Exploratory Mixed Methods Study Research Articles

Exploring the impact of blended learning instruction on preservice teachers' self-efficacy beliefs in organizing educational field trips to out-of-school learning environment

Abstract The integration of the flipped classroom model, self-efficacy theory, and the value of out-of-school learning environments forms the foundation for this study. By employing the flipped classroom model, preservice teachers can develop their instructional skills and build self-efficacy in organizing educational field trips. The active, student-centered learning experiences facilitated by the flipped classroom model can enhance preservice teachers' self-efficacy beliefs, preparing them to effectively utilize out-of-school learning environments in their future teaching careers. This study aims to explore the impact of the flipped classroom model on preservice teachers’ self-efficacy beliefs, specifically in the context of organizing and conducting educational field trips. By understanding the theoretical underpinnings and practical implications, the study seeks to contribute to the development of effective teacher education practices that promote innovative and confident teaching professionals. The study’s participants were 57 preservice teachers in the science teacher education program. It was undertaken employing a sequential, explanatory mixed-methods study. The preservice teachers in the experimental group were educated using the flipped classroom model, while the control group was instructed through the conventional classroom model. The “Self-Efficacy Belief Scale for Organizing Educational Field Trips to Out-of-School Environments” and a semi-structured interview form were used to gather data. Results indicate that the flipped classroom implemented in the course has positive effect on the self-efficacy beliefs of preservice teachers towards organizing trips to out of school learning environments. Furthermore, it was concluded that the use of this model was encouraging for pre-service teachers to use it in their teaching professions.

Determinants of continuation on HIV pre-exposure propylaxis among female sex workers at a referral hospital in Uganda: a mixed methods study using COM-B model

BackgroundFemale sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda.MethodsWe conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan–Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers.ResultsOf the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21–29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3–21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation.ConclusionContinuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.

Facilitating collaboration with collaborative technology: Prerequisites and evidence from an explanatory mixed-methods study

Collaboration is widely recognized as essential for mitigating resource dependency and effectively fulfilling public responsibilities. Meanwhile, the use of information technology is expected to enhance communication and strengthen interactions among collaboration participants. Given the substantial annual investments in IT and collaboration initiatives, public managers need to understand how technology, particularly collaborative tools, can be leveraged to achieve better collaboration outcomes. This case study examines the use of collaborative technology in an intraorganizational collaboration context, employing a mixed-methods approach that begins with an experiment followed by semi-structured interviews. The findings reveal that the use of collaborative technology alone does not guarantee improvements in the collaboration process or performance. Achieving desired outcomes requires a supportive organizational and technological environment characterized by sustained leadership, thorough planning, active stakeholder engagement, robust communication mechanisms, and a commitment to continuous learning. Most importantly, genuine collaboration and engagement from all parties involved are key to success.

Factors Influencing the Use of Shave Biopsy for Lesions Suspicious of Melanoma in Australia: An Exploratory Mixed-Methods Study.

Recent Australian trends indicate that shave biopsies for diagnosing lesions suspicious of melanoma are increasing, yet reasons for this remain relatively unknown. We sought to understand which factors influence Australian clinicians' use of shave biopsy for managing thin lesions suspicious of melanoma in sites of low cosmetic sensitivity. We used a convergent, exploratory mixed-methods design, with a cross-sectional online survey (n = 59) and semi-structured qualitative interviews (n = 15). We recruited clinicians working in skin cancer medicine across Australia, mostly general practitioners (> 80%) with some dermatologists (n = 7 survey and n = 1 interview participant). Survey participants indicated how frequently they used shave biopsies and rated the importance of factors when considering the use of a shave biopsy. Interview participants elaborated on the motivating factors for using different biopsy techniques. Qualitative data were professionally transcribed and analysed with content analysis. Most survey participants (95%) reported that identifying fewer signs of locally advanced melanoma was 'very important' for using shave biopsy. Fifty per cent of survey participants also reported that faster procedure speed and greater convenience were 'very important' reasons for using shave biopsy. Procedure speed was particularly important for using shave biopsy among clinicians self-identifying as time-poor. Interview participants noted (a) the risk of transecting the lesion base or (b) incomplete lesion removal from shave biopsies as reasons against their use. The relative speed and convenience of shave biopsies in clinical practice are strong motivators for their use. Further evidence on patient outcomes with widespread use of shave biopsy is required to inform clinical guidelines.

