Mixed-methods Descriptive Study Research Articles

Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India.

Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. This was a cross-sectional descriptive mixed-methods study. Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.

Serving the Underserved Amid COVID-19: The Case of a Virtual, Culturally Responsive Summer Engineering Camp

The societal disruptions due to the novel coronavirus (COVID-19) pandemic are well noted, especially in the context of science, technology, engineering, and mathematics (STEM) education. Absent a concerted effort to sustain hands-on learning opportunities in STEM amid the crisis, the consequences of COVID-19 may exacerbate existing inequities and racial disparities among youth of color further stratifying the STEM fields. In the current study, we applied a mixed-method descriptive case study design, using online learning theory and culturally responsive pedagogy as our conceptual framework, to describe how participants experienced this camp, held online due to disruptions of COVID-19, in the southeastern region of the USA. We also share findings from the implementation of a justice bots project, which enabled participants to connect social justice and engineering. Participants included middle school youth, undergraduate engineering students, and in-service math and science teachers. Data sources entailed focus groups, pre-post surveys, observations, and artifacts. Our results indicated that participants experienced gains in their communication skills, positive changes in attitudes toward STEM for middle school youth, established meaningful connections, and enhanced their technical knowledge. Middle school youth reported enjoying the online summer camp environment, though they had experienced more than a year of education online. Undergraduate engineering students asserted that it was challenging to communicate coding and other technical knowledge virtually but having to do so strengthened their capacity to teach others while honing their own competencies. Lastly, in-service math and science teachers reported a better understanding of the connection between engineering and social justice based on their experiences in the camp. We conclude this article with implications for engineering education.

"Teaching Through Your Fingertips": A Descriptive Study to Understand the Experiences and Needs of Online Educators in Postgraduate Nursing Education in Australia.

Even before COVID-19, enrolments in online postgraduate nursing and midwifery courses were growing globally. Teaching into planned online courses requires pedagogical considerations unique to the context. The objective of this descriptive mixed methods study was to understand the experiences and needs of Australian online educators who taught into planned online postgraduate nursing or midwifery courses. A 55-item online survey captured the experiences and needs of participants. This paper reports on the analysis of participants' qualitative responses in this survey, analyzed using a thematic analysis approach. Forty-nine postgraduate educators participated in this study. Five core themes were identified: time is precious; redefining the educator role; understanding the pedagogical shift; online and alone; and learning to teach online. Many educators report lacking the skills and confidence to deliver high-quality education to postgraduate students through their fingertips. This research highlighted that online educators need support through resources, education, and professional development.

Community Health Posts Impact on Adult Male Access to HIV Services in Lusaka, Zambia

Achieving HIV epidemic control is an ultimate goal for Zambia. To achieve this goal there is need to close services access gaps. Adult men are less likely to utilize existing health facility-based HIV services and they account for a significant proportion of new HIV infections with risk to onward HIV transmission in the community. Almost two-thirds of males (65.1%) and 79.2% of females aged 15-59 years reported ever having been tested for HIV and having received their results. Over two-thirds (67.1%) of HIV-positive males 25-29 years of age reported being unaware of their HIV status. Twenty-five percent of the national pandemic is in Lusaka. This non-experimental, descriptive mixed-methods study shows increase in number of adult males accessing services at community health posts and the impact of community health posts on improving adult male access to HIV services, including improved retention to HIV services and viral load suppression. The attitude or customer care of health care workers and the location of the community health posts played a bigger role in improving adult male access to HIV services, by creating a better, trusted environment and by bringing the services closer to where these males work or live. The community health post improved also the inequality in accessing HIV services for adult males, as this is one of the key factors to achieving the end of HIV pandemic. Keywords: Community Health Post, Control, Epidemic, HIV, Impact, and Inequality, Male Adult.

