Explanatory Mixed Methods Research Articles

Factors Influencing the Participation of Shared Decision Making in Stable Coronary Artery Disease Patient: Protocol of a Mixed Methods Study.

The "paternalistic decision-making model" is no longer well suited to the modern clinical environment, and therefore, shared decision making (SDM) has emerged as a key approach. Although the benefits of SDM have been largely reported, several studies have reported low participation in SDM in coronary artery disease (CAD) patients. The theory of planned behavior (TPB) model is one of the most frequently employed theoretical frameworks for predicting human behaviors. According to the TPB, intention is influenced by attitude, subjective norm, and perceived behavioral control, while behavior is influenced by both intention and perceived behavioral control. Therefore, we propose a mixed methods study based on TPB to investigate the status of Chinese stable coronary artery disease (SCAD) patients' participation in SDM, understand their experiences of SDM, and explore the factors that influence their participation in SDM. An explanatory sequential mixed methods design will be used to explore the study aims, including a quantitative phase, a subsequent qualitative phase, and the final integration study. The quantitative study will use convenient sampling from the Affiliated Hospital of Hangzhou Normal University to conduct a cross-sectional survey (n ≥ 252). The qualitative study will be sampled using the maximum difference sampling method from the quantitative study results, and then the data will be collected through semi-structured interviews (n = 10-20). This study will use descriptive statistics and test hypotheses while considering a p-value of <0.05, which will be considered statistically significant. The study employs a mixed method approach with an explanatory sequential design, incorporating qualitative and quantitative methods to comprehensively understand the factors influencing SCAD patients' participation in SDM. Furthermore, these findings can inform the design of future intervention studies and provide healthcare providers with targeted information and communication to help SCAD patients make the most appropriate decisions. Study participants will be recruited using convenience sampling from just one single clinical setting, which may limit the findings' generalizability. This study has been approved by the Ethical Committee of the School of Nursing, Hangzhou Normal University (Approval No.: 2024013). All the participants will sign an informed consent form before participating in the survey. The corresponding results and conclusions will be disseminated in journals and conferences after the completion of the study.

Why becoming a positive deviant for malaria prevention and control: a sequential explanatory mixed methods study in Bugesera district, Rwanda

BackgroundMalaria continues to be a significant global health challenge, particularly in sub-Saharan African regions. Effective prevention and control strategies are crucial in mitigating its impact. Therefore, assessing the use of malaria preventive measures, treatment-seeking behaviours, and understanding the motivating factors behind positive behaviours/practices and barriers to using malaria preventive and control measures is essential for designing successful intervention programs.MethodsUsing a sequential explanatory mixed methods design, a descriptive cross-sectional study was conducted among 382 heads of households in the Mareba sector, Bugesera district, Rwanda. A qualitative study followed with 30 in-depth interviews among the top performers and other community members to explore the motivations and barriers to performing positive behaviours. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used.ResultsThis study revealed that among those who own insecticide-treated nets, 234(89.3%) reported that they slept under the bed net the night preceding the survey; 256(67%) had fever cases in the last 24 months preceding the survey; and 214(87%) reported seeking care within 24 h. While almost all 243(98.8%) of participants who had fever case reported that they have taken all medicines as prescribed, however, a large number 263(68.8%) and 148(38.7%) still think that there are people in the community who do not take all malaria medications as prescribed and there are people who share malaria medications in the community, respectively. 82(65.1%) of those who never had a fever case believe that they have been using malaria preventive measures correctly and consistently. This study found that knowledge about malaria, family support, and community mobilization are the top motivating factors to practice positive behaviours while, lack of bet nets, poverty, and lack of time were reported as main barriers.ConclusionInterventions that target key motivating factors for adopting positive behaviours in malaria prevention and control should be prioritized. This, in turn, will reduce the disease burden on affected populations. Efforts to overcome barriers in malaria prevention and control should also be participatory. Community involvement should be at the centre of these interventions.

