Sequential Explanatory Mixed Methods Study Research Articles

Emergency Department and Dental Clinic Perceptions of Appropriate, and Preventable, Use of the ED for Non-Traumatic Dental Conditions in Hot-Spot Counties: A Mixed Methods Study.

Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics. Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed. North Dakota experienced a decline in NTDC ED visits between 2017 and 2020, though the rate is now increasing. The greatest proportion of NTDC ED visits were among persons ages 20 to 34 and 35 to 44. ED and dental care staff have misconceptions around each other's roles in reducing NTDC ED visits, but unanimously suggest community-level prevention as a solution. NTDC ED use was perceived as "appropriate" care. However, there is consensus that improved access to, and utilization of, affordable and quality preventative dental care would reduce NTDC ED visits and improve overall community health, especially among populations experiencing greater inequities.

Designing the Future of Medical Education: The EPA Framework as a Catalyst to Inform Family Planning and Reproductive Health Fellowship Training Program in Ethiopia Medical Education: An Exploratory Sequential Mixed Method Study.

Entrustable Professional Activities (EPAs) are tasks or responsibilitieswithin a specific field that can be given to a learneronce they are competent to perform them independently. EPAs are being used in various specialty programs and serving as valuable tool to inform educational program. However, due to disparities in professional practice between different contexts, the automatic transfer of a set of core EPAs is not feasible. Hence, our study aims to develop an EPA framework to inform the Family Planning and Reproductive Health Fellowship Program in the local context of Ethiopia. We employed an exploratory mixed-method design, which involved the collection of qualitative data using the Nominal Group Technique and quantitative data through a nationwide survey in all residency training institutions across the country. Qualitative data analysis involved several steps, including compiling a list of tasks, removing duplicate tasks, reviewing EPAs using criteria and an equal rubric tool. For quantitative data analysis, descriptive statistics, validity index analysis, and intra-class correlation coefficients, were used. Seven senior panelists were able to propose a total of 57 EPAs, with 17 remaining after qualitative data analysis. The panelist evaluated the relevance of each EPA in the second phase. As a result, 17 EPAs received a content validity index of >0.83, indicating satisfactory relevance. In the national survey, experts reached a high level of final agreement regarding the relevance and representativeness of all 17 EPAs (ICC = 0.815, 95% CI [0.0.756,0.865], p.0001). The final set of 17 end-of-training EPAs is valid, acceptable and representative of the discipline, and they can be used as a framework to inform Family planning and Reproductive Health Fellowship Program in Ethiopian medical education once these core EPA statements are described in sufficient detail. This can contribute to raise the quality of training and hence the quality of patient care.

Eudemonia of People Living with HIV at an Anti-Retroviral Therapy Center, Ron, Gadag District - A Mixed Method Feasibility Study

Background In the realm of health and wellbeing the cursed part is the illness. Times elapsed health problems and challenges evolved constantly. In 1980s the first case of HIV Human Immunodeficiency Virus was reported and according to World Health Organization WHO 36.9 million people worldwide are living with HIVAIDS Acquired Immunodeficiency Syndrome.Aim This study aimed to explore the meaning of lived experiences of people living with HIV PLHIV and evaluate the effectiveness of health interventions on the state of health of PLHIV at an Anti-retroviral therapy ART center Ron Gadag District.Methods A sequential exploratory mixed-method study was conducted from August 2022 to September 2022. The qualitative strand with five samples explored lived experiences of PLHIV to develop health related counselling programme and quantitative strand with 14 samples tested the health-related counselling programme developed based on the data extracted from qualitative strand leading to first level integration in addition to administration of oral zinc 20 mgday for one month. Qualitative data analysis was done using QDA Miner lite version 3.0 and quantitative data analysis was done using IBM SPSS version 29.0 followed by mixing of data by integrated analysis.Results After qualitative analysis six themes and twenty-one sub-themes were derived in development of phenomenology. After quantitative analysis H1 amp H2 were accepted as P value obtained was 0.001 for df - 01 at 5 level of significance. The integrated analysis showed that findings from both the strands complemented supported and synergized the state of eudemonia among PLHIV.Conclusion The study concluded that administration of oral zinc supplementation and regular health related counselling sessions are effective strategies in maintaining eudemonia of people living with HIV amp AIDS.

