Convergent Mixed Methods Study Research Articles

Decision-making and role preferences for receiving individual pharmacogenomic research results among participants at a Ugandan HIV research institute

Little is known about how people living with HIV should be engaged in the decision-making process for returning individual pharmacogenomic research results. This study explored the role people living with HIV want to play in making decisions about whether and how individual results of pharmacogenomic research should be presented to them. A convergent parallel mixed methods study was conducted, comprising a survey of 221 research participants and five deliberative focus group discussions with 30 purposively selected research participants. Most participants (122, 55.2%) preferred the collaborative role, 67 (30.3%) preferred the active role and 32 (14.5%) preferred the passive role. Factors that significantly influenced preference for an active role compared with a collaborative role were marital status (OR: 0.282, p = 0.013), research experience (OR: 4.37, p = 0.028), and religion (OR: 2.346, p = 0.041). The reasons proffered for the active role included prior experience with antiretroviral treatment and increased exposure to research activities. The reasons given for preferring the passive role included limited level of awareness about the interaction between patients’ genes and drugs, trust in researchers to make the right decision, and fear of making decisions with harmful implications. Overall, findings from our study show that participants want to be engaged in the decision-making process. Research teams ought to provide adequate and simple information about the pharmacogenomic research and implications of the results to support participants’ informed decisions.

Comprehensive investigation of ergonomic challenges and predictors of work-related musculoskeletal disorders among intensive care unit nurses of Western India through convergent mixed methods study

BackgroundWork-related musculoskeletal disorders (WRMSDs) are significant concern in intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU nurses, providing valuable insights for targeted interventions.MethodsIn this six-month convergent mixed methods study, 200 consenting nurses with over one year of experience from seven ICUs across three public tertiary hospitals of Ahmedabad participated. Structured questionnaires were used to collect data on socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain (through modified Nordic Musculoskeletal Questionnaire) and ergonomic issues using REBA (Rapid Entire Body Assessment) scale. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analysis involved chi-square, t-test and logistic regression, with a significance level set at p < 0.05. Thematic analysis was used to interpret the findings of qualitative study.ResultsThe study included predominantly female ICU nurses (78%) with a mean age of 34 years. A high prevalence of WRMSDs (84%) was observed, with the lower back and neck being the most affected regions. Nurses with WRMSDs reported significantly higher mean scores for physical factors (15.1 vs. 11.1, p = 0.00), physical workload (12.8 vs. 10.7, p = 0.001), work environment (13.1 vs. 10.1, p = 0.00), and risk perception (11.8 vs. 8.9, p = 0.00) compared to those without WRMSDs. Logistic regression identified key risk factors for WRMSDs, including longer ICU tenure [OR = 1.4 (1.13–1.66)], high shift frequency [OR = 2.7 (1.27–5.95)], higher physical factor score [OR = 1.2 (1.05–1.42)], higher physical workload score [OR = 1.2 (1.09–1.49)], higher risk perception [OR = 1.3 (1.10–1.78)], and lack of exercise [OR = 0.5 (0.27–0.93)]. The qualitative findings highlighted key ergonomic challenges, including inadequate equipment, heavy patient loads, poor posture during tasks, and insufficient breaks, contributing to WRMSDs among ICU nurses.ConclusionThe findings underscore urgent need for targeted interventions to address risk factors associated with WRMSDs, including ergonomic training, workplace modifications, and education programs to enhance risk awareness and preventive behaviours. Future research should focus on developing and evaluating comprehensive interventions that integrate both physical and work environment factors to effectively mitigate WRMSDs among ICU nurses.

Early implementation of an electronic measurement-based care tool in substance use disorder treatment clinics.

