Convergent Mixed Methods Study Research Articles

Rights-based reproductive services in medical schools in Rajasthan, Gujarat and Chandigarh, India: baseline findings of mixed-methods implementation research.

There is a need to assess and strengthen reproductive rights-based family planning and abortion services in Indian medical schools that play a key role in medical education and service delivery. This study presents the findings of baseline assessment across nine schools in two states and one union territory with objective to assess, identify the gaps and improve the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools. A convergent parallel mixed methods study was conducted in nine medical schools in Rajasthan, Gujarat, and Chandigarh a Union territory in India from October 2018 to June 2019. In-depth interviews with 33 faculty from the Department of Obstetrics and Gynaecology were conducted. The COM-B (Capability, Opportunity, and Motivation) model of behaviours was used to qualitatively identify barriers and facilitators of reproductive rights-based family planning and abortion services. Reproductive health services provided to 104 women for family planning and abortion were observed quantitatively using a pre-tested checklist. Providers' preference bias in recommending contraceptive methods to specific clients (wherein sterilisation was offered to women with two or more children and IUCD to women with one child) was observed as barrier to reproductive rights. The facilitators of rights based reproductive services included well-informed faculty regarding providing dignified and respectful care. Barriers included infrastructure gaps, high workload, insufficient human resources affecting privacy, and lower awareness and decision-making power of clients. Family planning counselling using the cafeteria approach was offered in 69.4% of cases, 31.6% of women seeking abortion services were offered counselling on both family planning and abortion. Sterilisation or IUD insertion was a pre-condition in 36.8% of women requesting an abortion. Right-based reproductive services around family planning counselling and abortion services were delivered partially despite the medical schools' trained faculty, mainly due to provider bias, high workload, and less autonomy and lower awareness of reproductive rights among women.

Abstract 4147628: A Mixed Methods Analysis of Patient Knowledge in Peripheral Artery Disease

Introduction: Patient knowledge of lower extremity peripheral artery disease (PAD) is low compared to other cardiovascular diseases. Research Questions/Hypothesis: We hypothesize that demographic and socioeconomic factors impact patient knowledge of PAD. Goals/Aims: To obtain qualitative description of and identify factors associated with patient knowledge of PAD. Methods/Approach: We performed a convergent parallel mixed methods study of participants with an established PAD diagnosis. Participants completed an 87-item survey assessing demographics, awareness of PAD diagnosis, and PAD knowledge. Functional health literacy (FHL) was measured using the short Test of Functional Health Literacy Assessment. Multivariable linear regression was used to identify factors associated with PAD knowledge scores. Semi-structured interviews were used to describe understanding of PAD. Transcripts were analyzed with inductive and deductive coding, and a constant comparative approach was used to identify themes. Results/Data: There were 91 participants (77.2% response rate, 49.5% female, 29.7% Black, mean age 68.6 years). Most participants (51.7%) had chronic limb-threatening ischemia and 17.6% had a previous major amputation. While 21.3% had poor FHL and 24.4% were unaware of their PAD diagnosis, the average knowledge score was 79.1%. On bivariate analysis, non-White race, non-ambulatory status, poor FHL, lack of awareness of PAD diagnosis, and not knowing the chronicity of diagnosis were inversely associated with knowledge score. Multivariate linear regression showed that poor FHL, non-White race, and not knowing the chronicity of PAD diagnosis were independently associated with low PAD knowledge. Qualitative analysis of 22 participants revealed that patients have difficulty understanding the name “PAD”, confuse PAD with other comorbidities, and have incorrect beliefs about PAD despite high knowledge scores. Conclusions: Knowledge of PAD is associated with health literacy. However, patients have incorrect beliefs and difficulty understanding the terminology associated with PAD despite a high average knowledge score. Knowledge scores may not adequately reflect understanding. Future research will focus on optimizing patient education, identifying strategies to appropriately gauge patient understanding, and understanding the association between knowledge and behavior in PAD.