Scale Development and Inferential Analysis of Service Quality in Higher Education: A Sequential Exploratory Mixed-Method Study

In response to the consumer-oriented shift in higher education, institutions are embracing technology and flexible delivery to enhance services. This is critical for student attraction, retention, and academic success. Consequently, the focus on service quality and student satisfaction has grown. This study investigates service quality expectations and perceptions of students in a local Caribbean -based tertiary institution. A novel scale, the “Service Quality Scale for Higher Education (SQSHE),” is developed using a sequential-exploratory mixed-method approach. The SERVQUAL-driven Disconfirmation framework informs this scale, measuring the gap between expected and perceived service encounters. Three focus group interviews generate a 53-item pool, refined to a 23-item scale with four dimensions: student well-being, service efficiency, social interaction, and value co-creation. The SQSHE demonstrates reliability, stability, and internal consistency. Data from 179 participants via an online questionnaire reveal four service quality dimensions, with two displaying significant negative gap scores. This culturally relevant four-factor scale contributes significantly to higher education research. By addressing student expectations, institutions can enhance strategies to elevate satisfaction and success rates.

Factors Influencing Oncofertility in Gynecological Cancer Patients: Application of Mixed Methods Study

This study aimed to identify factors influencing oncofertility and to explore the oncofertility experiences of patients with gynecological cancer using quantitative and qualitative methods, respectively. An explanatory sequential mixed-methods study was conducted. The quantitative study involved 222 patients with gynecological cancer recruited from online cafes and hospitals. Data were analyzed using IBM SPSS Statistics 28. For qualitative research, eight patients with gynecological cancer were interviewed. Data were analyzed using theme analysis method. Oncofertility performance was quantitatively assessed in 40 patients (18.0%). Factors that significantly affected oncofertility were fertility preservation awareness (odds ratio [OR] = 14.97, 95% confidence interval [CI]: 4.22~53.08), number of children planned before cancer diagnosis (OR = 6.08, 95% CI: 1.89~19.62; OR = 5.04, 95% CI: 1.56~16.29), monthly income (OR= 3.29, 95% CI: 1.23~8.86), social support (OR = 1.08, 95% CI: 1.01~1.17), and anxiety (OR = 0.79, 95% CI: 0.66~0.95). Qualitative results showed three theme clusters and eight themes: (1) themes for determinant factors affecting oncofertility selection: 'desire to have children' and 'special meaning of the uterus and ovaries;' (2) themes for obstructive factors affecting oncofertility selection: 'fertility preservation fall behind priorities,' 'confusion caused by inaccurate information,' and 'my choice was not supported;' (3) themes for support factors affecting oncofertility selection: 'provide accurate and reasonable information about oncofertility,' 'addressing the healthcare gap,' and 'need financial support for oncofertility.' Financial support, sufficient information, social support, and anxiety-relief interventions are required for oncofertility in patients with gynecological cancer.

Preservice Classroom Teachers’ Self-Efficacy Toward Providing Physical Activity in the Classroom

Purpose: The purpose of this study was to understand preservice classroom teachers’ perceptions of and efficacy toward providing physical activity (PA) during the school day. Method: One hundred and seventy-one participants (89% women; 12 universities; 25% secondary) participated in this exploratory sequential mixed-methods study. Teachers participated in a survey that included validated scales, and 20 teachers participated in follow-up interviews. Results: A series of analyses of variance showed significant differences between level of certification sought and teacher efficacy toward providing PA, specifically in areas of institutional and general self-efficacy. Regressions revealed that PA enjoyment was the only significant predictor of teacher efficacy (general, psychological, institutional, and educational efficacy) toward providing PA. Qualitative themes included: (a) perceived benefits of PA, (b) the need for meaningful preparation, and (c) motivation and enjoyment. Conclusion: Increasing PA enjoyment and providing professional development could help preservice classroom teachers be more efficacious toward providing PA in the classroom.

