Convergent Parallel Mixed Methods Study Research Articles

Development of the ¡Vamos por Mas! parenting program to prevent substance use among Chilean adolescents.

In Chile, the prevalence of tobacco, alcohol and drug use among adolescents is very high. Decades of research indicate that parenting interventions reduce these risky behaviors. However, there are no parenting interventions validated in Chile to prevent adolescent substance use. This article reports the development of the ¡Vamos por Mas! (¡VxM!) program following the recommendations of the Medical Research Council's framework for designing and evaluating complex interventions. After identifying key intervention components, a preliminary version of a substance-use prevention program was designed. The preliminary intervention targeted families with adolescents in fifth and sixth grade and had four components: personalized feedback, in-person workshops, virtual engagement, and family support, to deliver positive-youth development and family-strengthening content. Then, students, guardians, school staff and community experts from different school systems (N = 111) evaluated the preliminary version of the program through a convergent parallel mixed methods study, including focus groups (N = 14) and surveys (N = 101). In general, all participants had positive perceptions of the program and valued its purpose, strategies, objectives and contents. Suggestions included expanding the purpose to promote healthy relationships, focusing on schools with low and intermediate socioeconomic vulnerability, including self-control content, removing the personalized feedback component and adding two additional components: school partnership and external supervision, among other improvements. With this information, the final version of the ¡VxM! program was developed. After a rigorous intervention development process, the ¡VxM! program is ready to be piloted and evaluated in a randomized trial.

Parent-Reported Caregiving Roles of Siblings of Children with Inborn Errors of Metabolism.

Research examining sibling caregiving contributions to medically complex pediatric patients, including those with inborn errors of metabolism (IEMs), is limited. We assess caregiving roles and attributes of siblings and hypothesize that there will be differences in parent-reported contributions among siblings of children with IEMs and siblings of typically developing (TD) children. A convergent parallel mixed-methods study design guided analysis of data from parental surveys and semistructured interviews. Interviews were conducted with parents (n = 49) of children with IEMs and parents (n = 28) of exclusively TD children. We used inductive thematic analysis to identify themes related to sibling caregiving. The caregiving and support roles for siblings (n = 55) of children with IEMs and siblings (n = 42) of TD children were coded to assess each sibling's caregiving contributions and personal attributes. Logistic regressions, using generalized estimating equations, were fitted. Results showed that siblings of children with IEMs were significantly more likely to provide monitoring (odds ratio [OR]: 3.62, confidence interval [CI]: 1.30-10.07) and emotional/social support (OR: 4.02, CI: 1.67-9.67) than siblings of TD children. Themes arising from interviews with parents of children with IEMs focused on sibling attributes, parental expectations regarding sibling caregiving, and challenges to the sibling-sibling and parent-sibling relationships. Themes revealed nuances in the sibling caregiving experience. Siblings of children with IEMs make meaningful caregiving contributions and may provide care differently than siblings of TD children. Understanding childhood caregiving roles may inform how health care providers and parents encourage sibling caregiving contributions into adulthood.

What is the usage of the Brisbane Evidence Based Language Test in clinical practice?: A speech language therapy survey.

