Explanatory Sequential Mixed Methods Research Articles

The development and validation of the One Health Community Assessment

Interdisciplinary collaborations to address human, animal, and environmental health have been emphasized since the inception of the One Health framework. A quantitative survey instrument was developed to measure perceptions of the impacts of pets on One Health. Using the exploratory sequential mixed methods approach, 20 interviews were conducted with individuals from a racially diverse and low-socioeconomic status community in the U.S. to understand their perceptions of One Health. Data from those interviews informed the development of a Likert scale survey measuring individual perceptions of community, human, pet, and environmental health and welfare, as well as the connections between the domains of the One Health triad (human, animal, and environment). The resulting One Health Community Assessment (OHCA) was administered in two urban and two rural underserved U.S. communities longitudinally (2018–2021) through door-to-door data collection as well as phone, email, and text surveys. Validation of the instrument was completed using data collected in the third and fourth years of the study (n = 654). Factor analysis with orthogonal varimax rotation was used to assess the structure and internal consistency of the OHCA. Five subscales explained 42.4% of the variance in our 92-item instrument: community health (Cronbach's α = 0.897), human health (α = 0.842), pet health (α = 0.899), environmental health (α = 0.789), and connections between domains of One Health (α = 0.762). The OHCA represents the first reliable and validated instrument to measure the impacts of pets on One Health.

The Village Expansion Model for Village Governance and Public Service Improvement in North Lombok Regency

This study aims to analyze the model of village expansion for village governance and improving the quality of public services. The Explanatory Sequential Mixed Method was used in the analysis of this study. Using 122 respondents of village officials in North Lombok Regency in 2022 indicated that the village expansion model (objectivity, subjectivity and psychological) improves village governance (accountability, transparance, openness and rule of law) and the quality of public services (convenience, security, reliability, personnel attention, problem-solving approach, fairness, fiscal responsibility and citizens influence). In addition, good village governance can strengthen the quality of public services. This research implies that the model of village expansion used in participatory development planning is to strengthen strengths to overcome weaknesses.

Enhancing inclusive physical activity for students with disabilities: Patterns and opportunities

Physical activities and sports (PAS) participation primarily aim to contribute to enhancing the basic motor skills of students and their physical competencies to directly promote the behavioral, cognitive, and social skills of students to help enhance their future physical activity patterns. Regular physical activity participation among children with disabilities greatly fosters independence, coping abilities, competitiveness, and teamwork. Although active physical activities are beneficial, children with disabilities’ participation in physical activities has been reported to be little as a result of students’ disabilities and their lack of opportunities for participation. However, literature is yet to report on the types of PAS regularly participated in by students with disabilities, how frequently they engage in such activities, and how long a time they spend during their participation. This current study employed an explanatory sequential mixed method design that helped in the collection of both quantitative data (questionnaire) and qualitative data (interviews) from 194 (comprising 68.0% male and 32.0% female) students with disabilities and three teachers on types of PAS students with disabilities mostly participate in, how frequent and how long a time they spend during PAS participation. The findings of this study revealed students very often participate in physical activities in different activities for a long period as long as activities are made available, and opportunities provided. It is, therefore, recommended that not only should disability-friendly physical activities and sporting events be organized frequently and encouraged among students in special schools, but stakeholders should make opportunities available to students to participate.

A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study

IntroductionNeonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand...

Barriers and facilitators to using ophthalmic clinical health services following school vision screening: a mixed-methods study

ObjectiveTo identify determinants of the utilisation of ophthalmic clinical health services among students who failed school vision screening.MethodsThis study employed a sequential explanatory mixed methods design, underpinned by Andersen’s Behavioural...