Investigating the Development and Psychometric Testing of the Information and Communication Technology Use Scale in Iranian Patients With Chronic Conditions

Background: The high prevalence and associated costs of chronic diseases have challenged global community health. The use of information and communication technology offers patients and healthcare providers the ability to respond to healthcare needs. This study develops an information and communication technology use scale for patients with chronic diseases and evaluates its psychometric properties. Methods: This exploratory sequential mixed-method study was conducted in Kashan City, Iran from September 2020 to July 2021. In the qualitative phase, 18 patients with chronic conditions were recruited via the purposeful sampling method. The initial pool of 33 items was extracted in this phase. Psychometric evaluation of the scale was examined through face, content, and construct validity. The internal consistency of the scale was assessed with the Cronbach α and its stability was examined by the test re-test. To evaluate the scale’s construct validity, a cross-sectional study was performed with 300 patients referring to hospital wards and private centers that provide services to patients with chronic diseases. A sequential sampling method was used to select the subjects. The exploratory factor analysis was performed using principal component analysis and the varimax rotation method in the SPSS software, version 16. Results: The initial version of the scale consisted of 33 items. A total of 6 items were removed in the face and content validity evaluation phase. Factor analysis with the removal of 4 items resulted in the extraction of 4 factors that explained 67.45% of the variance in the total scale score. The Cronbach α coefficient and intra-class correlation coefficient were estimated at 0.93 and 0.88, respectively. Conclusion: The scale developed in this study is a valid and reliable tool for measuring formation and communication technology use (including its dimensions) in patients with chronic diseases.

Factors Related to Client Satisfaction with Community Based Health Insurance Services During COVID-19 Pandemic in Central Uganda: A Mixed Methods Healthcare Facility Based Study.

During the COVID-19 lockdowns, healthcare services were disrupted and community-based health insurance (CBHI) schemes could not operate efficiently. This study assessed the level of client satisfaction with CBHI schemes, associated factors, and service provider perspectives in central Uganda. This was an explanatory sequential mixed-methods (quantitative - qualitative) study that was conducted between March and September 2021. In the first phase, a cross-sectional study among the 365 clients of the CBHI schemes who were aged ≥18 years old. The participants were recruited consecutively as they reported to the healthcare facility. Quantitative data were collected at patient exit using a piloted semi-structured interviewer-administered questionnaire. In the second phase, qualitative data were collected through 11 key informant interviews. These data were analyzed using a deductive thematic analysis approach. Modified Poisson regression was used to assess factors associated with client satisfaction and a p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant. Of the total number of participants, 38.9% (142/365) were "satisfied" with the CBHI services. Less satisfaction was associated with secondary level of education or above (adjPR = 0.55, 95% CI: 0.36-0.85, P=.007); residing beyond 16 kilometers from the healthcare facility (adjPR = 0.68, 95% CI: 0.41-0.95, P=.014); staying on the scheme for over 3 years (adjPR = 0.71, 95% CI: 0.51-0.99, P=.046); and good knowledge about the CBHI (adjPR = 0.76, 95% CI: 0.58-0.99, P=.040). Irregular availability of healthcare workers and long waiting time affected client satisfaction. Satisfaction was considerably low during the lockdown. Lockdowns due to pandemics interrupt healthcare services and subsequently affect the satisfaction of CBHI clients with scheme services. Scheme managers need to identify facilities that are closer to enrolees and invest in technologies that reduce waiting time in the healthcare facility.

Design and psychometrics of the family caregivers burnout inventory of older adults with chronic disease.