Addressing diversity, equity, and inclusion in library and information science curriculum: Looking back and to the future

This study emphasizes the importance of library and information science (LIS) educators drawing insights from practitioners’ lived experiences, particularly considering perspectives of former students’ experiences when navigating the Master of Library Science (MLS) curriculum. Acknowledging the constructivist underpinnings of learning, with a focus on Schema Theory, is imperative for LIS faculty to learn more about how students perceived their past curriculum. Challenges occur when students lack the necessary schemata to comprehend unfamiliar concepts, particularly in areas like diversity, equity, and inclusion (DEI). Given the lack of diversity amongst the faculty population in LIS, faculty must navigate this discrepancy, recognizing the potential mismatch between their own life experiences, those of their student body, and the diverse patrons of varying genders, races, sexualities, income levels, locations, and abilities that libraries and librarians aim to serve. To address this, educators should not only activate existing student schema but also guide them in constructing new schemas, especially when delving into unfamiliar DEI topics. This study employed an explanatory sequential mixed methods design, involving 190 participants who responded to a survey. Additionally, 26 participants completed interviews. Following Creswell and Plano Clark’s approach, this design allowed for a quantitative phase to gather data, followed by a qualitative phase to further contextualize the quantitative results. The findings offer valuable insights into DEI education and the challenges faced by LIS educators in promoting meaningful learning experiences to prepare students to work with all library patrons.

Using Patient Experience Surveys to Identify Potential Diagnostic Safety Breakdowns: A Mixed Methods Study.

One in 20 outpatients in the United States experiences a diagnostic error each year, but there are no validated methods for collecting feedback from patients on diagnostic safety. We examined patient experience surveys to determine whether patients' free text comments indicated diagnostic breakdowns. Our objective was to evaluate associations between patient-perceived diagnostic breakdowns reported in free text comments and patients' responses to structured survey questions. We conducted an exploratory mixed methods study using data from patient experience surveys collected from adult ambulatory care patients March 2020 to June 2020 in a large U.S. health system. Data analysis included content analysis of qualitative data and statistical analysis of quantitative data. In 2525 surveys with negative comments, 619 patients (24.5%) identified diagnostic breakdowns, including issues with accuracy (n = 282, 46%), timeliness (n = 243, 39%), or communication (n = 290, 47%); some patients (n = 181) reported breakdowns in multiple categories. Patients who gave a low average score (50 or less on a 100-point scale) on provider questions were almost seven times more likely to perceive a diagnostic breakdown than patients who scored their provider higher. Similarly, patients who gave a low average score on practice-related questions were twice as likely to perceive a diagnostic breakdown. Patient feedback in routinely collected patient experience surveys is a valuable and actionable information source on diagnostic breakdowns in the ambulatory setting. The more easily monitored structured survey data provide a screening method to identify encounters that may have included a patient-perceived diagnostic breakdown and therefore require further examination.

Validation of a Clinical Teaching Competency Framework for Physical Therapists: A Mixed-Methods Approach.

A competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the clinical teaching competency framework by gathering input specifically from clinical education faculty. This study used an explanatory sequential mixed methods approach to seek input from clinical instructors (CI) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom. Survey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and enhancement of quality of clinical education (94.1%). Concern regarding ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of Collective Impact, with 4 subthemes: Assessment, CI development, Implementation, and Guidelines. Clinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework into practice should be collaborative and consistent across academic and clinical education programs. This study moves the profession one step closer to use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.

Influence of age and self-stigmatization on social eating and drinking issues in French outpatients living with and beyond head and neck cancer: a mixed-method study.

