Explanatory Sequential Mixed Methods Design Research Articles

Structure and process evaluation of complex interventions in pain therapy : Description of amethodological approach using the example of POET-Pain

To evaluate the quality of care, particularly in the case of new forms of healthcare interventions, the healthcare services to be provided are defined and documented in advance. The presented explanatory sequential mixed methods design combines quantitative and qualitative data collection and the analysis enables adeeper understanding of anew healthcare intervention. Using the example of the POET-Pain project, which investigates the effect of aperioperative transitional pain service (TPS), the methodological application of the explanatory sequential mixed methods design is demonstrated in order to present the structural and process evaluation of the new healthcare intervention (in this case TPS) and to understand its influence on the quality of care. The mixed methods design presented enables the results of the quantitative phase to be interpreted and expanded in depth using qualitative data, which leads to acomprehensive understanding of the subject matter (second pillar of health services research).

Eyes on communication: strategies to facilitate uptake of clinical practice guidelines for implementation of eye-gaze control technology by people with cerebral palsy. A mixed methods study

Guidelines for implementation of eye-gaze control technology by people with cerebral palsy were published in 2021. The purpose of this study was to identify barriers and facilitators clinicians perceive exist relating to use of these guidelines for eye-gaze control technology, and to explore potential resources that may be developed to support their implementation. A two-phased mixed methods explanatory sequential design was adopted. In phase 1, an online survey containing quantitative and open-ended questions was completed by 97 health professionals and in phase 2 two online focus groups of five clinicians were conducted. The guidelines for eye-gaze control technology were considered helpful for clinicians new to eye-gaze control technology, useful to provide insight into processes for implementing eye-gaze control technology, were flexible, supported clinical reasoning and professional credibility, and were easy to use. However, time to read the guidelines for eye-gaze control technology, and insufficient funding for time to implement the technology were prominent barriers identified in this study. Through the qualitative findings four themes emerged: (1) Complexity of learning to use and implement the guidelines for eye-gaze control technology; (2) Time and resources in short supply; (3) Takes a dedicated team working together; and (4) guidelines for eye-gaze control technology informing practice. Participants in both study phases identified: case studies and video examples; education and training; and practice in implementing eye-gaze control technology, as facilitators to aligning their practice with the guidelines for eye-gaze control technology recommendations and to optimise outcomes.

A pilot evaluation of school-based LEGO® robotics therapy for autistic students

There is emerging evidence that LEGO® therapy is an effective way of supporting younger autistic children develop their communication and social skills. LEGO® robotics therapy – which uses the principles of LEGO® therapy applied to LEGO® robotics – may be an age-appropriate intervention to reduce anxiety and increase social skills in autistic adolescents. The aims of this study, involving 24 autistic students aged 13–16 years, were to examine (a) the effect of an 8-week LEGO® robotics therapy on students’ anxiety, social skills, academic motivation, and engagement, and (b) the views and perceptions of all stakeholders (students, parents, school staff and facilitators) regarding the program. An adapted explanatory sequential basic mixed-methods design was used. Groups of three students supported by two facilitators participated in the LEGO® robotics therapy for eight sessions at school. Quantitative data was collected before and after therapy using the Anxiety Scale for children-Autism Spectrum Disorder, Social Skills Improvement System and the Motivation and Engagement scale. Qualitative data was collected using open-ended online questionnaires, interviews, and focus groups from all stakeholders. No statistically significant within group differences were found in relation to students’ anxiety, social skills, motivation and engagement before and after the program. Qualitative findings indicated predominantly positive student experiences and outcomes such as better school attendance, increased confidence, and social skills. The findings suggest that LEGO® robotics therapy may be associated with a range of nuanced positive experiences and outcomes for individuals and groups of students, suggesting potential value in further efforts to refine the program.

Development and Validation of a Novel Tool to Measure Medication Adherence for Noncommunicable Diseases in India: Protocol for an Exploratory Sequential Mixed Methods Multicentric Study.