Examining Health and Social Support Among University Housekeepers: A Mixed-Methods Exploratory Study.

This pilot, exploratory project examined the relationship among the health, work, and social support of university housekeepers. The first objective was to examine the influence of social support on work-related outcomes among university housekeepers. The secondary objective was to examine the influence of social support on physical and psychological health among housekeepers. Using a mixed-methods approach, the study assessed work-related outcomes and the influence of social support using least square regression models and multinomial logistic regression models. Qualitative data was obtained via one-on-one interviews. Participants (N = 46, 72% female; 87.2% Black) averaged 4.43 ± 0.72 for job satisfaction with stress levels occasionally high for most of the sample (75%). Support was moderate across all three types of support with the highest perceived support in tangible support (2.85 ± 0.52). Four major themes emerged from the interviews, including lack of support and trust from supervisors and administrators; lack of respect from other members of the university community; need for positive recognition; and impact of the job on health. Findings revealed that when housekeepers feel they belong and are appreciated at work, they feel more positive about their jobs and likely do better work. Housekeepers and their work are critical to students, faculty, and staff in the university system. Future research should examine existing health issues and assess for factors contributing to physical or mental health treatment, especially post-COVID. Universities should invest in wellness programming and policies supporting mental health leave to improve overall well-being and stress in this under-resourced population.

Advancing Quality and Safety Culture in Healthcare: Insights From the Evaluation of an Improvement Science Program for Nurses and Midwives.

This paper presents the outcomes and insights gained from the implementation of an Improvement Science program tailored for nursing and midwifery staff within a large local health district in New South Wales. The programme aimed to enhance frontline clinicians' confidence and capability in quality improvement, ultimately improving patient outcomes and safety culture. Through an explanatory sequential mixed-methods evaluation study, we assessed the programme's effectiveness in building capacity, sustaining practice changes and fostering a culture of continuous improvement. Quantitative data were collected through pre-post knowledge surveys, post workshop feedback and programme participation rates. Qualitative data were then collected via nine interviews with programme participants. Simple descriptive statistical analysis for quantitative data and a thematic analysis of qualitative data was undertaken. Data were then integrated from these multiple sources to gain a deeper understanding of the outcomes of the Improvement Science Program. Key findings indicate that coaching and mentoring support significantly contributed to project completion and sustained practice changes. Structured coaching sessions, collaborative team meetings, and executive sponsorship were vital components that facilitated successful outcomes. Notably, effective leadership, often demonstrated by Clinical Nurse Educators and Consultants, played a crucial role in fostering staff collaboration and participation. Insights from qualitative interviews highlight the transformative impact of the programme on participants' skills, confidence and practice. The paper concludes with recommendations for future Improvement Science programs, emphasising the importance of structured coaching, accountability mechanisms, and the identification and support of future coaches. Overall, this study underscores the value of ongoing training initiatives in promoting a culture of safety, quality improvement and enhanced patient outcomes in healthcare settings. This study had no patient or public contribution. Adherence to Standards for Reporting Qualitative Research (SRQR) EQUATOR guidelines (see Supplementary file).

An Explanatory Mixed-methods Study of "ICU net benefit": Triage and Trajectory for Sepsis and Acute Respiratory Failure.

