Exploratory Study Research Articles

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.

Understanding Driving Stress in Urban Bangladesh: An Exploratory Study, Wearable Development and Experiment

Driving stress significantly impacts driving behavior primarily from roadside factors, where driving is more challenging in developing countries (i.e., Bangladesh) for unique cultural and infrastructural setups. We conduct an exploratory study (Qualitative n = 26, and Subjective Feedback n = 80) and a correlational analysis involving professional and private car drivers in urban Bangladesh. The study reveals drivers' demography and driving stress factors on the road. These findings motivate us to identify driving stress from physiological factors by developing a low-cost wearable, Stress Wear . This can detect stress from varying Heart Rates, validated by expensive commercial wearables. Between subject experiments on drivers (total n = 14 in two phases) with wearables, we also found that road factors are responsible for driving stress. Therefore, the developed system is helpful for these drivers to self-sense their stress.

Translanguaging in a beauty salon

Abstract This is an explanatory case study of how translanguaging offers space for practicing two shared languages: Saudi Pidgin Arabic and English as a lingua franca (ELF). It attends closely to overt types of translanguaging resources practiced by interlocutors. The study utilizes the conversation analysis (CA) approach to analyze conversations totaling 240 minutes, held in a beauty salon, between a Saudi female client and a Filipino beautician who communicated with each other using English and Saudi pidgin. The results show that the speakers’ interaction is mainly in English, but they switch to pidgin Arabic to fix misunderstandings, create humor, and engage in cooperative interaction. The study demonstrates that overt translanguaging resources employed by participants strengthen the multilingual nature of their ELF interactions, during which another contact language–Saudi pidgin in this case–can be practiced as another lingua franca. The study extends the limited literature on the nature of translanguaging in lingua franca social contexts and demonstrates the uniqueness of the translanguaging resources employed by ELF users.

Bridging the divide: Exploring inequities between sworn and civilian leaders in a Canadian police service.

Policing in the 21st century has rapidly become more complex, accountable, and changeable. Concern has emerged across the globe over the sustainability of public policing. Empirical research has supported that effective leadership at all levels of an organization is necessary to achieve success. Much has been said about the importance of effective leadership in policing. This paper explores an unexpected key finding from a mixed-methods, explanatory sequential design doctoral study that examined the self-efficacy beliefs and the factors that have influenced the leader effectiveness of sworn and civilian police leaders in a major Canadian police organization.

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.

Midwives' practices on perineal protection and episiotomy decision-making: A qualitative and descriptive study.

Perineal trauma is associated with both short- and long-term morbidity which in turn relates to the degree of trauma. The objective of this study was to understand midwives' practices regarding perineal protection during the second phase of labor, emphasizing decision-making to perform an episiotomy. A descriptive and explanatory study was conducted with an intentional sample of twenty-two midwives working in the labor ward of a tertiary hospital in a metropolitan location and in the public service, in Portugal. A semi-open interview was applied to collect the data from 5 to 15 January 2019. The computer software package, NVivo version 10, was used to perform the thematic analysis. Four main themes arose from the midwives' data: 1) Factors affecting the application of perineal protection techniques', 2) Birth position, 3) Techniques for perineal protection, and 4) Episiotomy. The reasons for performing an episiotomy were the presence of tense perineum, large weight baby, previous obstetric anal sphincter injury, and Kristeller maneuver. Midwives' practices regarding perineal protection techniques and reasons for performing an episiotomy were not all in line with the evidence. Perineal massage was not mentioned as a perineal protection technique.

Strategies for digital entrepreneurship success: the role of digital implementation and dynamic capabilities