Social eating (SE) is a corner stone of daily living activities, quality of life (QoL), and aging well. In addition to feeding functional disorders, patients with head and neck cancer (HNC) face individual and social psychological distress. In this aging population, we intended to better assess the influence of age on these challenges, and the role of self-stigmatization limiting SE in patients with and beyond HNC. This was an exploratory multicenter cross-sectional mixed method study. Eligibility criteria were adults diagnosed with various non-metastatic HNC, before, during, or until 5years after treatment. SE disorders were explored with the Performance Status ScalePublic Eating rate(PSS-HN PE). In the quantitative part of the study, SE habits, Functional Assessment of Cancer Therapy Body Image Scale (FACT-MBIS) and specific to HNC (FACT-HN35) were also filled in by the patients. In the qualitative study, the semi-structured interview guide was drawn out to explore stigma, especially different dimensions of self-stigmatization. A total of 112 patients were included, mean age 64.7years, 23.2% of female. One-third (n = 35) of patients had an abnormal PSS-HN PE rate < 100. Younger patients had more often an impaired Normalcy of Diet mean (70.4 vs 82.7, p = .0498) and PE rates (76 vs 86.9, p = .0622), but there was no difference between age subgroups in MBIS nor FACT-HN scores. Seventy patients (72.2%) found SE and drinking « important» to « extremely important» in their daily life. The qualitative study reported self-stigmatization in two older patients and strategies they have developed to cope with in their behaviors of SE. This study confirms that SE remains of high concern in patients with and beyond HNC. Even in older patients experiencing less often functional feeding disorders, body image changes and SE issues are as impaired as in younger patients and need to be addressed.

Women's perspectives on the role and impact of breastfeeding support groups in Ireland

BackgroundBreastfeeding Support Groups are deemed effective in promoting breastfeeding initiation and duration, but few studies have addressed the mothers’ perspectives. Research aimTo investigate the role and impact of Breastfeeding Support Groups on breastfeeding mothers in Ireland from the women's perspective. Specific objectives included the assessment over time of breastfeeding self-efficacy knowledge, use, and limitations of BSGs and whether they contributed towards women achieving their breastfeeding goals. MethodsAn online survey using an established, validated Breastfeeding Self-Efficacy tool and custom-designed questions was administered at two time points as part of a larger sequential explanatory mixed methods’ design. Cultural Historical Activity Theory was used as the theoretical framework. ResultsMajority of respondents at Phase 1 (N = 978) were multiparous, urban dwellers, and breastfeeding more than twelve months. Mothers first attend Breastfeeding Support Groups primarily to meet other breastfeeding mothers with many attending multiple types of group formats weekly. Qualities considered extremely important in breastfeeding supporters were: personal breastfeeding experience breastfeeding knowledge empathy understanding and listening skills There was no statistical difference in breastfeeding self-efficacy over time (z = -1.296, p = .195, r = -0.06). ConclusionsParticipants attend Breastfeeding Support Groups to ‘meet other mothers’ in a convenient and local location, and not necessarily for a problem. Breastfeeding Support Groups normalise breastfeeding through social support, with breastfeeding supporters providing knowledge, empathy, understanding listening, and personal breastfeeding experience. Breastfeeding self-efficacy was high and did not increase over time, suggesting mothers need to be highly efficacious in this cohort to breastfeed.

Understanding the developmental well-being of children from refugee backgrounds in British Columbia, Canada: A population-level mixed methods approach

Objectives and ApproachThis study utilized an explanatory sequential mixed methods approach to investigate the developmental well-being of children from refugee backgrounds in British Columbia (BC), Canada. Objective 1 (quantitative) leveraged population-level, government administrative data individually linked to a province-wide, routinely collected, teacher-reported measure of children’s development in kindergarten (the Early Development Instrument; EDI) to examine developmental outcomes across five domains for children identified as first-generation refugees (N=770), first-generation immigrants (N=7875), and non-migrants (N=199,186). In Objective 2 (qualitative), the population-level EDI results were brought to focus groups with BC educators and settlement workers (N=7) who work closely with children from refugee backgrounds to further corroborate, expand, and elaborate on the findings. ResultsA series of multiple linear regression models; adjusted for age, sex, and English Language Learner status showed that first-generation refugee status was significantly predictive of lower EDI scores in the areas of language &amp; cognitive development, communication &amp; generation knowledge, social competence, emotional maturity, and physical health &amp; well-being. Focus group results corroborated the quantitative findings, added critical complexity/context (e.g., impacts of trauma), and identified important policy-oriented levers (e.g., early, accessible assessments and supports). ConclusionsThe study provided an understanding of the population-level developmental well-being of children from refugee backgrounds in BC, framed by rich, contextualized, and actionable knowledge from focus groups. ImplicationsShowcasing the combined breadth and depth of using a mixed methods approach, how we can best support the developmental challenges and build upon the strengths of children from refugee backgrounds will be discussed.