Measurement-based care (MBC), routinely measuring and reviewing treatment progress with a standardized tool, can inform clinical decision making and improve patient outcomes. Despite potential benefits, implementation of MBC in SUD treatment settings has been limited and little is known about its implementation in SUD settings. The goal of this convergent parallel mixed methods study was to understand staff experiences during early implementation of MBC in SUD treatment clinics. The Treatment Progress Assessment-8 (TPA8) is an 8-item measure that supports MBC with an electronic system (eTPA8) allowing client completion on electronic devices and providing staff reports. The study introduced the eTPA8 into 13 clinics using external practice facilitation and implementation teams. Quantitative data examining implementation included eTPA8 system data (1672 administrations) and staff surveys (n=70) using feasibility, acceptability, and appropriateness measures. Semi-structured interviews (n=34) were conducted with clinic staff. To analyze data, we classified clinics into adopters, non-adopters, and sustainers using eTPA8 system data. One-way ANOVA compared these classifications on the three implementation outcome measures. Rapid qualitative analysis was used for the interviews. There were significant differences between staff in sustainer (M=3.90) and non-adopter (M=3.21) clinics on the feasibility measure (F(2, 68)=[4.28], p=0.018). SUD program staff found the eTPA8 to be user-friendly, appropriate, and acceptable. There was some variation in perceived feasibility of regular use of the eTPA8, especially given competing demands and time constraints. Staff found the eTPA8 useful to support clinical interactions but varied in embracing new technology and the overall MBC concept. The inner and outer contexts influenced implementation and required attention by clinic champions and implementation teams. External practice facilitators were key to addressing barriers in an ongoing and flexible manner. Implementing MBC using the eTPA8 showed promise. Staff felt the TPA8 was generally clinically useful, appropriate, and acceptable; yet feasibility was variable. Adoption of MBC faced barriers (e.g., competing demands). Implementation required relatively intensive implementation supports that were dynamic, proactive, and responsive. Findings have implications for guiding development and refinement of responsive, theory-driven implementation strategies to support MBC in SUD treatment settings, with a particular focus on addressing feasibility.

Prevalence and factors associated with the multiple morbidity of postpartum depression, diabetes mellitus and hypertension among mothers in Mbarara district, south western Uganda: a parallel convergent mixed methods study

Prevalence and factors associated with the multiple morbidity of postpartum depression, diabetes mellitus and hypertension among mothers in Mbarara district, south western Uganda: a parallel convergent mixed methods study

Empowering Futures: The Impact of Surgical Research Pipeline Programs on Undergraduate Career Development.

Surgical research pipeline programs provide a unique insight into academic surgery, offering a distinctive opportunity for aspiring future surgeons and medical professionals to identify suitable mentorship. The objective of this study was to determine the impact of an academic summer research, shadowing, and mentorship program on undergraduate students with interest in the fields of medicine and surgery. We conducted a convergent mixed methods study on undergraduate students who participated in the Surgery Undergraduate Research Experience (SURE) program from 2017 to 2022, excluding the 2020 cohort as their experience was highly impacted by COVID-19. SURE, program connected academic surgeons with students interested in medicine, involving them in research, lectures, and clinical shadowing. Students completed questionnaires and participated in semi-structured focus group interviews to assess the program's impact on their career goals. Twenty-five undergraduate students completed the self-administered survey with a response rate of 51.0% and 5 participated in the focus group interviews. Among the participants, 12 (48.0%) students were currently enrolled in medical school, while an equal proportion had taken their Medical College Admission Test (MCAT) and were in the process of applying to medical school. 88.0% believed that their involvement in the program significantly increased their interest in academic surgery and empowered them to pursue a career in medicine. 84.0% reported that the program helped them find the right mentorship and guidance, while 80.0% reported increased proficiency in research skills. These quantitative findings were further substantiated by qualitative data obtained through focus group interviews. From these interviews, 4 noticeable emergent themes highlighted by the participants included the significance of right mentorship, a deeper understanding of healthcare and surgical career paths, increased research literacy, and career development. Early exposure to surgical practices and mentorship significantly enhanced the enthusiasm of undergraduate students toward a surgical career while expanding their comprehension of surgical professions. Investing in such pipeline programs can exert a positive influence on undergraduate students' perceptions of surgical careers, thereby creating new avenues of opportunity for them.