Embedding higher order thinking skills in Islamic history (Sirah) education in Malaysia

<span lang="EN-US">The promotion of integrating higher order thinking skills (HOTS) in the Malaysian education system is pivotal to producing analytical thinkers to keep up with the rapid globalization of this era. Thus, the implementation of HOTS in learning and facilitation (PdPc) has been emphasized. However, little is known about the integration of HOTS in Islamic history and civilization (</span><em><span lang="EN-US">Sirah</span></em><span lang="EN-US">) lessons. Furthermore, teachers continue to use traditional methods and disregard incorporating HOTS in PdPc. Therefore, the current study conducted an in-depth investigation into the components of </span><em><span lang="EN-US">Sirah</span></em><span lang="EN-US"> lessons to support the implementation of the Malaysian education development plan (PPPM) 2013-2015 by strengthening teaching techniques through the use of HOTS for a better understanding of </span><em><span lang="EN-US">Sirah</span></em><span lang="EN-US"> lessons. Using an explanatory sequential mixed method design, the findings reveal that the teaching components of </span><em><span lang="EN-US">Sirah</span></em><span lang="EN-US"> lessons with the integration of HOTS are at a moderate level in the conclusion stage of a lesson. Therefore, the current study proposes a model that integrates HOTS, i.e., the element of attitude, preparation and planning, teaching aids with relevant aspects of PAK21, knowledge of HOTS, mastery of the subject content, teaching techniques and approach, assessment, and evaluation.</span>

Clinical Decision Support for Surgery: A Mixed Methods Study on Design and Implementation Perspectives From Urologists

ObjectivesTo assess urologist attitudes toward clinical decision support embedded into the electronic health record and define design needs to facilitate implementation and impact. With recent advances in big data and artificial intelligence, enthusiasm for personalized, data-driven tools to improve surgical decision-making has grown, but the impact of current tools remains limited. MethodsA sequential explanatory mixed methods study from 2019-2020 was performed. First, survey responses from the 2019 American Urological Association annual census evaluated attitudes toward an automatic clinical decision support tool that would display risk/benefit data. This was followed by the purposeful sampling of 25 urologists and qualitative interviews assessing perspectives on clinical decision support impact and design needs. Bivariable, multivariable, and coding-based thematic analysis were applied and integrated. ResultsAmong a weighted sample of 12,366 practicing urologists, the majority agreed clinical decision support would help decision-making (70.9%, 95% CI 68.7–73.2%), aid patient counseling (78.5%, 95% CI 76.5–80.5%), save time (58.1%, 95% CI 55.7–60.5%), and improve patient outcomes (42.9%, 95% CI 40.5–45.4%). More years in practice was negatively associated with agreement (p<0.001). Urologists described how clinical decision support could bolster evidence-based care, personalized medicine, resource utilization, and patient experience. They also identified multiple implementation barriers and provided suggestions on form, functionality, and visual design to improve usefulness and ease of use. ConclusionsUrologists have favorable attitudes toward the potential for clinical decision support in the electronic health record. Smart design will be critical to ensure effective implementation and impact.

IJCM_43A: Status of sexual and reproductive health services among youths from a rural area of Madhya Pradesh: A mixed-method approach

Background: Warranting adequate sexual and reproductive health (SRH) among the youth population in India is challenging. While the Government has undertaken several measures to improve SRH services, gaps exist in terms of availability of these services at the health centre. Objective: To assess utilization of SRH services and explore the associated factors among youth population in rural area of Central India. Methodology: An explanatory sequential mixed method study was conducted which included collection and analysis of quantitative data pertaining to the utilization of SRH services from 236 youth (aged 15-24 years) selected through multistage cluster sampling. This was followed by 29 in-depth interviews conducted among the various stakeholders. Quantitative data was entered using MS Excel and analyzed using R v-4.1.0. The notes and audio recordings from the interviews were transcribed manually and thematic analysis was done. Results: Out of 236 youths, only 90 (38.1%) had ever availed SRH services, of whom 85.5% had visited the SRH clinic in the past 12 months. The most common reason to visit a government health facility was cited as a pregnancy test while in the case of private health facility the reasons were STD treatment, pregnancy tests, and abortions. Except the request for contraceptive services and adequate response to questions by clients, the services provided by the facilities were reported to be inadequate. Further exploration summarized the barriers and facilitators of the health care services under the themes of training, logistics, ARSH clinic, adolescent health days, and community awareness. Conclusion: Among the various influences of SRH, the healthcare system is a fundamental aspect; which seems to address inadequately the varied needs of the rural youth. Future efforts must focus on community awareness and involvement of all stakeholders to uplift SRH services, so as to have positive impact on their sexual health.