Factors associated with perceived health of school-aged children in rural Rwanda: an opportunity to leverage community health workers to enhance school health promotion and primary healthcare systems linkages

BackgroundIn many low-income countries, enhancing the health of school-aged children is often impeded by insufficient or limited knowledge regarding their health status. Further, hands-on health promotion interventions are nearly non-existent due to the lack of designated health workers. The disconnection between schools and primary care facilities further exacerbates this issue. To address these challenges, the World Health Organization has introduced the Health Promoting School (HPS) framework, a comprehensive model designed to integrate health into all aspects of school life and promote physical, mental, and social well-being. We sought to assess the perceived health status of school-aged children, identify associated factors, and explore the role of community health workers (CHWs) in public schools in rural Rwanda.MethodsWe carried out a convergent mixed methods study among teachers and community members in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization’s HPS framework and the literature. We conducted six in-depth interviews and three focus group discussions. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data.ResultsA total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the children’s health as poor. Many factors were associated with perceived children’s health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers.ConclusionThis study revealed that the health of schoolchildren needs particular attention. In resource-limited settings, HPS presents a promising opportunity to address the health and well-being of children at rural public schools. However, adapted policies, the establishment of health promotion teams, and hands-on orientation for teachers and community members are necessary to ensure an effective implementation of HPS. In Rwanda and other low-income countries where public schools lack nursing staff, CHWs could play a vital role in enhancing HPS and the linkage between schools and primary healthcare facilities.

Developing English language learners’ speaking skills through applying a situated learning approach in VR-enhanced learning experiences

A situated learning environment is crucial for language learners to develop speaking skills as learners can apply their speaking skills in context, helping them adapt language use to various situations and improve their language proficiency and communication effectiveness. Although various features of situated learning environments have been explored across different subject areas and in many platforms, there is limited research on their application to language learning within VR environments. This convergent mixed-method study adopts a situated learning framework and examines the impact of situated learning on learners’ English-speaking performance, specifically in areas of fluency, vocabulary, pronunciation, and grammar, and explores learners’ perception of the instruction based on the situated learning approach. Sixteen first-year English majors at a university in China participated in eight role-play speaking classes using the desktop-based VR application, Immerse. The study involved pre- and post-assessments of speaking performance and semi-structured interviews with six participants. Paired samples t-tests were used to assess the difference in the speaking performance and respective areas, and a thematic analysis was adopted to explore learners’ perceptions of the instruction based on the situated learning approach. Quantitative findings show a significant improvement in learners’ speaking performance (t(15) = 7.41, p < .001, Cohen’s d = 1.82), with notable progress in fluency, vocabulary, pronunciation, and grammar. Thematic analysis of the qualitative data indicated the authenticity of the context and activities, the collaborative nature of the tasks, the expert guidance, and the opportunities for reflection all contribute to a comprehensive learning experience that aligns well with the principles of situated learning.

Stakeholder Perspectives on a Heart Failure With Reduced Ejection Fraction Polypill: A Multi-Center Mixed Methods Study.

A polypill containing all 4 classes of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) has been proposed to change the heart failure treatment paradigm. The acceptability, appropriateness, and feasibility of a HFrEF polypill-based strategy are unknown. The purpose of this study was to elicit patients' and providers' priorities in the design of HFrEF polypills. From April 2023 to December 2023, we conducted a convergent parallel mixed-methods study at Washington University in St. Louis, the University of California, San Francisco, and the American College of Cardiology. We administered physician surveys containing adapted implementation outcome measures to elicit physicians' perspectives on the acceptability, feasibility, and appropriateness of a HFrEF polypill (Likert scale ranging from 1 [low] to 5 [high]). We used a purposive sampling frame to select patients and physicians for in-depth interviews. Using semi-structured interview guides, we elicited participants' perspectives on current HFrEF care, HFrEF polypill design, and supportive strategies. The Consolidated Framework for Implementation Research v2.0 guided thematic analysis. Of the 214 survey respondents across the United States, physicians agreed that HFrEF polypills are highly acceptable (mean [SD], 4.2 [0.7]), highly appropriate (4.1 [0.8]), and highly feasible (4.1 [0.7]). Key themes from 9 patient and 22 provider interviews included the following: (1) current determinants of HFrEF care, including medication adherence, variations in clinical practice, and health care access, (2) provider-level differences in preferred HFrEF polypill design, (3) cost and equity considerations in the implementation of HFrEF polypills, and (4) research priorities for evaluating polypill effectiveness and implementation. A HFrEF polypill-based strategy was viewed as highly acceptable, appropriate, and feasible by patients and physicians. Participants described key priorities in HFrEF polypill design, titratability, and potential impacts on health equity that will directly inform future randomized controlled trials.

