Sequential Explanatory Mixed Methods Study Research Articles

Untangling purpose: examining the nuanced influence of personal meaning and beyond-the-self orientation on youth mental health in unprecedented times

ABSTRACT This modified sequential explanatory mixed methods study explores how the components of purpose (personal meaningfulness and a beyond-the-self orientation) impact youth mental health outcomes (depressive and anxiety symptoms) in the context of COVID-19. We hypothesized that youth with higher scores on the components of purpose (goal-directedness, personal meaningfulness, and beyond-the-self orientation) would be less likely to experience anxiety and depressive symptoms during COVID-19. We also explored in what ways youths’ descriptions of their own prosocial behavior align with the relation between purpose and mental health. Data are from two waves of the Boy Scouts of America (BSA) Building Evidence in Scouting Together study. Quantitative data are from 4,896 youth and a subsample of 94 youth completed qualitative personal communication Results indicate the personal meaning component of purpose is protective against depressive and anxiety symptoms. However, the beyond-the-self orientation of purpose is associated with higher levels of depressive and anxiety symptoms. In addition, differences were found between youth who reported higher and lower levels of depressive and anxiety symptoms, and personal meaning and a beyond-the-self orientation for the following themes: 1) Empathy for others, 2) Desire to change the situation, 3) Solutions to change the situation, 4) Helping at home, 5) Following health advice, and 6) Scouting-specific examples. Taken together, this study provides useful insights into how each component of purpose can uniquely promote or provide a buffer for depression and anxiety among youth.

Satisfaction of chronic patients with community-based health insurance schemes and related factors: Explanatory sequential mixed methods study.

Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.

Assessment of knowledge, attitude, and practices toward malaria in the Lunglei district, Mizoram, North-East India

BackgroundThe western districts of Mizoram (Lunglei, Mamit, and Lawngtlai) are malaria hotspots. Understanding the knowledge, attitude, and practices of the tribal communities in Mizoram’s western districts will aid the development of specific interventions.MethodsAn explanatory sequential mixed-method study was conducted from April to November 2023 in the Lunglei district. In a community-based cross-sectional survey of 353 participants, the knowledge, attitude, practices, and care-seeking behaviour toward malaria were assessed using a semi-structured questionnaire. Data was analysed using SPSS version 29 software; univariate variables were presented in percentage, and bivariate and multivariate variables were analysed using the chi-square test and logistic regression, respectively. This was followed by in-depth telephonic interviews of twelve participants, and the data was analysed using NVivo.ResultsOut of the 353 respondents, 77.9%, 82.7%, 55.5%, and 63.2% of the participants had good knowledge, attitude, practices, and care-seeking behaviour, respectively. The in-depth qualitative interviews highlighted the villagers’ good knowledge of the various aspects of malaria transmission, treatment, and prevention practices (indoor residual spraying and use of insecticide-treated nets).ConclusionHigh disease endemicity, awareness programmes and vector control interventions might be contributing to the overall good knowledge, attitude, and practices toward malaria among the villagers. In addition to vector control measures, active parasite surveillance is key to malaria control in this region.

Effectiveness of a Group Counseling Intervention for Turkish University Students with Childhood Trauma

This research aimed to examine the effects of an eclectic group counseling intervention based on the cognitive and behavioral counseling approach and positive psychology-based practices on the rumination and life satisfaction levels of university students with childhood trauma in Turkey. The research was designed as an exploratory sequential mixed-method study. The first phase of the research focused on discovering what university students with traumatic stories needed to reduce their rumination levels and increase their life satisfaction. The themes that were obtained contributed to the content of the program. In the second phase, forty-two participants were randomly assigned to the experimental and control groups. The Rumination Scale and the Satisfaction with Life Scale were applied as data collection tools. A 12-session group psychological counseling program was provided once a week to the experimental group. No intervention was made in the control group. One week after the sessions were completed, the posttest was administered to the experimental and control groups, and follow-up measurements were carried out two months later. The participants in the experimental group showed significant improvements in decreasing rumination levels and increasing life satisfaction compared to the participants in the control group, and these improvements were maintained in the follow-up measurements. In the last phase, the qualitative data collected during the sessions were analyzed to evaluate the program. In conclusion, the group counseling intervention was effective in reducing the rumination levels and increasing the life satisfaction levels of university students.