Unmet Needs and Health-Related Quality of Life Among Patients With Relapsed/Refractory Indolent Non-Hodgkin Lymphoma: A Mixed-Methods Study.

Patients with relapsed or refractory (r/r) indolent non-Hodgkin lymphoma (iNHL) live with incurable disease for a long-term, experiencing multiple relapses and treatments that impair their health-related quality of life (HRQOL). We aimed to better understand the unmet needs and HRQOL of patients with r/r iNHL. This convergent mixed-methods study evaluated patients with r/r iNHL who received treatment. Unmet needs and HRQOL were assessed quantitatively using self-administered questionnaires and analyzed statistically. Qualitative data were collected through face-to-face semi-structured interviews for reflexive thematic analysis. Quantitative and qualitative findings were integrated through narrative discussion and joint display. Questionnaire respondents (50 participants, mean age: 72.42years) reported unmet needs in the health system and information and psychological domains and a negative association between unmet needs and HRQOL. Interviews (20 participants, mean age: 72.75years) identified four themes: "unremarkable symptoms," "anxiety of progression in the near future," "make the best of life," and "means to live with uncertainty." Integration revealed that participants accepted their low HRQOL and attempted to make the best of life, influencing their perception of unmet needs. Throughout the long course of r/r and repeated treatment, patients with iNHL accepted their low HRQOL, valued their current situations, and endeavored to make the best of life. In this situation, support in the psychological and health system and information domains is crucial. Support for the unmet needs of patients with r/r iNHL is essential as they strive to live their best lives while maintaining a favorable HRQOL.

Transition from child to adult health services for young people with cerebral palsy in Ireland; implications from a mixed-methods study

Background Poor transition from child- to adult-oriented healthcare may lead to negative outcomes and dissatisfaction with services in adulthood. The aim of the study was to examine how transition is provided to and experienced by young people with cerebral palsy in Ireland. This report provides integrated quantitative and qualitative findings and implications based on the totality of knowledge generated. Methods A convergent parallel mixed-methods study was conducted. Data were collected from people with cerebral palsy aged 16–22 years, parents, and health professionals using surveys and semi-structured interviews, which were both informed by a framework of nine key transition practices. Quantitative finding from the surveys and qualitative findings from interviews were integrated at the interpretation stage of the research using integration through joint displays. Implications were developed through discussions with health professionals, young people, and parents. Results Surveys were completed by 75 young people/parents and 108 health professionals. Interviews were conducted with 13 young people, 14 parents, and 27 health professionals. There was complementarity between quantitative and qualitative findings indicating lack of a named worker, limited information provision, insufficient self-management support, no opportunity to meet the adult team, limited contact with the general practitioner, and no opportunity for attending formal life skills training. There was dissonance between quantitative and qualitative findings regarding appropriate level of parental involvement. Quantitative findings identified limited promotion of health self-efficacy and a lack of senior managers responsible for transition. These practices were not described in the qualitative findings. Conclusion Implications of integrated findings include the need for a standardised transition pathway, intentional actions to enable parents and young people to adapt to changing roles, provision of information in a collaborative and phased approach, a common understanding of self-management between young people, parents and health professionals, and the need to involve general practitioners in transition.

Augmenting pediatric nursing clinical education with low-cost simulations.