An exploration of patient safety culture in NICUs: a convergent parallel mixed-method study

BackgroundSafety culture, as a component that improves the quality of safety and health care for neonates, serves as foundation for providing professional and high-quality care by creating positive insight among employees. This study aimed to explore the safety culture concept in neonatal intensive care units (NICUs).MethodsThis convergent parallel mixed-method study included Quantitative, Qualitative, and Integrated parts. In the Quantitative part, the psychometric properties of the Persian version of “Hospital Survey on Patient Safety Culture” were examined among physicians and nurses in NICUs. CFA was performed on the data obtained from 342 participants. The Qualitative section data were collected through in-depth and semi-structured interviews with 24 staff to understand the concept of safety culture. Data were analyzed through the Elo & Kyngäs approach. The interpretation of the results and the convergence of the data was done using the Onwuegbuzie and Teddlie method.ResultsThe initial CFA showed that the 12-dimensional model did not align well with indices. Subsequently, based on T-values, six heterogeneous items were eliminated. The revised 11-dimensional model consisting of 36 items showed an acceptable fit during the second CFA. In the qualitative part, five main categories of “Constructive interactions”, “Management’s commitment to neonatal safety”, “Organizational supportive climate”, “Professional development”, and “Planning and implementation of neonatal developmental care” were obtained. The comparison of the results showed that the dimensions of the quantitative part, except for “Overall perceptions of patient safety”, were also present in the qualitative part, but they were different in some aspects. New findings in the qualitative study such as “Striving for mutual empowerment”, “Constructive criticism in teamwork”, “Efficient supervision procedures”, “Inexperienced staff’ leading” and “Provision of care assistance equipment and facilities” were not found in the dimensions of the quantitative part. The main categories “Acquiring professional competence” and “Planning and implementation of neonatal developmental care” were not align with the dimensions identified in the quantitative study.ConclusionThe findings shed light on previously unexplored aspects of the safety culture concept within the nursing profession, leading to a better understanding and evolution of this concept in Iranian NICUs. The new definition obtained in this study can enhance nursing knowledge on safe care and improve patient safety culture in the NICUs in Iran and globally.

Implementing universal maternal depression screening in head start: A convergent mixed methods study

AimsImplementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs. MethodsQuantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data. ResultsIn terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff. ConclusionUniversal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.

Expectations and needs of gynecological cancer survivors at the end of primary cancer treatment: A convergent mixed methods study

Objectif : Les survivantes d’un cancer gynécologique souhaitent bénéficier d’interventions de soutien holistiques et axées sur la personne pour répondre aux besoins non satisfaits après le traitement. L’élaboration de ce genre d’interventions nécessite de comprendre à la fois les attentes et les besoins des survivantes de cancer gynécologique. L’objectif de la présente étude était de comprendre les attentes et les besoins des survivantes de cancer gynécologique après le traitement, et d’examiner comment ces attentes et ces besoins convergent et divergent afin d’orienter les soins. Méthodologie : L’étude faisait appel à un devis convergent à méthodes mixtes (qualitative+quantitative) parallèles. Les données qualitatives ont été recueillies lors d’entrevues téléphoniques individuelles. Les données quantitatives ont été recueillies à l’aide du questionnaire sur les besoins non satisfaits des survivants au cancer (Cancer Survivors’ Unmet Needs). Résultats : En tout, 24 personnes ont participé à l’étude. Les attentes des survivantes par rapport à la période post-traitement comprenaient deux catégories d’interventions (tant pour la mise en œuvre que pour les résultats) : la lutte contre l’inconnu et l’information fiable pour renforcer les capacités. Les besoins non satisfaits les plus courants touchaient l’aspect existentiel de la survivance; toutefois, l’analyse à méthodes mixtes a révélé que les participantes s’attendaient surtout à ce que les interventions post-traitement comblent leurs besoins informationnels. Conclusion : Les conclusions mettent en lumière les attentes et les besoins des survivantes de cancer gynécologique après le traitement, de même que l’importance d’analyser le moment où il convient de planifier les soins et de les dispenser. Les cliniciens pourront utiliser ces conclusions pour concevoir et raffiner les interventions visant à répondre aux besoins non satisfaits des survivantes de cancer gynécologique.