Unani Tibb students’ and educators’ perceptions of spirituality and spiritual care in education in South Africa: A mixed-methods study

Background. Unani Tibb promotes holistic patient care, yet spirituality and spiritual care seem to be neglected in education. This theory-practice gap was previously highlighted in studies on Unani Tibb practitioners. The role of spirituality and spiritual care in Unani Tibb education in South Africa (SA) remains unclear. Objectives. To explore Unani Tibb students’ and educators’ perceptions and attitudes of spirituality and spiritual care in SA. Methods. A two-stage sequential explanatory mixed-method study was conducted. Quantitative data from stage 1 was obtained using a cross-sectional descriptive study followed by in-depth interviews for the qualitative study in stage 2. Stage 1 guided the interview questions in stage 2. Descriptive data analysis was performed for the quantitative study, followed by thematic analysis for the qualitative data. Results. A total of 18 (90%) participants took part in the quantitative study followed by 10 participants (50%) in the qualitative study. Three study findings emerged: i) a heightened level of spiritual awareness was recorded for this cohort despite the lack of spirituality and spiritual care content in the curriculum, ii) participants viewed spiritual care as integral to Unani Tibb philosophy, education and practice and iii) formal integration of spirituality and spiritual care concepts in Unani Tibb education was identified as a necessity to ensure the integrity of the holistic approach required by the profession. Conclusion. This study has implications across the health education sector and more specifically for Unani Tibb educators to consider the inclusion of spiritual care content in education programmes.

The perceived relevance, utility and retention of basic sciences in general practice

BackgroundBasic sciences are crucial for clinical medicine, yet studies focusing on their perceived utility among general practitioners (GPs) are sparse. Considering the broad scope of GPs’ practice, an in-depth understanding of basic sciences is fundamental for making informed clinical decisions. This study evaluated GP registrars’ retention and perceptions of the utility of basic sciences in clinical practice.MethodsUsing sequential explanatory mixed methods study design, knowledge retention was assessed by a multiple-choice question (MCQ) examination followed by interviews on the perception of the relevance and utility of basic sciences among GP registrars at James Cook University's (JCU) General Practice Training (GPT) program. Descriptive and inferential statistical analyses were conducted on the MCQ exam data, while thematic analysis was employed for the qualitative interview data.ResultsSixty-one GP registrars participated in the MCQ exam, while 11 of them were involved in the interviews. The highest mean score was obtained in biochemistry (75.1 ± 2.23) while the lowest mean score was in anatomy (56.07 ± 3.16). Key performance predictors included the formative clinical examination scores (β = 0.83, 95% CI: 0.45 to 1.2, p < 0.001) and gender (β = -9.7, 95% CI: -17 to -2.3, p = 0.011). The qualitative data analysis revealed five themes, including the backbone of clinical medicine, varying utility over time and by specialty, clinical synthesis integrates encapsulated knowledge, professional pressures hinder revisitation of knowledge and knowledge renewal enhances updates.ConclusionBasic sciences were considered relevant in clinical practice. Development of continuing professional development (CPDs) sessions and clinically relevant online resources were measures proposed to enhance the retention of knowledge. Future research could focus on innovative educational strategies for GPs.

Unlocking the Potential in a Gamification-Based MOOC: Assessing Autonomous Learning and Self-Directed Learning Behaviors