Sustaining Education by Actualizing Affordances of Social Media Platforms During the Pandemic

This paper draws on the affordances theory and investigates the ways in which pre-service teachers are sustaining social media uptake in learning by taking advantage of the opportunities afforded by the new delivery methods during the pandemic. This research is part of a descriptive mixed methods study. A questionnaire and in-depth, qualitative interviews were used to explore pre-service teachers’ perceptions of the affordances of social media platforms for learning and the actualization of those affordances. The survey and interview data were analyzed through the theoretical lens of affordance theory. The results suggest that the pre-service teachers actualized the affordances of social media by their knowledgeable use in a dynamic learning environment. The key findings are that the teachers perceived the social media applications to be flexible, useful and practical (functional affordances), bridges formal and informal learning and supported self-regulated learning (cognitive affordances), allowed pre-service teachers to assume new identities and discover learning as independent learners who had control over their learning (identity creation affordances), and fostered interaction and collaborative feedback (social affordances). Lack of guidance or lack of teacher presence was the main constraint. This research produces new knowledge and analysis and makes new theoretical contributions on the specific affordances of social media technologies. This study adds to and extends existing literature by contributing to an understanding of the actualization of the affordances of social media platforms.

PRECEPTORS’ EXPERIENCES AND PRECEPTEES’ VIEWS REGARDING THE CLINICAL LEARNING ENVIRONMENT FOR NURSING IN THE BUEA REGIONAL HOSPITAL, CAMEROON

Background: Clinical teaching is the most important part of nursing education and the role preceptors play in clinical teaching and learning cannot be over emphasised. Students require a conducive clinical environment to allow the application of theory to practice.
 Objectives: This study sought to describe preceptors’ experiences and views of preceptees regarding the clinical learning environment.
 Methods: A hospital-based quantitative and qualitative (mixed method) descriptive cross-sectional study was conducted in a typical clinical learning environment in the Buea Regional Hospital. The population was made up of staff nurses (preceptors) and student nurses (preceptees) on clinical placement at the BRH. Purposive and convenient techniques were used to select the study site and enrolled study participants respectively. A self-administered questionnaire and an interview guide were used to collect data. Data was analysed using SPSS software and thematic analysis respectively.
 Results: A total of 14 preceptors and 112 preceptees participated in the study. In general, 36(32.1%) of preceptees fully agreed there was a positive atmosphere in the ward, 34.8% of them indicated that preceptors organised separate supervisory sessions once a week, while 16.6% of the preceptees said that preceptors do not organise supervisory sessions at all. There was significant positive relationship between the method of supervision and the level of satisfaction of preceptees (r=0. 295, p=0. 002). Regarding their experiences, the preceptors made mention of positive experiences such as hard working students, encouraging teachers, increased use of internet facilities. Negative experiences reported were, language barrier, lack of zeal to work and short duration of training.
 Conclusion: Even though there was a positive atmosphere in the ward, most students complained of not being comfortable during clinical learning. The preceptors had both positive and negative experiences which were both student and facility oriented. It is recommended that training schools and the hospital should endeavour to create an environment that is conducive for training of nursing students.

Prevalence, psychosocial correlates of youths’ suicidal behaviors and perspectives on the phenomena at Zagazig University: a mixed-methods study

BackgroundSuicidal behaviors are major public health concerns that affect large numbers of youth, leaving not only the youth but also their parents, family, friends, and peers in constant wailing. This study aimed to investigate the prevalence, psychosocial correlates, and perspectives of youths’ suicidal behaviors. A concurrent mixed-methods descriptive study was used in carrying out this study. This study was conducted at Zagazig University, Al Sharkia Governorate. A stratified multi-stage cluster sampling technique was used to enroll 364 youths. Four tools were used to collect quantitative data. They were as follows: The Youth Profile Questionnaire, composed of two parts (socio-demographic data and youth characteristics), the Suicide Behaviors Questionnaire-Revised (SBQ-R), Social Problem-Solving Inventory-Revised Short Form (SPSI-R-SF), and the Short Version of the World Health Organization Quality of Life (WHOQOL-BREF). For the qualitative part, focus group discussions were conducted to explore youths’ perspectives on the phenomenon of suicidal behaviors.ResultsQuantitative findings revealed that 25% of the youth participants had a significant risk for suicidal behaviors. Being female, in the first years of practical faculties and having no friends are significantly correlated with suicidal behaviors. Further, the quality of life had a statistically significant negative correlation with suicidal behaviors. Qualitative findings were discussed under one main category: youths’ perspectives about suicidal behaviors (pressure/escaping tool, seeking help/ending pain, attention-grabbing behavior, and stain for life).ConclusionsAccording to this mixed-methods study, youths’ suicidal behaviors are prevalent multifaceted phenomena that certain factors have been correlated with. It is suggested that female sex, having no friends, and academic stressors are risk factors for suicidal behaviors. Also, the quality of life was introduced as a protective factor against suicidal behaviors. Therefore, it is recommended to implement prevention and management approaches to realize the complexity of the phenomena of suicidal behaviors among youth; these approaches target the youths themselves (mental health promotion and strategies for coping with stress) and the population (careful media coverage, limit access to suicidal methods, and raise the awareness about mental illness).