Exploring how starting work during COVID-19 impacted post-foundation career decisions of new doctors: a mixed methods study

ObjectivesThis study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2?...

Understanding the behavioural determinants of active travel among older adults: A mixed methods study

IntroductionActive travel is an accessible form of physical activity, associated with physical and mental health benefits, particularly for older adults. This study aimed to identify the behavioural determinants that significantly impact older adults’ engagement in active travel as well as how and why these behavioural determinants occur. MethodsThis study employed an explanatory sequential mixed methods design informed by the Theoretical Domains Framework (TDF). The study focused on older adults in Scarborough, Canada. In the quantitative phase, a TDF-informed survey was distributed among Scarborough older adults and analyzed using descriptive statistics, Chi-squared tests, and generalized linear models. TDF determinants that significantly impacted older adult participants in active travel were identified. The qualitative phase followed up with select survey participants about their experiences with these TDF determinants. Semi-structured interviews were conducted, and data was analyzed using thematic codebook analysis. To integrate the quantitative and quantitative results, data were interpreted and integrated using a joint display matrix. ResultsThe survey results suggest that the TDF domains of motivation (i.e., feeling inspired to active travel) and skill (i.e., having the aptitude to active travel) were highly predictive of active travel behaviour among older adults in Scarborough, Canada. Beyond the TDF, the likelihood of active travel increased if participants reported being encouraged and satisfied with their health, fitness, exercise, and well-being in general. The interview results suggest that fostering motivation and skill require a network of interventions that address multiple TDF domains such as promoting action planning, creating commitment, building social connectedness, increasing awareness of active travel options, and building emotional and physical safety. By integrating the quantitative and qualitative results, three overarching themes were presented about older adults’ needs to engage in active travel: building reassurance (i.e., putting safety first); building meaningfulness (i.e., creating joy, fulfillment, and purpose); and building relatedness (i.e., creating awareness and connection). ConclusionsThis study suggests several important implications for future research and policy. The results of this study provide evidence to support investment in both built environment improvements (e.g., safer intersections, bike lanes, lower vehicle speed limits, public transit subsidies) as well as tailored activities to promote active travel (e.g., public awareness campaigns, skill development activities, organized walks). The mixed methods study design employed in this study in conjunction with a novel application of the TDF allowed for a more thorough understanding of behavioural determinants of active travel among older adults.

Potential, Challenges, and Opportunities of a Philippine State University in Central Philippines as a Farm Tourism Destination

Farm tourism also called agritourism is a growing business globally with limited expansion in the South Asian region. It is valuable as a form of leisure and as facilitator of sustainable rural development, sustainable agriculture and food security. Educational institutions abroad are exploring the potential of agritourism to catalyze development, facilitate learning and generate income. This explanatory mixed method sequential inquiry assessed the level of potential of a state university as an accredited farm tourism destination based on the Philippine’s Department of Tourism (DOT) standards for day farms and farm stays in terms of the 6As: attractions, accessibility, accommodation, activities, amenities, and accountability. For the quantitative part, the researcher used a researcher-made instrument based on the DOT-Department of Agriculture Rules and Regulations Governing the Accreditation of Farm Tourism Camps. For the qualitative part, the researcher used a semi-structured in-depth one-on-one interview. Quantitively, results determined that the state university has high potential to be accredited as farm tourism destination. Qualitatively, results revealed that the potential is due to its agriculture program, area and farm attractions. It is also due to the high presence of some supporting As of tourism. The challenges in tourism development are design and development of the attractions and inadequacy of the As. Nonetheless, accreditation is still possible. Also, it emerged that tourism offers internal and external opportunities. In conclusion, universities may become DOT-accredited tourist destinations if they possess attractive qualities. This is because academic institutions have a built-in readiness for tourism. Specifically, universities offering agriculture program or course may consider operating agritourism. Though there are challenges, these only signal a need for deliberate tourism planning on the part of the institution. Finally, the DOT accreditation process must be pursued in order that the potential of a destination for tourism may be fully realized.