Pediatric nursing education faces challenges due to limited clinical opportunities for students. Simulation-based education (SBE) is essential to address this gap, but high-fidelity/high-technology simulations can be expensive. Low-cost alternatives, such as pictocards, offer a diverse and cost-effective solution that aligns with competency-based education. This study aimed to evaluate the educational benefit of this low-cost solution on simulation effectiveness. A convergent mixed methods study design was used with undergraduate nursing students in a pediatrics skills lab. Quantitative data were collected using the modified Simulation Effectiveness Tool (SET-M; Leighton et al., 2015) and qualitative data were gathered from open-ended responses on the tool. Descriptive statistics and content analysis were used to analyze the data. A total of 164 learners participated in the study. SET-M results indicate that the simulation activity was effective, with an overall SET-M score of 2.49 (SD=0.23) out of 3.0. Means on the subscales ranged from 2.35 to 2.79 out of 3.0, with the highest subscale being Debriefing. Qualitative findings showed that learners found the simulation useful with an emphasis on enhanced understanding and exposure to diverse patient populations. This modality was an effective, low-cost solution for pediatric nursing SBE. Further exploration is needed with this modality and other low-cost solutions for competency development and interdisciplinary applications.

Towards person-centred maternal and newborn care in Ethiopia: a mixed method study of satisfaction and experiences of care

BackgroundPerson-centred maternal care is associated with positive experiences in high-income countries. Little is known about the transferability of this concept to non-Western, low-income settings. We aimed to explore women’s experiences of care and investigate satisfaction with antenatal care (ANC) in relation to person-centred care and unmet psychosocial needs in rural Ethiopia.MethodsDesign: facility-based, convergent mixed-method study. A cross-sectional survey included 2079 consecutive women attending ANC at eight health centres. Service satisfaction was measured using a 21-item validated measure. Independent variables: [1] person-centred care (1A: receipt of information; 1B: perceived adequacy of health worker responses) and [2] unmet psychosocial needs (2A: Patient Health Questionnaire for depressive symptoms; 2B: screening questionnaire for intimate partner violence (IPV)). Linear mixed effect regression assessed hypothesized associations between person-centred care/unmet psychosocial needs and service satisfaction, accounting for clustering at the health centre level. A linked qualitative study comprised eight in-depth interviews with women accessing ANC. Structured observations of ANC consultations rated health worker competencies (n = 65) and adherence to guidance promoting person-centred care (n = 53). Qualitative data were analysed thematically and triangulated with quantitative and observational data.ResultsWomen reported lowest satisfaction in relation to family involvement (71.5% dissatisfied) and continuity of care (65.7% dissatisfied). As hypothesised, satisfaction increased with more information received (adjusted regression coefficient (ARC) 0.96 95%CI 0.71,1.20) but reported adequacy of help from health workers did not show a dose-response relationship (test-for-trend p = 0.157). Undetected depressive symptoms (ARC − 0.21 95%CI -0.27,-0.15) and IPV (ARC − 1.52; 95%CI -2.43,-0.61) were associated with lower service satisfaction scores. Most observed consultations scored low on most indicators of person-centred care. In qualitative interviews, women valued respectful and responsive communication from health workers, which affected their willingness to disclose psychosocial problems. Triangulation of findings indicated a mismatch between what women valued about care, their reported satisfaction with care and the actual care they were observed to receive.ConclusionsSystems strengthening interventions to support person-centred maternal care appear contextually relevant but need to increase women’s expectations of care and agency to demand change. Prioritization of person-centred care could improve women’s experience of maternal care and better address psychosocial needs.

P-183. Barriers and Facilitators to Identifying and Treating Neonatal Sepsis in Ethiopia