In Search of a Professional Identity: An Analysis of Photographic and Illustrative Images of Nurses in Japan.

Purpose: Inaccurate portrayals of nurses and their roles in the media contribute to misleading public stereotypes that negatively affect the status and value of nurses. This study aims to clarify how nurses are portrayed visually on the Internet in Japan and what these images suggest about the role, value, and professional status of nurses in Japan. Methods: A descriptive mixed methods study: Forty photographs of nurses and 40 illustrations of nurses were analysed to make judgments about consistency with a contemporary profile that informs guidelines for professional education and practice.Results: Over three quarters (77.5%) of the images showed only female nurses and 55% were depicted smiling politely. None of the images depicted nurses engaged in high level care consistent with that of a professional dealing with typical contemporary client/patient needs. Conclusion: Our study suggests that in common with overseas research, nurses were predominantly being portrayed as feminine and caring but not as professionals capable of independent practice. Although representations were usually positive, the depictions were not entirely accurate, and this was more evident in the illustrations. Imagery can have a profound effect on ideas, attitudes and behavior; it is imperative that nurses are depicted as appropriately educated professionals and that stereotypes such as nurses being young, subservient, and female should be challenged.

The use of complementary and alternative medicine in fertility and gynaecological disorders in Jordan: a mixed-method descriptive study

Abstract Objectives The aim of the study is to assess the extent of CAM use, with emphasis on herbs, in treating gynecological disorders, and their perceived efficacy and safety. Methods This was a mixed-method study of two parts (cross-sectional quantitative and qualitative study) of 338 women suffering from gynecological disorders during the last 3 months. Data were collected using a self-administered questionnaire of three parts: demographics, medical history and the CAM use patterns. Qualitative part was conducted by a 20-min verbal face-to-face interview. Key findings During the last 3 months, 232 (68.64%) of participants had used CAM for various gynaecological conditions, of which, 135 (58.19%) used herbal remedies. Almost half of participants have a good awareness about CAM definition, and they mainly used CAM before or concurrently with traditional medicines. Conclusions This study provides an overview of various CAM remedies used to treat gynaecological disorders in the Jordanian society, which would draw attention to the necessity of conducting interventional studies to evaluate the efficacy and safety of CAM in treating gynaecological disorders, either as stand-alone or adjuvant treatment.

Female teachers’ double burden during the pandemic: overcoming challenges and dilemma between career and family

The coronavirus disease 2019 (Covid-19) challenged educators, especially female teachers, as they shouldered the double burden of being both teachers and spouses. This study articulates the online teaching experiences of Indonesian women that work as elementary school teachers. Moreover, the study explores strategies implemented by these teachers to overcome this career-family dichotomy. Carried out in Indonesia’s East Java province, this descriptive mixed method study surveyed 347 married female teachers, 212 of which have school-aged children. Results showed that home-based online teaching created additional burdens for female teacher and they experienced workload resulting from this dual role, further emphasized by the expectation of domestic duties that are primarily enforced on women. Several strategies, including time management, involving their husbands in domestic chores — that strengthened their social support —, and simultaneously teaching their own children along with their students, were implemented. Therefore, couple’s negotiations regarding role division are needed to achieve gender equality within familial structures.