Generation of preoperative anaesthetic plans by ChatGPT-4.0: a mixed-method study.

Recent advances in artificial intelligence (AI) have enabled development of natural language algorithms capable of generating coherent texts. We evaluated the quality, validity, and safety of this generative AI in preoperative anaesthetic planning. In this exploratory, single-centre, convergent mixed-method study, 10 clinical vignettes were randomly selected, and ChatGPT (OpenAI, 4.0) was prompted to create anaesthetic plans, including cardiopulmonary risk assessment, intraoperative anaesthesia technique, and postoperative management. A quantitative assessment compared these plans with those made by eight senior anaesthesia consultants. A qualitative assessment was performed by an adjudication committee through focus group discussion and thematic analysis. Agreement on cardiopulmonary risk assessment was calculated using weighted Kappa, with descriptive data representation for other outcomes. ChatGPT anaesthetic plans showed variable agreement with consultants' plans. ChatGPT, the survey panel, and adjudication committee frequently disagreed on cardiopulmonary risk estimation. The ChatGPT answers were repetitive and lacked variety, evidenced by the strong preference for general anaesthesia and absence of locoregional techniques. It also showed inconsistent choices regarding airway management, postoperative analgesia, and medication use. While some differences were not deemed clinically significant, subpar postoperative pain management advice and failure to recommend tracheal intubation for patients at high risk for pulmonary aspiration were considered inappropriate recommendations. Preoperative anaesthetic plans generated by ChatGPT did not consistently meet minimum clinical standards and were unlikely the result of clinical reasoning. Therefore, ChatGPT is currently not recommended for preoperative planning. Future large language models trained on anaesthesia-specific datasets might improve performance but should undergo vigorous evaluation before use in clinical practice.

Exploring the Association Between Loneliness, Subjective Cognitive Decline, and Quality of Life Among Older Thai Adults: A Convergent Parallel Mixed-Method Study.

Examining the rising prevalence of subjective cognitive decline as an early indicator of dementia in adults, this study investigates its complex interaction with loneliness and quality of life in individuals with preclinical dementia. Using a convergent parallel mixed-method approach, we employed Structural Equation Modeling on a cohort of 149 older adults. Qualitative insights were derived from focused group discussions and in-depth semi-structured interviews with a cohort of 23 older adults. Loneliness emerges as a pivotal contributor, exerting a discernible partial indirect effect on quality of life through subjective cognitive decline (indirect effect = -0.145, p = .006). Noteworthy differentials surfaced, with the impact of subjective cognitive decline on quality of life heightened in those with chronic diseases (△χ2 = 6.139, p = .013). Loneliness, wielding a palpable impact, intricately interlaces with quality of life, the nexus of which is intricately mediated by subjective cognitive decline.

L2 Learners’ Perspectives on Data-Driven Learning for Identifying Properties of Near-Synonymous Words: A Convergent Mixed-Methods Study

This study examines second language (L2) learners’ perspectives regarding the affordances and challenges of using the Data-Driven Learning (DDL) to identify the properties of near-synonymous words. Employing a convergent mixed-method design, this study deciphers the perceptions of 40 undergraduate L2 learners majoring in English language teaching. After an initial identification of the learners’ vocabulary levels, the experienced benefits and barriers associated with carrying out experiential tasks were elicited via questionnaire data and open-ended survey questions. Descriptive statistics, including means and standard deviations, were revealed and thematic analyses of the responses to the survey questions were documented. The results indicate that completing tasks through the corpus was found to enhance their knowledge of collocations. Integrating corpus tasks into YouGlish (an online practice tool for authentic spoken English in context) was found to increase their awareness of the contextual properties of words. The identification of condensed language exposure, lexical inference, and elicitation of flexible and context-specific patterns were reported to be beneficial. Acknowledging these benefits, gaining familiarity with the corpus interface, encountering limited access to search queries, and analyzing large amounts of concordance lines posed challenges for learners. This research presents the implementation of the DDL supported by experiential learning, contextually rich input, and inductive reasoning tasks in vocabulary learning by further offering instructional implications in L2 contexts.

