Explanatory Sequential Mixed Methods Research Articles

POSTTRAUMATIC STRESS DISORDER AND PSYCHOSOCIAL RISK FACTORS IN FIRST RESPONSE WORKERS TO EMERGENCIES. MIXED METHOD.

First responders to emergencies are exposed to various risks, including psychosocial risk factors. Caring for patients in critical situations, experiencing traumatic events, and working under highly complex conditions increase their probability of developing mental disorders, such as posttraumatic stress disorder (PTSD). The objective of the study was to determine the relationship between PTSD and psychosocial risk factors and to understand the experiences of the disorder in this population. An explanatory sequential mixed method research design was used. The quantitative phase was an analytical cross-sectional observational study (n = 193), and the qualitative phase was phenomenological (n = 5). The psychosocial risk factors that best explained the presence of PTSD symptoms were the influence of non-work conditions on work, religion, emotional avoidance, and professional support as individual factors related to coping strategies. Individual factors such as coping strategies were determining factors that explained the symptoms of PTSD, and the influence of non-work conditions on work. It was identified that the demands of the job and the organizational factors, such as leadership style and lack of institutional support, generate anguish in workers and affect their ability to regulate their emotions when exposed to critical incidents.

Entrepreneurship skills framework for fostering the employability of industrial technology students

<span lang="EN-US">The rising rate of youth unemployment and its attendant consequences on the general populace in Nigeria has assumed a frightening dimension. The academia and other relevant stakeholders have gradually come to realize that the possession of academic qualifications alone cannot guarantee a good quality job. Nigerian higher intuitions are now introducing entrepreneurship studies in their school curriculum without a clear framework. Research has shown that this does not guarantee total graduates unless we have an entrepreneurship skills framework that is functional and discipline-based. Noting that entrepreneurship is classified into two folds; entrepreneurship specific and entrepreneurship mindset, this study intends to develop an entrepreneurship skills framework that will promote the employability of the students of Electrical Technology in Colleges of Education in Nigeria. The survey research that employs the sequential exploratory mixed methods was used for the study. The population for this phase consists of entrepreneurs and academics in Nigeria. The use of the partial credit model in the Rasch analysis model guaranteed the consensus of the experts on each of the items being measured. The outcome of the study will contribute to the social-economic peace and sustainability in Nigeria and the body of knowledge in entrepreneurship regarding electrical technology.</span>

Identification of Critical Success Factors (CSFS) for PPP Scheme Toll Road Projects in Indonesia

Public-Private Partnership (PPP) models represent an innovative procurement approach and offer promising prospects for the future of the construction industry worldwide. However, in practice, not all PPP projects, particularly toll road projects, succeed in achieving their goals. This poses a unique challenge in determining the Critical Success Factors (CSFs) as the basis for evaluating project success. Therefore, the aim of this research is to identify and explore the concept of CSFs for toll road projects under the PPP scheme based on reputable academic journals in the last 10 years. This study employs a sequential exploratory mixed methods methodology to identify and explore CSF indicators for PPP scheme projects and to verify and validate the findings. The re-sults of this study reveal 13 indicators crucial for project success, categorized into 8 factors. The findings of this research contribute significantly to the management of PPP toll road projects in Indonesia, serving as a reference for stakeholders in decision-making to enhance the effective-ness and efficiency of toll road project management.

Current status of electronic health literacy among pregnant women with gestational diabetes mellitus and their perceptions of online health information: a mixed-methods study

