Sequential Explanatory Mixed Methods Study Research Articles

Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life.

Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.

Hospital Experiences of Carers in Relation to the Comprehensive Care Standard: A Mixed Method Study.

To explore the care experiences of informal carers of people with chronic conditions in hospitals and identify areas for improvement in the context of comprehensive care delivery. A explanatory sequential mixed-method study. This study was conducted, involving a survey with 182 carers and interviews with 31 carers of individuals who attended an Australian hospital. Descriptive analysis of quantitative data was performed using RStudio, while thematic analysis of qualitative data was conducted using NVivo. The findings revealed seven overarching components of care that influenced carers' hospitalexperiences and their perceptions of care quality. Areas requiring improvement were identified within these categories. This review identifies common perspectives of informal carers of people with chronic conditions in hospital settings and highlights important areas that require attention to improve carers' hospital care experiences. Carers should be welcomed, involved, informed and supported during hospital attendance to foster the most positive care experiences. Healthcare professionals should involve carers in assessment, shared decision-making and the care process and recognise and address carers' needs. The findings revealed the carer's hospital experiences in the context of comprehensive care delivery and identified areas requiring improvement. The CROSS and the COREQ guidelines were followed. The study protocol was presented to stakeholders from two hospitals in Australia, a Patient and Carer Advisory Board (attached to the parent project: evaluating Quality of Care (eQC))and the Australian Commission on Safety and Quality in Health Care, and discussions were held to assess the relevance and significance of this study to clinical practice and health policy.

The impact of collaborative reflection and dialogic journals on EFL teachers’ ecological agency

ABSTRACT This explanatory sequential mixed method study aimed to investigate the impact of collaborative reflection and dialogic journals on EFL teachers’ ecological agency. For this purpose, 60 EFL teachers selected through purposive sampling were randomly assigned to three groups, one control group, and two experimental groups. The participants of the control group took part in a 10-session teacher training course. The participants of experimental group 1 participated in collaborative reflection sessions for 10 weeks and the participants of experimental group 2 were required to keep dialogic journals for 10 weeks. To investigate the effect of the treatment, the teacher ecological agency questionnaire was administered twice in the pretest and posttest. Finally, a set of semi-structured interviews were conducted with the participants of both experimental groups. The results indicated that collaborative reflection and dialogic journals had a significant effect on the development of the participants’ ecological agency. However, the participants of experimental group 2 outperformed the participants of experimental group 1 in the posttest examining ecological agency. The thematic analyses of the semi-structured interview revealed that both collaborative reflection and dialogic journals have contributed to the development of EFL teachers’ ecological agency. The findings of the current study have significant pedagogical implications for teachers, teacher educators, policymakers, and researchers.

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.

Application of ICU electronic diary platform based on co-design concept in Chinese critically ill patients: a mixed methods study protocol.

Critically ill patients are at a heightened risk for post-traumatic stress disorder (PTSD). While the intensive care unit (ICU) diary has been shown to improve the mental health and quality of life of ICU patients, the handwritten version still has some limitations such as a lack of support for multimedia content and writing by remote family members, as well as being time-consuming and labour-intensive. We hypothesise that constructing an ICU electronic diary platform based on a co-design approach and verifying its applicability could alleviate these limitations, making the ICU diary more convenient for users. This sequential exploratory mixed-methods study will consist of four consecutive phases: understanding the ICU diary research content and implementation, developing an ICU electronic diary platform after conducting qualitative interviews with stakeholders, verifying the applicability of the platform and verifying its effectiveness. Ethics approval was obtained from the Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2023-602). The results of this study will be distributed through peer-reviewed journals. Chinese Clinical Trial Register (ChiCTR2400079903).