Massive open online courses (MOOCs) have significantly advanced online education. Yet, MOOC instructors still grapple with the ongoing challenge of low learner engagement while striving to foster autonomous and self-directed learning (SDL). Integrating gamification into these courses could be a promising solution. However, the extent to which gamification shapes autonomous and SDL behaviors within MOOCs remains underexplored. This mixed-methods sequential explanatory study investigates the interplay between MOOC, gamification, autonomous learning, and SDL behaviors to harness the potential of online education. We address this research void by delving into the intricate relationship between gamification and learners’ engagement in autonomous learning and SDL behaviors. Drawing upon self-determination theory (SDT) as a theoretical framework, we scrutinize how gamified MOOCs influence intrinsic motivation and SDL behaviors. Our study utilizes questionnaires and structured interviews to comprehensively examine the users’ experiences within a gamified MOOC. The findings suggest that thoughtfully integrated gamification elements not only enhance learner engagement but also stimulate autonomous learning and SDL behaviors. However, it is crucial to approach the integration of gamification thoughtfully, ensuring a balance that promotes intrinsic motivation without undue reliance on extrinsic motivators. These findings hold significant implications for educators, course designers, and policymakers leveraging gamification to enrich online learning experiences and cultivate self-directed educational pathways. They offer valuable insights for educators, course designers, and policymakers aiming to leverage gamification for enriching online learning experiences and nurturing self-directed educational pathways in MOOCs.

Understanding the capacity development of faculty development programs: a sequential explanatory mixed methods study

BackgroundFaculty development programs can bring about both individual and organizational capacity development by enhancing individuals’ attitudes, values, and skillsto enable them to implement organizational change. Understanding how faculty development programs produce capacity development, and the influencing factors, requires further understanding. This study aimed to explore the perceptions of the participants of a faculty development program about the capacity development features of the program and the influencing factors.MethodsA sequential explanatory mixed methods design was used. Faculty members were surveyed about their perspectives on capacity development of faculty development. Subsequently, 22 interviews were conducted with the respondents to deepem understanding of the survey results. Interview transcripts underwent conventional content analysis.ResultsA total of 203 completed the questionnaire. Most of the faculty highly agreed that the faculty development programs had produced capacity development. The combined data identified (a) “quality of faculty development programs”, underscoring the significance of robust and comprehensive initiatives, (b) “development in instruction”, emphasizing the importance of continuous improvement in pedagogical approaches (c) “development in professionalism”, highlighting the necessity for cultivating a culture of professionalism among faculty members, (d) “development in attitude towards education”, emphasizing the role of mindset in fostering effective teaching practices, and (e) “supporting faculty development programs”, with fostering organizational growth and innovation. Important barriers and facilitators of the capacity development process included several organizational, interpersonal, and individual factors.ConclusionThe study identified specific features of the capacity development process in the context of a faculty development program and highlighted the importance of these programs in producing changes in both individuals and within the wider organizational system. Several factors that enabled and constrained the capacity development process were also identified. The findings of the study can inform future implementation of faculty development programs for capacity development.

Satisfaction and wellbeing of general surgery trainees in the Saudi Arabian residency educational environment: A mixed-methods study

BackgroundSurgical residency training is prominently demanding and stressful. This can affect the residents' wellbeing, work-life balance and increase the rates of burnout. We aimed to assess rates of satisfaction and burn-out among GS residents in the national training programs and provide a subsequent in-depth analysis of the potential reasons. MethodA sequential explanatory mixed-methods study was conducted using an online survey and virtual interviews. The validated abbreviated Maslach Burnout Inventory (aMBI) was used to assess burnout while satisfaction was assessed via 5-points Likert scale. ResultsAfter excluding incomplete responses from the total 74 received, 53 were analyzed. The average participant age was 27.4 ± 2 years, with females comprising 52 % of the sample. Junior residents made up 58.5 %, and nearly half −45 %- considered quitting GS training. Moderate to high burnout rates were noted on each aMBI subscale, ranging from 41.7 % to 62.5 %. The majority of residents expressed dissatisfaction with the level of research engagement (81.1 %), supervision, and mentorship. However, operative exposure was a source of satisfaction. Dissatisfaction rates with intra-operative learning, academia, teaching, and clinical exposure were 62.3 %, 52.8 %, 50.9 %, and 35.8 %, respectively. Interviews revealed surgical case flow and a friendly work environment as major satisfaction sources. Conversely, lack of academic supervision and suboptimal hands-on training were major dissatisfaction sources. ConclusionDissatisfaction and burn-out is prevalent among national GS training programs. Sub-optimal educational delivery and low-quality hands-on operative exposure -rather than lack of exposure to cases- seem to be the culprit.

