Sequential Explanatory Study Research Articles

Brief communication: The extent and determinants of viral suppression among patients on protease inhibitor-based Anti-retro-viral therapy undergoing intensive adherence counselling in a public HIV care center in Uganda

BackgroundProtease inhibitor (PI)-based Antiretroviral Therapy (ART) regimens are key drugs in HIV management, especially when used as second line drugs. However, some PI-based ART have high adherence demands or tolerable adverse effects which may affect adherence and subsequently viral suppression. We assessed the extent of viral suppression, its determinants, and the experiences of clients on PI-based ART undergoing intensive adherence counselling (IAC) in a public HIV clinic.MethodsMixed methods sequential explanatory study involving a quantitative retrospective chart review for clients on PI-based ART who had received IAC from Dec 2016 to May 2023 and qualitative interviews for clients on PI-based ART who had received IAC in the past six months at an urban public HIV clinic in Uganda.ResultsIn this study, a total of 189 client charts were included. The median number of IAC sessions received was three (interquartile range, IQR, of 3 to 4) with median time of receiving IAC of three ( IQR, of 2 to 4). One half (51%, 95/186) of the clients had achieved viral suppression and the odds of suppression increased by 30% for every additional month on IAC. Respondents perceived the effectiveness of PI-based ART and IAC in achieving and supporting viral suppression, respectively.ConclusionDespite the perceived effectiveness of PI-based ART and IAC, suboptimal levels of viral suppression were observed among clients on PI-based ART who had received IAC. Therefore, it is important to provide IAC for optimal duration as it increases the chances of viral suppression. Further investigation of the barriers of viral suppression for clients on PI-based ART undergoing IAC is needed.

Multisystemic Resilience and Anxious-Depressed Symptoms in Black Youth Exposed to Maternal Syndemics: A Mixed-Method Study.

We explored associations between multisystemic resilience and anxious-depressed symptoms in Black families experiencing maternal syndemics (i.e., co-occurring epidemics of substance abuse, violence, HIV/AIDS), using a sequential explanatory study design. Hierarchical regression was used to analyze data from 171 Black youth (57% girls; Mage=12.13, SD = 2.90). Girls (β=-0.17, p = .02) with higher inter/intrapersonal skills (β = - 0.28, p = .004) and more open familial communication (β = - 0.40, p < .001) reported fewer anxious-depressed symptoms, F(12, 147) = 5.68; p < .001, Adj R2 = 26.1%. Qualitative results from a subsample of 10 Black youth-mother dyads explored inter/intrapersonal factors (i.e., emotion regulation strategies, goal setting, persistence and perseverance, problem-solving skills) and open communication factors (i.e., comfortable environment to talk, solving problems, processing feelings, showing affection, benefiting from open communication) that support Black youth resilience. Findings highlight key resilience factors that could be bolstered in future interventions to reduce anxious-depressed symptoms among Black youth exposed to maternal syndemics.

The effect of interprofessional education on the surgical team members' self-efficacy perception of interprofessional communication in the healthcare system.

The current study aimed to assess the effect of interprofessional education on participants' self-efficacy perception of interprofessional communication at different levels of a healthcare system (relationships in the interpersonal, interprofessional, and administration levels). This is a sequential explanatory mixed-method study. Learners include surgical residents, surgical technology nurses, and anesthesia nurses (n = 130) who participated in the intervention and control groups. The quasi-experimental study was conducted in the first step. The educational strategy was interprofessional education and the main teaching method was case-based learning. The self-efficacy perception of the participants was assessed by a 26-item questionnaire before and 1 month after the intervention. The descriptive tests (mean, SD, percentage), student t-tests, and ANOVA were analyzed. The participants' experiences were explored through semi-structured interviews. Qualitative content was analyzed by Lundman and Graneheim's approach. The results showed that the scores of the learners in the intervention group (4.05 ± 0.31) improved significantly compared to the control group (3.35 ± 0.37) (p = 0.0001). In the present study, the experiences of the participants were categorized into a theme "explicit and implicit confrontations with perceived distrust in the system" which includes two categories "failure to internalize professionalism among team members" and "dominance of a paternalistic culture within the health care system". The results showed the positive impact of interprofessional education interventions on participants' self-efficacy perception of interprofessional communication. The results showed that interprofessional education, with the participation of different professionals and managers at different levels of a healthcare system, improved the participants' perception of self-efficacy regarding interprofessional communication. The results showed the improvement in the participants' communication with team members and managers required to solve the perceived explicit and implicit confrontations in the surgical departments. The implementation of an interprofessional education strategy focused on interprofessional professionalism and collaboration principles in clinical activities, formal and informal education in the surgical department is recommended.

