeted interventions for LVAD caregivers. Identified targets to relieve caregiver burden and improve adjustment after patients are discharged home include the need for relief from isolation and 24/7 caregiving, promotion of sleep and routines, and social support.

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.

Natural science and engineering instructors’ knowledge and practice of brain-based instruction in Ethiopian higher education institutions

Currently, the Brain-Based Instructional approach has become an alternative instructional method in the schooling system of different countries of the world. This study explored the current situation of natural science and engineering instructors' knowledge and practices of brain-based instruction in Ethiopian higher education institutions. A descriptive survey research design with concurrent mixed methods was employed. Data collection tools were developed based on the twelve principles of brain-based learning theory and confirmed their validity and reliability. Survey questions were used to gather quantitative data from 512 randomly selected instructors. Qualitative data were collected through interviews with 14 purposely selected instructors. Classroom observation was also conducted to triangulate data obtained through interviews and survey questions. Quantitative data were analyzed using descriptive statistics, whereas qualitative data were analyzed thematically. The findings of this study depict that most natural science and engineering instructors have good knowledge of brain-based instruction but not transferable knowledge and skills. There is a clear gap between instructors’ knowledge and classroom practice of brain-based instruction. Thus, to improve instructional practices, higher education institutions need to work strongly to narrow the existing variation. Implications and further recommendations are also suggested.

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.

Perspectives on Perioperative Team-Based Morbidity and Mortality Conferences: A Mixed Methods Study

Morbidity and mortality conferences (MMCs) are quality improvement mechanisms during which adverse events are reviewed, often by physicians within a single discipline. There is a growing desire to include nonphysicians and physicians from other disciplines in team-based morbidity and mortality conferences (TBMMs). This mixed methods study investigates perioperative perspectives on MMCs generally and TBMMs specifically. A national survey of perioperative health care professionals, including surgeons, anesthesiologists, and nurses, was used to explore opinions about MMCs and TBMMs. Semistructured qualitative interviews and focus groups were conducted with health care professionals and leaders at a single study site. Quantitative data were compared using a Kruskal-Wallis test. Interview transcripts were inductively analyzed. Data were analyzed using a concurrent mixed methods approach, triangulating both sources of data. Survey respondents (N = 1,466) were generally positive about both MMCs and TBMMs, agreeing that conferences were respectful, affected practice, and were educational. Nurses, compared to surgeons and anesthesiologists, were more likely to find conferences educational (p = 0.004) and were less comfortable speaking up in conferences (p < 0.001). Attendees who had more experience with TBMMs rated conferences as having significantly higher utility in achieving educational and safety goals. Qualitative data from 14 participants identified barriers and facilitators at the micro, meso, and macro level. Barriers include negative personal interactions, unsupportive leadership, and legal and regulatory issues. Facilitators include interpersonal relationships between professionals, buy-in from leadership, and external motivators. Perceptions of TBMMs were overall positive, but significant barriers to implementation remain. Team members may be invited to the table, but more effort is needed to make the entire team feel included in the discussion and optimize the value of these conferences. Strategies for overcoming identified barriers remains an open area of research.

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.

Literacy and quality of life: a study of adults with poor literacy capabilities in western Rwanda

ABSTRACT This article explores the quality of life of adults with poor literacy capabilities (reading, writing and numeracy) in western Rwanda. A concurrent mixed methods research design was used. Data was collected from respondents aged 18 years and over through a survey and focus group discussions. Quantitative results from linear regression analysis indicate a clear relationship between literacy and life satisfaction in that literacy has a direct and indirect path to explaining quality of life. Qualitative results from thematic analysis identify three main pathways in which subjective quality of life is impacted by illiteracy or low literacy capabilities, namely: economic, familial, intrapersonal and interpersonal. Access to, and participation in, quality adult literacy education has the potential to enhancing subjective quality of life by developing relevant literacy capabilities in individuals.