In high-income countries, only 50% of patients treated for chronic diseases adhere to the prescribed treatment. This issue is even more pronounced in resource-limited countries. Medication adherence scales are simple, low-cost approaches to identify nonadherence in clinical practice. In India, nonadherence to medication varies from 18.7% to 74%, assessed using scales validated in the Western population, as there is no validated medication adherence tool contextualized to the Indian setting. The phrasing of questions in scales validated elsewhere and its interpretations may vary when applied in Indian patients unless accounting for the unique cultural, social, and economic factors influencing medication adherence in India. This could result in inaccurate reports of adherence behavior. This study aims to develop and validate a novel medication adherence tool for select noncommunicable diseases (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, bronchial asthma, and coronary artery disease) in the Indian population. An exploratory sequential mixed methods design will be used, beginning with a qualitative phase where the construct of the scale is defined and preliminary items are generated through a scoping review, focus group discussions, and in-depth interviews. This will be followed by the tool's development phase, including an expert panel review and item revision. Finally, a quantitative phase in 4 zones in India (North, South, East, and West) will be conducted to confirm and validate the newly developed scale. In the first phase, we will frame the construct definition and develop an inventory of potential items for the proposed medication adherence tool. In the second phase, item-level and scale-level content validity indices, along with content validity ratio, will be estimated. In the third phase, we will conduct an item reduction analysis and determine the scoring matrix and item weightage after expert review. We will assess the tool's psychometric properties, plot the receiver operating characteristic (ROC) curve to set an adherence cut-off score, and compute the construct validity and test-retest reliability from the quantitative survey. A medication adherence tool for noncommunicable diseases, developed after ensuring it is ethnically, culturally, and linguistically appropriate incorporating stakeholder perspectives and validated in community settings, would offer a real-world perspective of adherence. The tool will have 2 versions for clinical practice and research, aiding policy makers in adopting tailored adherence policies. PRR1-10.2196/60805.

Navigating The Duality: Privacy And Security Concerns In Knowledge Management Systems (KMS)

This study delves into the intricate relationship between privacy and security within Knowledge Management Systems (KMS). It identifies and analyzes distinct employee perceptions of these intertwined issues within a company's KMS environment. By exploring these perspectives, the authors aim to dispel the confusion surrounding privacy and security in KMS settings. The research employed an explanatory sequential mixed method design. First, a questionnaire survey was distributed directly to KM staff across three companies. This was followed by semi-structured interviews with four KM staff members. The findings reveal a high level of employee awareness regarding the importance of KMS and, consequently, the significance of personal information privacy and security. The study further distinguishes between privacy and security concerns within KMS. Privacy concerns, differentiated across three dimensions: confidentiality, trust, and behavior, are primarily viewed from the organizational layer. Security aspects, on the other hand, are seen as aligned with the ICT layer, governed by legal frameworks and KMS architecture.

Bee The CURE: Increasing Student Science Self-Efficacy, Science Identity, and Predictors of Scientific Civic Engagement in a Community College CURE.

"Bee the CURE" is a Power-of-Place course-based undergraduate research experience (PoP-CUREs; Jaeger et al., 2024) that combines place-based education (Demarest, 2014; Gruenewald, 2014) with CUREs, emphasizing student scientific civic engagement where research is relevant to the community where the research is taking place. PoP-CUREs have potential to build students' knowledge, skills, value, and self-efficacy when engaging with the public using science skills (i.e., scientific civic engagement). A mixed-methods sequential explanatory design utilizing surveys and semistructured interviews was used for this study (Warfa, 2016). Students made gains in science self-efficacy over the course of the semester and showed a trend of increasing science identity in both Fall 2021 and Spring 2022 semesters. Students' scientific civic knowledge, or a student's sense of how to use or apply knowledge and skills to help a community, increased significantly, while other predictors of scientific civic engagement started high and remained high throughout the course. Bee the CURE demonstrates psychosocial outcomes that are similar to previously studied CUREs and expands our understanding of how PoP-CUREs might influence outcomes with evidence that an important predictor of future scientific civic engagement increases. Implications for PoP-CURE instruction at Hispanic serving community colleges are discussed.