Abstract Background Neonatal sepsis is a major cause of death of children under the age of 5 years globally and in Ethiopia. The high mortality associated with neonatal sepsis is especially pronounced in low-birth weight infants (LBW). Antimicrobial resistance (AMR) further contributes to high mortality. Many hospitalized LBW newborns with sepsis are admitted to NICUs but mortality remains high, partly due to increasing AMR but also due to delayed identification and treatment. Thus, evaluating and describing the existing barriers to sepsis diagnosis and management is urgently needed. This may guide targeted innovations to predict, diagnose, and treat neonatal sepsis earlier and avert newborn deaths. Methods Utilizing structured chart review and focus groups we conducted a convergent mixed methods study evaluating facilitators and barriers to early identification and care of neonates admitted with sepsis to the neonatal intensive care unit at Tibebe Ghion Specialized Hospital in Bahir Dar, Ethiopia. Results 6 resident physicians and 6 nurses participated in 2 focus groups, and 142 charts were reviewed. Chart review revealed that infants with documented warning signs (such as fast breathing or failure to suck) begin an empiric course of ampicillin and gentamycin. Further diagnostic workup is often limited, and blood cultures are rarely performed. Qualitative interviews reenforced and expanded these results. Key barriers identified included limited physical resources (monitoring equipment, laboratory capacity, and imaging) and personnel barriers (limited staffing, low morale, and frequent staff transfer). Primary facilitators included understaffing, retention of experienced staff, and access to necessary equipment and diagnostics. Conclusion Even in a higher-level hospital in Ethiopia, neonatal sepsis is challenging to identify due in part to limited diagnostic capacity and understaffing. The absence of cultures and sensitivities and other diagnostics present barriers to early identification and targeted treatment. Future studies could focus on interventions to expand lab capacity and diagnostics, including point of care diagnostics for sepsis or AMR, capacity building of neonatal nursing, and expansion of access to low-cost vital sign monitoring. Disclosures All Authors: No reported disclosures

‘I wish I had been better prepared’: a mixed-methods study of psychological reactions, perceptions and opinions of cardiovascular preparticipation screening among young competitive athletes

ObjectiveTo evaluate the psychological reactions, perceptions and opinions of cardiovascular preparticipation screening (PPS) among young competitive athletes.MethodsThis convergent parallel mixed-methods study recruited 222 athletes (mean age: 18.7 years) who underwent...

Experiences Using Media Health Claims to Teach Evidence-Based Practice to Healthcare Students: A Mixed Methods Study

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in media to promote critical thinking and provide an accessible entry point to evidence-based practice for early-stage university healthcare students. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at the Faculty of Health Sciences, Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in bioengineering, physiotherapy, social education, and occupational therapy. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around health news. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches, including the group exam. Results Out of 446 participants, 136 (30.5%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, both the blended learning design and the group exam were identified as contributors to a positive perception of learning outcomes from the course. Conclusions Integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial for educating bachelor’s healthcare students. However, further rigorous study designs are needed to assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Evaluating the impact, implementation experience and political economy of primary care networks in Kenya: protocol for a mixed methods study

BackgroundPrimary care networks (PCNs) are increasingly being adopted in low- and middle-income countries (LMICs) to improve the delivery of primary health care (PHC). Kenya has identified PCNs as a key reform to strengthen PHC delivery and has passed a law to guide its implementation. PCNs were piloted in two counties in Kenya in 2020 and implemented nationally in October 2023. This protocol outlines methods for a study that examines the impact, implementation experience and political economy of the PCN reform in Kenya.MethodsWe will adopt the parallel databases variant of convergent mixed methods study design to concurrently but separately collect quantitative and qualitative data. The two strands will be mixed during data collection to refine questions, with findings triangulated during analysis and interpretation to provide a comprehensive understanding of PCN implementation. The quantitative study will use a controlled before and after study design and collect data using health facility and client exit surveys. The primary outcome measure will be the service delivery readiness of PHC facilities. We will use a random sample of 228 health facilities and 2560 clients in four currently implementing PCNs, four planning to implement and four control counties at baseline and post-implementation. We shall undertake a preliminary cross-sectional analysis of the data at baseline from October to December 2023, followed by a difference-in-difference analysis at the endline from October to December 2024 to compare the outcome differences between the intervention and control counties over a 12-month period. The qualitative study will include a cross-sectional process evaluation and political economy analysis (PEA) using document reviews and approximately 80 in-depth interviews with national and sub-national stakeholders. The process evaluation will assess the emergence of PCN reforms, the implementation experience, the mechanism of impact and how the context affects implementation and outcomes. The PEA will examine the interaction of structural factors, institutions and actors/stakeholders’ interests and power relations in implementing PCNs. We will also examine the gendered effects of the PCNs, including power relations and norms, and their implications on PHC from the supply and demand sides. We shall undertake a thematic analysis of the qualitative data.DiscussionThis evaluation will contribute robust evidence on the impact, implementation experience, political economy and gendered implications of PCNs in a LMIC setting, as well as guide the refining of PCN implementation in Kenya and other LMICs implementing or planning to implement PCNs to enhance their effectiveness.