Patients with sepsis and/or acute respiratory failure are at high risk for death or long hospital stays, yet limited evidence exists to guide triage to intensive care units (ICUs) or general medical wards for the majority of these patients who do not initially require life support. To identify factors that influence how hospitals triage patients with capacity-sensitive conditions and those factors that may account for observed ICU relative to ward, or ward relative to ICU, benefits for such patients. We conducted an explanatory sequential mixed-methods study. As part of a 27-hospital, two-health system retrospective cohort study, we calculated hospital-specific measurements of ICU net benefit for patients with sepsis and/or acute respiratory failure. Hospitals among the highest ICU net benefit and lowest ICU net benefit (or highest ward net benefit) from each study health system were selected for in-depth qualitative study. At each hospital interviews were conducted with emergency department (ED), ward, and ICU clinicians and administrators. Interview transcripts were analyzed using flexible coding and the framework method. Interviews were conducted with 118 respondents (46 physicians, 43 nurses, 5 advanced practice providers, and 24 administrators) from four hospitals. Respondents across hospitals agreed that the prediction of patient trajectory is central to triage decisions, but there was variation in opinion across work locations about optimal pre-triage ED interventions in terms of intensity, repetition, clinical reassessment, and observation duration. The main difference observed between high and low ICU net benefit hospitals related to the way respondents working in the ICU and ward described their responses to patients who experience rapid clinical deviations from triage-expected trajectories including sustained lack of critical care needs after admission to the ICU and acute critical care needs after admission to the ward. Hospitals with low ICU net benefit (or high ward net benefit) had particularly robust and proactive rapid response and clinical decompensation surveillance practices for ward-admitted patients. Particularly proactive rapid response programs that deliver on-location critical care may quantitatively increase ward net benefit by bringing ICU benefits without ICU-associated harms to ward patients who become critically ill.

Child welfare worker perspectives on documentation and case recording practices in Canada: A mixed-methods study protocol.

In health care and child welfare, clinical records and case notes serve multiple functions. When records are aggregated and processed to create administrative data, they can be analyzed and used to inform policy development and decision-making. To be useful, such data should be complete, accurate, and recorded in a standardized way. However, sources of bias and error can impact the quality of administrative data. During the development of national child welfare data in Canada, child welfare sector partners expressed concerns about the accuracy and completeness of data about children and families. This protocol describes a study that seeks to answer two questions: 1) What individual and institutional factors influence how client data is recorded by child welfare workers in Canada? 2) What data quality issues are created through documentation and case recording practices that may impact the use of clinical case management system data for public health statistics? In this protocol, we describe an exploratory mixed methods study that involves an online survey, interviews with a purposive sample of child welfare workers, and a document review of case recording guidelines. To be eligible for the study, participants must have worked at a child welfare agency or department with clinical documentation responsibilities as a part of their job. We will use descriptive statistics to analyze the survey data and thematic analysis to analyze the qualitative data. This study will help uncover strengths, limitations, and possible sources of bias created through case recording and documentation practices in child welfare. Study results will be shared through presentations to interest holders and will inform the further development of national child welfare data in Canada.

Unpacking Performance Factors of Innovation Systems and Studying Germany’s Attempt to Foster the Role of the Patient Through a Market Access Pathway for Digital Health Applications (DiGAs): Exploratory Mixed Methods Study

Background Health care innovation faces significant challenges, including system inertia and diverse stakeholders, making regulated market access pathways essential for facilitating the adoption of new technologies. The German Digital Healthcare Act, introduced in 2019, offers a model by enabling digital health applications (DiGAs) to be reimbursed by statutory health insurance, improving market access and patient empowerment. However, the factors influencing the success of these pathways in driving innovation remain unclear. Objective This study aims to identify the key performance factors of the innovation system shaped by the patient-relevant structural and procedural improvement (pSVV) pathway within the DiGA model. By examining how this pathway supports the entry of innovative digital health technologies, we seek to uncover the systemic dynamics that influence its effectiveness in fostering patient-centered digital health solutions. Methods This study, conducted from May 2023 to November 2024, used a mixed methods approach. A descriptive analysis assessed how DiGA manufacturers use positive health care effects, giving a market overview of the pSVV technology. A qualitative analysis using grounded theory and Gioia methodology provided insights into stakeholder perspectives, focusing on manufacturers and regulatory bodies. A functional-structural analysis examined how components of the innovation system, such as actors, institutions, interactions, and infrastructure, interact and impact the effectiveness of the pathway. Results The descriptive analysis showed that only 11 (20%) of the 56 DiGAs available in Germany used the pSVV pathway, with only 1 (2%) provisionally listed DiGA using pSVV as a primary end point; 6 of 9 (67%) pSVV key areas were used. The qualitative analysis revealed that manufacturers prioritize demonstrating medical benefits over pSVV due to evidence requirements and uncertainties around pSVV acceptance. Operational barriers hindered the adoption of pSVV, despite a positive reception among stakeholders. The systemic analysis identified key issues, including a lack of entrepreneurial focus on pSVV, limited regulatory experience, inadequate measurement methods, and entrenched practices prioritizing medical benefits, that hinder market formation and legitimacy. Conclusions This study identifies key factors for effectively implementing innovation systems through regulated market access pathways, including content and format security, clearer framework specification, active innovation process management, and market formation stimulation. Addressing these factors can reduce uncertainties and promote wider adoption of digital health technologies. The findings highlight the need for future research on patient empowerment and the development of methodologies beyond traditional therapeutic outcomes.