A number of practice barriers (e.g., time constraints, patient comorbidities and competing demands) exist as regards the evidence-based assessment of adult language within the acute hospital setting. There is need for an evidence-based, diagnostically validated, adaptable, comprehensive and efficient aphasia assessment. The Brisbane Evidence Based Language Test (EBLT) was developed to meet this need for a clinically appropriate and diagnostically robust assessment measure. Since the release of the EBLT, there has been no detailed investigation into speech and language therapists' (SLT) use and perceptions of the assessment. To inform future research and improvements to the EBLT, a better understanding of current language assessment practices, use and thoughts on the EBLT are required. To investigate SLTs' current language assessment practices; and to explore the current usage and future directions of the Brisbane EBLT. A convergent parallel mixed-methods study design with an electronic survey was utilized. The survey consisted of 16 multiple-choice, multiple-answer and free-text questions that explored respondents' perceptions of current language assessment measures, ideal language assessment features, Brisbane EBLT use, positives and negatives, and future directions for the EBLT. The survey was developed on Qualtrics and disseminated via email, social media and professional networks. Snowball sampling was used. Study inclusion criteria required participants to be qualified SLTs with clinical experience working with patients with aphasia. Quantitative data were analysed via descriptive and correlative statistics, and qualitative data were analysed via content analysis. The survey was completed by 115 SLTs from Australia, New Zealand, the United States, the UK, Canada, France, Lebanon and Belgium. Many respondents identified that a range of assessments is required to meet SLT clinical needs in the assessment of aphasia. Key desirable assessment features reported were: comprehensive, efficient, evidence-based, responsive and flexible. The EBLT was the most frequently used standardized measure reported by respondents (used by 78.63%). The EBLT reportedly has many positive features; however, respondents indicated dislike of the form layout, scoring and responsiveness. The majority of respondents indicated that the development of additional EBLT tests (94.29%) and additional cut-off scores (95.15%) would benefit their clinical practice. The study findings indicate that SLT assessment of language is complex and multifaceted. While the EBLT is reportedly used widely by SLTs, respondents identified areas for further research which would optimize the test's usability within their practice, to ultimately improve patient outcomes. What is already known on the subject Previous studies have explored existing SLT adult language assessment practices within acute settings; however, the most recent comprehensive study was completed in 2010. In 2020, the development, diagnostic validation, intra- and interrater reliability of the Brisbane EBLT were published. As of yet there has not been an investigation into clinician use and perspectives of the assessment since its release. What this paper adds to existing knowledge This study provides contemporary data about international aphasia assessment practices, as well as descriptive and qualitative information on the current use of the Brisbane EBLT, and the positives, negatives, and future directions for the assessment measure. What are the potential or actual clinical implications of this work? The study suggests that no one language assessment currently satisfies all SLTs' assessment needs. It additionally implies that a large proportion of SLTs believe that it is best practice to use multiple language assessment measures and select these based on the patient's presentation and context. Further research is required to aid the development of additional EBLT test versions and cut-off scores to improve SLT adult language assessment practices.

Out-of-pocket payments during childbirth in Kenya under the free maternity services: Perspectives of mothers, healthcare workers and county officials

Background: This study seeks to determine the extent of women's out-of-pocket (OOP) payments for delivery under the free maternity policy (FMP). Methods: We conducted a convergent parallel mixed-methods study using quantitative and qualitative data collection. The study was set in three facilities (levels 3, 4, and 5) in Kiambu County, Kenya. The study involved exit interview (EI) surveys with mothers (n = 553) who utilised FMP delivery services and focus group discussions (FGDs) with mothers who returned for postnatal visits (6, 10, and 14 weeks). There were 21 in-depth interviews (IDIs) with county officials and healthcare workers (HCWs). Quantitative data were analysed using descriptive statistics, while qualitative data were audio-recorded, transcribed and analysed using thematic analysis. Results: Despite the FMP being free on paper, mothers incurred OOP payments in practice. The overall mean OOP payments incurred by mothers who underwent normal delivery was 9.50 USD (SD 8.20 USD), and caesarean section (CS) was 10.88 USD (SD 15.16 USD). The main cost drivers were transport, lack of adequate supply and medications, lack of policy clarity by health workers, failure to notify the NHIF office of available clients, and ultrasound scan services. While the OOP payments were not deemed catastrophic, some women perceived it as a barrier to care as they ended up using savings or selling their assets to meet the costs. There were no patient characteristics associated with OOP payments. Conclusions: OOP payments during childbirth in Kenya place a considerable economic burden on mothers and their households. There is need to promote awareness of the policy and provide a sustainable form of transport, especially during emergencies, through collaboration with partners. Prioritising the supply of required medication used in maternal services in the universal health care benefits package to which Kenyan citizens are entitled, or sustainably financing the FMP is crucial.