Challenges and support factors in managing type 2 diabetes among pregnant women in Thailand: A convergent mixed-methods study.

Sociocultural and behavioral factors have a multifaceted impact on maternal health. In Thailand, cultural influences significantly shape behaviors of diabetes self-management in women. However, the experience of self-managing diabetes in pregnant women with preexisting Type 2 Diabetes Mellitus (T2DM) remains unclear. The study aimed to explore challenges and support factors of diabetes self-management among pregnant women with preexisting T2DM in Thailand, and to compare these factors between women in two groups (optimal and suboptimal maternal health outcomes). A convergent mixed-methods study was conducted at a tertiary hospital (March to October 2022). Eligible participants were Thai pregnant women, aged 20-44, diagnosed with T2DM. Participants first completed a questionnaire and then were interviewed about diabetes self-management. Maternal health outcomes (i.e., gestational weight gain and glycated hemoglobin [HbA1c]) were reviewed and extracted. Descriptive statistics were used for quantitative analysis, while directed content analysis was used for qualitative data. Side-by-side matrices were used to describe the qualitative subthemes with quantitative results. Twelve Thai pregnant women participated in the study, aged 27 to 40 years, with gestational ages ranging from 7 to 38 weeks and T2DM diagnoses spanning from 3 weeks to 10 years. Half of the participants were obese before pregnancy. Weight gain patterns revealed that 41.67% had inadequate gain, 33.33% had optimal gain, and 25% had excessive gain. HbA1C levels indicated that 75% had good glycemic control. Three women achieved optimal weight gain and glycemic control, while nine exhibited suboptimal health outcomes. We identified six main themes: 1) challenges at the individual level in managing diabetes, 2) support factors at the individual level for diabetes management, 3) challenges at the interpersonal level in controlling diet, 4) interpersonal support factors for managing diabetes, 5) challenges at the societal level in accessing healthcare, and 6) societal support factors for healthcare access. The findings suggest that managing diabetes during pregnancy necessitates dynamic, patient-centered care throughout the pregnancy journey. Regarding the clinical implication, it is important to tailor approaches to the Thai context and to prioritize education and boost women's confidence in managing diabetes throughout pregnancy.

Technology-supported self-triage decision making

Symptom-Assessment Application (SAAs) and Large Language Models (LLMs) are increasingly used by laypeople to navigate care options. Although humans ultimately make a final decision when using these systems, previous research has typically examined the performance of humans and SAAs/LLMs separately. Thus, it is unclear how decision-making unfolds in such hybrid human-technology teams and if SAAs/LLMs can improve laypeople’s decisions. To address this gap, we conducted a convergent parallel mixed-methods study with semi-structured interviews and a randomized controlled trial. Our interview data revealed that in human-technology teams, decision-making is influenced by factors before, during, and after interaction. Users tend to rely on technology for information gathering and analysis but remain responsible for information integration and the final decision. Based on these results, we developed a model for technology-assisted self-triage decision-making. Our quantitative results indicate that when using a high-performing SAA, laypeople’s decision accuracy improved from 53.2% to 64.5% (OR = 2.52, p < 001). In contrast, decision accuracy remained unchanged when using a LLM (54.8% before vs. 54.2% after usage, p = 79). These findings highlight the importance of studying SAAs/LLMs with humans in the loop, as opposed to analyzing them in isolation.

Beyond Survival: Unveiling Psychological and Social Adaptation After Visceral Transplantation.

