Convergent Mixed Methods Research Articles

Turkish textile and clothing SMEs: Importance of organizational learning, digitalization, and internationalization

Abstract The Turkish textile and clothing (TTC) industries, which are mainly made of small and medium enterprises (SMEs), are the main source of export for the Turkish economy since the end of 1980s. The introduction of digital technologies has changed the competition for the TTC industries and this change has been accelerated after the covid-19 pandemic. Digitalization of SMEs is accepted as a social and technical process in which organizational learning is the main actor and therefore, the aim of this research is to explore the relation between organizational learning, digitalization, and internationalization for TTC industries. A parallel-results convergent mixed method approach in which qualitative and quantitave analysis are performed seperately and integrated later is applied in this research. The data of the research were collected by semi-structured interviews and survey questionnaires, which are analyzed in MAXQDA and analysis of moment structures.

"How Do I Practise Palliative Care When I Don't Know How?" Exploring the Impact of EPAN, An Online Educational Intervention on General Nurses in Singapore: An Evaluation Study.

Objective(s): The majority of deaths in Singapore (62.1%) occur in the hospital, but most nurses do not have palliative care (PC) education. An online e-learning course, "Essential Palliative Care Approach for Nurses" (EPAN), was developed to close the learning gap. The study aimed to evaluate the impact of EPAN on general nurses' knowledge, confidence, and attitude in delivering end-of-life care. Methods: Convergent parallel mixed methods design. Results: 1708 nurses (67%), mostly from inpatient and ambulatory settings, completed EPAN. Statistically significant increases in mean scores across knowledge, confidence, and attitude (p < 0.05) remained consistent immediately post-course and 3 months post-course. Respondents shared their intentions to change practice in the immediate post-course survey (n = 1155) and how they have practiced end-of-life care in the 3-month post-course survey (n = 777). Major categories from the content analysis included: (i) actualise confidence to deliver effective communication, (ii) making time and showing empathy in end-of-life care, (iii) advocating for end-of-life care, (iv) proactive collaboration with other healthcare professionals, (v) navigated and accepted end-of-life boundaries, and (vi) able to self-manage emotions. Conclusions: EPAN, developed within an Asian context, has demonstrated a significant impact on nurses' knowledge, confidence, and attitude in delivering end-of-life care. This has broader implications for general palliative care education in countries of similar cultural concerns.

Nursing Documentation Practice and Associated Factors Among Nurses in East Guji, West Guji and Borena Zone Public Hospitals Southeastern, Ethiopia

Background: In health care systems, nursing care documentation is a vital and powerful tool that ensures continuity of care and communication between health personnel for better patient outcomes. The practice of nurses towards nursing care documentation affects the quality and coordination of patients’ care. Hence, this study aimed to assess the practice of documentation and its associated factors among nurses working in the Guji and Borena Zone public hospitals. Method: A hospital-based cross-sectional study design with a convergent mixed-method approach was employed from April 1 to May 30, 2022, among 502 sampled nurses working in East Guji, West Guji, and Borena Zone public hospitals in Ethiopia. Data were collected using self-administered structured and open-ended questionnaires for quantitative and qualitative data, respectively. Key informant interviews were conducted with nine respondents. Epi Data 4.6 was used for data entry, and SPSS version 26 software was used for data analysis. A logistic regression model was used to identify the determinants of nursing documentation practice, and statistical significance was declared at P &lt; 0:05. A thematic analysis approach was applied for the qualitative data analysis. Result: A total of 486 respondents provided complete responses, resulting in a response rate of 97%. The documentation practice was found to be 46.9%. Factors associated with good nursing documentation practice included the availability of guidelines [(AOR = 2.1), 95% CI (1.1-3.9)], education received in governmental institutions [(AOR = 2.6), 95% CI (1.7-4.0)], in-service training [(AOR = 1.7), 95% CI (1.01-2.7)], motivation [(AOR = 2.1), 95% CI (1.2-2.7)], favorable attitude [(AOR = 2.3), 95% CI (1.5-3.5)], documentation audit [(AOR = 2.0), 95% CI (1.0-3.7)], and good knowledge [(AOR = 2.1), 95% CI (1.2-3.5)]. The key informant interview explored factors like in-service. training, lack of supply, academic background, and educational status, as well as the vast nursing care format and lack of commitment, have a major impact on nursing documentation. Conclusion: In this study, the overall nursing documentation practice was poor. Therefore, it is important to make extra efforts to improve documentation practice by providing planned training on standards of documentation to all nurses, enhancing favorable attitudes, and increasing their knowledge by motivating them to develop a culture of good nursing documentation.