A national perspective of ambulance clinicians’ perceptions, experiences and decision-making processes when assessing older adults with a head injury: a mixed-methods study

Introduction: UK ambulance services employ diverse models of care, resulting in 40‐60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60 years and over) remain high (60‐70%), despite most being mild. This research aimed to explore ambulance clinicians’ perceptions, experiences and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions.Methods: This study used a mixed-methods sequential explanatory design comprising an online survey and one-to-one interviews with patient-facing ambulance clinicians in the UK. The survey, distributed through nine ambulance services and via social media, gathered data about clinicians’ experiences, confidence levels and perceptions when assessing older adults with head injuries. It focused on exposure frequency, confidence in assessing asymptomatic patients, perceived risks of medications and confidence in available decision tools. The subsequent interviews delved deeper into the survey responses.Results: A total of 385 participants were recruited, predominantly male paramedics (61%), with a median age of 35 years and a median of eight years of ambulance service experience. Participants reported frequent encounters with older adults with head injuries, and expressed high confidence in assessing visible injuries but lower confidence in conducting neurological examinations. Participants found NICE and JRCALC guidelines satisfactory, and reported confidence in conveying patients to the ED but less confidence in alternative referrals or discharges. The interviews revealed two overarching themes: guideline-based care and patient-centred care, with sub-themes emphasising the importance of shared decision making, collaboration with other healthcare professionals and safety-netting strategies.Conclusion: Although clinicians express confidence in using clinical guidelines for ED conveyances, they often find such guidance overly prescriptive and struggle to translate them for individual cases. There is a need for more patient-centred, holistic decision making, especially considering the unique aspects of head injuries in older adults. Challenges include fear of poor outcomes, limited feedback on patient outcomes and low confidence in making referral or discharge decisions. Specific guidelines tailored to this demographic, as well as improved support services, may aid in reducing unnecessary ED conveyances.

포스트 코로나 시대 학교상담자의 효과적인 비대면 상담 기술과 제한점 탐색

Purpose: This study investigated non-face-to-face counseling skills that could be effectively utilized by school counselors in the post-COVID-19 era, aiming to enhance their counseling competence. Methods: To achieve this objective, a sequential exploratory mixed methods design incorporating both quantitative and qualitative research approaches was employed. A total of 13 school counselors with extensive experience in non-face-to-face counseling participated in the study, and they were categorized into three groups based on educational stages: elementary, middle, and high schools. Focus Group Interviews (FGI) were selected as the qualitative research method to collect data on the usability, effectiveness, and limitations of non-face-to-face counseling skills that have been employed over the past three years. Data collected from FGIs was analyzed according to the roles based on the National Model by the American School Counselor Association. Additionally, a questionnaire was developed to assess the usability and effectiveness of these skills, ensuring objectivity of effective non-face-to-face counseling skills and distribution later in the field. Results: Subsequently, a survey targeting proficient school counselors in non-face-to-face counseling was conducted to perform descriptive statistical analysis. Six effective non-face-to-face counseling skills related to instructional aspects were found along with five limitations. Additionally, five effective counseling skills related to appraisal and three limitations were identified, as well as six effective counseling skills and five limitations pertaining to counseling-relevant skills. Conclusion: Based on the research findings, effective counseling skills and limitations for school counselors in the post-COVID-19 era were discussed and recommendations for theirapplication were suggested.

Investigating EFL instructors’ approaches to classroom-based assessment culture: an explanatory sequential mixed-method approach

Based on sociocultural theory and pragmatism philosophical underpinnings, this study explores the classroom assessment practices of tertiary EFL practitioners, focusing on their alignment with contemporary constructivist assessment trends, methods, and approaches, rather than psychometrical assessments. The study extends knowledge on language teachers’ preparedness for implementing classroom assessment literacy. Participants were tertiary EFL instructors from four higher educational institutions in Saudi Arabia. Adopting an explanatory sequential mixed-methods research design, data were collected through self-reported questionnaires, classroom observations, and a review of assessment documents and artifacts. Descriptive statistics were used to analyze quantitative data and thematic analysis qualitative data. The dominance of traditional over alternative assessment methods was demonstrated, indicating gaps in teachers’ classroom assessment literacy. The findings highlight the contradiction, discrepancy, and complexity of the relationship between teachers’ articulated and exercised assessment practices. They provide baseline data for L2 classroom assessment policy, a classroom-based assessment framework, and a guide for teachers’ professional development in language assessment literacy.