The Use of Community of Inquiry Framework-Informed Facebook Discussion Activities on Student Speaking Performances in a Blended EFL Class

Students’ extensive use of Facebook in their daily lives has led researchers to investigate the affordances of Facebook for educational purposes. To further the research into the use of Facebook to improve language teaching, we conducted a convergent parallel mixed-methods study to examine the use of Community of Inquiry-informed Facebook discussion activities on the speaking performances of undergraduate students in a blended EFL speaking class in Bangladesh. A Facebook group was maintained for both the treatment and control conditions; however, the discussion activities were required only by the treatment condition. We found a statistically significant difference between the initial and post-test speaking scores for the treatment and control conditions. While no difference was observed in post-test scores between the two conditions, students’ and the instructor’s comments on the Facebook group and student interview data revealed that Facebook was helpful for both conditions in improving their performances, but in different ways.

A Convergent Parallel Mixed-Methods Study of Screen Time and Social Behaviors in Early Childhood

ABSTRACT Using a convergent parallel mixed methods design, the present study examined children’s screen time and social behaviors through parents’ perceptions. The participants were 113 children and their parents for the quantitative strand and 42 randomly selected parents for the qualitative strand of the study. Parents reported on children’s social behaviors and screen time in the quantitative strand, and semi-structured interviews were conducted with parents in the qualitative strand of the study. Quantitative data were analyzed using cluster analyses, and qualitative data were analyzed using an open-coding system; following that, the quantitative and qualitative results were collaboratively discussed. Using cluster analyses, children were categorized into two groups (positive and relatively social negative behaviors) that reflect their social behaviors during peer play context. Qualitative analyses identified parents’ perceptions of their children’s social behavior and screen time. Accordingly, qualitative results consistently supported the two groups categorized in the quantitative strand. In addition, parents’ use of screen-related strategies was related to children’s positive social behaviors. Findings from the current study suggest that considering children’s engagement with screen time may contribute to a greater understanding of children’s social behaviors.

Artificial intelligence-informed mobile mental health apps for young people: a mixed-methods approach on users’ and stakeholders’ perspectives

BackgroundNovel approaches in mobile mental health (mHealth) apps that make use of Artificial Intelligence (AI), Ecological Momentary Assessments, and Ecological Momentary Interventions have the potential to support young people in the achievement of mental health and wellbeing goals. However, little is known on the perspectives of young people and mental health experts on this rapidly advancing technology. This study aims to investigate the subjective needs, attitudes, and preferences of key stakeholders towards an AI–informed mHealth app, including young people and experts on mHealth promotion and prevention in youth.MethodsWe used a convergent parallel mixed–method study design. Two semi–structured online focus groups (n = 8) and expert interviews (n = 5) to explore users and stakeholders perspectives were conducted. Furthermore a representative online survey was completed by young people (n = 666) to investigate attitudes, current use and preferences towards apps for mental health promotion and prevention.ResultsSurvey results show that more than two-thirds of young people have experience with mHealth apps, and 60% make regular use of 1–2 apps. A minority (17%) reported to feel negative about the application of AI in general, and 19% were negative about the embedding of AI in mHealth apps. This is in line with qualitative findings, where young people displayed rather positive attitudes towards AI and its integration into mHealth apps. Participants reported pragmatic attitudes towards data sharing and safety practices, implying openness to share data if it adds value for users and if the data request is not too intimate, however demanded transparency of data usage and control over personalization. Experts perceived AI-informed mHealth apps as a complementary solution to on–site delivered interventions in future health promotion among young people. Experts emphasized opportunities in regard with low-threshold access through the use of smartphones, and the chance to reach young people in risk situations.ConclusionsThe findings of this exploratory study highlight the importance of further participatory development of training components prior to implementation of a digital mHealth training in routine practice of mental health promotion and prevention. Our results may help to guide developments based on stakeholders’ first recommendations for an AI-informed mHealth app.