Using RE-AIM Framework to Evaluate Recovery Opioid Overdose Team Plus: A Peer-Led Post-overdose Quick Response Team.

Peer recovery coaches utilize their lived experiences to support overdose survivors, a role gaining prominence across communities. A convergent mixed methods design, informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, was used to evaluate the Recovery Opioid Overdose Team Plus (ROOT +), through an iterative evaluation using web-based surveys and qualitative interviews. Reach: Over 27months, ROOT + responded to 83% of suspected overdose referrals (n = 607) and engaged with 41% of survivors (n = 217) and 7% of survivors' family/friends (n = 38). Effectiveness: Among those initially engaged with ROOT +, 36% of survivors remained engaged, entered treatment, or were in recovery at 90days post-overdose (n = 77). Adoption: First responders completed 77% of ROOT + referrals (n = 468). Implementation: Barriers included lack of awareness of ROOT + , working phones, and access to treatment from community partner interviews (n = 15). Maintenance: Adaptations to ROOT + were made to facilitate implementation. Peer-led teams are promising models to engage with overdose survivors.

Maintaining Delivery of Evidence-Based Interventions to Reduce Under-5 Mortality During COVID-19 in Rwanda: Lessons Learned through Implementation Research.

Background: The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce U5M supported the maintenance of healthcare delivery. Methods: We used a convergent mixed methods implementation science approach, guided by hybrid implementation research and resiliency frameworks. We triangulated data from three sources: desk review of available documents, existing routine data from the health management information system, and key informant interviews (KIIs). We analyzed quantitative data through scatter plots using interrupted time series analysis to describe changes in EBI access, uptake, and delivery. We used a Poisson regression model to estimate the impact of COVID-19 on health management information system indicators, adjusting for seasonality. We used thematic analysis of coded interviews to identify emerging patterns and themes. Results: We found moderate 4% (IRR = 0.96; 95%CI: 0.93, 1.00) and 5% (IRR = 0.95; 95%CI: 0.92, 0.99) drops in pentavalent and rotavirus 2 doses vaccines administered, respectively. Nationally, there was a 5% drop in facility-based delivery (IRR = 0.95; 95%CI: 0.92, 0.99). Lockdown and movement restrictions and community and health-worker fear of COVID-19 were barriers to service delivery early in the pandemic. Key implementation strategies to prevent or respond to EBI drops included leveraging community-based healthcare delivery, data use for decision-making, mentorship and supervision, and use of digital platform. Conclusions: While Rwanda had drops in some EBIs early in the pandemic, especially during the initial lockdown, this was rapidly identified, and response implemented. The resiliency of the health system was associated with the Rwandan health system's ability to learn and adapt, encouraging a flexible response to fit the situation.

Households’ access and expenditure on water services: Examining intra-urban differences in the Accra metropolis, Ghana

Despite years of investment into the water sector in Ghana, access to and expenditure on potable water for drinking and domestic use remain a challenge for most urban households. However, within the urban context, the severity of water challenges varies from one residential community to another, with less research attention often given to such intra-urban differences. To address this gap, this study examines differences in household access and expenditure on pipe-borne water in three varying socio-economic residential communities in Accra. The study used a convergent mixed method design and drew on secondary literature, to examine the differences in households' access to and expenditure on water. The findings revealed that Jamestown, a low-income residential community, had the lowest connection to the Ghana Water Company Limited (GWCL) grid, with many respondents depending on pipe-borne water outside dwellings operated by private water retailers. While the findings showed no significant differences in the regularity of flow and expenditure on water among the three varying socio-economic communities, the paper argues that low-income communities such as Jamestown are likely to be more affected due to existing socio-economic deprivation and vulnerability contexts. Based on the study findings, we recommend that efforts be made to increase investment in water infrastructure to enable households to connect to the GWCL grid. Attention should also be given to low-income households, who often lack the means to pay for services that will enable them to connect to the GWCL grid. Further, we recommend improved collaboration between local communities and GWCL as a way of fostering strategies that address the peculiar water challenges in local communities.