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BackgroundIn recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of “Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model”.Methods/designThe current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants’ attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants’ average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.DiscussionThis is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.Ethical codeIR.MUMS.NURSE.REC. 1403. 014.

Music-guided resonance breathing – An exploratory sequential mixed-methods study for development and testing of a music intervention for pre- or perioperative stress reduction

Music-Guided Resonance Breathing (MGRB) is a combination of a technique for consciously slowed breathing and attentive music listening in health care contexts. MGRB is intended for clinical application to reduce anxiety and stress in patients undergoing strenuous medical treatment. The article sets out the basic principles and effects of resonance breathing and describes the development process of MGRB in form of an exploratory sequential mixed-methods study. Music therapy experts, healthy subjects and a professional composer have contributed to the research, aiming to understand the optimal musical characteristics of MGRB and anticipating feasibility as well as effects on the psychological and physical states of future patients. The results encourage to conduct a controlled clinical trial with MGRB.

The impacts of word attack strategies in improving students’ reading skill: A sequential explanatory mixed methods study

The impacts of word attack strategies in improving students’ reading skill: A sequential explanatory mixed methods study

Nurses’ moral judgements during emergency department triage – A prospective mixed multicenter study

IntroductionIn EDs, triage ensures that patients whose condition requires immediate care are prioritized while reducing overcrowding. Previous studies have described the manifestation of caregivers’ moral judgements of patients in EDs. The equal treatment of patients in clinical practice presents a major issue. Studying the impact of prejudice on clinical practice in the ED setting provides an opportunity to rethink clinical tools, organizations and future training needs. Our study sought to describe the moral judgements expressed by triage nurses during admission interviews in emergency departments and to assess their impact on patient management. MethodsAn exploratory sequential mixed-method study was performed. The study was conducted between January 1, 2018, and February 18, 2018, in the EDs of three French hospitals. Five hundred and three patients and 79 triage nurses participated in the study. Audio recordings, observations and written handover reports made by nurses during admission triage interviews were analyzed with a view to discerning whether moral judgements were expressed in them. We studied the impact of moral judgements on patient management in the emergency department. ResultsAbstract Moral judgements were made in 70% of the triage situations studied (n=351/503). They could be classified in seven categories. Patients were more likely to be subjected to moral judgements if they were over 75 years old, visibly disabled or if they had visible signs of alcohol intoxication. Being subjected to moral judgement was associated with differential treatment, including assignment of a triage score that differed from the theoretical triage score. ConclusionMore than two thirds of patients admitted to EDs were triaged using moral criteria. Patients who were morally judged at the admission interview were more likely to be treated differently.

Exploring Objective Simulation Competency Assessment Experience E-Learning Module Analytics: A Mixed-Methods Study to Improve Nursing Faculty Feedback.

Abnormal uterine bleeding is a common clinical concern for adolescent women. This research study aims to improve the clinical reasoning skills of advanced practice nursing students instructed in blended Objective Simulation Competency Assessment clinical experiences by enhancing feedback loops given to students during simulated experiences. A sequential explanatory mixed-methods study design was conducted with two cohorts of first-year women's health nurse practitioner graduate nursing students enrolled in the Women's Health Program at a large Midwestern university. Data were collected across 2 years from two separate cohorts, and analyses included data from 15 participants. The Abnormal Uterine Bleeding module designed with decision pathways was a worthy effort, and faculty value using data analytics from the e-learning module to evaluate student learning. This study describes how nursing faculty created abnormal uterine bleeding content in an online module format that can aid the diagnostic reasoning process and enable feedback to students.