Impact of workplace violence towards public service emergency care providers on access to emergency medical care in Gauteng Province, South Africa


 
 
 Background. Workplace violence is a global concern that threatens access to equal and efficient healthcare in developing countries. Objective. To discuss the impact of workplace violence towards Gauteng Province-based public service emergency care providers on access to emergency medical care within Gauteng communities.
 Methods. This study was based on a larger non-experimental, convergent parallel mixed-methods study guided by an interpretive framework founded on pragmatism. Evidence on workplace violence towards Gauteng-based public service prehospital emergency care providers was collected from the general population of Gauteng, sampled using multistage cluster sampling, public service emergency care providers, sampled using two-stage cluster sampling and purposively sampled managers of Gauteng Emergency Medical Services as well as South African Police Services. Surveys were used to gather information from the general population, focus group discussions were conducted with prehospital emergency care providers and semi-structured interviews were conducted to engage managers. Both quantitative and qualitative data were collected concurrently, and findings were triangulated. Parallel mixed-methods analysis that involved separate analysis of the quantitative and qualitative data was used to analyse the data.
 Results. A total of 413 survey questionnaires comprising of 196 web-based and 218 paper-based responses were included in the quantitative subphase of the study. The majority (66.1%; n=273) of participants resided in townships, 24.5% (n=101) in the city, 3.6% (n=15) in informal settlements, 2.9% (n=12) in school accommodation or school residences and only 2.9% (n=12) in flats, complexes, rural areas, security estates, smallholdings or suburbs. These are the participants who met the inclusion criteria, and specifically who were non-members of medical schemes and resided in communities where public service emergency care providers mostly render their services. For the qualitative subphase, two subthemes emerged during the interviews of managers supporting access to emergency medical care in Gauteng. The themes were ‘limited access to emergency medical care’ and ‘delayed response time’. At the same time a theme ‘leaving a violent scene’ emerged from the prehospital emergency care providers’ focus group discussions.
 Conclusion. The study revealed that workplace violence towards public service prehospital emergency care providers has a negative impact on access to emergency medical care among low- to middle-income communities in Gauteng who depend on state-funded healthcare.
 
 

Impact of workplace violence towards public service emergency care providers on access to emergency medical care in Gauteng Province, South Africa


 
 
 Background. Workplace violence is a global concern that threatens access to equal and efficient healthcare in developing countries. Objective. To discuss the impact of workplace violence towards Gauteng Province-based public service emergency care providers on access to emergency medical care within Gauteng communities.
 Methods. This study was based on a larger non-experimental, convergent parallel mixed-methods study guided by an interpretive framework founded on pragmatism. Evidence on workplace violence towards Gauteng-based public service prehospital emergency care providers was collected from the general population of Gauteng, sampled using multistage cluster sampling, public service emergency care providers, sampled using two-stage cluster sampling and purposively sampled managers of Gauteng Emergency Medical Services as well as South African Police Services. Surveys were used to gather information from the general population, focus group discussions were conducted with prehospital emergency care providers and semi-structured interviews were conducted to engage managers. Both quantitative and qualitative data were collected concurrently, and findings were triangulated. Parallel mixed-methods analysis that involved separate analysis of the quantitative and qualitative data was used to analyse the data.
 Results. A total of 413 survey questionnaires comprising of 196 web-based and 218 paper-based responses were included in the quantitative subphase of the study. The majority (66.1%; n=273) of participants resided in townships, 24.5% (n=101) in the city, 3.6% (n=15) in informal settlements, 2.9% (n=12) in school accommodation or school residences and only 2.9% (n=12) in flats, complexes, rural areas, security estates, smallholdings or suburbs. These are the participants who met the inclusion criteria, and specifically who were non-members of medical schemes and resided in communities where public service emergency care providers mostly render their services. For the qualitative subphase, two subthemes emerged during the interviews of managers supporting access to emergency medical care in Gauteng. The themes were ‘limited access to emergency medical care’ and ‘delayed response time’. At the same time a theme ‘leaving a violent scene’ emerged from the prehospital emergency care providers’ focus group discussions.
 Conclusion. The study revealed that workplace violence towards public service prehospital emergency care providers has a negative impact on access to emergency medical care among low- to middle-income communities in Gauteng who depend on state-funded healthcare.
 