Challenges Experienced by U.S. Cancer Patients during COVID-19: Implications for Future Public Health Emergency Preparedness

This study aims to examine the specific health challenges experienced by cancer patients and survivors during the COVID-19 crisis. It's a descriptive mixed-methods study with 317 participants recruited from multiple sources. Participants were asked to complete an online anonymous 35-question semi-structured questionnaire. Data was analyzed both quantitatively and qualitatively. During the COVID-19 pandemic, 56% of the participants felt their medical care was disrupted or delayed. About 85% believed healthcare providers were taking the necessary measures to address COVID-19, yet, 50% of the participants felt they had received adequate information from healthcare providers. Participants had 49% satisfaction with general healthcare provided through telehealth, while only 33% were satisfied with telehealth cancer care. Common themes of challenges confronted by cancer patients during COVID-19 also include, delays in testing and treatment leading to cancer metastasis; lack of family and general support in hospitals/office visits, and feelings of isolation as a result of the quarantine; limited access to mental healthcare services; limited communication with medical personnel. There is an urgent need for medical and oncological institutions to create streamlined protocols for cancer treatment, appointments, and communication to minimize the number of challenges endured by cancer patients during a health pandemic.

Understanding COVID-19's Impact on Nursing Students' Education, Professional Perceptions, Stress, and Coping.

This descriptive mixed-methods study was conducted to understand the impact of COVID-19 on undergraduate nursing students' education, perceptions of nursing, stress, and coping. A convenience sample (N = 150) reported high levels of stress with higher stress levels significantly associated with lower coping. The essence of nursing, emotions surrounding the transition to nursing, educational barriers, and faculty-student relationships emerged as themes. The findings can be used to revise curricula and better support nursing students in future disasters and transitions to practice during unpredictable times.

Challenges and knowledge gaps facing hemophilia carriers today: Perspectives from patients and health care providers

BackgroundHemophilia carriers experience abnormal bleeding symptoms; however, a lack of awareness about this topic coupled with additional knowledge gaps and barriers leads to suboptimal care for this population. ObjectiveThe primary objective was to describe the current knowledge gaps and challenges from the perspective of both hemophilia carriers and their health care providers. MethodsWe carried out a mixed methods descriptive study with two population groups between September and December 2020. The hemophilia carrier perspective was obtained through both focus groups and questionnaires, whereas the health care providers perspective obtained via questionnaire sent to the Association of Hemophilia Care Directors of Canada and the Canadian Association of Nurses in Hemophilia Care. Focus groups were analyzed using descriptive thematic analysis and quantitative survey data was also analyzed. ResultsEleven hemophilia carriers participated along with 19 health care providers (11 physicians, eight nurses). Hemophilia carrier focus group discussions identified four areas representing major challenges or knowledge gaps: (1) negative psychosocial impacts; (2) difficulty determining symptom significance; (3) need for self‐advocacy; (4) testing concerns. Survey results from both groups were aligned with the most important topics for ongoing education identified as information on abnormal bleeding symptoms, where to seek treatment, and considerations for heavy menstrual bleeding/menstruation. The majority of both study groups believe obligate or potential carriers should have factor levels checked regardless of age if symptoms of abnormal bleeding occur or before an invasive procedure. However, hemophilia carriers were significantly more in favor of genetic testing under the age of consent than health care providers in all scenarios evaluated.

Views on education and upcoming profession among newly admitted students at a Swedish baccalaureate nursing program: A descriptive mixed method study

AimThe aim of this study was to investigate newly admitted nursing students’ views on nursing education and their future profession. BackgroundStudents' choice of education can be influenced by societal and familial values and among nursing students’ altruistic motives are common. Students’, conceptions, expectations and doubts combined with their orientations to learning affect their ability to successfully cope with studies in higher education. DesignA descriptive design using mixed method. MethodsThis mixed-method study is based on 126 qualitative semi-structured interviews and 158 questionnaires with newly admitted nursing students. The data collection was conducted during their first six weeks of education. Collected data were analyzed using content analysis and descriptive statistics. This study was conducted and reported in accordance with the COREQ checklist. ResultsThe overarching theme: “Making a difference if managing to become a professional nurse”, describing students’ dichotomous emotions of expectations and doubts in relation to their conceptions, emerged from seven main categories. Students’ ratings of emotions revealed high ambition and motivation. Fears and worries about uncertainty expressed in interviews correlated with ratings of negative emotions. ConclusionNewly admitted nursing students think highly of the nursing profession and upcoming education. Students put faith in their own ability which is accompanied by doubts derived from uncertainty about forthcoming demands in academic, clinical and personal settings. Understanding of students’ conceptions, expectations, doubts and their orientations to learning could be helpful in guiding them to acquire the nurse competencies necessary to become professional nurses that are able to handle complex situations.