Exploring barriers and facilitators to increase the engagement with a digital app (OLIO) for food/non-food sustainable consumption in citizens from Bogotá, Colombia

AbstractEngaging in sustainable behaviours is a key priority for environmental sustainability. Behavioural changes such as recycling, and food sharing are needed to achieve a zero-emissions society. Digital technologies can support engagement with these behaviours through publicly accessible digital platforms such as mobile apps which connect those with surplus items to those who need or wish to consume these items. However, very little research has examined the factors influencing engagement with mobile apps, particularly in the context of developing countries. This exploratory sequential mixed methods study used behavioural science models to identify factors influencing engagement with the Olio app, a mobile application for food and non-food items sharing in Bogota, Colombia. Influencing factors were analyzed and categorized as barriers or enablers using the Capability (C), Opportunity (O), and Motivation (M) model of behaviour (B) change (COM-B). Regarding barriers, two were strong influencers “perceived difficulty to use a mobile app” for donating items (physical opportunity, β = -.25, p &lt; .001), and “lack of time to collect a used item in others’ location” (physical opportunity, β = -.18, p &lt; .01). As to the enablers, the strongest predictor for collecting was “finding mobile apps to share used items to be widely disseminated on social media channels” (physical opportunity, β = .27, p &lt; .001) and for donating “Knowing how to use mobile apps” (psychological capability, β = .19, p &lt; .01). Findings are discussed along with implementation strategies that could potentially increase engagement with the Olio app to support sustainable consumption.

Prevalence and barriers to early initiation of breastfeeding among urban poor full-time readymade garments working mothers: a mixed-methods study in Bangladesh

BackgroundEarly initiation of breastfeeding is the initiation of breastfeeding within one hour of birth, which plays a significant role in a born baby’s growth and survival, however its prevalence and predictors among urban full-time readymade garments (RMG) working mothers are not investigated. The purpose of this study is to determine the prevalence and factors affecting early initiation of breastfeeding among urban RMG working mothers.MethodsA sequential explanatory mixed-methods study was conducted between March 2023 and December 2023 in Dhaka, Bangladesh. A total of 452 full-time female RMG workers were included for the quantitative study. Qualitative study was carried out among 30 full-time female RMG workers, four female physicians who were employed in the RMGs, four RMG factory managers, and four local pediatricians.ResultsThe prevalence of early initiation of breastfeeding was 40% among the women. It was significantly associated with various factors, including socio-cultural barriers, the advanced age of the mother (AOR 3.93, 95%CI 1.18, 13.04), lack of education (AOR 6.86, 95%CI 1.11, 42.49), lack of awareness, and cultural practices such as initiating goat milk and honey instead of breast milk. The absence of colostrum feeding (AOR 8.96, 95%CI 4.30, 18.70) and pre-lacteal feeding (AOR 0.06, 95%CI 0.03, 0.11) were significant baby feeding practice-related barriers to early initiation of breastfeeding. Maternal health factors, notably post-delivery sickness, cesarean delivery, and lack of breastmilk production, were revealed as a significant hindrance to the early initiation of breastfeeding explored from qualitative analysis. In addition, RMG factory-related factors that significantly affect early initiation of breastfeeding include a strong focus on production, a busy schedule, and a lack of initiative regarding the early initiation of breastfeeding.ConclusionsThe prevalence of early initiation of breastfeeding among RMG working women is poor. This study emphasizes the need for interventions that address specific challenges of early initiation of breastfeeding faced by working mothers in RMG sectors, including improved lactation education, increased awareness to mitigate cultural barriers, RMG factory-based initiatives to empower female workers early initiation of breastfeeding, and preparing early initiation of breastfeeding -friendly post-cesarean unit at the health care facility.