Identifying the hidden and pervasive phenomenon of burnout among family caregivers of older adults with chronic disease requires the use of a valid and reliable tool tailored to the cultural structure of the target community. Therefore, the present study aimed to design and psychometrically evaluate the family caregivers burnout inventory (FCBI) of older adults with chronic disease. This research is a sequential exploratory mixed-methods study focused on instrument design, conducted in Iran in 2024. The study employed classical theory, involving three stages to create a valid instrument: item design using inductive (semi-structured face-to-face interviews with 13 caregivers) and deductive (literature review) methods, tool design, and tool evaluation using face validity, content validity, construct validity [exploratory factor analysis (EFA) (N = 297) and confirmatory factor analysis (297 participants)], convergent validity, and reliability (internal consistency and stability). Data were analyzed using AMOS version 24 and SPSS version 26. Based on qualitative findings, participant quotes, and item adoption from other studies, a pool of 228 items was designed using a 5-point Likert scale (always to never). After several stages of review by the research team, 102 items remained. Following face validity (2 items), content validity (46 items), and construct validity (23 items due to factor loadings less than 0.4 and cross-loadings), 71 items were eliminated, leaving 31 items. EFA results indicated that the family caregiver's burnout construct of older adults with chronic diseases comprises six factors include; "neurosis," "feeling victimized," "extreme fatigue and helplessness," "neglect or abuse of self and others," "adaptation deficiency" and "emotional separation" explaining 52.93% of the total variance. The fit indices showed acceptable model fit with the data. In this study, composite reliability and average variance extracted (AVE) for the six factors were greater than 0.7 and 0.5, respectively, and the (AVE) for each factor was higher than the composite reliability. Cronbach's alpha coefficient for the entire scale was 0.975, and there was a significant correlation between test and retest scores (p < 0.001). FCBI demonstrates suitable validity and reliability and can be used in various settings by health service providers to identify symptoms of burnout in family caregivers.

Identifying the Components of Job Leaving Intention Among Faculty Members of Azad Universities in Fars Province

Objective: In the contemporary era, having a capable workforce is considered a competitive advantage for universities, and the job turnover intention among faculty members is one of the fundamental challenges for universities. Accordingly, this study aimed to examine the job leaving intention among faculty members of Azad Universities in Fars Province. Methodology: This research was an exploratory sequential mixed-methods study of the instrument development type. In the qualitative section, using purposive sampling and the theoretical saturation technique, 16 experts were selected for the study on job turnover intention among faculty members of Azad Universities in Fars Province. Initially, the main influencing indicators were extracted from the theoretical foundations and validated by experts using the fuzzy Delphi methodology. Since consensus among experts is the decision criterion in the Delphi method, the questionnaire was distributed and collected over three stages to achieve overall expert consensus on the classification. Then, using the matrix questionnaire and interpretive structural modeling technique distributed among specialists, the leveling of these factors was carried out. Findings: According to the obtained results, it is shown that ten factors pertain to the first level: a sense of injustice, personality traits, lack of adaptability, neglect, environmental factors, individual factors, job involvement, lack of social belonging, presence of conflict, and value differences. Additionally, two factors belong to the second level: organizational factors and human factors. The only factor related to the third level is the lack of employee work independence. The factor of non-implementation of a coordinated and fair system remains in the model and pertains to the fourth level of the model. Conclusion: It is recommended that attention to key dimensions such as organizational empathy, participative management, understanding employees in the workplace, attention to their individual issues and problems, addressing their demands, understanding discriminations, striving to reduce them, and focusing on positive psychology can contribute to organizational growth and excellence. This can lead to reducing or eliminating the adverse effects of job turnover intention, such as increasing intra-organizational conflicts, tensions, lack of organizational participation, secrecy, job abandonment, and damage to organizational performance.