Patient experiences of a student-led physiotherapy neurological rehabilitation clinic: a mixed methods study

Background: Student-led clinics (SLCs) are becoming increasingly prevalent across allied health professions curricula; however, little is known about patient experiences of these clinics. This study explored the experiences of patients attending a physiotherapy neurological rehabilitation SLC. Methods: This study utilized a sequential explanatory mixed methods approach focusing on people with neurological conditions who voluntarily attended a SLC of 12 weeks duration. The data collection process was initiated following the conclusion of the final SLC session. The methodology employed a survey followed by semi-structured interviews to explore emerging areas in more depth. Interview data were descriptively analyzed, and reflexive thematic analysis guided the analysis of the interview data. Results: Twelve participants completed the survey, and seven also participated in a semi-structured interview. Overall, patients were very satisfied with the service received at the SLC. Three themes were identified from the interview data: patients’ perceptions of the benefits and impact of the SLC; the importance of individualized care, and patients' preferences for SLC delivery. Discussion: The findings of this study indicate that participants perceived this SLC positively in relation to care quality, student skills, and individualized rehabilitation. This suggests that SLCs of this type may potentially be acceptable and applicable across different settings, student groups, and possibly for those living with other health conditions. Future research should investigate patient experiences of SLCs with larger sample sizes, different student cohorts, stages, and patient groups and establish the effectiveness of patient clinical outcomes.

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

ObjectiveWorkplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.MethodsSequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.ResultsThe average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.ConclusionThe study’s results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

Sustainability and impact reporting in US higher education anchor institutions

PurposeThe purpose of this study is to assess how higher education anchor institutions (HEIs) voluntarily report their non-economic impacts. Its goals are to quantify the ease of public access to this information; strengthen the conceptual foundation for HEI impact reporting; and provide guidance for making HEI voluntary disclosures more accessible, comparable and systematic.Design/methodology/approachUsing an exploratory mixed methods design and purposeful sampling, this study analyzed voluntary public disclosures of 41 anchor institution universities in the USA to assess how they communicate their public value creation to stakeholders. Data sources included impact reports, donor reports, annual reports and sustainability reports. The study also analyzed the accessibility of this information by timing how long it took to locate.FindingsThe sampled US anchor institutions communicate their non-economic impact to stakeholders in myriad ways using a variety of formats. Time required to find the reports ranged from 37 to 50 min, with an average of 42.30 min. Disparate reporting formats inhibit comparability.Research limitations/implicationsOnly 41 anchor institutions were examined. The small sample may not be representative of the broader landscape of higher education institutions.Practical implicationsFindings offer guidance for improving voluntary nonfinancial disclosures to increase public confidence in higher education institutions while advancing community and global resilience. To strengthen voluntary disclosure practices, the study recommends using a standardized reporting format, framing HEI impact through socio-ecological resilience indicators, integrating reports and obtaining some form of assurance. These changes would enhance the credibility and comparability of the disclosures.Originality/valueThis research provides some of the first empirical insight into how US higher education anchor institutions report their value creation to the public. Its application of socio-ecological systems theory outlines an actionable conceptual foundation for HEI reporting by linking organizational, community and global resilience.

Development and Validation of Ikhlaas Scale for Pakistani Muslim Adults.