Influence of Teacher Appraisal Systems on Teacher Performance in Public Secondary Schools in Koibatek Sub County, Kenya

The study aimed at establishing the influence of teacher appraisal systems on teacher performance in public secondary schools in Koibatek Sub County, Kenya. The study sought to establish the extent to which teacher appraisal was conducted in secondary schools in Koibatek Sub-County. Vroom’s Expectance Theory guided the study. Concurrent mixed methods research design was used. The target population comprised of all principals, teachers and Quality Assurance and Standards Officers. Simple, stratified and purposive sampling techniques were used. Questionnaire, in-depth interview guide, document analysis schedule and a lesson observation schedule were used to data collection. Data were analyzed using frequencies, percentages, mean scores and standard deviations were computed while Pearson’s Product Moment Correlation was used to test the hypothesis. Qualitative data were coded into relatedthemes and categories. The study findings indicated that the appraisal process was effective in schools. On teacher performance based on appraisal documents analyzed, teachers scored fairly well on co-curricular activities and lesson attendance. Majority of the teachers were found not having scheme of work and lesson plans. Records of work covered were not written by most teachers. Creativity and innovation were scored dismally by most teachers. Parental involvement and guidance and counselling are other areas which attracted low marks. It was established that there was a statistically significant relationship between teachers’ performance appraisal scores and teachers’ lesson observation scores. The study findings would benefit principals, teachers, DQASOs, TSC and MOE on teacher appraisal implementation. It was recommended that emphasis was to be made to teachers on their preparation towards lessons with regard to professional documents.

A blended module (STAIRS) to promote functional and personal recovery in patients with a major depressive disorder in remission: study protocol of a concurrent mixed methods randomized controlled trial

BackgroundDespite the availability of a wide variety of evidence-based treatments for major depressive disorder (MDD), many patients still experience impairments in their lives after remission. Programs are needed that effectively support patients in coping with these impairments. The program Storytelling and Training to Advance Individual Recovery Skills (STAIRS) was developed to address this need and combines the use of peer contact, expert-by-experience guidance, family support and professional blended care. The aim of the planned study is (1) to assess the efficacy of the STAIRS program in patients with remitted MDD, (2) to investigate patients’ subjective experiences with STAIRS, and (3) to evaluate the program’s cost-effectiveness.MethodsA concurrent mixed-methods randomized controlled trial design will be used. Patients aged between 18 and 65 years with remitted MDD (N = 140) will be randomized to either a group receiving care as usual (CAU) + the STAIRS-program or a control group receiving CAU + some basic psychoeducation. Quantitative efficacy data on functional and personal recovery and associated aspects will be collected using self-report questionnaires at the start of the intervention, immediately following the intervention, and at the six-month follow-up. Insights into patients’ experiences on perceived effects and the way in which different program elements contribute to this effect, as well as the usability and acceptability of the program, will be gained by conducting qualitative interviews with patients from the experimental group, who are selected using maximum variation sampling. Finally, data on healthcare resource use, productivity loss and quality of life will be collected and analysed to assess the cost-effectiveness and cost-utility of the STAIRS-program.DiscussionWell-designed recovery-oriented programs for patients suffering from MDD are scarce. If efficacy and cost-effectiveness are demonstrated with this study and patients experience the STAIRS program as usable and acceptable, this program can be a valuable addition to CAU. The qualitative interviews may give insights into what works for whom, which can be used to promote implementation.Trial registrationThis trial was registered at ClinicalTrials.gov on 1 July 2021, registration number NCT05440812.

Professional Roles, Services, and Quality of Life for End-of-Life Doulas in the United States.

End-of-life doulas provide support to the chronically ill, dying, and their families. However, little is known about the roles and services of doulas practicing in the United States. The purpose of the current study is to gain understanding of the roles and experiences of death doulas in the United States. The current study used concurrent triangulation mixed methods design combining survey data with video and audio file submissions from end-of-life doulas. The survey included demographics information, a questionnaire about the roles, services, and training of doulas, and the Professional Quality of Life Scale. There were 74 (77.08%) complete responses from doulas practicing in the United States. Doulas shared about the types of services offered and professional roles they filled in work with the dying and their families. Many doulas offered hybrid or virtual services in addition to in-person care. Many worked at least partially on a volunteer basis. Professional Quality of Life Scales indicated a high level of compassion satisfaction, a low level of burnout, and a low level of secondary trauma. In the complex healthcare system of the United States, end-of-life doulas offer valuable interpersonal services like legacy and grief work as well as practical services like financial and logistical end-of-life planning.

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.