Nurses' perceptions of caring behaviors at referral hospitals in Ethiopia: A mixed-methods approach.

Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding. A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results. The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=-0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=-0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data. Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors.

Understanding science teachers’ TPACK for virtual lab adoption in rural schools in South Africa: a mixed-methods approach

IntroductionThis paper reports on a sequential explanatory mixed-methods study that assessed technological, pedagogical and content knowledge (TPACK) competency among life sciences teachers in the context of virtual lab adoption in rural schools in South Africa.MethodsDrawing from TPACK framework as the study’s theoretical foundation, data gathered through questionnaires (N = 186) and in-depth semi-structured interviews (N = 4) were analysed using descriptive and thematic analysis.ResultsThe study uncovered a ubiquitous deficiency in TPACK competency among the participating life sciences teachers. The teachers demonstrated significant expertise in conventional areas such as content knowledge (CK), pedagogical knowledge (PK), and pedagogical content knowledge (PCK), mainly influenced by teaching experience. However, they exhibited a noticeable gap in technology-related TPACK domains, including technological knowledge (TK), technological pedagogical knowledge (TPK), and overall TPACK proficiency.DiscussionThis paper aspires to address a significant gap in educational research by spotlighting the often-overlooked rural teaching contexts. In addition, the paper advocates for tailored professional development initiatives to enhance teachers’ overall TPACK proficiency. Such initiatives are crucial for empowering teachers to integrate technology into their teaching and improve learning outcomes effectively.

Just another tool in their repertoire: uncovering insights into public and patient perspectives on clinicians' use of machine learning in perioperative care.

Successful implementation of machine learning-augmented clinical decision support systems (ML-CDSS) in perioperative care requires the prioritization of patient-centric approaches to ensure alignment with societal expectations. We assessed general public and surgical patient attitudes and perspectives on ML-CDSS use in perioperative care. A sequential explanatory study was conducted. Stage 1 collected public opinions through a survey. Stage 2 ascertained surgical patients' experiences and attitudes via focus groups and interviews. For Stage 1, a total of 281 respondents' (140 males [49.8%]) data were considered. Among participants without ML awareness, males were almost three times more likely than females to report more acceptance (OR = 2.97; 95% CI, 1.36-6.49) and embrace (OR = 2.74; 95% CI, 1.23-6.09) of ML-CDSS use by perioperative teams. Males were almost twice as likely as females to report more acceptance across all perioperative phases with ORs ranging from 1.71 to 2.07. In Stage 2, insights from 10 surgical patients revealed unanimous agreement that ML-CDSS should primarily serve a supportive function. The pre- and post-operative phases were identified explicitly as forums where ML-CDSS can enhance care delivery. Patients requested for education on ML-CDSS's role in their care to be disseminated by surgeons across multiple platforms. The general public and surgical patients are receptive to ML-CDSS use throughout their perioperative care provided its role is auxiliary to perioperative teams. However, the integration of ML-CDSS into perioperative workflows presents unique challenges for healthcare settings. Insights from this study can inform strategies to support large-scale implementation and adoption of ML-CDSS by patients in all perioperative phases. Key strategies to promote the feasibility and acceptability of ML-CDSS include clinician-led discussions about ML-CDSS's role in perioperative care, established metrics to evaluate the clinical utility of ML-CDSS, and patient education.