Development, implementation, and evaluation of a spiritual health promotion program for mothers of children with acute leukemia based on mobile health: A mixed-methods protocol study

BACKGROUND: Considering the importance of the spiritual health promotion of Mothers of Children with Acute Leukemia (MoCwAL), designing a native mobile health (mHealth) application that is compatible with the beliefs, values, and cultural context of Iranian society is essential. This study aims to develop a Spiritual Health Promotion Program (SHPP) for MoCwAL based on a mHealth application, including design, implementation, and evaluation. MATERIALS AND METHODS: This is a sequential exploratory mixed-methods study (qual → QUAN). This study will be conducted in four phases. The first phase includes the development of the content of the SHPP using Ewles and Simnett’s (2010) designing pattern. After finalizing the SHPP, at the beginning of the second phase (mHealth application development), a panel of experts will be present. Based on the outputs obtained from this panel, the research team will proceed to design the application. The output of the second phase will be an initial version of the mHealth application. In the third phase, the usability and quality of mHealth application questionnaires will be evaluated. Results will be refined by the expert panel, and the final version of the application will be available. In the fourth phase, the SHPP for MoCwAL based on mHealth will be implemented as a quasi-experimental intervention, and mothers’ spiritual health be evaluated. CONCLUSION: This program can be useful in providing care, education, policy-making, and future research. Providing the SHPP in the form of an application will enable program users to benefit from the many advantages of information technology and will contribute to the expansion of the role of mHealth in the healthcare system and the strengthening of policies related to digital health in the field of chronic diseases.

Barriers to reporting adverse events from the perspective of ICU nurses: A mixed-method study.

Nurses represent the largest group of healthcare professionals and are responsible for improving patient safety, including reporting adverse events. However, adverse events are underreported due to the many barriers that compromise patient safety in the hospital setting. The study aimed to investigate the barriers to reporting adverse events as perceived by nurses working in intensive care units (ICUs). The exploratory sequential mixed-method study design was used. Data were collected between January 2022 and March 2023 in intensive care units of one selected university hospital in the Slovak Republic. The quantitative phase was carried out using a specific instrument to explore barriers to reporting adverse events and included 111 nurses from the ICU. The qualitative phase was conducted using semi-structured face-to-face interviews and consisted of 10 nurses from the ICU. In terms of quantitative aspect, fear of liability, lawsuits, or sanctions was the most significant barrier to reporting adverse events among ICU nurses. As a result of qualitative thematic analysis, four significant barriers to reporting adverse events were identified: negative attitude toward reporting adverse events; lack of knowledge and experience in reporting adverse events; time scarcity; fear. Based on the results of the study, it is evident that only effective and regular reporting of adverse events leads to the minimization of adverse events. To improve patient safety in hospitals, education and management practices must be implemented to overcome barriers to reporting adverse events. The most important approach to overcoming barriers to reporting adverse events is to implement a culture of no blame and a positive culture of patient safety.

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

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.

Schoolwork With Purpose: A Mixed Methods Study on Youths’ Perspective on What Makes Learning Meaningful

Making school meaningful is a widely accepted goal in education, yet what is considered meaningful, meaningful to whom, and why, leaves room for interrogation. This sequential explanatory mixed methods study aims to understand: (1) The extent to which students experience meaningful education at EL Education schools compared to comparison schools, and (2) How adolescents describe meaningful schoolwork. Survey responses were gathered from 258 students at nine middle schools (five EL Education, four comparison). Participants self-identified as 49% male, 47% female, 2% gender non-binary, 41% Black, 40% Latina/o, 33% White, 16% Multiracial, 1% Asian, and 31% low-income. Controlling for demographic characteristics, EL Education students reported statistically significantly more meaningful school experiences than comparison school students. Subsample analyses showed substantially greater meaningfulness at EL Education than comparison schools for Black ( n = 107; p < .01) and Latina/o students ( n = 40; p < .001). Interviews from 32 students and grounded theory analysis revealed that meaningful schoolwork focuses on: (a) Learning about and addressing “real-world problems” (e.g., racism, environmentalism, sociopolitical development), (b) Engaging content that was personally relevant, hands-on, and socially interactive, and (c) Future-oriented academic or social skills. Findings point to promising practices at EL Education schools and implications are discussed.