To explore the meaning of adaptation after visceral transplantation in terms of patient experiences, symptoms, self-efficacy, transplant-specific and mental well-being. A convergent parallel mixed-methods study, consisting of interviews and generic as well as transplant-specific questionnaires. Results were integrated using meta-inference. The study comprises a population of 17 visceral transplant recipients in Scandinavia, 12 women and 5 men with a mean age of 40.6 years (range 19-63 years) and an average follow-up of 9.4 years (range 0-25 years). Data were collected between May 2023 and January 2024 through open-ended in-depth interviews with 12 participants and analysed in accordance with phenomenological hermeneutics. Questionnaires from all 17 participants were analysed to measure transplant-specific well-being, symptoms, self-efficacy as well as anxiety and depressive symptoms. Being a visceral transplant recipient is a dynamic and life-long adaptation process that comprises two distinct yet interconnected trajectories: coherence and endurance. Coherence involves the person's ability to make sense of their situation and find meaning despite the challenges and adversity of the chronic condition. In contrast, endurance involves a person's capacity to withstand hardship and endure unpleasant or difficult experiences. Both trajectories interact dynamically, influencing and reinforcing each other. Resilience based on coherence enabled acceptance and adjustment. Conversely, uncertainty, resignation and feeling unsupported resulted in a lack of acceptance, manifested as resistance. The challenge involved in adaptation was demonstrated by 47% showing borderline elevated or elevated levels of anxiety and 18% reporting symptoms of depression. Self-efficacy varied considerably. The meaning of adaptation after visceral transplantation in terms of experiences, symptoms, transplant-specific and mental well-being is balancing between coherence and endurance facilitated by acceptance and hampered by resistance. The uncertainty inherent in being a visceral transplant recipient may lead to heightened self-rated anxiety symptoms and diminished self-efficacy. What problem did the study adress? This study adresses the challenges involved in being a visceral transplant recipient and adapting to life after a visceral transplantation. What were the main findings? COREQ checklist (consolidated criteria for reporting qualitative research). No Patient or Public Contribution was organised.

The Holistic Effect of Complementary Interventions in Reducing Stress in College Students.

The purpose of this research was to examine the holistic effects of combined complementary therapies in reducing stress in college students. This convergent mixed-method study provided aromatherapy, massage, and meditation music sessions to college students (N = 50) just before finals week. Paired t-tests analyzed pre-session and post-session perceived stress and anxiety as well as objective physiological measures, including salivary cortisol, heart rate, and blood pressure. There was a significant difference in the scores for perceived stress before and after the sessions, t(49) = 4.72, p < .001, as well as pre-anxiety and post-anxiety, t(49) = 10.27, p < .001. Additionally, salivary cortisol levels significantly reduced from pre-session to post-session t(49) = 2.76, p = .008; and a significant reduction in heart rate from pre-session to post-session, t(49) = 3.73, p < .001. This study demonstrates that 20 min of brief complementary interventions can alter students' subjective holistic health perspectives, with objective physiological data confirming changes that promote health and wellbeing.

Evaluating the implementation of online research training and mentorship among early-career family physicians in sub-Saharan Africa.

Research is needed to improve the performance of primary health care. In Africa, few family physicians conduct research, and therefore an online research training and mentorship programme was developed to build research capacity amongst novice and early career researchers. To evaluate the implementation of the AfriWon Research Collaborative (ARC) training and e-mentorship programme in sub-Saharan Africa. A 10-module online curriculum was supported by peer and faculty e-mentorship, to mentor participants in writing a research protocol. A convergent mixed methods study combined quantitative and qualitative data to evaluate nine implementation outcomes. Fifty-three participants (20 mentees, 19 peer mentors, and 14 faculty mentors), mostly male (70%), participated in the ARC online programme. The programme was seen as an acceptable and appropriate initiative. Mentees were mostly postgraduate students from African countries. Faculty mentors were mostly experienced researchers from outside of Africa. There were issues with team selection, orientation, communication, and role clarification. Only 35% of the mentees completed the programme. Alignment of mentoring in teams and engagement with the online learning materials was an issue. Costs were relatively modest and dependent on donor funds. Despite many challenges, the majority of participants supported the sustainability of the programme. The evaluation highlights the strengths and weaknesses of the ARC programme and e-mentoring. The ARC working group needed to ensure better organization and leadership of the teams. Going forward the programme should focus more on developing peer mentors and local supervisory capacity as well as the mentees.