Key factors for inappropriate supplement intake in risk-taking users: An exploratory sequential mixed-methods pilot study in Japan.

This study identified the control factors of inappropriate supplement intake to support public agencies in preventing health problems. We used an exploratory sequential mixed-method design with the integrated behavioral model (IBM). Control factors in the IBM were identified with 95 participants. The highest impact behavioral change was established for the following two out of 19 control factors: "I trust others' blogs as a source of information when they post the bad as well as the good" (r = -0.324, p < 0.001) and "I can control any health problems by adjusting the amount and frequency of my supplement intake" (r = -0.308, p < 0.001). The findings suggest that when providing safety information on supplement use, it is important to: (1) disseminate information to online communities of supplement users who share knowledge based on real experiences and (2) effectively demonstrate the risks associated with continued supplementation.

Does access to and use of primary healthcare services influence health insurance uptake? A mixed-methods study in the Wa Municipality, Ghana

ABSTRACT Purpose This study explored access to quality primary healthcare services under Ghana's National Health Insurance Scheme (NHIS), its impact on NHIS enrolment, and the implications for attaining Universal Health Coverage (UHC). Methods A sequential explanatory mixed-method research design was employed using a multistage sampling technique. We collected data from 413 insured individuals and 47 healthcare facilities for quantitative community-level analysis using questionnaires. Purposive sampling was used to select 17 healthcare providers and 20 insured key informants for qualitative investigation using interview guides. Quantitative data were analyzed using descriptive statistics, independent t-tests, and binary logistic regression. Qualitative data were thematically analyzed to explain the quantitative findings. Results The results indicated a positive association between outpatient and inpatient services, maternal healthcare, and laboratory testing. Maternal healthcare and laboratory diagnostics positively influenced the renewal of NHIS membership. Binary logistic regression revealed that access to, and utilization of PHC services significantly increased the likelihood of NHIS membership renewal, influenced by healthcare system factors such as service availability, acceptability, and affordability. Conclusion Our findings suggest that policymakers must enhance the NHIS with improved service delivery to attain UHC in Ghana.

Insights into Health Program Implementation and Evaluation in Iran: A Brief Review of National Healthcare Programs in Iran.

Healthcare program monitoring can play a key role in evaluating their implementation and identifying their strengths and weaknesses. This study was performed with the exploratory sequential mixed methods design in 2023 at Tehran, Iran. The information was categorized into indicators, refining, analysis, interpretation, reporting, and proposed challenges and recommendations. Medical Sciences Department of Public Health (TUMSDoPH) evaluation of its public health programs revealed a comprehensive approach covering a wide spectrum from disease management to health promotion, emphasizing electronic health records, targeted disease interventions, and strategies for non-communicable diseases, alongside efforts to enhance community health. There is a need for initiating "the monitoring committee" under the supervision of the deputy chancellor for public health to monitor key performance indicators and policies to discover the problems of each part of the health system and provide recommendations.

Experiences of gender-affirming healthcare among transgender and gender diverse (TGD) people during the COVID-19 pandemic: an explanatory sequential mixed methods study

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.