Returning to Work After Cancer Treatment: An Exploratory Sequential Mixed-Methods Study Guided by Transitions Theory.

Although many individuals return to work after cancer treatment, supports to facilitate this transition are ineffective or lacking. Transitions Theory can be useful to conceptually explain the transition back to work after cancer; however, no known studies have used Transitions Theory to empirically examine this transition. To explore how and why Transition Theory concepts can be used to understand individuals' transition back to work after cancer treatment. Using an explanatory sequential mixed-methods design, breast or colorectal cancer survivors who had returned to work completed questionnaires aligned with Transitions Theory concepts. Spearman correlations were used to explore associations, and significant results were used to draft interview questions. One-to-one telephone interviews with a subsample of participants provided elaborations to quantitative results. Qualitative data were analyzed using template analysis. Among the 23 participants who returned questionnaires, most identified as female (n = 21 [91%]) and had been back at work for 28.9 months (range, 3-60). The sample's productivity loss was 7.42%, indicating an incomplete mastery of their return to work. Only 2 significant associations were revealed with higher productivity loss: higher anxiety (r = 0.487, P = .019) and a greater number of unmet relational needs (r = 0.416, P = .048). Twelve participants engaged in interviews wherein explanations for quantitative results were uncovered. To support a smoother transition back to work after cancer, assessment and interventions should focus on individuals' psychological well-being and relationship needs. Transitions Theory can be useful in developing interventions to support a successful return to work after cancer.

How People React to the Termination of an Intimate Relationship: An Exploratory Mixed-Methods Study.

Intimate relationships frequently come to an end, and in the current research, we have endeavored to examine how individuals would potentially react in the scenario where their intimate partner decides to terminate a relationship they wish to continue. More specifically, employing open-ended questionnaires on a sample of 219 Greek-speaking participants, we identified 79 possible reactions. Subsequently, using close-ended questionnaires on a sample of 442 Greek-speaking participants, we categorized these reactions into 13 broad factors. Participants indicated that they were more likely to feel sadness, inquire of their departing partners why they wish to end the relationship, and attempt to divert their thoughts elsewhere to avoid dwelling on the end of the relationship. Men indicated a higher likelihood than women to seek revenge sex, although significant sex differences were not observed in other reactions. Furthermore, we classified these 13 factors into three broader domains. The highest-rated domain was "Accept and forget," followed by "Sadness and depression," and "Physical and psychological aggression." These findings could enable us to gain a better understanding of the process of relationship dissolution, and could potentially be employed to identify and prevent reactions that may have harmful repercussions for the individuals involved in the relationship.

Exploring Self-Management Behavior Profiles in Patients with Multimorbidity: A Sequential, Explanatory Mixed-Methods Study.