BackgroundWomen diagnosed with gestational diabetes mellitus often rely on internet-based health information for managing their condition. This study aims to investigate the present state of electronic health literacy among women with gestational diabetes mellitus, analyze the influencing factors, and explore their experiences regarding accessing, comprehending, evaluating, and applying online health information pertinent to gestational diabetes mellitus.MethodsA sequential explanatory mixed methods research design was adopted in this study. Initially, 235 women with gestational diabetes mellitus participated in a cross-sectional survey. The research tools included general information and the Chinese version of the electronic Health Literacy Scale (eHEALS). Descriptive analyses were conducted to describe the characteristics of the sample, and multiple linear regression analyses were used to explore the factors influencing electronic health literacy among women with gestational diabetes mellitus. Secondly, 11 women with gestational diabetes mellitus joined semi-structured in-depth interviews to obtain their perceptions about online health information. The data were analyzed using inductive content analysis to develop themes.ResultsThe median score of eHEALS in the Chinese version among 235 women diagnosed with gestational diabetes mellitus was 29 (interquartile range [IQR], 26 to 32). Factors influencing electronic health literacy among these women included accessing health information from medical professionals (β = 0.137, p = 0.029) and utilizing health information from applications (β = 0.159, p = 0.013). From the qualitative phase of the study, four thematic categories emerged: reasons and basis for accessing health information from the Internet; address barriers to accessing and applying online health information; desires for a higher level of online health information services; outcomes of accessing and applying online health information.ConclusionThe electronic health literacy of women diagnosed with gestational diabetes mellitus remains suboptimal and warrants improvement. The sources of access to health information affect electronic health literacy in women with gestational diabetes mellitus. Moreover, women facing gestational diabetes encounter numerous impediments when attempting to access health-related information online, underscoring the necessity for enhanced online health information services to meet their needs.

Evaluating the effectiveness of the cardiovascular assessment screening program with nurse practitioners and patients: results of a cluster randomised controlled trial

BackgroundThere is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada.MethodsA two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40–74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG).ResultsEight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category.ConclusionNP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting.Trial registrationClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.

Exploring Science Teachers’ Belief towards Inquiry Based Teaching Learning Activity at Grade –VI

The National Curriculum of Bangladesh (2012) recommends student-centric IBT (IBT) learning activities in the science classroom. However, teaching science in Bangladesh is hardly follows the instructions of curriculum, and most teachers are found not to place adequate emphasis on involving the students in the inquiry process. A possible reason might be science teachers’ belief. The focus of the research questions is to find out firstly, the beliefs of both urban and rural sixth grade science teachers and secondly, the differences between genders and lastly to explore the challenges of IBT. Thereby, a sequential explanatory mixed method was adopted for this study. The participating teachers were from both rural and urban areas. An interview was taken to support statistical and quantitative data for an in-depth explanation. The result revealed that teachers from both urban and rural areas have positive beliefs towards inquiry, and there is no significant difference between urban-rural and male-female teachers. In the case of urban teachers, the challenges were time and classroom management, but not for rural teachers. This study recommends that stakeholders use the inquiry instruction, reshape the training, and provide the teachers with the necessary opportunities for professional development programs in an effective way. Teacher’s World: Journal of Education and Research, 49 (2),135-149

Constructing student agency: The nexus between classroom activities and engagement

Student agency refers to the quality of students’ self-reflective and intentional actions and interactions concerning their activities and engagements both inside and outside the classroom. The engagements and activities help to increase the level of personal agency. This study mainly aims to determine the nexus between constructing student agency and engagements and activities in higher education English as a Foreign Language (EFL) classrooms. This study adopted a sequential explanatory mixed method design. To collect quantitative data, a survey was conducted with a set of five-point Likert scale questionnaires among 107 students studying at bachelor’s level in Dhading district, Nepal. The students represent different years of the bachelor’s level. Semi-structured interviews were conducted among three teachers teaching at the same level to collect qualitative data. The findings of the study hold important insights for higher education teachers, emphasizing the significance of incorporating agency into classroom activities and fostering engagement. Additionally, this study contributes to the development of agency when students have opportunities to be selective in actions, engagements and interactions in classrooms. To effectively address this issue, the researcher strongly advocates highlighting the importance of classroom engagement and activities as essential components in enhancing student agency in EFL classrooms and beyond.