PurposeTo augment sales revenue, B2B digital start-ups aim to create and sustain commercial relationships with industry incumbents. However, since these incumbents have traditionally struggled with implementing disruptive digital artifacts, most studies have almost exclusively concentrated on their challenges, leaving the digital start-ups' side underexplored. Therefore, this study seeks to understand how digital start-ups navigate digital implementation (DI) hardships to ultimately achieve digital entrepreneurship success.Design/methodology/approachAn abductive explanatory multi-case study of four industries that pose a variety of implementation challenges for B2B digital start-ups (agriculture, insurance, real estate and construction, and healthcare) was conducted using data collected from 40 interviews with Israeli experts and relevant digital data observations.FindingsThis study articulates two main observations. (1) Throughout their journeys, digital start-ups have utilized newly created and/or refined dynamic capabilities (DC) to successfully implement their digital artifacts. Simultaneously, successful DI has enabled digital start-ups to create new DC or sustain and evolve current DC. (2) We provide empirical evidence outlining how digital start-ups using continuous learning have combined causation and effectuation logic throughout their DI journeys.Originality/valueThis study answers a call to explore more explicit digital-related drivers (i.e. DI) for digital entrepreneurship success by studying a highly-ranked country on the Global Entrepreneurship Index (GEI) to achieve this. Moreover, it illustrates how digital start-ups evolve throughout their commercial relationships with industry incumbents, thereby enabling an effective approach for successful DI. Such an approach can be considered very valuable for both practitioners and policymakers. Consequently, it advances digital entrepreneurship as an independent research topic.

Khat use and related determinants among pregnant women within Haramaya, Ethiopia: a mixed methods study

IntroductionKhat, a green leafy plant grown in East Africa and throughout the Arabian Peninsula, is chewed for its psychoactive and amphetamine-like effects, serving as a significant aspect of culture, economic livelihood, and global trade. Khat consumption during pregnancy has been associated with adverse effects, including anemia, premature rupture of membranes, and low birth weight, among others.MethodsThis cross-sectional, explanatory sequential mixed methods study was conducted in the Haramaya District of eastern Ethiopia using a questionnaire and focus group discussions. Questionnaires assessed socio-demographic information, pregnancy history, and diet, including khat use. Data were analyzed using SPSS v28 to include descriptive statistics, proportions, odds ratios, binary logistic regression, and chi-square analysis. FGDs expanded on the knowledge, attitudes, and practices of khat in the region, including pregnant or lactating women from two different kebeles. Two independent reviewers conducted a qualitative content analysis to examine the qualitative findings from the FGDs. Transcripts from the focus groups were entered into NVivo 14 to aid in capturing salient themes.ResultsA total of 444 pregnant women with a median age of 25 years completed the questionnaire. Two-thirds of the women, 66.9%, reported currently consuming khat while pregnant, and 72.7% of them reported daily consumption. The FGD analysis resulted in the discovery of five themes: Economic Livelihood, Maternal Significance, Medicinal Implications of Khat, Pesticide Use, and Social and Cultural Applications.DiscussionThis study revealed an alarming high prevalence of khat consumption among pregnant women in the Haramaya District, highlighting the pressing need for long-term studies to assess the health consequences. The role of khat as both an economic staple and an energy source for daily activities underscores the challenges in curbing its use. The documented health risks associated with the chemicals used in khat cultivation, including cancer, call for interventions to enhance safe agricultural practices in households involved in khat farming.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.

Responding to the real problem of sustainable resuscitation skills with real assessment. Mixed-methods evaluation of an authentic assessment programme.

The retention of resuscitation skills is a widespread concern, with a rapid decay in competence frequently following training. Meanwhile, training programmes continue to be disconnected with real-world expectations and assessment designs remain in conflict with the evidence for sustainable learning. This study aimed to evaluate a programmatic assessment pedagogy which employed entrustment decision and the principles of authentic and sustainable assessment (SA). We conducted a prospective sequential explanatory mixed methods study to understand and address the sustainable learning challenges faced by final-year undergraduate paramedic students. We introduced a programme of five authentic assessments based on actual resuscitation cases, each integrating contextual elements that featured in these real-life events. The student-tutor consensus assessment (STCA) tool was configured to accommodate an entrustment scale framework. Each test produced dual student led and assessor scores. Students and assessors were surveyed about their experiences with the assessment methodologies and asked to evaluate the programme using the Ottawa Good Assessment Criteria. Eighty-four students participated in five assessments, generating dual assessor-only and student-led results. There was a reported mean score increase of 9% across the five tests and an 18% reduction in borderline or below scores. No statistical significance was observed among the scores from eight assessors across 420 unique tests. The mean student consensus remained above 91% in all 420 tests. Both student and assessor participant groups expressed broad agreement that the Ottawa criteria were well-represented in the design, and they shared their preference for the authentic methodology over traditional approaches. In addition to confirming local sustainability issues, this study has highlighted the validity concerns that exist with conventional resuscitation training designs. We have successfully demonstrated an alternative pedagogy which responds to these concerns, and which embodies the principles of SA, quality in assessment practice, and the real-world expectations of professionals.