Evaluating the feasibility of an Adapted Physical Activity intervention among breast cancer patients

Abstract Adapted physical activity (PA) programs have shown promising results to reduce physical, psychological and social side effects associated with breast cancer (BC), but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thérapie, Escrime), an innovative intervention focused on improving the quality of life (QoL) of BC surgery patients through fencing. A convergent mixed-methods pilot study was conducted to evaluate the RE-AIM dimensions of RIPOSTE. 24 participants who have just undergone surgery for invasive BC were randomly allocated either in the “RIPOSTE” group (starting immediately after their inclusion), or the “Delayed RIPOSTE” group (starting at 3 months following their inclusion). They answered to questionnaires at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and PA. Interviews were conducted with 10 participants, 3 sports physicians and 1 fencing master. RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of health indicators, even without any significant differences between the two groups. The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during vacations were the main barriers. Maintenance analyses showed that most participants continued to practice PA after the program. RIPOSTE is an acceptable and effective program for involving BC survivors in PA, that needs to be tested at larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide. Key messages • These results would help to enrich the literature on how to best intervene to enhance treatment and recovery among patients and facilitate transfer from a research program to a field daily practice. • By highlighting complexities of RIPOSTE effectiveness and implementation, this study could lead to a more complete program that addresses issues related to improving external and internal validity.

Cultural Adaptation of RUBI Intervention with Korean Families(K-RUBI): A Mixed Method Study.

Challenging behaviors of young autistic children remain a major parenting challenge for many of their family members, including caregivers. Caregivers from underrepresented cultural or linguistic backgrounds may experience exacerbated difficulties related to challenging behaviors due to limited access to culturally sustaining and responsive interventions. Evidence-based behavior parent training programs, such as RUBI, are highly effective in increasing caregivers' capacity in preventing and responding to these behaviors in naturalistic settings using behavior analytic principles. Therefore, the purpose of this study was to examine the effectiveness, acceptability, and feasibility of the culturally adapted RUBI program with underserved families. We conduct a convergent mixed-methods study using a pilot randomized controlled trial with a waitlist control group and focus group interviews with 31 Korean families of young children with or suspected of autism. The Korean RUBI underwent rigorous cultural adaptation using the Cultural Adaptation Checklist, including the use of multiple community advisory boards to inform cultural adaptation. Both quantitative and qualitative findings revealed significant improvements in parents' confidence and knowledge in behavioral principles and decrease in severity of challenging behaviors, which suggest clinical utility of RUBI in an underrepresented, low-resourced community. A culturally adapted intervention for a different population can be perceived as a newly constructed intervention. This study provides insight on the systematic process of cultural adaptation of an established autism intervention and effectiveness, feasibility, and acceptability of RUBI.

National Collegiate Athletic Association Athletic Trainers’, Head Coaches’, and Student-Athletes’ Perceptions of Professional Titles Used in Sport PsychologyA

The purpose of this convergent mixed-methods study was to explore National Collegiate Athletic Association (NCAA) Division I athletic trainer (AT), head coach, and student-athlete perceptions of three commonly used sport psychology professional titles in the United States: Certified Mental Performance Consultant (CMPC), mental conditioning coach, and sport psychologist. Participants included 73 ATs, 79 head coaches, and 76 student-athletes. Participants completed an online questionnaire that assessed their previous exposure to these professionals, the services they believed these professionals could provide, their confidence in sport psychology consultation from these professionals, and their stigma tolerance of these professionals. A series of Friedman tests found that ATs and student-athletes perceived significantly more confidence in the services of a sport psychologist compared to a CMPC and a mental conditioning coach. A series of Kruskal-Wallis tests revealed that student-athletes perceived significantly more stigma in using services from all three professionals than head coaches and ATs. Participants reported that sport psychologists could provide mental performance and mental health services, while CMPCs and mental conditioning coaches primarily provided mental performance services. However, short answer responses from many ATs and head coaches about CMPCs demonstrated some doubt and misunderstanding of this professional title.