Usability, Engagement, Learning Outcomes, Benefits and Challenges of Using a Mobile Classroom Response System During Clinical Simulations for Undergraduate Nursing Students

BackgroundThis study evaluated the perceived usability, engagement, learning, benefits and challenges as well as academic achievement of using a mobile classroom response system (CRS) in the classroom and clinical simulation lab with undergraduate nursing students. MethodA descriptive mixed-methods study was conducted with second year BSN students (n = 81) in two streams, a traditional four year and accelerated twoyear track accelerated standing track (AST). Learner perceptions were measured using the Classroom Response System Perceptions (CRiSP) Questionnaire and qualitative feedback. ResultsOverall, nursing student ratings on the CRiSP Questionnaire were moderately high, with a mean total score of 94.1 (SD = 14.7) out of 135. Mean subscale scores were also moderately high for usability (16.1 out of 20; SD = 3.5), engagement (36.7 out of 55; SD = 7.0) and learning (41 out of 60; SD =7.1). Participants described several perceived benefits that are represented by six themes and a few challenges that are represented by two themes. ConclusionsMobile CRSs can support nursing student's engagement and learning in presimulation preparation, and in the prebriefing and debriefing phases of clinical simulations.

Implementation of Interventions and Policies on Opioids and Awareness of Opioid-Related Harms in Canada: A Multistage Mixed Methods Descriptive Study.

In Canada, interventions and policies have been implemented to minimize the risk of opioid-related harms. This mixed methods study aimed at describing trends over time in implementation, as well as in awareness and health outcomes. For implementation, we conducted a scoping review to identify opioids interventions and policies implemented in Canada between 1 January 2016 and 15 November 2019. Awareness was measured through a descriptive analysis of opioid-related harm cases reported by consumers and health care professionals (HCPs) to the national spontaneous reporting system and of social media coverage, while health outcome consisted of opioid-related deaths recorded in the coroner’s reports database of the province of Quebec, Canada. Trends over time in implementation of interventions were compared to trends in awareness and opioid-related deaths, without implying causality. There were 413 national or provincial interventions on opioids implemented over the study period, with a four-fold increase in 2016. The most common (31.5%) was harm reduction strategies, such as naloxone distribution. The reporting rate of opioid-related harms ranged between 0.1 and 0.2 per 100,000 persons with no observed time trend. Compared to 2015, the number of social media posts increased in 2016 by 35.4% (Reddit), 329.0% (Facebook), and 381.5% (Twitter). Between 2016 and 2019, there was a slight decrease in the number of opioid-related deaths recorded in the coroner’s database. Overall, the increase in the number of policies did not see a parallel increase in spontaneous reports of opioid-related harms as an indicator of consumer or HCP awareness. Conversely, the dramatic increase in social media coverage was consistent with heightened public awareness. Although no inferences of causality were made in this study, the decrease in opioid-related deaths observed in the recent years may indicate a potential effectiveness of interventions and policies.

Role of community health volunteers in education and promotion of birth preparedness to support maternal healthcare services in the Dadaab refugee camp, Kenya