Posttraumatic growth, spiritual damage, and psychosocial and mental health problems in survivors of clergy-perpetrated child sexual abuse: A mixed methods approach

IntroductionAlthough clergy-perpetrated child sexual abuse (CSA) implies severe traumatic repercussions for the victims, they may also experience posttraumatic growth (PTG) deriving from the need to deal with the trauma suffered. This PTG is associated with the processes of recovery, healing, and empowerment. ObjectiveApplying a mixed methods approach to analyse PTG outcomes and to explore experiences of PTG in survivors of Spanish clergy-perpetrated CSA and its relation with psychosocial, mental and spiritual suffering. ParticipantsThirty-one survivors (M = 51.6 years; SD = 12.4) in the quantitative stage of the research, and seven (M = 49.3; SD = 8.9) in the qualitative stage. MethodsA sequential explanatory mixed methods study design was applied using standardized questionnaires and semi-structured interviews. Descriptive, correlation and thematic analyses were conducted. The quantitative and qualitative data were integrated. ResultsPositive associations were found between PTG and psychosocial and mental health problems (r = 0.53; p < .01), damage to faith in God (r = 0.43; p < .05) and damage to faith in the Church (r = 0.48; p < .01). Three themes emerged from the qualitative data that explained, expanded, and complemented the quantitative results, highlighting the relationship between damage and growth and the specific meanings of PTG from the perspectives of the survivors. ConclusionsThis study shows that survivors may develop PTG in the course of the processes of psychological suffering, spiritual transformation, and meaning-making of traumatic experiences.

A formative mixed methods evaluation of a new Ross program: why context matters

BackgroundThe Ross procedure is a technically complex operation to address the pathology of the aortic valve. Prior attempts at widespread implementation have been plagued with variations in effectiveness. We report our initial programmatic outcomes using dissemination and implementation (D&I) science frameworks, with an aim to define both programmatic efficacy and effectiveness. The study design was a single center, explanatory sequential mixed methods evaluation of a Ross surgery program from June 2020 to April 2023. Quantitative measures for baseline patient characteristics and postoperative outcomes were summarized. Qualitative measures were obtained using semi-structured interviews and characterized using implementation science frameworks.ResultsA total of 71 patients underwent the Ross procedure at a single academic center. Mean age was 40 years (± 13). There were no perioperative deaths or valve-related reinterventions (0%). During the follow-up period, 2 (2.8%) patients required re-operation and 2 (2.8%) required balloon dilation of the pulmonary homograft. Qualitative measures noted communication and prospective self-audit facilitated measures of effectiveness, as dichotomy within expected vs. observed outcomes led to program modifications. Collaboration across hospital systems promoted adoption and implementation, which led to the incorporation of the Ross procedure into accepted organizational practice.ConclusionsIn this formative evaluation, limited-efficacy outcomes demonstrated similar programmatic success to data from other established centers. With the prerequisite center volume and case selection, the Ross procedure is a safe and efficacious treatment for aortic valvular disease. Implementation science can be used both in real-time and retrospectively to guide organizational efforts to improve outcomes and to improve the translation of results across centers.

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BackgroundEmergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses’ health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.PurposeThe purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.MethodsThe study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.ResultsA total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.Conclusion and implications for practiceFuture strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

The Use of Oxford’s Memory Strategies to Improve Vocabulary Learning Among Eleventh Grade EFL Students in Oman

Omani students must acquire English vocabulary to achieve educational qualifications and effectively communicate with English-speaking individuals, as vocabulary plays a crucial part in studying a foreign language and achieving academic success. Omani eleventh-grade students require assistance in employing effective ways for acquiring and retaining English vocabulary. They struggle with word retrieval in both spoken and written language. This study investigates the memory strategies utilised, preferred strategies, and influencing factors among eleventh grade EFL students in Oman. This study utilises an explanatory sequential mixed methods methodology. Convenience sampling was used to involve 126 students in this study. The researcher gathered data through a questionnaire, a semi-structured interview, and an observation checklist. The questionnaire data is analysed by descriptive statistical analysis, which includes calculating the mean and standard deviation. Thematic analysis is utilised for analysing the semi-structured interview data, while observation analysis is carried out to assess the classroom observation checklist. The findings showed that the most utilised category of methods is reviewing well (x=3.99), followed by employing actions (x=3.07). Interviews reveal that students favour utilising movies, visual aids, gaming, or competitive activities while interacting with their peers and friends. Additionally, CML tactics are predominantly utilised by teachers in their classrooms. The study results would assist educators in developing their vocabulary teaching strategies more efficiently, resulting in increased advantages for students. The curriculum developers could create tasks that enhance language acquisition.