Online Collaborative Strategies of ESL Learners in Precis Writing

It can be difficult to make the switch to online learning, and there are questions about how well students will be able to work together on group writing assignments. This study aims to identify the synchronous collaboration strategies employed by ESL students and how they affect their precis writing. Purposive sampling was employed in this study to select twenty-five (25) ESL students. Data was gathered using interviews, observation, and checklists as part of an explanatory mixed-method study design. According to the study's findings, students gain strategic thinking skills through online collaborative writing assignments; they also get better at summarizing, working in teams, and communicating important ideas in texts; and they stress the value of editing their work and utilizing both conventional and modern writing tools. Through the provision of resources, technology, and mentorship, educational institutions should establish settings that support collaborative writing.

Business Management as a Link Between Competitiveness and Sustainable Development in the Textile Sector

Efficient resource management plays a crucial role in the sustainable development of companies, aiming to maximize economic performance, minimize environmental impacts, and contribute to social welfare. This quantitative and explanatory study analyzed resource management in textile microenterprises in Metropolitan Lima, with a sample of 370 participants. The methodology used was non-experimental and cross-sectional, allowing for a detailed analysis of the relationship between business management and sustainable development in this specific context. Two questionnaires of 20 questions each were administered. Both instruments were validated by five experts in the business area. The Aiken's V for the first instrument was 0.83 and for the second instrument was 0.79. Additionally, a pilot test was conducted for instrument reliability, obtaining 0.89 for the first instrument and 0.81 for the second. The results highlight the significant relationship between business management and sustainable development, especially in terms of competitiveness and general management aspects. However, there is a relatively lesser association of eco-efficiency, eco-effectiveness, and continuous improvement in the variability of sustainable development. It is concluded that, while business management is considerably related to sustainable development, aspects such as eco-efficiency and continuous improvement show a less pronounced relationship in sustainable development variability. These findings underscore the importance of sustainability-focused business management to enhance competitiveness and foster equitable and long-term sustainable development. Received: 15 February 2024 / Accepted: 26 April 2024 / Published: 5 May 2024

The Role of the Implementation Matrix in Designing and Reporting Integration Decisions in a Mixed Methods Study

The purpose of this article is to illustrate the process and insights gleaned from developing an implementation matrix to convey a concise, yet detailed representation of the project integration steps in a single diagram. The article is based on an explanatory sequential study conducted with 248 teachers exploring how beliefs shaped their use of technology. This article contributes to mixed methods research (MMR) by providing an example that can be used as guide by other researchers in developing and using the implementation matrix as a tool for communicating procedurally the mixed methods project integration steps for an explanatory sequential study. It also provides analytical insights gleaned and recommendations for how the implementation matrix can be developed and utilized.

Evaluating the Impact of a Recreational Therapy and Rock Climbing Program on Resilience and Self-Efficacy in College Students

This exploratory study evaluated a program focused on building resiliency and self-efficacy in college students through a combination of rock climbing and recreational therapy interventions that included mindfulness, and reflective journaling activities. The study imbedded therapeutic programming in an introductory rock climbing course offered through a university over three consecutive days. Secondary aims were to determine the feasibility of offering therapeutic programming to college students within a recreation-based academic course and to evaluate the program’s value to students. Results indicate participants (N = 12) experienced a significant increase in resilience (p = .003) and self-efficacy (p = .01) post-program, and all participants either agreed (n = 4) or strongly agreed (n = 8) the program had value to them. Feasibility data using multiple measures indicate it is feasible to offer brief, therapeutic programming as part of a university rock climbing course.