Social Support Assets and Needs of Underrepresented Students Participating in Health Sciences Pathways Programs in Birmingham, Alabama.

Using the Asset Bundle Model, we sought to understand the social support assets and needs of underrepresented minority (URM) high school, undergraduate, and graduate students. Study participants were or had participated in health sciences pathway programs at Birmingham City Schools and/or the University of Alabama at Birmingham. We took a concurrent mixed methods approach to conduct an environmental scan of health science pathway programs in the Birmingham, AL area. Four focus groups were conducted between November 2022 and January 2023, and a 225-item online survey was administered between November 4, 2022, and February 4, 2023. Both tools collected data from high school, undergraduate, and graduate students to examine key components of existing health care pathways programs for URMs and identify barriers and facilitators to successful implementation of such programs. Twenty-two students participated in the focus groups, and 168 individuals responded to the survey. Both focus group participants and interview respondents were primarily URMs (eg, 68.2% and 65.7% identified as Black or African American, respectively). Survey responses and focus group discussions showed that, overall, undergraduate and graduate students programs develop more robust identities as future health care professionals through friendships and institutional supports, expand their networks more broadly through mentorship, and feel more supported by family members in their academic endeavors than high school students. Health science pathway programs for URMs should facilitate and bolster social supports for students, especially those in high school, to enhance persistence through education and into the workforce.

Assessing Electronic Health Record (EHR) Use during a Major EHR Transition: An Innovative Mixed Methods Approach

BackgroundElectronic health record (EHR) transitions are inherently disruptive to healthcare workers who must rapidly learn a new EHR and adapt to altered clinical workflows. Healthcare workers’ perceptions of EHR usability and their EHR use patterns following transitions are poorly understood. The Department of Veterans Affairs (VA) is currently replacing its homegrown EHR with a commercial Cerner EHR, presenting a unique opportunity to examine EHR use trends and usability perceptions.ObjectiveTo assess EHR usability and uptake up to 1-year post-transition at the first VA EHR transition site using a novel longitudinal, mixed methods approach.DesignA concurrent mixed methods strategy using EHR use metrics and qualitative interview data.Participants141 clinicians with data from select EHR use metrics in Cerner Lights On Network®. Interviews with 25 healthcare workers in various clinical and administrative roles.ApproachWe assessed changes in total EHR time, documentation time, and order time per patient post-transition. Interview transcripts (n = 90) were coded and analyzed for content specific to EHR usability.Key ResultsTotal EHR time, documentation time, and order time all decreased precipitously within the first four months after go-live and demonstrated gradual improvements over 12 months. Interview participants expressed ongoing concerns with the EHR’s usability and functionality up to a year after go-live such as tasks taking longer than the old system and inefficiencies related to inadequate training and inherent features of the new system. These sentiments did not seem to reflect the observed improvements in EHR use metrics.ConclusionsThe integration of quantitative and qualitative data yielded a complex picture of EHR usability. Participants described persistent challenges with EHR usability 1 year after go-live contrasting with observed improvements in EHR use metrics. Combining findings across methods can provide a clearer, contextualized understanding of EHR adoption and use patterns during EHR transitions.

Acceptability and Utilization of Livelihood Programs In Higher Education

This study evaluated the acceptability and utilization of livelihood programs in Higher Education. The study's respondents were divided into two; for the quantitative data, the respondents were the 75 beneficiaries from the two partner communities of Camarines Sur Polytechnic Colleges (CSPC), while for the qualitative part, there were ten extensionists of CSPC. A semi-structured questionnaire was used to collect the data for the study. Frequency count, mean, and percentage weighted mean were used in the study. Likewise, the following statistical tools were used for the appropriate treatment of gathered data, in observance of the concurrent mixed method design, and to test the relationship, Pearson R was utilized to know the relationship between the two variables of acceptability and utilization of livelihood programs and to test the difference, Anova (two-way) was used. Results of the study showed that the level of acceptability of livelihood programs along the three skills training was interpreted as highly acceptable. Findings further revealed that the extent of utilization of extension programs for all five deliverable are interpreted as highly utilized. Results further showed that the rating of beneficiaries, along with training, community outreach, and technical assistance, have a significant relationship with the level of acceptability and utilization of livelihood programs. In contrast, communication information and technology transfer and utilization have no significant relationship. Likewise, results showed no significant differences in the ratings of beneficiaries on the level of acceptability and utilization along the five deliverable. The extensionists encountered different challenges in implementing the various extension programs. Thus, an action plan was proposed as an intervention strategy based on the study results.