Refining Innovative Teaching Processes for Core Competencies Among Teachers in Vocational Universities: An Exploratory Mixed-Method Approach Informed by China's Reform Policy

Objective: This study aims to explore stakeholders' perspectives on the "1+X" certificate policy and its impact on innovative teaching methods to enhance instructors' core abilities at vocational colleges. It also aims to develop a management model for innovation processes based on this policy and instructors' essential skills. Theoretical Framework: The project involves key stakeholders, including executives, teachers, and students. Consequently, this study commences with an exploration of the policy implementation process, drawing upon the practical experiences of these key stakeholders. Subsequently, it seeks to evaluate the proficiency levels of university teachers. Lastly, it endeavors to examine the relationship between the key factors of the innovative management process and teachers' competencies. Method: Using a sequential exploratory mixed-method approach, qualitative data was collected from vocational college administrators, industrial managers, and certified instructors in Yunnan and Chongqing in 2023. A purposive sample of 30 individuals was analyzed using data from institutional reports, interviews, and focus groups, with thematic analysis for interpretation. Results and Discussion: Qualitative findings identified three key factors affecting the management of innovative teaching processes and teachers' core competencies: policy implementation, training, and knowledge transfer. Based on these insights, the PTKT model was proposed and empirically tested with PLS-SEM. Results showed that knowledge transfer plays a mediating role between policy implementation and teacher core competencies, as well as between training and teacher core competencies, with all hypotheses supported. Research Implications: The study provides dual recommendations. For innovation management, it suggests administrators and HR managers focus on continuous skill development before, during, and after training, emphasizing aspects such as recruitment, selection, fostering a supportive work environment, and enhancing knowledge transfer. For future research, it proposes adopting action research methodologies, customizing courses, and engaging in project-based training and R&amp;D activities to facilitate mutual learning.

Individual differences in learning agility at work: A mixed methods study to develop and validate a new scale

AbstractThe unprecedented complexity of today's business and working environment increases the need for leaders and employees to learn new skills, be adaptable, and open to embracing change. New abilities and mindsets emerge, and their evaluation is challenging. This research utilized an exploratory sequential mixed methods design to develop and provide a preliminary validation of a scale measuring individual differences in learning agility (LA) at work. The measure has been tested in Central‐Eastern European countries, Italy, and Egypt. Results showed satisfactory reliability and nomological validity. The final scale of 11 items provides HRD researchers and practitioners with a reliable and concise tool suitable for investigating individual differences in LA across different job roles and positions. The scale has been tested in a cross‐cultural setting and is available in English, making it especially appropriate for multinational contexts.

Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial.

Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention-Pregnancy Story I Didn't Know in Interactive Webtoon Series (PSIDK-iWebtoons)-designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn't Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857. DERR1-10.2196/58326.

Parenting experiences and outcomes among former adolescent mothers: A mixed methods study.

The purpose of this explanatory sequential mixed methods study was to examine parenting outcomes and experiences over time among marginalized adolescent mothers enrolled in randomized clinical trials (RCT) between 2002 and 2016 testing Minding the Baby® (MTB), an early home visiting program. The quantitative phase examined associations between measures of maternal experiences and parenting outcomes from 71 participants 2-8 years since RCT completion. MTB mothers reported less hostile parenting and fewer child behavior problems. The sequential qualitative phase involved interviews with a subsample (n = 31) and revealed six themes about their personal and parenting maturation. Through integration of quantitative and qualitative data, we generated metainferences, revealing a nuanced understanding of participants' experiences. Integrated findings revealed the complex personal and parenting experiences among former adolescent mothers during their developmental phases of emerging and early adulthood. Findings inform clinical and research approaches to promote personal growth and positive parenting outcomes over time among women who began childbearing in adolescence.

