Convergent Parallel Mixed Methods Study Research Articles

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.

"God is going to help me get through this": spirituality perspectives from Hispanic adolescent and young adult cancer survivors.

Describe spirituality's role in a sample of Hispanic adolescent and young adult (AYA) cancer survivors. This phenomenology-informed convergent parallel mixed-methods study aimed to explore participants' lived experiences with hope during cancer treatments and cancer survivorship. A purposive sample of Hispanic AYAs who completed cancer treatments 2-5years ago were virtually recruited for participation. Participants completed virtual semi-structured interviews about their experiences with hope during cancer treatments and cancer survivorship and prepared narratives about their experiences. Thematic analyses were iteratively performed across the data set to identify final themes. Ten Hispanic AYA cancer survivors (mean age 30.2, SD = 4.5) years participated in this pilot study. Seven participants (70%) were female, and three participants (30%) were male. Six participants (60%) experienced non-hematologic malignancies, and four participants (40%) experienced hematologic malignancies. Eight (80%) participants' language preference was Spanish, while two (20%) participants' language preference was English. The theme spirituality and subthemes living by faith, god as a resource, and spiritual gratitude were identified as concepts participants linked to their conceptualization of hope during cancer treatment and survivorship. Hope and spirituality may be conceptually linked to coping behaviors among Hispanic AYA cancer survivors. Hope through faith may be a learned spiritual value in Hispanic AYAs and might play a role in their spiritual and cognitive development. Further research is needed to explore the potentially protective value of hope and spirituality for the Hispanic AYA population.

Parent, physician, and therapist experience of in-person, hybrid, and all-virtual models of physiatry care for children with special healthcare needs

ObjectiveThe purpose of this study was to compare three models of pediatric physiatry care (in-person, hybrid, and all-virtual) in terms of parent experience and physician- and therapist-reported quality of care. We hypothesized that the all-virtual model would have lower parent experience scores and lower quality scores compared with the other two models of care. MethodsWe designed a convergent parallel mixed methods study incorporating a cluster-randomized crossover design. Quantitative data included surveys of parents, physicians, and therapists after visits to 13 medical therapy units in Northern California between January 2020 and January 2022. Qualitative data were collected in six focus groups with parents, physicians, and therapists. ResultsA total of 2,455 visits were completed for 1,281 unique children during the study period, including 507 in-person visits, 246 hybrid visits, and 1,702 all-virtual visits. There were no differences in parent experience scores between the three models of care. Physicians and therapists rated all-virtual visits significantly lower in terms of quality of care, parent education, and physical exam, compared with the other two models of care, but qualitative results highlighted specific instances where all-virtual visits could be useful. ConclusionsOur findings suggest that parents, therapists, and physicians find a hybrid virtual model is an acceptable model of care that maintains the quality of care and facilitates parent education. All-virtual models may be appropriate for specific circumstances but are perceived as lower quality. Research exploring implementation of these models would be valuable for providing practical guidance in the future. What’s NewThis study is the first to compare three models of pediatric physiatry care (in-person, hybrid, all-virtual) from the perspectives of parents, physicians, and therapists. Qualitative data provides insights into the perceptions of these different stakeholders.

Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study

BackgroundKenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)),...

Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol.

According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO. This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination. The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections. https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).

"It Kills Your Soul": A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses.

Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care.

A Protocol for Patients' Education Based on Andragogy: A Convergent Parallel Mixed Methods Study

Background: Patients' education is a key factor in patients' care. The purpose of this study is to design a protocol for a convergent parallel mixed methods study to explore the experiences of patients about their received educations based on andragogy model. Methods: This convergent parallel mixed method study includes two parallel quantitative and qualitative phases. During the quantitative phase, a cross-sectional survey will be conducted on 350 adult patients who had the history of hospitalization and received patient education from selected hospitals of Tehran, Iran. Sampling method will be random, and data collection tool will be a researcher-made questionnaire based on the principles of andragogy. The questionnaire’s validity and reliability are also measured, and data will be analyzed using SPSS 16. The qualitative phase will be conducted on adult patients who will be recruited purposively with maximum variation from the selected hospitals. Data will be gathered through semi-structured interviews and analyzed by directed content analysis. With regard to mixed method and using aligning convergence method, the results of the two sets of data will be compared or merged to see if the findings confirm or disconfirm each other. In this parallel section, the similarities between quantitative and qualitative results for assessing patient education are discussed and adapted to suit each other based on andragogy. Conclusions: The findings of this study will provide information regarding defects in patient education, suggesting that the principles of andragogy will develop patient education programs.

Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol

BackgroundDiabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women’s experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes.Methods/designThe study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women’s understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data.DiscussionThe implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system.Trial registrationIranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206.

Towards leaving no one behind in North Macedonia: a mixed methods assessment of barriers to effective coverage with health services

BackgroundThe Government of North Macedonia’s Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability.MethodsThis study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward.ResultsDespite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products.ConclusionsThe outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.

Freshmen’s Technological Expertise and Distance Learning Readiness: A Convergent Parallel Design

This convergent parallel mixed methods study primarily focused on technological expertise and distance learning readiness of freshmen students. The study had two phases: the quantitative phase and the qualitative phase. In the quantitative phase, results found that technological expertise and distance learning readiness were highly correlated with each other, with an R-value of .828 and a p-value of 0.000. In the qualitative phase, four themes were extracted: Technological Tools as a Significant Factor in Distance Education, Technological Expertise as Influenced by Minor Skills and Educational Courses, Technological Use Due to Education’s Status Quo, Challenges in Technological Availability, and Technological Background. The results showed a merging and converging characteristic of both data. The lived experiences of the freshmen students showed that technological tools, which are an indicator of technological expertise, are also a factor to be considered in distance learning readiness.

General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study

BackgroundIn low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration.MethodsThis convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards.ResultsThis study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers.ConclusionThe study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.

Prevalence, correlates, and reasons for substance use among adolescents aged 10–17 in Ghana: a cross-sectional convergent parallel mixed-method study

BackgroundSubstance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10–17 in Ghana.MethodsData were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8–17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children’s rights and wellbeing. Overall, 4144 adolescents aged 10–17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson’s chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.ResultsThe prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10–13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.ConclusionsThere is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

Examining Parental Stress and Autism in the Early Days of the Pandemic: A Mixed-Methods Study

In this convergent parallel mixed-methods study, we investigated the early impact of the COVID-19 stay-at-home mandate in Illinois on 16 caregivers of children with autism. Our goal was to understand contributors to caregivers’ stress by integrating qualitative and quantitative data. Through a joint display, we explored the intricate relationship between caregivers’ perceptions of their child’s needs, the loss of essential services, and stress levels. The caregivers’ reported needs, wishes, barriers, and coping strategies informed and corroborated final quantitative results on stress levels. Significant associations were found between stress levels and caregivers’ agreement with statements on child supervision, service loss, and perceived level of their child’s independence. These findings underscore the importance for robust support systems that enhance family resilience and validate prior research during exceptional circumstances. They offer insights for policymakers and service providers seeking to improve the well-being of families raising children with autism, particularly in times of crisis.

Development and Implementation of an Elementary School-Based Indigenous Knowledge Pedagogical Model on Native Tree Species for Environmental Sustainability Education in Ghana