Ikhlaas refers to the capacity of having sincere intentions in both acts of worship (ibadah) dedicated to God and our dealings with others, as we strive to seek God's pleasure. The present research was primarily conducted to develop a psychometrically sound measure of ikhlaas and establish its construct validity. Using an exploratory sequential mixed methods design, it comprised two studies. Study 1 was conducted in three phases. In Phase 1, an initial set of 17 items for the Ikhlaas Scale (IS) was developed through the thematic analysis of Quranic verses, semi-structured interviews, and focus group discussions. Phase 2 was related to the translation and cross-language validation of scales. Phase 3 involved administering this item pool to a sample of Pakistani Muslim adults (N = 300) and conducting an exploratory factor analysis (EFA) that revealed a two-factor structure (item loading 0.45-0.89) for the 12-item IS, accounting for 43.65% of the variance. The first factor measured ikhlaas in worship (7 items), while the second factor measured ikhlaas in dealings with others (5 items). Ikhlaas had a significant positive correlation with taqwa and significant negative correlations with materialism, providing evidence for the convergent validity of the IS. In Study 2, confirmatory factor analysis (CFA) conducted on a sample of Muslim adults (N = 702) confirmed the 12-item, two-factor structure of the IS observed in the EFA. Ikhlas was positively related to religious commitment and religious emphasis. In the final measurement model, the average variance extracted (AVE) of all constructs (ikhlaas, religious emphasis, and religious commitment) was > 0.50, the values of maximum shared variance (MSV) were lower than those of AVE, and the diagonal values of the square root of the AVE were higher than the intercorrelations. The heterotrait-monotrait correlation ratio (HTMT) ranged from 0.51 to 0.61, which testified to the discriminant validity of IS. Overall, the IS is a robust measure of ikhlaas that needs to be further studied for developing its nomological network across global Muslim populations.

Exploring the barriers and enablers of industrial solutions in renovation projects: a mixed-methods study in the finnish AEC industry

Offsite construction is a major approach to promote industrialisation in construction. However, implementation of prevailing industrial solutions is often less adequate and unsatisfactory, especially in renovation projects. Thus, the overall objective of this study is to understand the reasons behind the poor performance in implementation of the industrial solutions. The specific objectives include identifying the prominent barriers and enablers of prefabricated products in renovation projects. This study employed exploratory sequential mixed method. The qualitative data were gathered via semi-structured interviews to collect experiences and perception of experts related to industrial solutions. This was followed by quantitative data collection via questionnaire survey using a seven-point Likert scale. The major barriers and enablers of industrial solutions in renovation projects have been ranked in this study. The findings reveal that immutability of heritage buildings, the tolerances of old buildings and insufficient spaces to ensure construction work ranked the top three barriers for implementing industrial solutions in renovation projects. Moreover, the study identifies the most significant enablers including shorter project schedules, quality improvement and work safety improvement. The novelty of the research lies in the comprehensive presentation of the barriers and enablers of industrial solutions in the renovation project context. Policymakers, designers, and contractors can utilize these findings as guiding principles to enhance decision-making processes and create viable solutions for the obstacles encountered in renovation projects. This study further represents a vital step towards the efficient and effective implementation of industrial solutions in renovation projects, resulting in more sustainable and cost-effective outcomes.

Essential Package of Palliative Care for Iranian Children with Cancer

Background: Despite medical advancements and treatment development, children with cancer experience a wide range of symptoms related to the disease and treatment side effects. Providing palliative care is essential to improve the quality of life for both the child and the family. Given limited available resources, cost-effective service packages can address this need. Objectives: This study aimed to develop an essential palliative care package for children with cancer in Iran. Methods: The study was under Health System Research and employed an exploratory mixed method design in three phases. The initial stage involved two sub-studies including a review of literature and a qualitative study. In the subsequent phases, the package draft was compiled and validated using the Delphi technique with input from 12 experts. Results: The essential palliative care package for children with cancer comprised two main components: INPUT, including dimensions related to medicine, human resources, equipment, and service delivery setting. INTERVENTION, encompasses physical, psychological, social, spiritual symptom management, and growth and development. Conclusions: Customized for Iran's social and cultural context, this essential service package provides safe, efficient, convenient, and affordable care. Physicians and nurses with primary training can integrate it into primary care including home care, emphasizing the importance of palliative care.

Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study.

Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

31 Barriers to Physical Activity in Pregnant Women: An Explanatory Sequential Mixed Method Study

31 Barriers to Physical Activity in Pregnant Women: An Explanatory Sequential Mixed Method Study

How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self-Management Solution.

Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app. (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.