Cognitive Distortions and College Adjustment of First Year Students in Samar State University

The transition to college is challenging, often linked to adjustment difficulties and mental health risks. This mixed-methods sequential explanatory study examined factors impacting these difficulties among freshmen, focusing on cognitive distortions (illogical thinking patterns). Quantitative results reveal a significant relationship between socio-economic factors, cognitive distortions, and adjustment difficulties. Qualitative interviews then identified five key themes: academic adjustment difficulties, financial stress, career choice difficulties, social adjustment difficulties, and psychological distress. These themes illustrate how socio-economic pressures and negative thought patterns manifest in specific challenges faced by students. These findings underscore the need for comprehensive support programs addressing both financial and psychological well-being, as well as targeted interventions focusing on cognitive restructuring and coping skills development to facilitate a smoother transition to college life.

Design, Implementation and Evaluation of a Health Promotion Program for Family Caregivers of Chronic Mental Disorders: A Mixed Methods Study.

Family caregivers of patients with chronic mental disorders who are responsible for taking care of the patient face many problems that can endanger the psychosocial health of these people. This study was conducted to develop, implement, and evaluate a psychosocial health promotion program for family caregivers of patients with chronic mental disorders. This research is an exploratory sequential mixed-method study conducted using a qualitative-quantitative design. A qualitative study was conducted to explain the needs and psychosocial problems and the solution to improve the psychosocial health of family caregivers of patients with chronic mental disorders in two psychiatric care centers in Isfahan were conducted. Then the program was written based on Kern's programming development approach. In the quantitative stage, a part of the developed program was implemented as virtual group psychoeducation for 67 caregivers, and its impact on caregivers' burden of care was evaluated. The findings from the qualitative phase of the study led to the emergence of 3 main categories and the findings from the quantitative phase of the study indicated that the implementation of the compiled program causes a significant reduction in the burden of care in family caregivers of chronically mentally ill patients (p<0.05). The current program was prepared and developed using an evidence-based approach. Policymakers and members of the mental health team can take a valuable step toward reducing the care burden of family caregivers of chronic mental patients by using the content of the developed mental health promotion program.

Digital Generations Paradox in Pre- and In-service Teachers’ Literacy Practices: An Explanatory Sequential Mixed Methods Study/Hizmet Öncesi ve Hizmet İçi Öğretmenlerin Okuryazarlık Uygulamalarında Dijital Nesiller Paradoksu: Açıklayıcı Sıralı Karma Yöntemler Araştırması Çalışması

Digital practices have become more prominent due to the growing demand in digital exposure in education. While technology has been used as a metaphorical divide between generations in many studies, very few studies include individuals’ definitions of their generational sense of belonging. By administering an online questionnaire (N=111) and conducting semi-structured interviews with pre-service and in-service teachers (n=6), this mixed methods study aimed to capture participants’ self-definitions and changes in these definitions. The results of this study provided evidence about the convergence impact of technology in educators’ personal and professional lives. This study contributes to the field of digital literacy by offering different perspectives about digital generations and discussing the use of technology to create collaborative and cooperative educational settings.

Unmet Sexual Health Resource Needs and Preferences for Interventions to Address These Needs Among Female Partners of Patients With Prostate Cancer

ObjectivesTo characterize unmet sexual health resource needs and preferences for interventions to address unmet needs among female partners of patients with prostate cancer (PCa), given the significant negative impact of PCa on the sexual health of partners. MethodsWe conducted an exploratory sequential mixed methods study of female partners recruited from multiple U.S. clinical locations, websites, and support groups for caregivers. We first conducted semi-structured in-depth interviews. Qualitative results informed development of a cross-sectional survey, which was administered to a larger sample of partners. ResultsOverall, 12 and 200 female partners participated in the qualitative and quantitative portions of the study. Major emergent themes from interviews were the benefits and drawbacks of technology-based interventions, the importance of sexual health resources throughout the PCa journey, and a desire for sexual health support groups that include partners. In the survey, the most common sexual health topics that partners wanted more information about were male libido problems (30.0%), erectile dysfunction (26.5%), and female libido and arousal problems (24.5%). Additionally, 41.5% wanted more information about sexual health websites, 35.0% about partners-only support groups, 29.5% about support groups for couples, and 23.5% about sexual medicine specialists. ConclusionsTo our knowledge, this is the largest study to date on female partners’ unmet sexual health resource needs and preferences for sexual health interventions. Partners prefer technology-based interventions, desire sexual health-focused support groups, and want more information about a variety of sexual issues and specialists who treat them.