Background/Aims Community health volunteers are used in healthcare in low- and middle-income countries around the world, based on the idea of task-shifting. Task-shifting is a strategy for making efficient use of human resources, addressing the health worker shortage and increasing universal access to healthcare. This strategy has been adopted in the Dadaab refugee camp, Kenya to provide healthcare services to refugees. The role of community health volunteers in maternal healthcare in the refugee camp has not been clearly described. This study aimed to determine the roles of community health volunteers in providing maternal education and promoting birth preparedness in the Dadaab refugee camp, Kenya. Methods This mixed-method descriptive cross-sectional study was conducted at the IFO-1 camp, in the Dadaab refugee complex. Simple random and purposive sampling were used to recruit 74 community health volunteers and five key informants (sector heads of department working with community health volunteers) respectively. The participants were interviewed using questionnaires and key informant interviews. Data were analysed descriptively and thematically. Results The community health volunteers provided education services: maternal education was provided by 93% of the community health volunteers who participated in the study. All respondents engaged women and families in birth preparations and conducted home visits, with 66 (89%) community health volunteers conducting more than two antenatal care home visits per client and assessing birth preparedness levels. However, there were variations in training on maternal healthcare and birth preparation information, with 21 (28%) of the community health volunteers having no training at all. Conclusions Despite a lack of training, community health volunteers played a significant role in supporting the provision of maternal health services in the Dadaab refugee camp through health education and promotion of birth preparedness. Community health volunteers need training on maternal healthcare to strengthen community maternal health education and birth preparedness.

"I Guess I'm On Alert All The Time": Dyadic Symptom Appraisal In Heart Failure With And Without An LVAD

Background Symptom monitoring is an essential component of heart failure (HF) self-care for HF patients with and without a left ventricular assist device (LVAD). Attention to HF symptoms by the caregiving dyad is important for prompt recognition and response. The purpose of this analysis was to characterize patient and caregiver agreement within dyads on appraisals of patient HF symptoms, and explore dyadic agreement across dyads, comparing LVAD and non-LVAD experiences. Methods This was a post-hoc analysis of a mixed-methods descriptive study of HF caregiving in dyads with and without an LVAD. We recruited HF patients and their caregivers from outpatient HF and LVAD clinics at Johns Hopkins Hospital. We administered surveys and qualitative interviews with each dyad. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS; higher scores = higher burden). We used raw difference scores to quantify the magnitude and direction of agreement within dyads. Dyads with difference scores of <|5| were considered in agreement. Dyads with difference scores ≥|5| were grouped based on the direction of agreement ([+] caregiver scored patient symptoms higher; [-] patient scored their symptoms higher). We integrated these appraisal patterns with qualitative quotations relevant to symptom appraisal. Results We enrolled 10 LVAD and 12 non-LVAD dyads. There were 7 dyads with agreement and 15 dyads with disagreement of which 6 had [+] agreement scores and 9 had [-] agreement scores. Qualitative data analysis revealed a theme common to both types of dyad relevant to symptom appraisal: “monitoring/vigilance”. However, the monitoring/vigilance described differed between LVAD and non-LVAD dyads (figure). In LVAD dyads, vigilance related to monitoring of the LVAD while non-LVAD dyads described monitoring symptoms and signs of disease progression. Dyads with agreement spoke less about monitoring/vigilance than dyads with disagreement. Dyads with higher caregiver rating of symptoms spoke of specific actions they take to monitor the patient's symptoms. Dyads with higher patient rating of symptoms described monitoring and vigilance in ways that were similar to stress. Conclusions Although quantitative comparisons were not powered to detect statistical significance, this study showed differences in HF symptom appraisal agreement and symptom monitoring behaviors between LVAD and non-LVAD dyads. Additional investigation may suggest targets for dyadic interventions to improve symptom burden, appraisal, and management. Symptom monitoring is an essential component of heart failure (HF) self-care for HF patients with and without a left ventricular assist device (LVAD). Attention to HF symptoms by the caregiving dyad is important for prompt recognition and response. The purpose of this analysis was to characterize patient and caregiver agreement within dyads on appraisals of patient HF symptoms, and explore dyadic agreement across dyads, comparing LVAD and non-LVAD experiences. This was a post-hoc analysis of a mixed-methods descriptive study of HF caregiving in dyads with and without an LVAD. We recruited HF patients and their caregivers from outpatient HF and LVAD clinics at Johns Hopkins Hospital. We administered surveys and qualitative interviews with each dyad. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS; higher scores = higher burden). We used raw difference scores to quantify the magnitude and direction of agreement within dyads. Dyads with difference scores of <|5| were considered in agreement. Dyads with difference scores ≥|5| were grouped based on the direction of agreement ([+] caregiver scored patient symptoms higher; [-] patient scored their symptoms higher). We integrated these appraisal patterns with qualitative quotations relevant to symptom appraisal. We enrolled 10 LVAD and 12 non-LVAD dyads. There were 7 dyads with agreement and 15 dyads with disagreement of which 6 had [+] agreement scores and 9 had [-] agreement scores. Qualitative data analysis revealed a theme common to both types of dyad relevant to symptom appraisal: “monitoring/vigilance”. However, the monitoring/vigilance described differed between LVAD and non-LVAD dyads (figure). In LVAD dyads, vigilance related to monitoring of the LVAD while non-LVAD dyads described monitoring symptoms and signs of disease progression. Dyads with agreement spoke less about monitoring/vigilance than dyads with disagreement. Dyads with higher caregiver rating of symptoms spoke of specific actions they take to monitor the patient's symptoms. Dyads with higher patient rating of symptoms described monitoring and vigilance in ways that were similar to stress. Although quantitative comparisons were not powered to detect statistical significance, this study showed differences in HF symptom appraisal agreement and symptom monitoring behaviors between LVAD and non-LVAD dyads. Additional investigation may suggest targets for dyadic interventions to improve symptom burden, appraisal, and management.