A Comparative Analysis of English Language Student and Teacher Training in Inclusive Education and Specific Learning Difficulties in Canton Sarajevo in Bosnia and Herzegovina

The aim of this study was to conduct a comparative analysis of topics on inclusive education and Specific Learning Difficulties (SpLDs) provided in initial and continuing training opportunities for English language students and teachers in Canton Sarajevo in Bosnia and Herzegovina. The study follows a convergent mixed methods design with an explanatory nature. A questionnaire was used to gather both quantitative and qualitative data on student and teacher views about training in inclusive education and SpLDs at the English Department of the University of Sarajevo and the formal English language teacher professional development programs in Canton Sarajevo. The results suggest that teachers are exposed to more topics on inclusion and SpLDs in their professional training compared to students and potential future English language teachers in their initial training, with a focus on strategies of reflective practice to inclusive language teaching and language learning processes of students with SpLDs.

A mixed methods evaluation of the breastfeeding memory aide CHINS.

Breastfeeding rates remain persistently low in the United Kingdom (UK) despite wide-scale rollout of UNICEF Baby Friendly Initiative training and accreditation. More must be done to ensure breastfeeding practitioners can provide effective support. The memory aide CHINS (Close, Head free, In-line, Nose to Nipple and Sustainable) could help practitioners remember, recall, and apply breastfeeding theory in practice and this paper presents a UK evaluation of its impact. A concurrent, convergent mixed methods approach was adopted using Normalisation Process Theory (NPT) as an overarching framework. An online survey targeted breastfeeding practitioners and academics from the UK (n = 115). A sub-set (n = 16) of respondents took part in qualitative focus groups. Survey data was subjected to descriptive and inferential statistical analysis, and the focus group data was analysed, using NPT. CHINS is widely used in breastfeeding education and practice largely because of its simplicity and ease of integration in everyday practice, as well as its sustained inclusion in UNICEF Baby Friendly Initiative training. CHINS has introduced a standardised approach to the principles of positioning for effective breastfeeding. Doing so has helped address inconsistencies and poor practice in this area, and CHINS plays a role in assisting practitioners in building confidence in their breastfeeding practice. More needs to be done to ensure the breastfeeding workforce develop and maintain the requisite skills to promote and support breastfeeding, including the role of memory aides such as CHINS in achieving this.

Patient participation-18 months of patient and staff perspectives in kidney care: A mixed methods study addressing the effects of facilitating staff person-centredness.

Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure. To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation. By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively. Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time. Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.

Determining what matters most to Marfan syndrome (MFS) patients: a convergent mixed method study of the health-related quality of life and psychosocial effects of MFS aortovascular manifestations

Abstract Background Marfan Syndrome (MFS) affects multiple organ systems but the aortovascular manifestations are the most serious and life-threatening. However, there is no available evidence on the effect of the aortovascular manifestations on health-related quality of life (HRQoL) and psychosocial wellbeing of MFS patients. Purpose This study aims to determine the HRQoL and the psychosocial effects of the aortovascular manifestation of MFS. Methods A convergent mixed-method design was used in this single site study. Specifically, the quantitative study (S1) is an observational exploratory study using seven validated questionnaires relating to HRQoL (SF36, EQ-5D-5L) and psychosocial health (depression [CESD], illness perception [IPQ], fatigue [FSS], self-esteem [RSES], stigma [PSQ]), previously used in MFS research. The qualitative study (S2) is an exploratory study using semi-structured interviews. Analysis consisted of descriptive and inferential statistics and Framework method1 for S1 and S2, respectively. Joint display was used for data integration. Results A total of 75 participants completed the questionnaires (S1) and 20 were interviewed (S2). The mean age was 43 years (S1) and 40 years (S2) and the majority (S1: 54 (72%); S2: 17 (85%)) were white British. S1 found the majority of MFS participants experienced depression, anxiety, pain and fatigue. These areas were confirmed in S2. A positive self-esteem was generally reported in S1, but this is not supported by S2, which highlighted patients experience a loss of self-esteem due to perceived body image disturbance. Finally, S2 generated new areas not identified in S1 including health anxiety, loss of personal efficacy, self-stigma and ‘invisible disability’ affecting work and socio-economic condition. Overall, the joint display generated three confirmed, seven expanded and one discordant finding. Conclusion MFS patients with aortovascular manifestations experienced several HRQoL and psychosocial issues related to their condition. Collaborative efforts are needed to develop multifaceted interventions and programs to address their needs and provide a holistic and comprehensive service for MFS patients. Finally, four new areas were identified in S2, which added important new evidence in this body of knowledge.