Perceptions of Undergraduate Students Regarding the Inclusion of Clinical Audit in their Curriculum

Objective: To find out undergraduate students' perceptions regarding the inclusion of clinical audits in their curriculum. Study Design: Exploratory sequential mixed methods study. Place and Duration of study: Combined Military Hospital, Lahore Pakistan, from Dec 2022 to Mar 2023. Methodology: The first phase of the study comprised a quantitative research questionnaire regarding undergraduate students' perceptions about the inclusion of a clinical audit in their curriculum. These perceptions were explored in depth in the second phase with focus group discussions (FGD). Thirty students participated in the study, ten from the fourth year and twenty from the final year MBBS. Results: The study included 30 participants. The results showed that (24, 80%) of participants were able to develop skills as team members, (22, 73%) were able to identify audit topics, collect data, write audit reports and understand conflicts of interest, and (21, 70%) were able to write audit proposal and develop skill in life long audit learning. The key themes emerging from clinical audit focus group discussions (FGD) were better clinical care, patient safety, lack of understanding about audit by students and faculty and improper implementation mechanisms. Conclusion: In conclusion, a clinical audit promotes a safe, good-quality, and evidence-based environment for patient care. It also decreases the risk of clinical negligence and should be incorporated as an integral part of the undergraduate curriculum.

Gendering trust in general surgery training: Examining the role of trust between residents and attendings

In medical training and throughout medical careers, women face a disadvantage –especially in surgery. To better understand its origins, this study examines the role of gender in surgical training, focusing on trust between faculty and medical residents. An environment of trust enables surgical residents to gain hands-on experience and acquire practical skills during surgeries performed jointly with faculty. In this sequential explanatory mixed-methods study, 105 surgical encounters were rated utilizing the OpTrust tool, an instrument designed to measure entrustment between surgery residents and faculty. Furthermore, seventeen attendings and ten surgery residents gave in-depth interviews. Entrustment was modeled using linear regression models with robust estimators, controlling for resident and faculty demographic background and intraoperative factors. The results revealed gender disparities in trust. Prior experience in the operating room benefited male trainees more than female trainees in terms of faculty trust. Qualitative results indicate that gender stereotypes and biases may influence attendings’ trusting behaviors toward female residents, thus limiting their active participation inside the Operating Room. These findings can inform interventions to ensure equal surgical opportunities for female residents.

Social support in low-income women with Fibromyalgia Syndrome from a sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain): a mixed method study

BackgroundWomen with Fibromyalgia Syndrome (FMS) can benefit form adequate social support to fight the consequences of their illness, but the extent to which this is available to those with low incomes who live in depressed areas of Tenerife (Canary Islands, Spain) is currently unknown. The purpose of this study was to explore social support in low-incomes women with FMS in sub-urban and peri-urban areas of Tenerife.MethodologyA sequential exploratory mixed method study was carried out from January 20, 2023, to June 10, 2023, at the Fibromyalgia and Chronic Fatigue Association of Tenerife (AFITEN) using non-probability convenience sampling. Social support was analyzed quantitatively through MOS-SSS survey and Duke-UNC-11 questionnaire, while qualitative data were obtained through semi-structured interviews to identify social support providers and analyze their satisfactions levels.ResultsA total of 49 women, with a mean age of 57.80 years-old (SD = 13.25) were finally included in this study. MOSS-SSS and Duke-UNC-11 both indicated lower social support levels at 68.6 (SD =16.3) and 38.0 (SD = 9.74), respectively. The qualitative analysis revealed that partners and friends provided the most significant support with the highest satisfaction scores.ConclusionsThe socioeconomic status of low-income women with FMS living in sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain) influences on their social support, with the affective support and confidentiality being the most affected dimensions.