COVID-19 Vaccine Hesitancy Among Healthcare Workers: A Phenomenological Study of Skepticism.

Despite the prioritizing the healthcare workers (HCWs) for COVID-19 in a systematized manner the phenomenon of vaccine hesitancy was observed in them. HCWs are presumed to be pre-emptive in up-taking the vaccine due to their closest association and having reasonable background information. Hence, we intended to explore and investigate the phenomenology of skepticism and hesitancy toward the COVID-19 vaccine among HCWs. A sequential explanatory mixed methods study design incorporating a baseline cross-sectional survey followed by qualitative and semiquantitative text-mining approach was adopted in a tertiary care center in Madhya Pradesh, India. Six hundred seventy-nine HCWs for quantitative data and 30 HCWs for qualitative interviews were surveyed. After determining the quantum and baseline traits of hesitant HCWs, 30 participants were purposively selected for in-depth qualitative analysis based on grounded theory using a framework approach and consolidated from the psychological and philosophical plane of skepticism. This was complementedby a semiquantitative text-mining approach using mono/bigram analysis and network plotting. Approximately one-fifth of participants (18%,122 out of 679) were initially, and one-tenth of initially hesitant (10 out of 122) were terminally hesitant. Hesitant and non-hesitant participants were similar except for comorbidity status.Five themes emerged namely individual, vaccine-related, social, system, and contextual after thematic consolidation. Words/phrases indicating individualistic desire to knowing more, internal conflicts, and conjecture were mined further. The network plot showed diversified expressionsof participants. There seems to be a requirement to prime HCWs by offering objective information beforehand and removing diffidence using a systematic approach addressing the psychology and prevalent partisan belief in similar circumstances in the future.

Relationships between global orientations and attitudes toward integration policies: A sequential explanatory mixed methods approach.

Based upon a mixed methods follow-up explanation model, the present research examined the relationships between global orientations and the attitudes toward integration policies among both locals (majority group) and South Asians (minority group) in Hong Kong. In Study 1, quantitative data were collected from a community sample of 1,614 adults comprising 1,007 locals and 607 South Asians in three minority groups (Indians, Nepalese, and Pakistanis). In Study 2, a follow-up explanation phase of qualitative investigation was conducted, with 12 in-depth semistructured focus group discussions among seven locals and 49 South Asians, generating three main themes and six subthemes. Quantitative results showed that the positive link between multicultural acquisition and instrumental integration policies was significantly stronger for South Asians than for locals, and that ethnic protection was negatively associated with a positive attitude toward symbolic integration policies in the majority group but had no effects in the minority group. The three main themes generated from the qualitative results include alleviating minority disadvantage, preserving majority privilege, and embracing diversity for the common good. The combined quantitative and qualitative results suggest that the differential relationships of multicultural acquisition and ethnic protection with support for specific integration policies can be understood with the underlying structural power asymmetry between the majority and minority groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Senior high school chemistry teachers’ knowledge and use of group work as a teaching strategy

The study investigated the knowledge of chemistry teachers in using group work as a teaching strategy in teaching chemistry at the senior high schools (SHSs) in Ahafo and Bono Regions of Ghana. The sequential explanatory mixed method design was adopted for the study. All 58 chemistry teachers in the 20 purposively sampled SHSs participated in the study. A structured questionnaire, interview guide and an observation checklist were the research instruments. The descriptive techniques used for the analysis of data were percentages, means and standard deviation while Chi-square used for inferential analysis. The results revealed that a statistically significant number of chemistry teachers were knowledgeable in the use of the cooperative teaching strategies but adopted it occasionally based on unavailability of time and resources. The study recommended in-service training and workshops be organized on the impact of group work as a teaching strategy to enhance chemistry teachers understanding and motivation to use group work more frequently in their teachings. This promotes active learning among students through debates, questioning and discussions.