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

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

Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study

ObjectiveThis study aimed to develop and apply a nomogram with good accuracy to predict the risk of CRAB infections in neuro-critically ill patients. In addition, the difficulties and expectations of application such a tool in clinical practice was investigated.MethodsA mixed methods sequential explanatory study design was utilized. We first conducted a retrospective study to identify the risk factors for the development of CRAB infections in neuro-critically ill patients; and further develop and validate a nomogram predictive model. Then, based on the developed predictive tool, medical staff in the neuro-ICU were received an in-depth interview to investigate their opinions and barriers in using the prediction tool during clinical practice. The model development and validation is carried out by R. The transcripts of the interviews were analyzed by Maxqda.ResultsIn our cohort, the occurrence of CRAB infections was 8.63% (47/544). Multivariate regression analysis showed that the length of neuro-ICU stay, male, diabetes, low red blood cell (RBC) count, high levels of procalcitonin (PCT), and number of antibiotics ≥ 2 were independent risk factors for CRAB infections in neuro-ICU patients. Our nomogram model demonstrated a good calibration and discrimination in both training and validation sets, with AUC values of 0.816 and 0.875. Additionally, the model demonstrated good clinical utility. The significant barriers identified in the interview include “skepticism about the accuracy of the model”, “delay in early prediction by the indicator of length of neuro-ICU stay”, and “lack of a proper protocol for clinical application”.ConclusionsWe established and validated a nomogram incorporating six easily accessed indicators during clinical practice (the length of neuro-ICU stay, male, diabetes, RBC, PCT level, and the number of antibiotics used) to predict the risk of CRAB infections in neuro-ICU patients. Medical staff are generally interested in using the tool to predict the risk of CRAB, however delivering clinical prediction tools in routine clinical practice remains challenging.

Unveiling the impact: A mixed-method inquiry into the impact of leadership development programs

PurposePrior research and theory have shown that transformational leadership can be developed through leader development programs (LDPs). To explain how this happens, research suggests a strong connection between an individual’s leader self-concept and their leadership behavior that can be manipulated through LDPs. The purpose of this article is to delve deeper into this phenomenon to understand how development occurs and to better understand how an LDP can improve leadership behaviors by influencing one’s self-concept and ultimately reduce the training transfer gap. As a broader goal, this article contributes to the existing literature on the value proposition of investing in LDPs.Design/methodology/approachWe conducted an explanatory sequential design mixed-methods study to measure the development of participants and the impact of the program. The quantitative phase of the study used self-report surveys to measure the LDP’s impact on participants’ transformational leader behavior (TLB) and concept of themselves regarding leadership, their leader self-views (LSVs). The study also measured the relationship between LSVs and later enactment of leadership behaviors as the second hypothesis. The subsequent qualitative study was designed to understand the mechanisms that might explain the quantitative results.FindingsThe study’s empirical findings indicate a positive relationship between LSVs (efficacy, self-awareness and identity) and distal leader development outcomes (TBLs). The study’s findings also provide support for the claim that LDPs convert knowledge and skills into TLB, expanding an individual’s capacity to be effective in leadership roles and processes (Day &amp; Dragoni, 2015). Qualitative results also show LDPs improve leader behavior by influencing their self-efficacy via providing tools and knowledge as well as building experimental mindset.Originality/valueBy showing LDPs' long term impacts, this paper demonstrates why short-term leadership development programs are worth investing.

Understanding Preventive Health Behavior: A Mixed-Methods Study to Explore Factors Influencing the Practice of Breast Self-Examination Among Indian Medical Students.

Breast cancer (BC) is among the most prevalent oncological cases in the world, and the global burden of the disease is expected to rise further in the coming years. Strategies aiming at early diagnosis, backed by research and a well-trained healthcare cadre, can aid low- and middle-income countries (LMIC) in tackling the possible cancer-caused strain on healthcare systems. Our study aimed to evaluate the level of knowledge of medical students concerning BC and explore barriers and facilitators of breast self-examination (BSE). A sequential explanatory mixed-methods study approach to better understand factors and beliefs influencing preventive health practice in BSE was conducted among students at a medical college in rural Maharashtra, India. One hundred and two female medical students completed the quantitative phase, and 15 of them gave in-depth interviews (IDIs) for the qualitative aspect. Among the participants, 67.6% had good knowledge of risk factors, but only 10% knew the recommendations for BSE, clinical breast examination (CBE), and mammography. We found that being taught BSE by a trusted source and knowing a BC patient were significant facilitators. In contrast, lack of self-efficacy and two fear factors were found tobe acting as barriers for BSE, one being the absence of fear of ever getting BC and the other fear of detecting a lump. This study reveals a gap between knowledge of risk factors and their translation to disease prevention practice. The barriers elicited are modifiable by planning and implementing an appropriate training program covering risk factors and recommending all available screening and preventative modalities. A well-trained medical staff will be instrumental in improving the health status of our community and country.