An analysis of safety practices for small, medium, and large construction projects: A resilience engineering perspective

The varied nature of the construction industry, involving projects of different sizes, poses significant challenges to improving its Occupational Health and Safety (OHS) performance. The existing literature identifying strategies for improving the performance of small construction projects has focused on a deterministic and reactive view of safety. However, recent theoretical advancements in safety criticize this view. Alternatively, a Resilience Engineering (RE)-based perspective is deemed suitable for construction projects to be adaptive in managing safety. However, none of the previous studies analyzed the prevalence of RE-based attributes within the construction industry and across projects of different sizes. This study has adapted a RE-based questionnaire to which 180 survey responses from site professionals were obtained. A concurrent triangulation mixed method was used to analyze this data, supplemented with 16 interviews and field observations from 27 building construction projects in India. The 'contract value' was used as a metric to aggregate the responses for three project types, i.e., 'small', 'medium', and 'large'. The study results indicate that most practices promoting RE-based attributes, such as Monitoring, Learning, and Anticipating, are neither prevalent in the industry nor are significantly different among projects of various sizes. The findings show that small and medium-sized projects may exceed larger projects in several RE-based safety practices, suggesting that pathways to improve safety for smaller projects may not necessarily be limited to emulating larger projects, as typically recommended in the literature. The study advances the understanding of RE-based safety practices and supports safety initiatives in all construction sites.

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.

Health and Sanitation Condition of Pregnant Women: A Case of Arghakhanchi District

This paper aims to explore the situation of sanitation and changing the behaviour of married Nepalese women of reproductive age (15-49). A concurrent mixed-method (qual-quan) research design was employed in this research under the pragmatism worldview. The data are collected through a questionnaire survey, in-depth interviews, and a transect walk. Arghakhanchi district was selected purposively in this study. Diffusion of innovation theory was applied to understand the factors influencing sanitation and hygiene behavior change. The key research participants were the pregnant women of reproductive age (15-45) in the study. A thematic framework was used to analyze qualitative data, while bivariate analysis was performed to show the association between the background variables of sanitation and the health condition of pregnant women. It was found that most of the women used soap and water for hand washing before each meal and after the toilet. There is the provision of soap at hand washing stations and toilets among the study population. However, sufficient hand washing and toilet facilities were not available and 23% of the women reported being scratchy with the use of soap and water regularly.

MIDWIVES POPULATION AND ANTENATAL CARE (ANC) SERVICE PROVISION IN CROSS RIVER STATE, NIGERIA: A QUANTITATIVE-QUALITATIVE APPROACH

The main thrust of this study was to assess midwives’ population and service provision at Primary Health Care level in Cross River State, Nigeria. To achieve this objective, two research questions and one hypothesis was postulated to guide the study. The adopted design for this study is a concurrent triangulation mixed method design, which utilizes both quantitative and qualitative approaches. The sample comprised of 70 mid-wives for the quantitative approach and 8 mid-wives for the qualitative approach through the use of census and purposive sampling techniques respectively. A questionnaire developed by the researcher on the type of services provided by mid-wives was used to collect data for the qualitative approach, while a focused group discussion was used to collect data for the qualitative approach. The data gathered were analyzed with descriptive and inferential statistics as well as qualitatively. Results indicated that only forty-four (44) PHCs have midwives while one hundred and fifty-eight PHCs have no midwife at all. The result also indicated that the one PHC that has above 3 midwives render high quality care services to client than the 43 PHC that have below 3 midwives population has the calculated t-value of 17.225 is greater than the critical t-value of 1.980 at 0.05 level of significance and 68 degrees of freedom. This implies that there is a significant relationship between midwives’ population and ANCs service provision in PHCs in Cross River /State, Nigeria. Based on this finding, it was recommended that the presence of midwives in State Primary Health Care Development Agency should be strengthened. Nursing and midwifery council should review the policy to establish community midwifery in Cross River State were more midwives will be trained and automatically employed to PHC level in the State.

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.