A cross-sectional study to assess the prevalence of health behaviors and protective factors among schoolchildren in a rural area in West Bengal.

Background:Adolescence is the most vulnerable developmental period in one’s life. In low to middle-income countries like ours, adolescence living in the rural area face increasing physical and mental health challenges that are not addressed due to ignorance or resource limitation. This study is conducted with the aim of assessing the magnitude of health behavior and protection factor among school children in the study area and to compare the same between boys and girls.Materials and Methods:An explanatory sequential mixed method descriptive observational study with cross-sectional study design was conducted on 102 students aged 15-19 years studying in a government school in Amdanga block, West Bengal. Purposive sampling was done for the quantitative part. Global school health survey questionnaire was used. Qualitative study with FGD was done after the quantitative part.Results:Out of 102 students, 58 (56.66%) re females and 44 (43.13%) are males, only 10 (9.8%) have consumed alcohol and 14 (13.72%) have consumed tobacco of some form. 15 (14.8%) students were bullied last year. Around 11 (10.8%) students had suicidal thoughts in the last 1 year. Most of them have proper hygiene behavior. Qualitative analysis revealed issues amongst both males and females regarding body image perception etc.,Conclusion:It is seen that males have more addictive behavior and gets into fighting easily then females. It is found that there are many issues regarding mental and physical health of the adolescents. That needs to be addressed and measure should be taken seriously and proper services like counseling, monitoring, parent’s support should be given.

The Role of School Engagement in Increasing Vaccination During Measles Mass Vaccination Campaign in Nigeria, 2018: The Lagos State Experience

Background: Schools based vaccination provide opportunity for the delivery of routine vaccines, using the school as the venue of delivery. During the 2017/2018 measles vaccination campaign, the school system stakeholders were systematically engaged for buy-in to vaccinate 9-59 months old children in Lagos State, Nigeria. This paper is a report of how the Lagos state school authority were engaged for the 2018 measles vaccination campaign. It also highlights the contribution of the engagement in the overall performance of the state looking at the vaccination coverage data and comparing that with the previous campaign. Method: We reported on the role of engaging the school health system in improving coverage using a descriptive mixed-method study design. The stakeholders cutting across the government, education sector, public and private schools were identified and engaged through coordination meetings, dialogues, lobby and sensitization to support vaccination in schools. We summarized the outcome of the engagement activities, analyzed the administrative, post-campaign coverage data and compared it with the 2016 measles supplemental activities coverage. Results: A total of 12,903 schools were used as venues (vaccination posts), while 22 sensitization meetings were held with school associations. About 80% of all eligible children vaccinated in the Local Government Areas (LGAs) during the 2018 Measles Vaccination Campain (MVC), received the vaccine at schools. The lowest proportion of children vaccinated at school was 45.0% in Oshodi LGA. Surulere LGA had the highest proportion of children vaccinated in schools (95.0%). Overall, Lagos state had a weighted average coverage of 93.8% for the post-campaign coverage survey. Conclusion: The implementation of the school engagement process for supplemental immunization activities contributed to achieving high vaccination coverage as most of the children aged 9-59 months were vaccinated in schools.