This study aims to identify self-management behavior profiles in multimorbid patients, and explore how workload, capacity, and their interactions influence these profiles. A sequential explanatory mixed-methods design was employed. In the quantitative phase (August 2022 to May 2023), data were collected from 1,920 multimorbid patients across nine healthcare facilities in Zhejiang Province. Latent Profile Analysis (LPA) was used to identify distinct self-management behavior profiles. Multinomial logistic regression was then used to assess the influence of workload and capacity dimensions (independent variables in Model 1), as well as their interaction (independent variables in Model 2), on these profiles (dependent variables in two models). The qualitative phase (May to August 2023) included semi-structured interviews with 16 participants, and the Giorgi analysis method was used for data categorization and coding. Quantitative analysis revealed three self-management behavior profiles: Symptom-driven Profile (8.0%), Passive-engagement Profile (29.5%), and Active-cooperation Profile (62.5%). Compared to the Active-cooperation Profile, both the Symptom-driven and Passive-engagement Profiles were associated with a higher workload (OR > 1, P < 0.05) and lower capacity (OR < 1, P < 0.05). An interaction of the overall workload and capacity showed a synergistic effect in the Passive-engagement Profile (OR = 1.08, 95% CI = 1.03-1.13, P < 0.05). Qualitative analysis identified six workload themes, and related coping strategies of three self-management behavior profiles. The integrated results highlighted distinct characteristics: Symptom-driven Profile patients exhibited reactive behaviors with limited health awareness, Passive-engagement Profile patients reduced engagement once symptoms stabilized, while Active-cooperation Profile patients proactively managed their conditions. Identifying three distinct self-management behavior profiles and their relationship with workload and capacity provides valuable insights into multimorbid patients' experiences, emphasizing the need for tailored interventions targeting workload and capacity to improve health outcomes.

Advance care planning readiness, barriers, and facilitators among seriously ill Black older adults and their surrogates: A mixed methods study.

Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates. We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What "matters most" and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results. Older adults (N=30) and surrogates (N=12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes - illness experience, social connections, interaction with health providers, burden - supports identification of barriers and facilitators to ACP engagement. We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

Impact of Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study

Impact of Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study

US MEN’S SHEDS: MAINTAINING PURPOSE AND CONNECTION WITH OTHERS

Abstract The purpose of this study was to explore U.S. Men’s Sheds, learn how they operate, who attends them, and how participants perceived them. It is the first study exploring Men’s Sheds in the U.S. An explanatory sequential mixed methods study was conducted, and paper-based surveys were sent to sheds registered with the U.S. Men’s Sheds Association. Shed chairpersons encouraged members to complete surveys (N = 76), and results showed that most members were male (91%), older adults (M = 70), in good/excellent health (76%), and joined to make new friends or learn new skills. Four interviews were also conducted and two themes and a subtheme were noted. Theme 1: Purpose of the Men’s Shed represented the varied perspectives on what the Men’s Shed was meant to do for the community. Some members saw it as an extension of the church and felt it was important to share religious perspectives with the community, while others disagreed. A Subtheme on Serving the Community was also noted where members did agree on the importance of serving the community. Theme 2: Building Connections- Possibilities and Challenges illustrated the opportunities Men’s Sheds create for men in/approaching retirement. However, the lack of a formal space for members to meet was a barrier and reduced informal socializing that might otherwise occur. These findings revealed that many of the men joined because they wanted something worthwhile to do with their time. The interviews revealed that there may be opportunities to start Men’s Sheds within existing faith- based organizations.

Construction and Validation of a Secure-base Leadership Model in Educational Organizations: A Mixed-methods Exploratory Study

There is no doubt about the importance of leadership and attachment styles on individual behavior and organizational outcomes. However, researchers have neglected to apply and integrate attachment concepts in management and organizational studies for years. One of the basic concepts in attachment theory is the secure base. In 2010, Coombe considered the application of this concept in leadership, which resulted in representing the theory of secure base leadership. The present study aimed at constructing and validating a secure base leadership model. The research method is a mixed exploratory method composed of qualitative and quantitative measures including thematic analysis and survey, respectively. The participants of the qualitative section were 14 faculty members, specialists, and experts in the field of educational management and psychology selected using the purposive sampling method and snowball technique. Besides, the participants of the quantitative part included 441 administrative staff and teachers in Tehran were by cluster sampling. Open, axial, and selective coding was used to analyze interview data in the former part, while in the latter, structural equations were used. The results of the qualitative analysis indicated that secure base leadership includes three main aspects, namely security (accepting people (acceptance), support, providing security, mutual trust, independence, fairness, staying calm (controlling and adjusting emotions)), exploration (risk-taking, increasing individual capacities, being responsive and sensible, intellectual stimulation), and deep intellectual bond (positive attitude, high emotional capacity, transparency in relationships, compatibility, being a good listener). Also, the quantitative part of the research results showed validity and reliability as well as a good fit of the proposed model.