 

Upgrading the Problem-Solving Experiences of the Primary Students Using an Online Singapore Mathematics Platform

This convergent parallel mixed-methods study examined the effectiveness of a self-directed online platform that promotes the use of the Singapore model method in solving mathematics problems among primary students in a private school in the Philippines. There were 275 students and 4 mathematics teachers that were involved in the study using stratified sampling method. Mathematics achievement test, survey, and interviews were utilized in gathering data. Findings show significant learning gains among the primary students on their pretest and posttest scores. Both the quantitative and qualitative data reveal that students’ problem solving experiences improved because they can visualize the abstraction of the problems using pictorial and bar modeling methods. The respondents enjoyed the self-directed nature of the platform, where they could solve problems in the comfort of their own homes. However, the respondents shared that unstable internet connection and the overwhelming number of lessons in the integrated curriculum were some areas for improvement. Overall, the initial assessment shows promising results on the integration of the online self-directed platform that promotes an innovative and creative way of solving mathematical problems among primary students. Further assessments in the future should be made to ensure that integration can bring positive learning outcomes in the long run.

It’s all relative: Changes in teachers’ knowledge and instruction during COVID-19

In this convergent-parallel mixed-methods study, we explored the effect that teaching remotely during the first months of the pandemic had on teachers’ TPACK and how teachers leveraged their new and existing knowledge to facilitate remote instruction. Survey results indicated that teachers’ self-reported knowledge decreased across multiple TPACK subdomains, which is likely an indicator of teachers’ recalibration of their knowledge as they experienced a new instructional context. Findings from semi-structured interviews indicated that although instruction narrowed at times when teachers struggled to enact their knowledge in less-than-ideal circumstances, teachers were often able to successfully facilitate remote instruction.

Service Learning in the Nursing Bachelor Thesis: A Mixed-Methods Study.

The Final Degree Project (FDP) is a module that, although intended for the completion of a bachelor thesis (BT), consists of theoretical and clinical teaching. Therefore, introducing service learning (SL) can support student adjustments to the real-world professional role. This study plans to evaluate a teaching innovation project that combines BT and SL through Kirkpatrick’s four-level model (reaction, learning, behaviour and results). It takes the form of a convergent parallel mixed-methods design study. The participants were 15 final-year students obtaining a Bachelor of Nursing degree, 4 BT supervising mentors and 4 nurses. At the request of a hospital institution, in their BT, students completed a review of evidence-based nursing protocols. For data collection, the researchers used: an SL questionnaire, student narratives, mentor field diaries and nurse interviews. According to student opinion, the results showed high satisfaction rates (4.44 out of 5), the most developed skills were Independent Work and Information Management, but they signal the need to reinforce the research methodology skills. Finally, positive feedback from all participants is that using SL promotes both the opinion that the BT is useful and also promotes a collaboration between academic and clinical settings.

Exploring the Connectivity Paradox: How the Sociophysical Environment of Telehealth Shapes Adolescent Patients’ and Parents’ Perceptions of the Patient-Clinician Relationship

ABSTRACT Even before the widespread transition to telehealth as a result of COVID-19, there was a considerable amount of research exploring its value and impact. However, telehealth research with adolescent patients is somewhat limited, with most work focusing on access, feasibility, and acceptability but reporting far less frequently on relationship building and rapport. This study examines qualitative interviews with adolescent patients (n = 14) and parents (n = 20) from a larger convergent parallel mixed methods study to explore how they understand telehealth to have altered the sociophysical environment of primary care clinic encounters and whether they perceive these changes to influence adolescents’ relationships with clinicians. We show that participants perceived the sociophysical environment of telehealth to be both less institutional (e.g. more relaxed and less rushed) and more instrumental (e.g. more focused on the chief complaint), which shaped interactions with clinicians in ways that were experienced as paradoxically less personal (e.g. lacking social connection) and more person-centered (e.g. more attentive to the individual patient). We discuss theoretical and practical implications of these findings and what they mean for defining person-centered communication for adolescent care.