The Effectiveness of an Intervention Based on the Information, Motivation, and Behavioral Skills Model on Treatment Adherence and Self-Efficacy in Patients with Coronary Artery Diseases: An Explanatory Mixed Method Study

Background: Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases. Methods: This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings. Results: The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p&lt;0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results. Conclusion: The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.

Economic, social, and administrative barriers to achieving the sustainable development goal of good health and well-being

Good health and well-being are embedded in the 3rd Goal amongst the UN Sustainable Development Goals. The primary objective of this research was to identify the most critical economic, social, and administrative barriers to implementing the Expanded Program on Immunization (EPI) in the Punjab Province of Pakistan. A sequential exploratory design and case study technique were used, employing both qualitative and quantitative methods. In the first stage, in-depth interviews with 50 key officials were conducted to identify the most critical barriers to the EPI program. A quantitative analysis was then performed based on the results obtained from qualitative analysis, and rank orders of barriers were received from the same health department experts. The results indicate that twenty-eight barriers can cause implementation problems for this program. Still, the ten barriers that gained the maximum hits are the most important barriers, which include Shortage of vaccinators, mismanagement of vaccines’ cold chain, biometric android application, ice-lined refrigerators, communication gap, inadequate legislation of EPI program, capacity building issues with EPI staff, Misconceptions about EPI program, lack of awareness of the parents and community, refusal cases and inadequate cooperation of lady health workers (LHWs). Coordinated efforts of the government and the public are highly recommended to address these barriers.

The Influence of the Sherman STEM Teacher Scholars Program on Persistence in Science, Technology, Engineering, and Mathematics: A Mixed-Methods Study

This sequential explanatory mixed-methods study investigated the differences in persistence between students from the Sherman STEM Teacher Scholars Program (STEP), a STEM teacher scholarship and career preparation program, and STEM majors not in the program. Quantitative results indicated that STEP participants had higher levels of academic integration, women scored higher on persistence factors than men, and White students had a higher degree commitment than students of color. Qualitative findings indicated that STEP provided a family atmosphere and connected their coursework to their career aspirations. Women of color felt stereotyped by White classmates in STEM courses, which impacted their degree of commitment, and students of color in STEP relied on the program as a counterspace to racially insensitive STEM classrooms.

Evaluation of childbirth readiness and its associated factors and consequences in pregnant women referring to health centers in Tabriz, Iran and providing strategies to promote childbirth readiness: a sequential explanatory mixed method study protocol.

Childbirth readiness encompasses interventions conducted during pregnancy that encourage pregnant women, their families and communities to plan for a healthy pregnancy, childbirth and postpartum period. It enhances women's childbirth experience and diminishes maternal mortality rates. This study seeks to assess the level of childbirth readiness, relevant factors and outcomes among pregnant women who have completed 37 or more weeks of gestational age and are attending health centres in Tabriz, Iran. The objective is to offer strategies for enhancing childbirth readiness. This sequential explanatory mixed-method study comprises three phases. The initial quantitative phase involves a descriptive-analytical longitudinal study focusing on pregnant women at 37 weeks of gestation or beyond. The quantitative data will be gathered by the sociodemographic and obstetric information questionnaire, the childbirth readiness scale, the pregnancy experience scale, the Wijma delivery expectancy/experience questionnaire (version A) (W-DEQ-Version A), the childbirth experience questionnaire-2, the childbirth outcome checklist, the Edinburgh's postnatal depression scale (EPDS), the postpartum specific anxiety scale research short-form, the next pregnancy desire questionnaire and the exclusive breastfeeding checklist. In the subsequent qualitative phase, purposive sampling will be employed, and data will be collected through individual, in-depth and semi-structured interviews featuring open-ended questions. Data analysis will be conducted using conventional content analysis techniques. In the final mixed-method phase, strategies to enhance childbirth readiness will be formulated by integrating findings from the quantitative and qualitative studies, a comprehensive literature review, and employing the Delphi method. This study has received approval from the Ethics Committee of Tabriz University of Medical Sciences in Tabriz, Iran (code number: IR.TBZMED.REC.1401.557). All participants will provide written informed consent before taking part in the study. The outcomes will be shared through articles published in journals, presentations at medical conferences, the validation of a reliable scale for assessing the level of childbirth readiness in pregnant women and the development of a policy brief outlining supportive strategies to improve childbirth readiness. These resources will be valuable for healthcare providers.