How does family resilience develop among stroke survivors and their caregivers? A mixed-method study using a chain mediating model

BackgroundWalsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience among Chinese stroke survivors and their caregivers. ObjectivesTo explore the direct and indirect relationships between the family resilience of stroke survivors, perceived social support, self-perceived burden, self-efficacy, and the burden on their principal caregivers, and to examine the journey of adapting to family resilience among stroke survivors. DesignAn explanatory sequential mixed-method study. MethodsA quantitative assessment of perceived social support, self-perceived burden, self-efficacy, and family resilience was conducted among a cohort of stroke survivors. For a deeper understanding of the family resilience formation process, semi-structured, in-depth interviews were undertaken with a purposefully selected subset of participants, consisting of 15 stroke survivors and their principal caregivers who met the study criteria. Data analysis encompassed descriptive statistics, mediation models, and content analysis to integrate and interpret both quantitative and qualitative data. ResultsIn a comprehensive hospital in Guangdong Province, China, 379 participants—229 men (60.4%) and 150 women (39.6%)—completed a cross-sectional questionnaire survey. The quantitative phase revealed significant statistical differences (p < 0.05) in total family resilience scores among stroke survivors related to various factors, such as age, marital status, educational level, occupational status, average monthly income per capita, first-time onset, and types of stroke. Self-perceived burden and self-efficacy partially mediate the relationship between perceived social support and family resilience, contributing to a sequential chain-mediated effect. During the qualitative phase, in-depth interviews revealed a progressive trajectory from the initial shock of diagnosis through the ongoing presence of stress and challenges to the ultimate development of family resilience and an adaptive perspective toward the future. ConclusionsExploring the factors influencing family resilience in stroke survivors could assist healthcare professionals developing interventions to enhance family resilience and lessen the burden on principal caregivers from individual, family, and social perspectives.

International students' perceived quality of university health centre services: an exploratory sequential mixed methods study.

This study aims to investigate international students' perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students' requirements, including healthcare services, is essential. A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students' perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students' perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. The qualitative strand revealed five major themes representing the study participants' thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students' socio-demographic characteristics.

Predictors of depression among caregivers of patients with severe mental illness in Northwest Ethiopia, 2023: an explanatory sequential mixed-method study.

Severe mental illness results in an enormous social and economic burden on affected individuals, their families, and communities, especially in developing countries, such as Ethiopia. The aim of this study was to assess the level of depression among caregivers of patients with severe mental illness in Debre Tabor Town, Northwest Ethiopia in 2023. This institution-based explanatory mixed study was conducted at Debre Tabor Compressive Specialized Hospitals between September 30 to October 30, 2023. A systematic random sampling technique was used to select 260 study participants, and a public health questionnaire was used to assess depression. Epicollect5 was used to collect data, which were then exported to the SPSS-25 for analysis. Variables with a p-value <0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratios with a 95% confidence interval were used to determine the strength of the association. An in-depth interview was conducted with 11 participants, selected using purposive sampling. The prevalence of depression was 31.3% (95% CI = 29.7-38.6). The multivariate analysis showed that being female (AOD = 2.43, CI = 1.42-7.23), divorced/widowed (AOD = 1.8, CI = 1.32-6.34), poor social support (AOD = 2.2, CI = 1.9-5.87), and perceived stigma (AOD = 2.33, CI = 0.24-13.22) were positively associated with depression. The qualitative results suggest that being female, illiterate, severity of the illness, poor social support, and stigma were factors for depression. The prevalence of depression was high among caregivers of patients with severe mental illness. Female sex, being divorced or widowed, being illiterate, poor social support, and perceived stigma were the contributing factors. This implies that a greater focus on caregivers and the government increases mental health literacy and mental health community services.

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.

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.

Shaping Student Relationships: The Role of Personality in Early Childhood Pre-Service Teachers.

The purpose of this explanatory sequential mixed-methods study is to explain teacher-student relationships in preschool classrooms in terms of the child's temperament and the pre-service preschool teachers' personalities. The study was conducted using a sequential exploratory mixed-methods design. Since both quantitative and qualitative data were obtained, sampling was carried out in two stages: quantitative random stratified sampling, and qualitative purposive sampling. Quantitative data were obtained from 126 pre-service teachers. The qualitative study group consisted of 18 pre-service teachers. Quantitative data were collected using the Student-Teacher Relationship Scale-Short Form, the Short Temperament Scale for Children (STSC), and the Five Factor Personality Inventory (FPI). Qualitative data were obtained from interviews with 18 teachers. The findings revealed that the student-teacher relationship can be explained by adult and child characteristics. In addition, pre-service teachers' perceptions of the student-teacher relationship are explained by adult characteristics much more than pre-service teachers' perceptions.