Māori, pharmacists, and medicines adherence – A mixed methods study exploring indigenous experiences of taking medicines ‘as prescribed’ and mechanisms of support

BackgroundMedicines are the most common medical intervention and medicines adherence is associated with improved clinical outcomes. Understanding drivers and experiences of medicines adherence is important for optimising medicines use. Māori (Indigenous people of Aotearoa New Zealand) experience inequities in access to medicines yet little evidence exists regarding Māori and medicines adherence, or the role of pharmacists in supporting medicines adherence for Māori. ObjectivesTo explore Māori experiences of medicines adherence and non-adherence, and pharmacists' role in supporting adherence. MethodsThis was a convergent parallel mixed methods study. Facilitated wānanga (collaborative knowledge-sharing group discussions) were undertaken either online or in-person with eligible participants, using convenience and snowball sampling to recruit. Participants were eligible if they were Māori, 18 years or older, and had recently obtained medicine from a pharmacy. Wānanga involved semi-structured interviewing and questionnaire completion. General inductive coding and thematic analysis and descriptive statistical analysis were used respectively, and findings were situated in social, cultural and political Māori contexts. ResultsThirteen wānanga were conducted with 62 participants (71% female, median age range 35–44) from September 2021 to February 2022. Four themes were identified: The aspirations of hauora Māori (Māori wellbeing) - medicines as a component of holistic wellbeing; whanaungatanga (relationships); knowledge; and whānau (family and support network) advocacy and problem solving. Forgetting to take medicines was the most frequently identified reason for non-adherence, followed by not having medicines on hand, adverse effects, and lack of symptoms of health conditions. Participants identified that proactive pharmacist support, including developing caring therapeutic relationships, sharing knowledge, acknowledging medicines as just one component of holistic wellbeing, and giving adherence tips to support routine medicine taking were positive ways that pharmacists could support medicines adherence. ConclusionsFactors contributing to medicines adherence were diverse and participants identified numerous practical solutions that pharmacists, health service providers and policymakers could employ to support Māori medicines adherence.

A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors

PurposeThe use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. MethodsThis is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). Results76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. ConclusionWomen may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors’ surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.

Comparing the quality of care for long-term ventilated individuals at home versus in shared living communities: a convergent parallel mixed-methods study

BackgroundPeople on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC?MethodsThis study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care.ResultsThe quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs (n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL (n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers (n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18).ConclusionThis study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.

Perceptions and utilization of a multimedia teaching strategy to prevent student nurse attrition

Untethered Lecture Capture (ULC) is a teaching method facilitating student classroom engagement while simultaneously creating audiovisual lecture capture (LC) resources. This single-site, convergent parallel mixed-methods study qualitatively described how nursing students with attrition risk factors perceived ULC influenced learning and quantified how such students utilized LC. Study participants (N = 28) reported watching most LC resources (57.1%) and 42.9% watched entire LC videos from start to finish. Qualitative findings produced new evidence about untethered faculty proximity in the classroom and ULC techniques supporting in-class focus and post-class self-paced learning efficiencies. Findings help nurse educators prioritize instructional methods among students with attrition risk factors.

Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study.

ObjectiveThe purpose of this study was to explore perceived ease of use, usability, and the feasibility of using mobile health applications to manage hypertension self-care in rural Black older adults with hypertension.MethodsA convergent parallel mixed method design was used to study a purposeful sample of 30 Black older adults (29 females, 1 male) from rural East Texas. Quantitative data included demographic characteristics and measured blood pressure, height, and weight, along with questionnaires: the Hill-Bone Compliance to High Blood Pressure Therapy Scale, the Krousel-Wood Medication Adherence Scale-4, and the Technology Acceptance Model Questionnaire (adapted). Qualitative data were obtained from five focus groups and analyzed using thematic analysis.ResultsMean age was 66.3 ± 9.6 years. Less than half of the participants (46.7%) had a systolic and/or diastolic blood pressure >130/80. Greater participant adherence was noted with the Hill-Bone Compliance scale (63.3%) than the Krousel-Wood scale (23.3%). With the Technology Acceptance Model, perceived ease of use was significantly correlated with behavioral intention (r = 0.654, p < 0.000) and perceived usefulness (r = 0.585, p < 0.001), while behavioral intention was negatively associated with age r = −0.047 (p=0.009). Focus group data revealed five themes: 1) useful, 2) counterintuitive, 3) communication, 4) comfort with the status quo, and 5) educate/show me how.ConclusionSmartphone technology and other health-related computer technologies were not preferred by older adults in this study due to limited digital literacy. Simplicity and easy navigation in the design of mHealth apps are needed to improve treatment adherence and blood pressure control in rural older adults with hypertension.Clinical RelevanceMobile health applications have the potential to increase self-management of chronic hypertension if users are digitally literate. Health-care providers need to assess older patients for digital literacy and offer educational support and assistance.