Engaging husbands in a digital mental health intervention to provide tailored counseling for women experiencing postpartum depression: A mixed methods study in Nepal

BackgroundPostpartum depression (PPD) is a common experience among mothers worldwide. Family members, especially husbands, can play an integral role in supporting and helping mothers recover from PPD. However, husbands are typically not included in interventions to address postpartum depression among women. This study explored husbands’ perspectives on engaging in a counseling intervention augmented with a digital health component for the treatment of PPD. MethodsA convergent mixed methods design was used to evaluate husbands’ attitudes and involvement in a counseling and digital intervention for mothers in a semi-urban region of Nepal.Thematic analysis of semi-structured interviews was used to derive emergent themes. A joint display examined differences in themes for husbands whose wives experienced a significant decline in PPD symptoms as measured by the Patient Health Questionnaire-9 pre and post intervention, as compared to husbands of women whose symptoms stayed the same or worsened. ResultsThirteen husbands were interviewed. Three primary themes emerged: the impact of gender norms and attitudes on engagement in the intervention, involvement and support in the intervention, and suggestions for future interventions for PPD. Among wives who experienced a reduction in depression symptoms, their husbands were more likely to endorse gender-equitable norms and attitudes and the husbands provided emotional support, as well as participating in household chores and childcare. ConclusionWhen husbands are living in the same household, providing support and being involved in their wives’ PPD treatment can help them recover. Husbands describe time at home and work as barriers to being able to help their wives. PPD interventions that involve husbands might need to educate husbands about how they can provide emotional support to their partner.

Promoting Wellness for Architecture and Landscape Architecture Students: Lessons Learned from a Mixed Method Study

Background: Universities face increasing pressure to model healthy campuses in response to the ongoing mental health crisis, yet limited research explores ways to improve student wellness. Aim: This study explored strategies architecture and landscape architecture students adopt to overcome stress and solutions for promoting wellness in a school of architecture. Methods: The study utilized a convergent mixed methods research design. First, design students (n = 277) responded to an online wellness survey to explore how they lower stress during their academic studies. Second, semi-structured interviews (n = 37) uncovered students’ coping mechanisms to overcome stress during their academic studies and recommendations for creating a more healthful environment. Results: Strategies students most often adopted to lower stress were socializing, sleeping, exercising, taking personal time, spending time outdoors, and improving time management. Students recommended improving communication and time management, a sense of community, and building a health and wellness culture. Findings were translated into design considerations for creating healthier places on college campuses. Conclusions: Design students employ a variety of strategies to overcome the debilitating effects of mental distress. Policies and campus planning efforts should work toward student-informed solutions to promote wellness.