Improvements in Transitional Care Among Medicaid-Insured Patients With Serious Mental Illness.

The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients. To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI. We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis. Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care. Participants with and without SMI benefit equitably from Thrive.

The Effects of Restorative Practice Curriculum on Student Behavior at A Disciplinary Alternative Secondary Campus

This mixed-methods, sequential explanatory case study was designed to assess the effects of a Restorative practices intervention curriculum on student behavior at a disciplinary alternative secondary campus, and to assess the effects of this curriculum on teacher and administrator decisions regarding student discipline, through the lenses of Social Justice Theory. There is currently no data available on the effects of Restorative practices among students who are already receiving the impact of exclusionary discipline in schools in the United States. Quantitative data was extrapolated using campus disciplinary data over the course of two academic school years. Qualitative data was extrapolated through a 42-question survey protocol and an eight-question interview protocol. The results assert Restorative practices curricula appear to have a positive impact on student’s behavior, teacher’s classroom management decisions, and administrator’s disciplinary decisions at the disciplinary alternative school.

A Comparison of Standards-Based Assessment Between Leveled and Unleveled Middle Schools in Gyeonggi Province: An Explanatory Sequential Design Study

A Comparison of Standards-Based Assessment Between Leveled and Unleveled Middle Schools in Gyeonggi Province: An Explanatory Sequential Design Study

Examining peer review network dynamics in higher education visual communication courses using ERGM

Peer review plays a pivotal role in shaping collaborative learning environments and evaluating student engagement, but there is a lack of research on the relational dynamics that underlie the interactions between students during the peer review process, which is critical for understanding the effectiveness of peer review for students’ learning outcomes. Using explanatory sequential study design, this study’s objectives are to explore the dynamics of peer review as a feedback mechanism in higher education within a social network context, focusing on student interactions during the feedback process. Specifically, we applied dyadic-independent Exponential Random Graph Modeling (ERGM), along with mixed-methods design to analyze peer review interactions within a visual communication course at a large state university. We collected and analyzed two samples: a quantitative sample of 167 students for network analysis, drawn from 3082 peer reviews and rubric scores, and a qualitative sample of 136 students from post-course surveys that provided feedback on the peer review process and course methodologies. Our investigation revealed the inherently social network nature of peer review, shedding light on its significance in engaging students and assessing student engagement. Specifically, we examined the role of students’ performance levels, edge-based attributes derived from the visual peer review rubric, and language used in the feedback on the likelihood of forming peer review connections in the network. Our findings indicate that attributes derived from the visual peer review rubric significantly influence the likelihood of peer connections. On the other hand, students’ performance levels do not have any impact on the formation of peer connections. The findings highlight the importance of visual peer review activities in shaping peer connections in the classroom. Future studies will incorporate higher-order structures, such as transitivity and triadic closure, into our ERGM model to further enhance our understanding of peer review dynamics in educational settings.