Assessing the sensitivity and acceptability of the Royal Marsden Palliative Care Referral “Triggers” Tool for outpatients with cancer

PurposeTo evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting.MethodsA two-phase convergent parallel mixed-methods study. Patient participants who met any of the “Royal Marsden Triggers Tool” criteria were compared with those who did not in terms of demographic data, palliative care needs (Integrated Palliative Outcome Scale, IPOS) and quality of life indicators (EORTC-QLQ-C30).In-depth interviews were carried out with patients and oncology staff about their views and experience of the “Royal Marsden Triggers Tool”. Qualitative and quantitative data were triangulated at data interpretation.ResultsThree hundred forty-eight patients were recruited to the quantitative phase of the study of whom 53% met at least one of the Triggers tool palliative care referral criteria. When compared with patients who were negative using the Triggers tool, “Royal Marsden Triggers Tool” positive patients had a lower quality of life (EORTC QLQ-C30 Global Health Status scale (p < 0.01)) and a higher proportion had severe or overwhelming physical needs on IPOS (38% versus 20%, p < 0.001). Median survival of “Royal Marsden Triggers Tool” positive patients was 11.7 months.Sixteen staff and 19 patients participated in qualitative interviews. The use of the tool normalised palliative care involvement, supporting individualised care and access to appropriate expertise.ConclusionThe use of a palliative care referral tool streamlines palliative care within oncology outpatient services and supports teams working together to provide an early holistic patient-centred service. Further research is needed to evaluate the effectiveness and feasibility of this approach.

The Effectiveness of a MOOC as a Form of Professional Learning: An Examination of an Adolescent Learner Social and Emotional Well-Being Course

Massive Open Online Courses (MOOCs) provide borderless opportunities to engage with content and ideas, with prospective participants from around the globe being able to easily register. The course featured in this study focused on the social and emotional well-being of adolescents, selected because of a recognized need for professional learning related to this topic. It was purposely designed for delivery as a MOOC and was designed as a 6h program around four topics to be completed over two weeks in asynchronous mode. It was delivered seven times from 2019 to 2023, with 32,969 individuals enrolled across these deliveries. The effectiveness of engaging in the course for professional learning purposes is of particular interest to this study. To that end, a convergent mixed methods study was conducted. First, quantitative and qualitative survey data collected at various course stages were examined to reveal the demographic characteristics of participants and their experiences in the course using data from surveys and comments about their experiences. The findings revealed, among other factors, that 65% were female, with just under half (47%) aged 45 years or less, nearly half (44%) held a bachelor’s degree as their highest level of qualification, and 48% were employed within the teaching and education sector. The most active learners were from Europe (48%) and Asia (27%), with active learners from a total of 178 countries. The course has a high course retention index, with 51% of learners completing 51% of the course and 8383 learners completing 90% or more of the course. The qualitative findings reveal the strongly positive experiences reported by the active participants. Secondly, we examined the effectiveness of the MOOC for participants’ professional learning needs by assessing the course using a framework with ten domains related to its core design features, modified for use by the course designers as a self-reflective tool. We found that the domains that scored the lowest were collaboration, interactivity, and, to a lesser extent, pedagogy. The study’s limitations include the incomplete data provided as part of the MOOC protocols, and the use of a self-reflection tool, which may inadvertently incorporate bias. This study points to these gaps in the data, including the need to access longitudinal data that go beyond a focus on the design of courses to extend to the impact and outcomes of the experience.

Efficacy of Occupation-Based Intervention in Promoting Well-Being Among Occupational Therapy Graduate Students.

Occupational therapy graduate students report poor well-being during their educational experience. This convergent mixed-methods study (quantitative approach presented) examined the effectiveness of an occupation-based intervention in promoting well-being. Forty-one entry-level doctorate students (intervention = 18, control = 23) completed four standardized measures at three timepoints. The manualized intervention included six 45-minute virtual synchronous sessions, once per week. Data were analyzed using two-way mixed analysis of variance (ANOVA). Statistically significant differences in well-being (p = .024, = .09), self-compassion (p = .006, = .12), and engagement in meaningful occupations (p = .014, = .10) between groups, indicating intervention effectiveness. Intervention study participants were self-compassionate and intentional about promoting their well-being; therefore, increasing their participation in a variety of meaningful occupations moved them toward more occupational balance and improved well-being. This occupation-based intervention could be offered to promote student well-being through engagement in meaningful occupations.