Speech-Language Pathologists' Language Practices During Speech-Language Therapy for Bilingual Children

Purpose: Previous research and clinical practice guidelines indicate that it is best practice to support bilingual children with communication disorders in both of their languages. However, there is a shortage of bilingual speech-language pathologists (SLPs) in the United States. Therefore, it is important to examine how SLPs with varying linguistic backgrounds serve their bilingual clients. This study investigated the language practices of SLPs during intervention with bilingual children and identified needed resources. Method: This convergent mixed-methods study included a survey and semistructured interviews, with interviewees sampled purposively based on survey responses. Quantitative analyses were examined alongside qualitative themes to address each research question. Results: Overall, 21.5% of the bilingual clients described by survey respondents were reported to receive intervention in both of their languages. SLPs who shared both languages with their clients and had a professional level of proficiency were more likely to provide services in both languages and to engage in code-switching during sessions. Qualitative analysis revealed creative strategies that SLPs used to overcome their own linguistic limitations when they lacked skills in a client's heritage language. Although practices varied based on the SLP's linguistic background, respondents identified similar priorities, including more bilingual providers and access to training, multilingual materials, and interpreters. Conclusions: This study contributes insights into how SLPs serve their bilingual clients and what resources are needed to improve services. Although this study focused on Massachusetts and had a small sample, the findings may apply to other states, and there may be benefits to addressing these questions at a state level to provide targeted advocacy, training, and resources.

A mixed methods study investigating factors affecting adherence to Plasmodium vivax malaria primaquine radical cure regimens among migrants along the Myanmar-Thailand border.

The countries within the Greater Mekong Region of Southeast Asia have pledged to eliminate malaria by 2030. Elimination of Plasmodium vivax malaria is challenging as it requires radical cure to prevent relapse. Understanding and facilitating adherence to primaquine radical cure regimens is necessary for malaria elimination. A convergent parallel mixed methods study was conducted to investigate the barriers to and facilitators for completing primaquine treatment of P. vivax infection among mobile migrant communities on the Myanmar-Thailand border. Quantative data were derived from routine malaria consultations. Qualitative data, informed by the social cognitive theory and health belief model, were collected through in-depth interviews with patients and focus group discussions with local health providers and community leaders. Of 729 adult patients with primaquine treatment outcomes, 45% did not complete the follow-up of 28 days and were assumed to be non-adherent to primaquine treatment. Patients of Karen ethnicity (OR 1.7, 95% CI 1.2-2.3; p = 0.001) or having a previous episode of malaria from any species (OR 1.6, 95% CI 1.1-2.3; p = 0.007) were more likely to report completing the 14-day primaquine radical cure regimen. Five focus group discussions with front-line healthcare workers and community members and 16 in-depth interviews with patients who were prescribed P. vivax radical cure were conducted. Key themes related to the social cognitive theory included behavioral factors where work outweighed the choice to complete treatment; environmental factors where access to care determined primaquine treatment completion; and cognitive factors having a positive but limited influence on treatment completion. According to the health belief model, prioritizaton of work reduced seeking diagnosis and completing treatment, and often outweighed facilitating factors such as malaria literacy, health education, and social norms; and affected the perceived susceptibility and severity of P. vivax infections. Work and productivity were identified as primary behavioral factors affecting adherence to primaquine radical cure and follow up in a migrant population. Community support and cultural cues may overcome these barriers. Understanding the rationale of patient adherence to primaquine may help guide programming for P. vivax elimination among migrant populations in resource-constrained settings.