Student and faculty perceptions of summative assessment methods in a Block and Blend mode of delivery

The recent increase in the number of higher education institutions adopting block teaching has prompted questions about the appropriateness of assessment methods that were commonly used in a semesterised delivery model. This paper explores student and faculty perceptions of summative assessment methods in a block and blend mode of delivery at a higher education institution in the United Kingdom. In this study, we used a convergent mixed methods approach to explore student and faculty perceptions of different assessment methods as accurate evaluations of learning using surveys, combining Likert-type and open-ended questions. The findings highlight how traditional, single assessment methods occurring at the end of a block were perceived as less accurate in evaluating learning when compared to multiple smaller assessments that occur throughout a block. The thematic analysis revealed the latter was perceived as allowing for a broader range of skills to be evaluated while simultaneously facilitating effective workload management and timely feedback. These outcomes indicate the need for assessment redesign that considers the characteristics of a block and blend mode of delivery and illuminates the shared perception of students and faculty that multiple smaller assessments are more accurate evaluations of learning. Further research with larger, more diverse samples, accommodating for different fields of study, could further our understanding of effective assessment methods and inform our practice in a block and blend mode of delivery.

Integrated group antenatal and pediatric care in Haiti: A comprehensive care accompaniment model.

The J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes. We conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais. Quantitative data was collected retrospectively to compare dyads receiving J9 care to usual care. A secondary analysis of qualitative data described patient perspectives of J9 care. Antenatal care attendance was significantly higher among women in J9 (n = 524) compared to usual care (n = 523), with 490(93%) and 189(36%) having >4 visits, respectively; p <0.001, as was post-partum visit attendance [271(52%) compared to 84(16%), p<0.001] and use of post-partum family planning methods [98(19%) compared to 47(9%), p = 0.003]. Incidence of pre-eclampsia with severe features was significantly lower in the J9 group [44(9%)] compared to the usual care group [73(14%)], p <0.001. Maternal and neonatal mortality and low birth weight did not differ across groups. Cesarean delivery [103(20%) and 82(16%), p<0.001] and preterm birth [118 (24%)] and 80 (17%), p <0.001] were higher in the J9 group compared to usual care, respectively. In the qualitative analysis, ease of access to high-quality care, meaningful social support, and maternal empowerment through education were identified as key contributors to these outcomes. Compared to usual care, the J9 Plus maternal-child accompaniment model of care is associated with increased engagement in antenatal and postpartum care, increased utilization of post-partum family planning, and lower incidence of pre-eclampsia with severe features, which remains a leading cause of maternal mortality in Haiti. The J9 accompaniment approach to care is an empowering model that has the potential to be replicated in similar settings to improve quality of care and outcomes globally.

How to investigate differences in indoor environmental comfort and adaptation? Mixed methods research with patients

ABSTRACT Ensuring hospitalized patients’ comfort requires understanding differences in comfort and adaptation to discomfort, as well as the role of the built environment therein. Shortcomings in this understanding result from limitations of existing research methods. Therefore the potential of a mixed methods research design to investigate when and why experiences of and adaption to (dis)comfort differ among hospitalized patients was explored. A convergent mixed methods case study was conducted in two hospital wards of a Belgian hospital. Qualitative data included interviews with 19 patients about their experiences and information about the patients at the two wards during the fieldwork; quantitative data included sensor measurements of indoor environmental quality parameters (i.e. illuminance and indoor temperature), a questionnaire among 238 patients about their assessment of the indoor conditions, and simulations of these conditions. Joint displays allowed comparing situations in which characteristics related to the patients or their setting differed in an integrated way. The displays provide an intermediate step between purely qualitative descriptions of comfort and adaptation and purely quantitative models that predict both. Scenarios that the joint displays allow identifying inform about characteristics that could improve these models, and about roles of the built environment in experiences.

The impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days in older adults with chronic illness – a mixed methods study

BackgroundCare transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients’ self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.MethodsThe study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a “do not resuscitate” statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of “SAFE-D score”. Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.ResultsAll discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.ConclusionsWhile written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.Trial registrationClinical Trials. giv, NCT02823795, 01/09/2016.

The Connections among Interacting with Nature, Nature Relatedness and Dietary Choices: A Pilot Mixed Methods Study.