Perception of caregivers on ITNs utilisation and its effectiveness among children under 5 years of age in Chikwawa district, Malawi

BackgroundIn 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017–2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers’ perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them.MethodsThis study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children’s caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran’s formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively.ResultsThe study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment.ConclusionThe study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

Emotion and cognition in customer experience: a mixed-method study on loyalty formation in the hospitality sector

PurposeThis study investigates the dual roles of emotion and cognition in shaping customer experiences within the hospitality sector, examining their distinct impacts on the formation of customer loyalty.Design/methodology/approachEmploying a sequential exploratory mixed-method design, this research integrates qualitative interviews with eighteen hospitality managers and a quantitative survey involving 595 customers to develop and validate a new instrument measuring affective and cognitive experiential states for general hospitality consumers.FindingsThe study's results reveal that emotional experiences strongly correlate with affective loyalty, while cognitive experiences significantly influence cognitive loyalty. The study contributes to the existing literature by introducing a robust instrument that effectively captures the experiential dimensions, offering insights into customer loyalty formation.Research limitations/implicationsThe reliance on retrospective self-reporting in the quantitative phase may introduce recall bias, potentially limiting the precision of the findings. Future research should seek to mitigate this by employing real-time data capture methods.Practical implicationsThe newly developed measurement tool presents a practical solution for industry professionals aiming to enhance customer experience management by focusing on both affective and cognitive aspects, thus facilitating targeted strategies to cultivate customer loyalty. The implications for service design suggest that both emotional and cognitive elements must be considered to optimize customer experiences and drive loyalty.Originality/valueThis work advances the theoretical understanding of customer experience by distinguishing between its affective and cognitive dimensions and their respective contributions to loyalty. It offers a validated empirical tool, setting a foundation for future investigations.

What Comes After the Algorithm? An Investigation of Journalists’ Post-editing of Automated News Text

ABSTRACT Journalists often perceive that automated journalism produces news texts that lack narrative and editorial quality. Therefore, they sometimes manually edit automated output before publication, creating so-called “post-edited” variants. Using an exploratory sequential mixed-methods design, this study aims to advance research on automated journalism by investigating the steps journalists say they take when post-editing and testing whether—and if so, how—these steps are reflected systematically on a larger scale in post-edited news texts. First, journalists’ statements about the post-editing process were gathered in semi-structured interviews. Then, qualitative content analysis of automated news stories and their post-edited offspring examined whether post-edited stories contain evidence of forms of editing not mentioned by the journalists. Second, the qualitative findings were investigated quantitatively using comparative content analysis (N = 282). The qualitative findings suggest that a range of editorial steps may be taken during post-editing. The quantitative analysis shows that some of these steps are reflected systematically in post-editing, resulting in significant differences between automated news stories and their post-edited offspring. However, findings also show differences between journalists’ reports and post-editing practice on a larger scale, including evidence that forms of editing were taking place that were not mentioned in the interviews.

Comparing the psychological impact of the Shanghai lockdown on local and non-local college students: an explanatory sequential mixed method approach.

In 2022, the Shanghai municipal government enforced strict COVID-19 lockdown measures. Lockdown experiences for college students varied. Local students normally returned home and had familial support while non-local students relied more on institutional support when quarantining in dormitories. The difference could profoundly impact their access to necessary material resources and emotional support, affecting their mental health. This study compared the psychological effects of the Shanghai Lockdown on local and non-local college students using an explanatory-sequential mixed methods design. Quantitative analyses of data from 327 college students examined local and non-local students' mental health outcomes during the lockdown. Follow-up qualitative interviews (N = 12) contextualized their sources of stress and group differences. Higher prevalences of probable anxiety (34.6%), depression (45.1%), and poor subjective mental well-being (65.4%) are found among non-local students compared to local students (23.7% anxiety, 29.4% depressive symptoms, and 47.9% poor well-being). Suicidal ideation was higher among local students (8.6% prevalence difference). Being a non-local college student was associated with increased odds of probable anxiety, depression, and poor well-being. Interviews identified group differences such that non-local students received more school support (i.e., food and financial) and perceived emotional support but faced poorer quarantine living environments compared to local peers. Non-local college students were more vulnerable to the impact of lockdown. Our findings also provide insights into the impact of familial versus institutional support on student mental health during times of crisis.