Enhancing Academic Success: A mixed Study on the Influencing Factors among Pharmacy Students in Syrian Universities.

Academic achievement is the result of both effort and perseverance exerted by the students. This mixed-methods study aims to investigate the factors affecting the academic achievement of pharmacy students in Syrian universities. A convergent parallel mixed-methods study was utilized. In the quantitative phase, a cross-sectional study was conducted on 1008 students (773 females and 235 males) from 23 Syrian universities. A questionnaire consisting of 48 items was designed to be completed by pharmacy students using a 5-point Likert scale.In the qualitative phase, twelve questions were developed to interview thirty pharmacy students from five Syrian universities to obtain in-depth insights into the factors influencing their academic achievement. A significant number of students lacked effective time management skills, identified as a weakness among students. The majority of students faced challenges in maintaining a consistent study routine, averaging a score of (2.0).Motivation towards learning emerged as a crucial factor in enhancing academic performance. Lecturers in the pharmacy faculty employed traditional teaching methods (2.01), and the pharmacy curriculum was perceived as lacking modernity (1.92).Quantitative findings demonstrated that pharmacy students experienced exam-related anxiety (2.05), identified as a weakness in the qualitative phase.Factors associated with the Syrian crisis, like unreliable electricity (1.87) and transportation issues (1.83), could have an impact on academic achievement. Economic conditions were identified as challenging to students' academic performance, negatively affecting the learning process (1.98). The results of the study demonstrate that personal factors, lecturers, educational environment, exams, and the Syrian crisis influence the academic achievement of pharmacy students in Syrian universities.

Using social media to share universal messages about early language and literacy development with parents and caregivers

Purpose Health promotion and prevention interventions to support children’s early language and literacy development are essential, however little is known about how social media can be used in this context. This study evaluated an intervention which aimed to build capacity of parents in supporting children’s language and literacy skills, implemented using Facebook. Method A cross-sector partnership of Australian speech-language pathologists developed a suite of universal messages for parents to support their child’s language development. Messages were delivered across 12 weeks via Facebook. A convergent mixed methods study design was used to evaluate survey responses from parents of children aged 0–5 years, before (n = 136) and after the intervention (n = 61). Social media analytics were collected. Result Participants identified social media was a helpful way to receive information about supporting their child’s language and literacy development, reporting an increase in knowledge following the intervention. Participants reported they trusted information provided in Facebook posts as it was from professionals and evidence-based sources. The usability (i.e. look and layout) was generally rated highly. Conclusion Social media is a valuable tool for speech-language pathologists to deliver universal messages. Future social media initiatives should be co-designed with families and social media professionals to ensure delivery of trusted, consistent, and user-friendly information.

Public satisfaction with the Ethiopian healthcare system: a mixed methods approach.

The satisfaction of the public with the healthcare system of Ethiopia is a crucial but unanswered question. This is an essential issue since recent trends indicate that the demographic and epidemiological makeup of the population is changing. Therefore, the aim of this study was to assess the overall satisfaction of the public with the Ethiopian healthcare system in Addis Ababa, Ethiopia, in 2022. A community-based convergent parallel mixed methods study was conducted. Bivariable and multivariable logistic regression analyses were used to determine the factors associated with public satisfaction. A 95% confidence interval along with a p < 0.05 was deemed sufficient to declare a significant association. For the qualitative component, we used thematic analysis. The vast majority, 77.2% (95% CI: 76.18-78.22%), of respondents were dissatisfied with the existing healthcare system. Moreover, Community-Based Health Insurance (CBHI) enrollment (2.35; 95% CI: 1.32-4.19), poor linkage to social capital (0.46; 95% CI: 0.25-0.83), poor access to healthcare services (0.39; 95% CI: 0.21-0.76), and absence of satisfactory responses to complaints (0.11; 95% CI: 0.04-0.27) were significantly associated with public dissatisfaction. Public satisfaction with the Ethiopian healthcare system is notably low and is affected by various factors, including enrollment in the CBHI, linkage to social capital, accessibility to healthcare, and satisfactory response to issues. Therefore, the Ethiopian government should focus on expanding CBHI coverage, improving access to healthcare services, and developing an immediate compliant solution strategy.