Mentorship of Junior Surgical Faculty Across Academic Programs in Surgery

Because mentorship is critical for professional development and career advancement, it is essential to examine the status of mentorship and identify challenges that junior surgical faculty (assistant and associate professors) face obtaining effective mentorship. To evaluate the mentorship experience for junior surgical faculty and highlight areas for improvement. This qualitative study was an explanatory sequential mixed-methods study including an anonymous survey on mentorship followed by semistructured interviews to expand on survey findings. Junior surgical faculty from 18 US academic surgery programs were included in the anonymous survey and interviews. Survey responses between "formal" (assigned by the department) vs "informal" (sought out by the faculty) mentors and male vs female junior faculty were compared using χ2 tests. Interview responses were analyzed for themes until thematic saturation was achieved. Survey responses were collected from November 2022 to August 2023, and interviews conducted from July to December 2023. Mentorship from formal and/or informal mentors. Survey gauged the availability and satisfaction with formal and informal mentorship; interviews assessed broad themes regarding mentorship. Of 825 survey recipients, 333 (40.4%) responded; 155 (51.7%) were male and 134 (44.6%) female. Nearly all respondents (319 [95.8%]) agreed or strongly agreed that mentorship is important to their surgical career, especially for professional networking (309 respondents [92.8%]), career advancement (301 [90.4%]), and research (294 [88.3%]). However, only 58 respondents (18.3%) had a formal mentor. More female than male faculty had informal mentors (123 [91.8%] vs 123 [79.4%]; P = .003). Overall satisfaction was higher with informal mentorship than formal mentorship (221 [85.0%] vs 40 [69.0%]; P = .01). Most male and female faculty reported no preferences in gender or race and ethnicity for their mentors. When asked if they had good mentor options if they wanted to change mentors, 141 (47.8%) responded no. From the interviews (n = 20), 6 themes were identified, including absence of mentorship infrastructure, preferred mentor characteristics, and optimizing mentorship. Academic junior surgical faculty agree mentorship is vital to their careers. However, this study found that few had formal mentors and almost half need more satisfactory options if they want to change mentors. Academic surgical programs should adopt a framework for facilitating mentorship and optimize mentor-mentee relationships through alignment of mentor-mentee goals and needs.

Improving Athletic Trainers' Knowledge of Clinical Documentation Through Novel Educational Interventions: A Randomized Controlled Trial.

Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation. To investigate the effectiveness of passive and active educational interventions to improve practicing ATs' clinical documentation knowledge. Randomized controlled trial, sequential explanatory mixed methods study. Online module(s), knowledge assessment, and interviews. We emailed 18 981 practicing ATs across employment settings, of which 524 ATs were enrolled into a group (personalized learning pathway [PLP = 178], passive reading list [PAS = 176], control [CON = 170]) then took the knowledge assessment. A total of 364 ATs did not complete the intervention or postknowledge assessment; therefore, complete responses from 160 ATs (PLP = 39, PAS = 44, CON = 77; age = 36.6 ± 11.2 years, years certified = 13.9 ± 10.7) were analyzed. Knowledge assessment (34 items) and interview guides (12-13 items) were developed, validated, and piloted with ATs before study commencement. We summed correct responses (1 point each, 34 points maximum) and calculated percentages and preknowledge and postknowledge mean change scores. Differences among groups (PLP, PAS, CON) and time (preintervention, postintervention) were calculated using a 3 × 2 repeated-measures analysis of variance (P ≤ .05) with post hoc Tukey HSD. Semistructured interviews were conducted (PLP = 15, PAS = 14), recorded, transcribed, and analyzed following the consensual qualitative research tradition. No differences in the preknowledge assessment were observed between groups. We observed a group × time interaction (F2,157 = 15.30, P < .001; partial η2 = 0.16). The PLP group exhibited greater mean change (M = 3.0 ± 2.7) than the PAS (M = 1.7 ± 3.0, P = .049) and CON (M = 0.4 ± 2.2, P < .001) groups. Descriptively, ATs scored lowest on the legal (61.3% ± 2.1%), value of the AT (63.7% ± 4.3%), and health information technology (65.3% ± 3.7%) items. Whereas ATs described being confident in their documentation knowledge, they also identified key content (eg, legal considerations, strategies) which they deemed valuable. The educational interventions improved ATs' knowledge of clinical documentation and provided valuable resources for their clinical practice; however, targeted continuing education is needed to address knowledge gaps.