Budgeting Behavior: Indonesian Local Government Budget Predictions

Objective: The behaviors of overreaction and underreaction exhibited by public sector budget planners have an impact on the disparity between the initial budget set at the beginning of a period and the actual budget realization at the end of the period. This study aims to examine how budget planners in Indonesia predict budgets for local governments, specifically whether there is a difference in the overreaction or underreaction behavior of public sector budget planners among districts and cities in the South Sulawesi Province of Indonesia. Theoretical Framework: This study aims to elucidate the cognitive mechanisms of representativeness bias and the anchoring-adjustment heuristic, which may impact the behavior of individual budget planners in determining budget amounts for future periods and their reliance on past information. Method: This research employs a quantitative approach with a causal and explanatory study design. In this study, the independent variable is the behavior of public sector budget builders, while the accuracy of their predictions for the future budget of the public sector constitutes the dependent variable. The quantitative approach was selected because it aligns with the research's objective of discerning potential misestimations in the behavior of budgeting teams when determining the budgetary allocations for the upcoming year in various patterns or conditions. The research's respondents are the budgeting teams from various districts and cities in the South Sulawesi Province. To test the research subjects, a heuristic of representativeness and anchoring-adjustment is followed when utilizing patterns of revenue realization from previous years (time series). Results and Discussion: This study found that the average Uncertainty in Budget Planner Predictions for Local Governments in each district and city in South Sulawesi, Indonesia, is consistent and does not exhibit significant differences. This research is highly significant as it can provide a valuable contribution to public sector budget planners in Indonesia when establishing budget amounts for the forthcoming period. Research Implications: This study seeks to contribute to advancing research in the realm of public sector budgeting in South Sulawesi, particularly by providing an overview of the occurrence of overreaction and underreaction behaviors among the planners of Local Own-Source Revenue (PAD) budgets in South Sulawesi Province. Originality/Value: The novelty of this study lies in the empirical validation of the utilization of the concepts of representativeness and anchoring-adjustment in the behavior of public sector budget planners when determining the budget amounts for the upcoming period.

Is it an abortion: Classification of pregnancy-ending interventions after 24 weeks in the presence of lethal fetal anomalies

ObjectiveTo determine how obstetrician-gynecologists categorize pregnancy-ending interventions in the setting of lethal fetal anomalies. Study DesignWe conducted a sequential explanatory mixed methods study of U.S. obstetrician-gynecologists from May to July 2021. We distributed a cross-sectional online survey via email and social media and completed qualitative telephone interviews with a nested group of participants. We assessed institutional classification as induced abortion versus indicated delivery for six scenarios of ending a pregnancy with lethal anomalies after 24 weeks, comparing classification using McNemar chi-square tests with Benjamini-Hochburg correction for multiple comparisons with false discovery rate of 0.05. We performed thematic analysis of qualitative data and then performed a mixed methods analysis. ResultsWe included 205 respondents; most were female (84.4%), had provided abortion care (80.2%), and were general OB/GYNs (59.3%), with broad representation across pre-Dobbs state and institutional abortion policies. Twenty-one qualitative participants had similar characteristics to the whole sample. Scenarios were classified as induced abortion by the majority of respondents, ranging from 53.2% for 32-week induction for anencephaly, to 82.9% for feticidal injection and 24-week induction for anencephaly. Mixed methods analysis revealed the relevance of gestational age (later interventions less likely to be considered induced abortion) and procedure method and setting (dilation and evacuation, feticidal injection, and freestanding facility all increasing classification as induced abortion). ConclusionThere is wide variation in classification of pregnancy-ending interventions for lethal fetal anomalies, even among trained OB/GYNs. Method, timing, and location of ending a nonviable pregnancy influence classification, though perinatal outcome is unchanged. ImplicationsThe classification of pregnancy-ending interventions for lethal fetal anomalies after 24 weeks as indicated delivery versus induced abortion is reflective of sociopolitical regulatory factors as opposed to medical science. The regulatory requirement for classification negatively impacts access to care, especially in environments where induced abortion is legally restricted.

Analysis of library resources and services in developing confidence for language use

Reading is a form of social activity that connects the readers to transformational learning. Library resources offer an opportunity to build competence in language use. In essence, the library resources can impact how students perceived reading as a channel to academic success, which in turn—develops a lifelong learner. This study was an exploratory study that analyzed how library resources and services develop confidence in language use. Eight (8) college students were purposively selected for one-on-one interview. The data gathered were narrative from college students on how they utilized resources from their local library. The findings suggested that college students considered their local library as a reliable site to search for information. In-depth analysis showed that students were confident in language use because their resources were reliable and accurate. Language use covered mostly phonological and morphological aspects of language, including lexicons, writing styles, and writing formats. Librarians had the role of encouraging the students to read contents from the library and assisting them in utilizing in-print and online contents. Library assistance enabled the students to build their ideas into meaningful developmental contents. This study provided an angle for language confidence, language success, and language competence. These components of language learning were essential in predicting the linguistic capacity of students.