Breastfeeding mothers' self-confidence: A mixed-method study

Objective: To establish the association of the mother's breastfeeding self-efficacy with infant feeding in the first six months of the child's life and identify the mothers’ perception of their confidence to breastfeed. Background: Breastfeeding is a multi-determined process. Many factors contribute to a mother’s ability to exclusively breastfeed until a child reaches six months of age. Among these factors is a mother’s confidence in her abilities to breastfeed her baby, referred to as breastfeeding self-efficacy. Thus, self-efficacy for breastfeeding could be an essential predictor of reducing the risk of early weaning. Study design and methods: This is a mixed-method sequential explanatory study. The short form of the Breastfeeding Self-Efficacy Scale was used to determine the level of the mothers' confidence. 158 mothers were surveyed during their postpartum hospital stay, and 128 were included in a follow-up six months after delivery. Additionally, 22 participants were randomly selected for an in-depth interview (qualitative stage). Data were analysed using inferential statistics and thematic content analysis. Results: High levels of breastfeeding efficacy were identified during the hospitalisation and after discharge among all participants. Exclusive breastfeeding was practised among 45.31% of mothers six months after delivery. Return to work was a key factor contributing to early weaning. Family and health professional support during the breastfeeding process were associated as crucial for the duration of exclusive breastfeeding. Discussion: Exclusive breastfeeding for the first six months after delivery involves various factors, such as the mother’s confidence in her breastfeeding skills and the specific circumstances she faces while breastfeeding. Thus, through the mixed qualitative and quantitative approaches, it was possible to identify the convergence of self-efficacy scores and the breastfeeding mothers' perception of their confidence and intention to maintain exclusive breastfeeding. Conclusion: High self-efficacy to breastfeed alone was not enough to maintain exclusive breastfeeding. It is necessary to combine self-efficacy and family or health service support and guidance to clarify the mother's doubts about potential difficulties that may appear throughout the breastfeeding process, the maintenance of lactation when she plans to return to work, and the breastfeeding technique. Implication for practice: Applying the Breastfeeding Self-Efficacy Scale associated with the breastfeeding mothers' interview during the prenatal and perinatal period facilitates early identification of mothers at risk for early weaning and helps nurses in planning interventions to support the breastfeeding mother and her child in favour of exclusive breastfeeding duration. What is already known about the topic? Exclusive breastfeeding (EBF) is recommended for the first six months of a child's life; however, many mothers do not follow this recommendation due to multiple barriers such as mental health issues (i.e., postpartum depression or anxiety), educational gaps, physical discomfort like sore nipples, engorgement, return to work, and lack of support. Breastfeeding self-efficacy has been associated with the duration of breastfeeding. What this paper adds Breastfeeding mothers' self-efficacy is essential for stimulating maintenance. Questions 3 (I always feed my baby without using powdered milk as a supplement) and 11 (I always breastfeed my baby on one breast and then switch to the other) of the Breastfeeding Self-Efficacy Scale (short form) predicted early weaning risk. Planning nursing care intervention for breastfeeding mothers in their follow-up after birth should include assessing their breastfeeding self-efficacy and factors that could contribute to early weaning, such as returning to work and the lack of a support network.

Parental Preferences and Shared Decision-Making for the Management of Febrile Young Infants.

To inform shared decision-making by identifying parental preferences for the management of their febrile young infant. This was a sequential explanatory mixed-methods study using a cross-sectional questionnaire (May 2020-May 2022) followed by qualitative focus groups (September-December 2022) with parents of infants aged ≤60 days evaluated for fever at a tertiary pediatric hospital. Parental expectations, stressors, and desired level of decisional involvement were assessed using multiple-choice and 6-point-Likert scales. Questionnaire results informed the qualitative naturalistic inquiry into parents' decision-making experiences and preferences regarding the need for lumbar puncture (LP) and hospitalization. Among 432 parents (64.9% response), few anticipated the need for LP (10.2%) or hospitalization (20.8%), and these were selected as the most stressful aspects of management. No parent identified lack of decisional involvement as the most important stressor, although nearly all (97.5%) wanted to be involved in management decisions. Six focus groups with a subset of 17 parents revealed 4 main themes: (1) varying preferences for decisional involvement depending on the strength of the medical recommendation; (2) importance of involving parents in their infant's medical care; (3) need for tailored information; and (4) importance of supportive relationships. Parents reported feeling involved in discussions about their infant's care but that decisions regarding LP and hospitalization were usually made by the medical team. Parents of febrile young infants identified LP and hospitalization as the most unexpected and stressful aspects of care. Understanding individual family expectations and tailoring information based on the strength of medical recommendation is necessary to guide shared decision-making.