Acceptability of a resource-oriented approach (DIALOG+) among patients with chronic physical illnesses in primary health care-Uganda, a qualitative study

BackgroundChronic physical illnesses are often associated with significant psychological distress and chronic mental illnesses are often co-morbid with physical illnesses. Efforts to integrate mental health into primary health care in Uganda are underway. However, there are enormous logistical challenges. Effective resource-oriented and evidence-based interventions such as DIALOG + have the potential to improve treatment outcomes for patients with chronic conditions. We aimed to assess the acceptability of DIALOG + among patients with chronic physical illnesses in Uganda.MethodsThis was a qualitative aspect of a mixed methods exploratory non-controlled study conducted in chronic physical illness out-patient clinics at two hospitals in Uganda. We conducted fifteen in-depth interviews with patients, ten key informant interviews with clinicians, and four focus group discussions with patients. Thematic data analysis was done through an iterative process.ResultsThe results support the acceptability of the intervention as evidenced by willingness to participate, better relationships between patients and clinicians, and improved control of both physical illnesses and psychological distress. Participants also talked about ways in which the implementation of DIALOG + could be improved.ConclusionDIALOG + is acceptable among patients with chronic physical illness in primary health care settings in Uganda.

Evaluating quality of life changes in patients with cleft lip or palate: a mixed method pre- and postsurgical analysis in Karachi

BackgroundCleft lip and/or palate (CLP) is the most common orofacial congenital disability, presenting significant medical, psychological, and social challenges. In Pakistan, the incidence of CLP is high, estimated at one in 523 live births, but accurate data are lacking due to the absence of a birth registry. Early diagnosis and intervention are crucial for improving outcomes. This study evaluated the impact of CLP on patients’ quality of life in Karachi, comparing pre- and post-surgical phases.MethodsA sequential exploratory quantitative-qualitative mixed-methods study was conducted at two tertiary care hospitals in Karachi. In the quantitative phase, 280 patients with CLP, either awaiting or post-surgery, completed the Oral Health Impact Profile (OHIP-14) questionnaire to assess oral health-related quality of life (OHRQoL). Based on questionnaire responses, 30 participants were purposively selected for in-depth, semi-structured interviews exploring their experiences. Quantitative data were analyzed using SPSS version 25; qualitative data were analyzed thematically.ResultsQuantitative findings revealed significant gender disparities in cleft types and correction status; females had a higher prevalence of unilateral cleft lip, while males had more cleft palate cases. Dental and oral health issues significantly affected daily activities, with higher impacts in cleft palate patients. OHRQoL varied by gender, cleft type, and correction status, with those post-surgery reporting poorer OHRQoL. Qualitative analysis identified six themes: Diagnosis and Early Treatment, Challenges and Impact, Postsurgical Experiences, Support Systems, Healthcare Experiences, and Future Perspectives. Inconsistencies in psychological support, accessibility and financial burdens were presented as significant issues. Sentiment analysis highlighted varied emotions, from despair to hope and gratitude.ConclusionsCLP significantly affects patients’ quality of life in Karachi across multiple dimensions. Early diagnosis and surgical intervention are essential but often hindered by financial and accessibility issues. Psychological effects, including low self-esteem and social isolation, highlight the need for integrated mental health support. Family and community support are critical for patient resilience. A comprehensive approach addressing medical, psychological, social, and systemic factors is necessary to improve outcomes for individuals with CLP.

Teacher Mental Health and District Employee Support in Rural Communities: A Sequential Exploratory Mixed Methods Study

Although existing research explores the need for mental health for students in P-12 schools, scholarship regarding mental health needs and support for teachers is lacking, particularly in rural contexts. This study used sequential exploratory mixed methods to explore mental health needs and support in school districts in a predominantly rural state. Analysis included qualitative survey data from P-12 teachers in school districts about how teaching impacts mental health, and a quantitative analysis of employee assistance programs in participant school districts. Findings demonstrated teachers struggling with mental health, and a lack of employee support available. Implications and exploration of district policy are discussed.

Implementing primary care concepts in higher education: a mixed method study in Flanders (Belgium)

BackgroundThe policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation.MethodsA sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated.ResultsThe results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction.The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies.ConclusionsThe study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.