Secondary School Teachers’ Conceptions of Teaching Science Practical Work through Inquiry-Based Instruction

Contemporary science teaching pedagogy in Namibia places a strong emphasis on fostering inquiry-based instruction and practical work in secondary school science education. In recent years, there has been a growing recognition of the need to move beyond traditional, rote-based methods towards more learner-centred approaches that encourage active inquiry and critical thinking. Teachers are encouraged to design lessons that promote inquiry, where learners actively investigate scientific phenomena, ask questions, and develop solutions through hands-on experimentation. Science practical work, which involves conducting experiments and investigations, is considered a cornerstone of this approach as it provides learners with opportunities to apply theoretical knowledge, develop laboratory skills, and gain a profounder understanding of scientific concepts. This sequential explanatory mixed methods study explored Namibian secondary school teachers’ conceptions of teaching science practical work through inquiry-based instruction to provide a comprehensive understanding of teachers’ perspectives and practices. Findings from this study revealed that many teachers held traditional views of science practical work, emphasizing cookbook-style experiments and memorisation. These teachers often faced challenges in implementing inquiry-based instruction due to a lack of training and resources to facilitate science practical work. However, a subset of teachers who embraced inquiry-based methods reported increased learner engagement, critical thinking, and in-depth understanding of scientific concepts. Additionally, the findings underscored the importance of aligning teacher conceptions with contemporary pedagogical approaches for effective secondary science education in Namibia. The study thus, highlighted the need for professional development and support to help more teachers transition to inquiry-based instruction and improve science education in Namibian secondary schools.

Collaborative design of a health research training programme for nurses and midwives in Tshwane district, South Africa: a study protocol

IntroductionNurses are essential for implementing evidence-based practices to improve patient outcomes. Unfortunately, nurses lack knowledge about research and do not always understand research terminology. This study aims to develop an...

Why Do Students Drop Out of High School?: The Case Study of Kasi District in Lao PDR

Purpose: This study explored why high school students decided to drop out in rural area of Lao PDR and further aimed to propose possible prevention to improve the drop out situation of the countries.&#x0D; Originality: Previous research that primarily focused on specific factors and dropout rate cannot explained why students decided to leave high school in early grade. Therefore, using comprehensive framework including individual and institutional factors, this study examined the dropout factors from individual perspective in qualitative way.&#x0D; Methodology: The study uses an explanatory sequential mixed method approach that employs both a questionnaire and interviews. Total 30 participants engaged in interviews including students and their parents, teachers and governmental officials. A thematic analysis was utilized for data analysis.&#x0D; Result: The results highlight that at the individual level, such as lack of motivation, peer pressure, early marriage, and cultural norms, pose barriers to high school attendance. Low household income and negative family dynamics also contribute significantly to dropout rates, with agricultural demands and family particular situations. Insufficient school resources, including materials and extracurricular activities, along with a shortage of qualified teachers, affect student engagement. Additionally, the community's low human and social capital increase dropout rates by limiting employment opportunities.&#x0D; Conclusions and Implication: The results indicated that both individual and institutional factors played a role in the dropout decision-making process. Furthermore, they suggested essential considerations such as examining job prospects for high school graduates in the local community, and evaluating the availability of resources within the school and community to assist students at risk of dropping out.