Perceived discrimination and mental health among female migrant domestic workers in Hong Kong: A sequential explanatory mixed-methods study.

Female migrant domestic workers (MDW), often unemployed in their home country, are household workers that migrate abroad for better wages. Although poor employment conditions have shown detrimental effects on MDWs health, the mental health effect of perceived discrimination remains understudied among MDWs. This mixed-methods study seeks to (a) assess the association between perceived discrimination and mental health among female MDWs and (b) explore in-depth the common ways MDWs experience discrimination. A cross-sectional self-administered survey (n = 1965) was conducted among Filipino and Indonesian MDWs from August 2020 to August 2021 in Hong Kong. A multivariable logistic regression model, controlling for background characteristics, assessed associations between perceived discrimination with anxiety and depression. Qualitative semistructured interviews were then conducted (n = 20) to provide in-depth information about perceived discrimination. Thematic analysis was used to identify the contexts and types of discrimination experienced. Among survey respondents, 60.4% reported ever experiencing discrimination, and 10.5% reported often/always feeling discriminated against. Of MDWs, 18.1% and 31.5% were classified with anxiety and depression, respectively. MDWs reporting higher frequency of discrimination were at increased risk of anxiety (ORadj: 2.30-6.60) and depression (ORadj: 2.06-5.91). In-depth interviews revealed that perceived discrimination inside the workplace (from overwork, lack of autonomy, and employer-imposed restrictions) and outside the workplace (from MDW policies) had strong effects on MDWs' mental health. Increased availability to mental health services should be considered. To improve MDW mental health, policymakers may also regulate maximum weekly working hours and ensure minimum standards for living environments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

Validation of a quantitative instrument measuring critical success factors and acceptance of Casemix system implementation in the total hospital information system in Malaysia

ObjectivesThis study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a...

Providers’ knowledge and perception of xylazine in the unregulated drug supply: a sequential explanatory mixed-methods study

BackgroundXylazine is increasingly prevalent in the unregulated opioid supply in the United States. Exposure to this adulterant can lead to significant harm, including prolonged sedation and necrotic wounds. In the absence of literature describing healthcare providers’ experiences with treating patients who have been exposed to xylazine, we aimed to explore what gaps must be addressed to improve healthcare education and best practices.MethodsFrom October 2023 to February 2024, we conducted a sequential explanatory mixed-methods study, with (1) a quantitative survey phase utilizing convenience sampling of healthcare providers treating patients in Connecticut and (2) a qualitative semi-structured interview phase utilizing purposive sampling of providers with experience treating patients with xylazine exposure. Summary statistics from the survey were tabulated; interview transcripts were analyzed using thematic analysis.ResultsSeventy-eight eligible healthcare providers participated in our survey. Most participants had heard of xylazine (n = 69, 95.8%) and had some knowledge about this adulterant; however, fewer reported seeing one or more patients exposed to xylazine (n = 46, 59.8%). After sampling from this subgroup, we conducted fifteen in-depth interviews. This qualitative phase revealed five themes: (1) while xylazine is novel and of concern, this is not necessarily exceptional (i.e., there are other emerging issues for patients who use drugs); (2) participants perceived that xylazine was increasingly prevalent in the drug supply, even if they were not necessarily seeing more patients with xylazine-related outcomes (XROs); (3) patients primarily presented with non-XROs, making it difficult to know when conversations about xylazine were appropriate; (4) patients with XROs may experience issues accessing healthcare; (5) providers and their patients are learning together about how to minimize XROs and reduce the sense of helplessness in the face of a novel adulterant.ConclusionsXylazine-specific education for healthcare providers is currently insufficient. Improving this education, as well as resources (e.g., drug checking technologies) and data (e.g., research on prevention and treatment of XROs), is crucial to improve care for patients who use drugs.