Environmental education across countries is seen as the surest means of nurturing pro-environmental behaviours in children so that the conservation of biodiversity in the environment can be guaranteed. Unfortunately in Ghana, there is no indigenous-knowledge inspired pedagogical model that would aid elementary school teachers in carrying out such education. This convergent parallel mixed method study was aimed at developing, implementing and evaluating an indigenous knowledge inspired pedagogical model for native tree education among elementary school learners in Ghana. The indigenous-knowledge inspired pedagogical model was developed by the researchers under the expert guidance of some curriculum planners in Ghana with inputs from elementary school teachers and in tandem with the elementary school curriculum strand on environmental education. It was implemented in classroom and off-classroom contexts and finally evaluated for its potential in inciting elementary school learners in engaging in helpful native tree conservation activities. The quantitative results show high viability scores (100%) of the ESBIK pedagogical model’s capability of impacting significantly on the sustainability consciousness and competence of elementary school learners (Very Important-72.2%, Extremely Important-27.7%). On the other hand, the qualitative findings indicated the model’s capability of imparting knowledge on the essential roles that native tree species play in their lives and the broader benefits to ecosystem. Elementary school learners demonstrated care for native trees through tree planting, making of nurseries and gardens, and engaging in native tree conservation campaigns. The study recommends that the Ministry of Education should adopt, improve and widely disseminate the pedagogical model. Future studies should consider using a larger sample size comprising elementary schools from several regions out of the sixteen (16) regions and engage in scholarly regional comparison of the results after the implementation of the ESBIK pedagogical model.

Knowledge, perceptions and practices towards blood donation among undergraduate medical students in an upcountry Ugandan university: A mixed methods study

ABSTRACT Background Due to the different factors affecting the maintenance of a constant supply of human blood in health facilities, this study aimed at exploring the knowledge, perceptions, and practices towards blood donation among under graduate medical students at Busitema University Faculty of Health Sciences (BUFHS). Methods Using a convergent parallel mixed methods study design, 384 students were recruited into the study. Questionnaires and focused group discussions were used to collect the data. Stata version 15.0 and thematic analysis were used to analyze quantitative and qualitative data respectively. Results Of the respondents, 151 (39.4%) had ever donated blood and 50.4% had good knowledge about blood donation. The commonest motivating factor towards blood donation was “to save someone’s life”. Factors associated with practices towards blood donation included: religion, year 2 of study and prior blood donation history. Being Jehovah’s Witness reduced the willingness to donate blood by 88% compared to other religions. Thematic analysis revealed four themes namely; students’ experiences and thoughts, driving forces to donate blood, fears and misconceptions, and suggestions to increase blood donors. Conclusion The proportion of undergraduate medical students who had adequate level of knowledge about blood donation was moderately high, however, some of their perceptions towards it were unconventional. To ensure safe and adequate blood supply, design of strategies and tailored programs that promote blood donation is highly recommended..

Lessons learned in measuring patient engagement in a Canada-wide childhood disability network

BackgroundThe CHILD-BRIGHT Network, a pan-Canadian childhood disability research Network, is dedicated to patient-oriented research, where numerous stakeholders, including patient-partners, researchers, and clinicians are involved at different levels. The Network is committed to continuously improving the level of engagement and partnerships’ impact. Measuring patient engagement is therefore important in reflecting on our practices and enhancing our approaches. We aimed to measure patient engagement longitudinally and explore in greater depth the perceived benefits, barriers and facilitators, and overall satisfaction with patient engagement, from the perspectives of the different stakeholders.MethodsPatient engagement was measured using online surveys. In a longitudinal study design over a 3-years period (2018–2020) the Community-Based Participatory Research (CBPR) questionnaire was used. To enrich our understanding of patient engagement in Year 3, we employed the Public and Patient Engagement Evaluation Tool (PPEET) in a cross-sectional, convergent parallel mixed-method study design. Descriptive statistics and a thematic-based approach were used for data analysis.ResultsThe CBPR questionnaire was completed by n = 167 (61.4% response rate), n = 92 (30.2% response rate), and n = 62 (14.2% response rate) Network members in Years 1, 2, and 3, respectively. Ninety-five (n = 95, 21.8% response rate) members completed the PPEET in Year 3. CBPR findings demonstrate a stable and high satisfaction level with patient engagement over time, where 94%, 86%, and 94% of stakeholders indicated that the project is a “true partnership” in Years 1, 2, and 3, respectively. In Years 2 and 3, we noted an improvement in patient-partners’ comfort level in sharing their views and perspectives (92% and 91% vs. 74%). An increase in critical reflective trust (i.e., allowing for discussing and resolving mistakes) from Year 1 to 3 was found, both from the perspectives of patient-partners (51–65%) and researchers (48–75%). Using the PPEET, patient engagement factors (i.e., communications and supports for participation, ability to share views and perspectives) and impact were highly rated by most (80–100%) respondents. PPEET’s qualitative responses revealed several patient engagement advantages (e.g., increased projects’ relevance, enhanced knowledge translation), barriers (e.g., group homogeneity), facilitators (e.g., optimal communication strategies), and solutions to further improve patient engagement (e.g., provide clarity on goals).ConclusionOur 3-years patient engagement evaluation journey demonstrated a consistent and high level of satisfaction with patient engagement within the Network and identified advantages, barriers, facilitators, and potential solutions. Improvements were observed in members’ comfort in sharing their views and perspectives, along with an increase in critical reflective trust. These findings underscore the Network's commitment to enhancing patient engagement and provide valuable insights for continued improvement and optimization of collaborative efforts.