Chinese Senior High EFL Learners’ Foreign Language Reading Anxiety: Profile and Sources

In comparison with other skill-specific foreign language anxiety, foreign language reading anxiety (FLRA) was a less-researched realm. The purpose of the study was to investigate the general profile and possible sources of FLRA in the under-explored Chinese senior high EFL students. The 60 participants were from 2 high schools in China. The study employed the &amp;ldquo;explanatory sequential mixed method design&amp;rdquo; (Creswell &amp;amp; Plano Clark, 2018). First, the quantitative data were collected via the adapted Foreign Language Reading Anxiety Scale (FLRAS) (Lu &amp;amp; Liu, M., 2015), and analyzed with SPSS. Then, based on participants&amp;rsquo; scores on FLRAS (adapted), specific responses, and consent to further interviews, 4 subjects were selected as sources of qualitative data. The conclusions were drawn that (1) more than half the learners (78.33%) were generally exposed to little FLRA (M=2.57); (2) possible FLRA sources could be divided into 4 main categories, with overall 16 subsets: (a) individual factors (reading interest, self-expectation, reading strategy use, background knowledge); (b) textual factors (topic, task type, text length, tested vocabulary, grammar, text structure, rhetoric); (c) instructional factors (teaching method, evaluation); (d) situational factors (teacher-student dynamic, parental anticipation, peer pressure). Despite limitations such as limited sample size and scope, absence of further validation testing, and neglect of examination of background variables, the study purveyed valuable suggestions for language educators to enhance strategies addressing FLRA among Chinese EFL senior high learners. These suggestions included considering the impact of text structure and rhetorical devices on FLRA, prioritizing vocabulary instruction, and implementing anxiety-reducing interventions, e.g. the &amp;ldquo;flipped classroom model&amp;rdquo; (G&amp;ouml;k et al. 2021). Furthermore, the study emphasized the need for further research on the more representative FLRA profile of Chinese young EFL learners, statistical examination of the relevance of various sources to FLRA, investigation of the relationship between background variables and FLRA among Chinese senior high EFL learners, and exploration of the universality and language-specific nature of different FLRA sources.

Development and validation of the clinical judgment capability questionnaire in nurses: A sequential exploratory mixed method study

BackgroundClinical judgment is one of the most important competencies required for safe care, decision-making, and diagnosis in nursing profession. Therefore, it is necessary to examine clinical judgment in nursing care. Existing a standard questionnaire based on cultural and social conditions can accurately evaluate clinical judgment in nurses. ObjectiveThe present study aimed to develop and validate clinical judgment capability questionnaire in nurses. DesignThe current research was a sequential exploratory mixed method study. SettingThe teaching hospitals affiliated to Jahrom University of Medical Sciences in the South of Iran in 2023. ParticipantsTwelve clinical nurses were included in the qualitative part and 181 nurses in the quantitative part. MethodsThe study was conducted in two parts: one qualitative and one quantitative. In the qualitative part, the concept of clinical judgment was explored using qualitative content analysis. Then, the initial pool of items was generated to develop a questionnaire. In the quantitative part, psychometric properties of the questionnaire were evaluated including face, content, and structure validity and reliability (internal consistency and stability). ResultsAfter examining the psychometric properties, 22 items were developed for the final questionnaire. The results of factor analysis led to the extraction of four factors, including noticing, interpreting, responding, and reflecting. The internal consistency of the questionnaire was confirmed with a Cronbach's alpha coefficient of 0.95 and its stability with an intraclass correlation coefficient of 0.84. ConclusionThe developed 22-item questionnaire is a valid and reliable tool for assessment of clinical judgment capability in nurses.