Development of a plant-based culinary nutrition model for sports science students

Introduction: Food and fitness levels are key factors required to maintain functional life. Hence, nutrition education is crucial in spreading awareness among Sports Science students. There is a paucity of plant-based nutrition knowledge and plantbased culinary skills for fitness locally. Therefore, this study aimed to develop a valid Plant-Based Culinary Nutrition Model (PBCNM) with nutrition knowledge and basic culinary skills to improve fitness among Sports Science students. Methods: This exploratory sequential mixed method study consisted of 2 phases. In Phase 1, a three-round modified Delphi method was conducted with 13 experts to generate a questionnaire that was validated. Lawshe worksheet determined the content validity ratio (CVR) for an item. Content validity index (CVI) for each section and the overall instrument was calculated. In Phase 2, quantitative data collection and analysis addressed the research questions and research gaps leading to model development. A total of 271 undergraduate Sports Science students at higher learning institutions were recruited as respondents. Results: In Phase 1, CVR of the overall survey was 1.0 and CVI was 0.834. Subsequently, the questionnaire was pilot tested for reliability and a Cronbach’s alpha score of 0.836 was obtained for the overall questionnaire. In Phase 2, the respondents’ mean and standard deviation score for the model’s components and needs was 4.21±0.73 for items 1-15. The integration of experts’ perspectives on the need of PBCNM for fitness and feedback from respondents resulted in the development of PBCNM. Conclusion: This study highlighted PBCNM as a helpful guideline for better fitness management.

A Study of Effective Dual Language Program Models for Non-Native Spanish Speakers

As the United States population becomes increasingly ethnically and linguistically diverse, more school districts, families, and students are beginning to recognize the need and value of bilingual education, specifically dual language programs, for both native and non-native Spanish speakers (Collier &amp;amp; Thomas, 2020). With dual language programs on the rise, it is important to consider which program model(s) most benefit the students within a particular program. The purpose of this explanatory sequential mixed methods study was to compare the effect of different dual language program models (including immersion programs) on primary-level students’ Spanish and English language acquisition by the time students reach fourth grade. The study fRobocused specifically on non-native Spanish speakers, utilizing both quantitative and qualitative data. Such data included Spanish and English literacy levels of students who had been in a dual language program from kindergarten through fourth grade and evidence from surveys and interviews of students and teachers. The study compared two schools, one with an 80:20 program model and one with a 50:50 program model. Overall, School 1’s 80:20 dual language program model appeared to be more effective than School 2’s 50:50 model in equally developing students’ Spanish and English language acquisition. Teachers and students from both schools indicated room for growth in their respective programs.

The Effects of Ecology-Oriented Instruction on Enhancing EFL Learner’s Writing Competence

The twenty-first century has witnessed an unprecedented pace of environmental issues with catastrophic consequences. Accordingly, an increasing number of initiatives have been seized to solve ecological problems in cooperation. In this regard, integrating eco-friendly practices into EFL classes has received considerable attention globally. However, the effects of ecology-oriented writing instruction have not been explored thoroughly in the Iraq context. Thus, this study was carried out to fill this gap in the literature with 30 EFL learners who studied at a language preparatory school of a private university in the spring semester of the 2022-2023 Academic Year in Erbil. Participants, whose ages were between 18 and 24, were chosen through the convenience sampling method. The study lasted eight weeks when data were gathered via writing exams and interviews in this explanatory sequential mixed-methods research design study. Control group students were exposed to traditional instruction, while experimental group students’ lessons were enriched by ecology-oriented writing topics. The in-depth analysis was performed through SPSS 27 and NVivo. The former revealed that experimental group students increased their writing competence more substantially than the control group students. Likewise, interview findings unearthed that students’ awareness about ecological problems increased dramatically in the experimental group, while the difference was not significant in the control group. The findings of this study may drive authorized bodies to integrate eco-friendly approaches into academic writing lessons on a global scale.