Interacting with nature and a connection to nature (Nature Relatedness [NR]) have been associated with better mental and physical health as well as higher levels of physical activity. However, limited research has explored how interacting with nature and NR may promote healthful dietary behaviors. The purpose of this pilot convergent mixed methods study was to explore the connections between interacting with nature, NR, and dietary choices. For descriptive purposes, we measured participants' (n = 25) interactions with nature, NR (total, experience, perspective, and self) scores, physical activity, and Healthy Eating Index-2020 scores. In-depth interviews (n = 13) explored the factors that influence interacting with nature and food choices. Quantitative and qualitative data were analyzed separately, and later integrated to yield a more complete understanding of the research inquiry than either form of data would have provided alone. The results from this pilot mixed methods study indicate that there are connections between the variables of interest and that NR may play a pivotal role in how interacting with nature may promote sustainable dietary behaviors. These findings could promote the potential for utilizing nature-based experiences to improve dietary intake.

Leadership Perspectives on Nursing Home Operations From Crisis to Control: A Mixed Methods Study

ObjectivesNursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward. DesignThis was a cross-sectional, parallel convergent mixed methods study. Setting and ParticipantsThis study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15). MethodsPublicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display. ResultsNH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities. Conclusion and ImplicationsNH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.

A construct validation of the perceived Negative Context of Reception Scale with Indian American youth.

Crucial to the resettlement experiences of immigrants is the degree to which the receiving country accepts them and affords them social support and opportunities. Through the factor structure and incremental validity of scores generated by the Negative Context of Reception (NCR) Scale, in the present study, we examine Indian American youths' perception of their context of reception using a sample of youth residing in the United States. Data came from a sample of 223 Indian American youth (aged 12-17) as part of a larger convergent mixed-methods project. Using confirmatory factor analysis, we examined the scale's validity and the relationship between perceived NCR and criterion-related factors such as perceived discrimination and depressive and anxiety symptoms. Interpretive Phenomenological Analysis was then used to analyze qualitative data from 11 of these Indian American youth. Qualitative data provided additional insights about NCR in this population. NCR scores evidenced strong psychometric properties among Indian American youth. Confirmatory factor models demonstrated good model fit. NCR yielded significant associations with perceived discrimination (r = .33, p < .001) and depressive symptoms (r = .25, p < .002). Two major themes (parental/family sacrifices and being treated differently from White peers) emerged from the qualitative data. Results validate NCR as a construct relevant to Indian American youth and associated with negative mental health symptoms such as anxiety and depression. Furthermore, these results underscore the importance of a welcoming and supportive environment for Indian American youths' well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Utilization of sexual and reproductive health services among young people living with HIV and attending selected HIV clinics in selected sub-counties of Nairobi, Kenya

Background Young people living with HIV in Sub-Saharan Africa account for the largest proportion of the vulnerable population in the world. Kenya has little evidence to showcase the utilization of sexual and reproductive health services among young people living with HIV. Nairobi County has one of the highest HIV burdens among adolescents and youth in the country. Consequently, assessing the factors associated with the utilization of sexual and reproductive health services among young people aged 15–24 years living with HIV motivates this study. Methods A health facility-based cross-sectional study design with convergent parallel mixed methods technique was used. Purposive sampling with predetermined criteria was used to select six high-volume public health facilities in six high-burden sub-counties of Nairobi. A total of 253 participants completed the semi-structured questionnaires on utilization and associated factors.12 purposively selected healthcare workers were in key informant sessions on their perception of young people’s utilization. Stepwise binary logistic regression was used to analyse the quantitative data using Stata version 14. NVivo software was used to code and thematically analyse the data. Results 47 % of the participants had utilized the services. Collection of condoms (45.7%) was the most utilized while treatment of sexually transmitted infections (8.2%) was the least utilized services. Female sex (AOR: 3.60 95%, Cl: 1.67-6.40), increase in age (AOR: 2.27 95%, Cl: 1.1C-4.65), HIV status disclosure to a sexual partner (AOR: 2.00 95%, Cl: 1.11-3.80) and privacy for sexual and reproductive health services at a health facility (AOR: 3.27 95%Cl: 1.42-7.60) were factors significantly associated with utilization. Conclusions Although this vulnerable population has frequent contact with healthcare providers, utilization of sexual and reproductive services is low. Stakeholders are recommended to put more emphasis on behavioural interventions to promote male involvement and HIV disclosure to sexual partners.