The roles of protective factors in facing gender-related interpersonal stigma among Chinese transgender and gender diverse individuals: A mixed-method study

Background Transgender and gender diverse (TGD) individuals report high rates of mistreatment in the form of interpersonal stigma. These experiences can negatively impact their mental health. However, few studies have explored this relationship within a Chinese context. This study aims to investigate the connection between various forms of interpersonal stigma and mental health among Chinese TGD individuals. It also seeks to understand the role of collective and personal protective factors in mitigating the effects of interpersonal stigma. Methods This study used explanatory sequential mixed methods, combining primary quantitative research with supplementary qualitative research. A total of 398 Chinese TGD individuals participated in an online questionnaire survey, with seven of these participants also taking part in semi-structured interviews. Results Of the Chinese TGD participants, 48.7% reported experiencing mild or more severe depressive symptoms, while 42.2% of them reported a low level of well-being status. The interpersonal stigma was found to be positively associated with depression and negatively associated with well-being status. Among the examined protective factors, the interactions of community consciousness and identity pride with the interpersonal stigma aggravated the relationships between the interpersonal stigma and well-being status. The qualitative interviews confirmed the widespread presence of interpersonal stigma and provided additional insights into the exacerbating effects of community consciousness and identity pride. Conclusions This study highlighted the existence of pervasive interpersonal stigma and its negative impact on the mental health of Chinese TGD individuals. The community consciousness and identity pride should be questioned for the validity of acting as protective factors. Such findings provided evidence for further developing intervention programs and clinical instructions for healthcare providers.

Digital competence of Vietnamese citizens: An application of digcomp framework and the role of individual factors

AbstractAssessment of digital competence for citizens could support the Education Action plan at a national level, a regional level, or even at a global level to enhance the digital skills and competence gap for work and life for digital transformation. This study applies the DigComp framework through a self-administered online survey to 723 citizens in Vietnam, using a sequential exploratory mixed methods research design. Data were analysed using factor analysis, standard descriptive statistics, and simple regression methods, followed by qualitative content analysis from interviews with ten respondents and a focus group discussion with eight stakeholders on digital competence. The results confirmed the validity of the DigComp framework for measuring the digital competence of Vietnamese citizens. Overall, the proficiency level of the 723 surveyed Vietnamese citizens falls between basic and intermediate levels, being more advanced in areas in information and data literacy and communication and collaboration, compared to digital content creation, safety, and problem solving. The results further showed that male citizens with a higher education level, working in the public sector, or living in province with high provincial digital transformation index rankings perceived themselves to be more digital competent than females with a lower educational level, working in the private sector, or living in the province with low provincial digital transformation index rankings. To improve citizens’ digital competence, training should be designed that considers not only citizens’ digital competence profiles but also their individual characteristics.

TEACHER TALK AND STUDENTS TALK IN EFL CLASS ACTIVITY: SECONDARY SCHOOL CONTEXT

The study focuses on the dynamics and types of teacher and student talks in EFL classrooms. It highlights whether teacher or student talk dominates class and impacts students' language acquisition. It was conducted in an Eastern Indonesian secondary school and employed exploratory sequential mixed methods. The data were collected from an English teacher and 32 students through interviews and observations. Thematic analysis and relative frequency distribution table were used for data analysis. The findings showed that teacher talk dominated classroom activities and made student-centred learning lacking, thus affecting students' language acquisition. Various teacher and student talk categories were identified using the Flander Interaction Analysis Category (FIAC) framework. Teacher Talk (TT) involved indirect influences such as accepting feelings, praises or encourages, using students' ideas, and asking questions. The direct influence includes lecture, giving directions, and criticizing students' behaviour. While Student Talk (ST) had students' responses, students-initiated silence and confusion. Implications suggest enhancing teachers' conversation management skills and fostering a more student-centred approach to facilitate students' language practice and participation. Additionally, future researchers who wish to conduct similar research can develop deeper by looking at other aspects that positively impact interaction in the English language classroom.

Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study

BackgroundNarrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students.MethodsNarrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students’ empathy using the Jefferson Scale of Empathy– Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students’ emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach.ResultsThere was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 (“Standing in People’s Shoes”) following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students’ motivation and faculty’s perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students’ motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation.ConclusionThis study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients’ perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.