Ethnic differences in pre-hospital ambulance care in the UK: a mixed method study

BackgroundThe Equality Act 2010 ensures fair access to healthcare services by eliminating discrimination. Previous research indicates that ethnic minority communities are more likely to face significant disparities in prehospital ambulance care. The aim of this study was to identify barriers and facilitators associated with ambulance response in ethnic minority communities in the East Midlands region in the UK. MethodsWe used an explanatory sequential mixed methods design. First, in a cross-sectional design, we analysed retrospective electronic clinical data from East Midlands Ambulance Service NHS Trust (EMAS). Multivariable logistic regression analysis was used to identify ethnic differences in ambulance transportation whilst accounting for confounders including age, gender, ethnicity, NEWS2 score, socio-economic deprivation, and urban or rural place of attendance. Second, a qualitative study used online semi-structured interviews with purposive sample of ethnic minority patients who used EMAS. Thematic analysis was used to explore barriers and facilitators. FindingsThe observational study included 2 324 439 clinical records from Jan 1, 2018 to Dec 31, 2021. After adjusting for confounders, Asian (odds ratio [OR] 0·81, 95% confidence interval [CI] 0·80, 0·82), Black (OR 0·90, 95% CI 0·88, 0·93), and Mixed ethnicity patients (OR 0·92, 95% CI 0·89, 0·95) were significantly less likely than White British patients to be conveyed to hospital. The qualitative study included 11 individuals from mainland European countries, Asian, Black, and Mixed ethnicities. We identified five main barriers including delays in ambulance arrival, high costs for uninsured, language barriers, racism, and trust issues with ambulance staff. We also found that cultural and communication training for ambulance staff, and better-equipped ambulances were key facilitators for ensuring effective ambulance care. InterpretationProviding financial support and promoting awareness of available resources for transportation costs, along with implementing cultural competency training for ambulance staff, are steps that will help to eliminate ethnic minority disparities. Further research is needed given the varying requirements of heterogeneous and diverse ethnic minority communities. FundingThe Türkiye Ministry of National Education supported this research.

Critical incidents in schools. Staff wellbeing and perceptions of psychological support

AimsAcross the United Kingdom (UK), schools are required to respond to and support students, families and staff following a traumatic event and Educational Psychology (EP) Services often provide support to schools. This study explored school staff wellbeing in the context of critical incidents in schools along with their views and perspectives of psychological support.MethodsAn explanatory sequential mixed methods design was utilised consisting of two phases. In phase one, quantitative data was collected through an online questionnaire which gathered information on staff wellbeing, the impact of the event and EP support. For phase two, interviews explored staff perspectives on the support provided by the EPs.FindingsAnalysis found a significant positive relationship between wellbeing and EP support. Themes provide insight into the impact of the support provided by the EPs, including barriers and negative perceptions of the support as well as benefits.LimitationsIt is likely that there is a selection bias operating in teachers who chose to take part in the research. Additionally, the number of teachers taking part was not as high as might have been hoped for.ConclusionsA number of implications and conclusions are set out. In particular, effective articulation of what support will look like and being clear what is offered by an EP service is a crucial element of the support provided.

Preventive Practices of Hantavirus in a Rural Community in Panama: An Explanatory Sequential Mixed Methods Study.

Preventive care practices are a challenge in community care. This study examined hantavirus preventive practices and their relationship with personal and social factors, lifestyle, and cultural beliefs. An explanatory sequential mixed methods design, guided by Leininger's Theory of Culture Care Diversity and Universality, was used in two phases: (a) a cross-sectional relational design (n = 109) and (b) ethnonursing research (n = 30), in an endemic community in Panama. Univariate and bivariate analyses were used to analyze the quantitative data, whereas the Leininger's analysis model was used to analyze the qualitative data. In the quantitative phase, the most frequent preventive practice was household hygiene, and the least frequent was vector control. Two of the eight preventive practices were associated with personal factors and two were associated with social factors. In the qualitative phase, lifestyle, beliefs, and context were found to influence the adoption of hantavirus preventive practices and help explain the quantitative findings. Knowledge and understanding of the social and cultural contexts are essential for hantavirus prevention.