THE CO-INTEGRATION AND CAUSALITY EFFECT BETWEEN GLOBAL COVID-19 PANDEMIC AND THE STOCK MARKET RETURN IN MALAYSIA: AN EXPLORATORY SEQUENTIAL MIXED METHODS APPROACH

The COVID-19 pandemic is one of the most unparalleled disasters the world has ever seen. Previously, the global community hasfaced the Middle East Respiratory Syndrome (MERS), Ebola Virus Disease (EVD), and Severe Acute Respiratory (SARS). However,the tremendous rate of infection created by the global COVID-19 pandemic is unmatchable with its rapid spread all over the world. Therefore, it is considered as a Black Swan event as created previously by the 2008 financial crisis, SARS, and 9/11 terrorist attack. All these events have triggered panic selling that affected the confidence of investors and businesses. Subsequently, stock market performance has affected the choice of investment decisions that translated into stock return. Therefore, this paper was undertaken to investigate the co-integration and causality relationship among global COVID-19 daily infected cases, COVID-19 recoveries rate, COVID-19 death rate, investor sentiment, government policy, foreign exchange rate, Malaysia gold price, and crude oil price towards the KLCI stock market return. This study employed an exploratory sequential mixed methods approach along with Johansen and Julius Co-Integration and Granger Causality in explaining the Malaysia stock market return. The empirical analysis concluded that COVID-19 daily cases, COVID-19 recoveries rate, government policy and foreign exchange have had a long-term effect in explaining the Malaysia stock return. On the other hand, all the study variables, except for government policy indicated a short-term effect on the Malaysia stock return. This study will contribute significantly to the body of finance literature on the impact of a disease outbreak, with highlights on the considerations of investors on the global COVID-19 pandemic in illuminating the variation of Malaysia stock market returns.

Telehealth resources and utilization interest among women who sell sex: An explanatory sequential mixed methods study

ObjectiveAmong a sample of women who sell sex (WSS), we examined unmet health needs, resources for telehealth, utilization interest, and attributes associated with interest in using telehealth. Study designExplanatory sequential mixed methods. MethodsWSS (N = 52) completed a fixed choice survey and focus group (N = 6, 26 individuals) from drop-in centers serving WSS. Chi-square/t-tests and results from the survey data informed the semi-structured focus group interview guide. Thematic analysis of focus group data was conducted to identify themes. ResultsOver half (58 %) of participants expressed interest in using telehealth; however, some lack the necessary resources for use. While 60 % of participants own mobile phones and 46 % have access to a computer, only 35 % have a secure, private space for telehealth appointments. Interest in telehealth was higher among participants who self-identified as having high risk for HIV compared to low risk for HIV (79 % versus 46 %, p = 0.024), and among those considering PrEP for HIV prevention versus not considering PrEP (68 % versus 32 %, p = 0.046). Focus group participants preferred face-to-face encounters for complex medical concerns but expressed interest in telehealth for improved access to healthcare providers for routine care and mental health. ConclusionIncorporating telehealth into community organizations could be one strategy to address health inequities experienced by WSS. Access to resources, including technology and safe spaces may be well-accepted if offered at trusted community organizations. Such accessibility addresses a gap in care for WSS and paves the way for new avenues for HIV prevention, mental health support, and research related to unmet health needs among WSS.

Citizen Charter as Governance Reform Initiative for Quality Services

The Citizen Charter (CC) is implemented to enhance the capabilities of local government in delivering services to people. It represents the official commitment to providing quality services to the public, and all service recipients need to have clear and concise information about the services and goods being provided. At the heart of the discussion on governance reform and the CC lies the question of whether public institutions foster the creation, dissemination, and processing of knowledge on the CC, which could ultimately lead to improved service delivery quality. Thus, this study examines the role of institutional factors such as procedural transparency and clarity, timely service delivery, and grievance handling systems in municipal service delivery post-implementation of the CC. The philosophical underpinning of this study adopts a pragmatic approach, utilizing a sequential explanatory mixed method. The findings reveal that there is increasing procedural transparency, and timely service delivery is gradually improving. However, the grievance handling system within the municipality still appears to be weak. It is evident from the study that the implementation of the Citizen Charter as a governance reform practice must address issues of reliability, responsiveness, and accuracy (RRA) to ensure quality service delivery (QSD) at the local level.

Time use of patients in a secure forensic hospital: A mixed methods study.

Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004. An explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey. Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use. Patient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems.

Evaluating the new family medicine internship programmes in the Western Cape, South Africa

Background: In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape.Methods: A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences.Results: Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% – 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%).Conclusion: The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.