Drivers of irrational use of antibiotics among children: a mixed-method study among prescribers and dispensers in Tanzania

BackgroundMisuse of antibiotics has been associated with poor knowledge, attitude and practice (KAP). Therefore, this study aimed to assess if KAP of prescribers and dispensers could drive irrational use of antibiotics among children in Tanzania.MethodsA convergent parallel mixed-methods study design that employed quantitative and qualitative approaches was conducted in 14 regional referral hospitals (RRHs). A total of 108 participants, prescribers [54] and dispensers [54] working with the pediatric population in the respective regions participated in a quantitative survey, by filling the standard questionnaire while 28 key informant interviews were conducted with in-charges of units from the pharmacy and pediatric departments. Two key informants (prescriber and dispenser) were selected from each RRH.ResultsOverall, among prescribers and dispensers, there was adequate knowledge; 81.5% and 79.6%, p = 0.53, those with positive attitudes were 31.5% and 81.5%, p < 0.001 and poor practices were among 70.4% and 48% p = 0.0312 respectively. Among prescribers, 14.8% agreed and strongly agreed that prescribing antibiotics that a patient did not need does not contribute to resistance. Moreover 19% disagreed to prescribe antibiotics according to local guidelines. Among dispensers, a-quarter of the dispensers thought individual efforts to implement antibiotic stewardship would not make a difference, 17% agreed and strongly agreed that antibiotics can treat viral infection and 7% agreed and strongly agreed antibiotics can be stopped upon resolution of symptoms. From qualitative interviews, both participants displayed an adequate understanding of multi-contributors of antibiotic resistance (AR) including polypharmacy, community self-medication, among others. Regardless, both professions declared to prescribed and dispensed antibiotics according to the antibiotics available in stock at the facility. Furthermore, prescribers perceived laboratory investigation took a long time, hence wasting their time. On the other hand, Dispensers reported not to provide adequate instruction to the patients, after dispensing antibiotics.ConclusionsBoth prescribers and dispensers had adequate knowledge, few prescribers had positive attitudes and the majority had poor practices. Few dispensers had poor attitude and practice. These findings highlight the need to provide adequate training on antimicrobial stewardship and enforce regulation that foster appropriate medical practice.

Determinants of the Limpopo Province of South Africa's Response to COVID-19: A Mixed Methods Protocol to Analyze and Share Lessons Learned.

COVID-19 is a priority health research agenda item in South Africa. The World Health Organization declared the COVID-19 outbreak as a Public Health Emergency of International Concern, which requires all countries to respond and share data with others. Responses included the implementation of measures to reduce the spread of COVID-19 and protect health systems from being overwhelmed by seriously ill patients. Each country was mandated to assess its own risk and rapidly implement the necessary measures to reduce COVID-19 transmission and minimize its impact. Countries were further encouraged to share their experiences of responding to the COVID-19 pandemic. Media reports in South Africa suggest that the Limpopo Department of Health implemented a successful COVID-19 response. This study aims to analyze, document and publish those successes to make them accessible to other researchers and public health practitioners. The study will also allow for the participation of public health students to meet the requirements of their postgraduate degrees. This convergent parallel mixed method study will collect secondary data of responses to COVID-19 by the Limpopo Department of Health from the records the department keeps. Quantitative and qualitative data detailing activities and statistics describing facilitators and barriers to implementation of COVID-19 response from March 2020 will be extracted from records.