Family Physicians' Perspectives and Practices on Advance Care Planning in Regional Cities in Japan and the United States: A Convergent Parallel Mixed-Methods Study.

Advance care planning (ACP) has been widely recognized and practiced worldwide since the 1990s. However, only a few studies have compared clinicians' international perceptions of and experiences with ACP. Therefore, this study explored the perceptions and practices of family physicians (FPs) regarding ACP in Japan and the United States. We conducted a convergent parallel mixed-methods study using a cross-sectional web-based anonymous questionnaire survey to examine how the perceptions and practices of ACP differ between Japanese and American FPs working in regional cities. Responses from 20 and 19 FPs in Japan and the United States were obtained, respectively. Both FP groups received ACP training during their residency and practiced ACP with the highest regard for the patient's wishes and values. Quantitative analysis revealed that American FPs placed more emphasis on documentation and patient language skills. Qualitative analysis revealed that Japanese FPs equally emphasized communication with patients' families and with patients. We merged the results of both analyses and hypothesized that the variations in the FPs' approaches to ACP might reflect variations in their backgrounds, such as health insurance systems, cultures, and values in the two countries, rather than differences between individual physicians. Our study showed that both Japanese and American FPs respect patients' wishes in ACP, with some differences in their perceptions and practices. Therefore, FPs should understand and be flexible with their patients' values and cultural backgrounds as intercultural translators while following appropriate management procedures for successful ACP.

Digital food behaviours, motivations, and delivery application usage among saudis during COVID-19: A mixed-methods study

Food delivery apps (FDAs) and smartphones in Saudi Arabia have become ubiquitous and increasingly popular methods for food ordering and consumption. Such app use during the COVID-19 pandemic has become a convenient and popular response to pandemic restrictions. However, the motivations and preferences behind FDA use are complex, as are the perceptions of FDA users regarding nutrition and healthy foods. To explore FDA usage, motivations, perceptions, and food behaviours in the unique cultural context of Saudi Arabia at the intersection of two epidemics, COVID-19 and obesity, a convergent parallel mixed-methods study design was used with 566 Saudis in the quantitative phase and 17 continuing to the qualitative phase. Of the respondents, 71.9 % reported using FDA typically once a week. Frequent FDA usage was reported by 33.3 % of the participants aged 30–40 years (P = .049). Nearly two-thirds of the sample (62 %) reported that time and convenience were the driving factors in using FDAs. Qualitatively, six main themes were identified: ‘Perceived benefits and drawbacks’, ‘Effects of Promotions and Food Preferences’, ‘Nutritional information and dietary guidelines’, ‘Concepts of healthy food’, ‘Obstacles to healthy food consumption’, and ‘Maintaining Customs and Traditions’. Although convenience and taste were the primary drivers of FDA usage, the roles of tradition and culture in Saudi Arabia were also important FDA usage factors. Overall, understanding the determinants of how Saudis engage with FDAs, in concert with a deeper understanding of food preferences, perceptions, and nutritional knowledge, should help guide future efforts in nutrition education, app development, and public health policy.

Participation of Veterans Affairs Medical Centers in veteran-centric community-based service navigation networks: A mixed methods study.