Is There A Conflict Of Interest In Indonesia’s Soe Investment Decision?

In financial management, the Director of State-Owned Enterprises (SOEs) in Indonesia synergizes with the Ministry of SOE to make investment decisions. One of the most common types of investment in SOEs is the purchase of shares in private companies. Through buying shares, SOEs can expand their business lines and project bigger profits. However, it is often found that the decision to purchase private company shares is made by SOEs due to a conflict of interest. This paper aims to determine the level of involvement of conflicts of interest in the decisions of SOEs in Indonesia to invest in the purchase of shares of private companies. Due to data limitations, the authors used a qualitative technique with an explanatory case study to meet the research aims. The analysis tested of 14 Indonesian SOEs' investment decisions when investing in the purchase of shares in private companies during the 2013–2022 period. The findings show allegations of conflicts of interest in several share investment decisions made by SOEs in Indonesia. This conflict of interest can occur because of a family relationship between the Board of Directors of SOEs and the management of private companies. In addition, there is also a political-party relationship between the parties involved. These findings can help several parties, including SOE and the Ministry of SOE, better understand the limits of investment that can be made. In the long run, the Ministry of SOE, as the supervisor of SOEs, can establish an early warning system to determine whether or not the investments made are appropriate. Most of the previous research only examined the effects of a company's investment and its impacts. It explores the company's stock price valuation process. No research has been found that specifically discusses SOE investment in Indonesia in private company shares.

Macro and micromanagement practices of reading comprehension programs in selected grade schools in the post-pandemic

After years in distance learning, grade school teachers are now facing the threat of declining reading comprehension among elementary pupils in post-pandemic settings. Teachers observed a spike in the number of non-readers and frustrated readers in intermediate grade levels. Teachers expressed concerns about the state of the education system in the aftermath of the pandemic. The purpose of this exploratory study was to establish an understanding of the challenges and mechanisms of macro- and micro-management strategies of grade school institutions. There were six teachers and six reading coordinators who participated in the study. The findings suggested that while reading comprehension was a problem before the pandemic, teachers realized a surge in the number of non-readers after opening back to face-to-face classes. This was an unanticipated phenomenon that called the academic institutions to respond immediately. Significant mechanisms of reading comprehension programs were profiling, initial detection, policy-based initiatives, and institution-based design. Collaborative and collective responsibility represented macro-management practices, while initiative and responsiveness reflected micromanagement practices. These practices and strategies provided conceptual and phenomenological underpinnings relevant to early-education reading comprehension.

Enhancing COVID-19 Vaccine Uptake among Tribal Communities: A Case Study on Program Implementation Experiences from Jharkhand and Chhattisgarh States, India

Tribal populations in India have health care challenges marked by limited access due to geographical distance, historical isolation, cultural differences, and low social stratification, and that result in weaker health indicators compared to the general population. During the pandemic, Tribal districts consistently reported lower COVID-19 vaccination coverage than non-Tribal districts. We assessed the MOMENTUM Routine Immunization Transformation and Equity (the project) strategy, which aimed to increase access to and uptake of COVID-19 vaccines among Tribal populations in Chhattisgarh and Jharkhand using the reach, effectiveness, adoption, implementation, and maintenance framework. We designed a qualitative explanatory case study and conducted 90 focus group discussions and in-depth interviews with Tribal populations, community-based nongovernmental organizations that worked with district health authorities to implement the interventions, and other stakeholders such as government and community groups. The active involvement of community leaders, targeted counseling, community gatherings, and door-to-door visits appeared to increase vaccine awareness and assuage concerns about its safety and efficacy. Key adaptations such as conducting evening vaccine awareness activities, holding vaccine sessions at flexible times and sites, and modifying messaging for booster doses appeared to encourage vaccine uptake among Tribal populations. While we used project resources to mitigate financial and supply constraints where they arose, sustaining long-term uptake of project interventions appears dependent on continued funding and ongoing political support.