To understand the determinants and benefits of cross-sector partnerships between Veterans Affairs Medical Centers (VAMCs) and geographically affiliated AmericaServes Network coordination centers that address Veteran health-related social needs. Semi-structured interviews were conducted with AmericaServes and VAMC staff across seven regional networks. We matched administrative data to calculate the percentage of AmericaServes referrals that were successfully resolved (i.e., requested support was provided) in each network overall and stratified by whether clients were also VAMC patients. Convergent parallel mixed-methods study guided by Himmelman's Developmental Continuum of Change Strategies (DCCS) for interorganizational collaboration. Fourteen AmericaServes staff and 17 VAMC staff across seven networks were recruited using snowball sampling and interviewed between October 2021 and April 2022. Rapid qualitative analysis methods were used to characterize the extent and determinants of VAMC participation in networks. On the DCCS continuum of participation, three networks were classified as networking, two as coordinating, one as cooperating, and one as collaborating. Barriers to moving from networking to collaborating included bureaucratic resistance to change, VAMC leadership buy-in, and not having VAMCs staff use the shared technology platform. Facilitators included ongoing communication, a shared mission of serving Veterans, and having designated points-of-contact between organizations. The percentage of referrals that were successfully resolved was lowest in networks engaged in networking (65.3%) and highest in cooperating (85.6%) and collaborating (83.1%) networks. For coordinating, cooperating, and collaborating networks, successfully resolved referrals were more likely among Veterans who were also VAMC patients than among Veterans served only by AmericaServes. VAMCs participate in AmericaServes Networks at varying levels. When partnerships are more advanced, successful resolution of referrals is more likely, especially among Veterans who are dually served by both organizations. Although challenges to establishing partnerships exist, this study highlights effective strategies to overcome them.

Factors influencing the uptake and utilization of cervical cancer screening services among women attending public health centers in Addis Ababa, Ethiopia: mixed methods study

BackgroundCervical cancer is the second cause of cancer deaths among Ethiopian women. Despite multifaceted government efforts, the uptake and utilization of cervical cancer screening remain very low. This study aimed to assess factors influencing the uptake and utilization of cervical cancer screening at public health centers in Addis Ababa.MethodsA convergent parallel mixed-method study was employed to collect data through eight focus group discussions with 66 women purposively recruited from outpatient clinics, and cross-sectional face-to-face exit interviews with 80 women attending cervical cancer clinics in four high-patient volume health centers. The group interviews were tape-recorded, transcribed in Amharic, translated into English, and a thematic analysis approach was used in the analysis. Exit interview data were collected using a structured questionnaire in the Open Data Kit tool on an android tablet. STATA version 17 was used for descriptive and inferential data analyses. Statistical significance was set at p < 0.05.ResultsThe majority of focus group discussion participants had lack of knowledge of cervical cancer and its screening services. The major barriers to the uptake of screening were inadequate public awareness, fear of the procedure, embarrassment, provider’s gender, lack of male partner support, and childcare. Women aged 40 years and above were 13.9 times more likely to utilize cervical cancer screening than those under 30 years (AOR = 13.85; 95% CI: 1.40, 136.74). There was a strong preference for a female provider (AOR = 7.07; 95% CI: 1.53, 32.75) among women screened after attending antiretroviral therapy clinics and those screened due to abnormal vaginal bleeding than women referred from family planning clinics (AOR = 6.87; 95% CI: 1.02, 46.44). Safety of screening was negatively associated with women aged 30–39 (AOR = 0.045; 95% CI: 0.003, 0.696), and those who attended primary education, and secondary education and above, (AOR = 0.016; 95% CI: 0.001, 0.262), and (AOR = 0.054; 95% CI: 0.004, 0.724), respectively.ConclusionsThe study identified low public awareness, inadequate provider preference, safety concerns, and poor male partner support for cervical cancer screening. We recommend the decision-makers enhance public messages, maintain provider choices, ensure safety, and engage males to improve the uptake and utilization of cervical cancer screening.