Mixed Methods Research Articles

Applying a Three-Tier Approach to Address Gaps in Oral Pre-Exposure Prophylaxis Uptake and Continuity in Uganda: A Mixed Methods Approach.

We describe a 3-tier approach involving a gap analysis, root cause analysis, and pre-exposure prophylaxis (PrEP) collaborative to understand the gap and identify and address the main barriers to oral PrEP uptake and continuity in Uganda. We used a mixed methods design with retrospective, cross-sectional, and prospective components. The gap analysis involved descriptive analysis of PrEP uptake and continuity. The RCA identified the main barriers to initiation and continuity on PrEP among 1,334 clients who declined to start PrEP and 1,266 who missed their appointment but were at risk. The PrEP collaborative tested changes mapped onto specific barriers to optimize the PrEP clinical service delivery. A trend analysis of routinely collected data of the PrEP cascade determined significant shifts and trends in PrEP uptake and continuity. Only 60% of the high-risk population eligible for PrEP were enrolled, while fewer than 30% of the cumulative number of PrEP users were refilled each quarter. Uncertainty and fear of side effects, perceptions about the harmfulness of the medication, perceived inability to adhere to PrEP, and stigma were the main reasons why clients rejected PrEP. Lack of access to the facility, side effects, pill burden, stigma, perceived low-risk exposure to HIV, and preference of staying at work as opposed to picking up refills affected continuity on PrEP. The collaborative registered statistically significant shifts in PrEP enrollment from 64% to 89% and continuity from 51% to 78% between July 21 and November 22 following the collaborative intervention. We recommend using a 3-tier approach for other similar implementation contexts to strengthen PrEP programming, given the marked statistical shift in PrEP uptake and continuity. This begins with understanding the gap and barriers to use among clients, followed by mapping interventions to specific barriers through a quality improvement collaborative.

Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study.

The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma. This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy. The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools. Pilot data are being collected, and the protocol will be modified based on the results. Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals. DERR1-10.2196/52949.

Hydrological balance and runoff from a montane peat bog traced by water temperature

ABSTRACT Peatlands are hydrologically significant landscape units in mountain headwater catchments in Central Europe. In this study, the contribution of a peat bog to runoff and its annual water balance were analysed and compared with those of a forested mineral soil hillslope. A mixing model method using the water temperature as a tracer was applied, and the resulting ratio of peat bog water in streams was incorporated into a hydrological model. The mean peat bog contribution during baseflow ranged from 33.4% during the cold season to 48.9% during the warm season, while during runoff events, the contribution reached over 83%. The simulated water balance results showed a higher actual evapotranspiration on the mineral hillslope, which suggests a higher total runoff from the peat bog (1523 versus 1327 mm/year on the mineral hillslope). The results of this study enable more reliable modelling assessments of peatland reactions to climate change.

Research Progress on Spatiotemporal Interpolation Methods for Meteorological Elements

With the development of mathematical statistics, people have developed the spatiotemporal interpolation methods based on the spatial interpolation method or the temporal interpolation method. These methods fully consider the comprehensive effects of time series changes and spatial distribution to better handle complicated and changeable meteorological element data. This article systematically reviews the current research progress of spatiotemporal interpolation methods for spatiotemporal sampling data of meteorological origin. Spatiotemporal interpolation methods of meteorological elements are classified into three categories: spatiotemporal geostatistical interpolation methods, spatiotemporal deterministic interpolation methods, and spatiotemporal mixed interpolation methods. This article summarizes the theoretical concept and practical application of the spatiotemporal interpolation methods of meteorological elements, analyzes the advantages and disadvantages of using spatiotemporal interpolation methods for estimating or forecasting meteorological elements, combined through some measures and their application to explain the accuracy of the spatiotemporal interpolation methods; and discusses the problems and challenges of spatiotemporal interpolation. Finally, the future research focus of spatiotemporal interpolation methods is proposed. This article provides a valuable method reference for estimating or predicting meteorological elements such as precipitation in unsampled points.

Freshmen’s Technological Expertise and Distance Learning Readiness: A Convergent Parallel Design

This convergent parallel mixed methods study primarily focused on technological expertise and distance learning readiness of freshmen students. The study had two phases: the quantitative phase and the qualitative phase. In the quantitative phase, results found that technological expertise and distance learning readiness were highly correlated with each other, with an R-value of .828 and a p-value of 0.000. In the qualitative phase, four themes were extracted: Technological Tools as a Significant Factor in Distance Education, Technological Expertise as Influenced by Minor Skills and Educational Courses, Technological Use Due to Education’s Status Quo, Challenges in Technological Availability, and Technological Background. The results showed a merging and converging characteristic of both data. The lived experiences of the freshmen students showed that technological tools, which are an indicator of technological expertise, are also a factor to be considered in distance learning readiness.

Economic value assessment of industrial heritage in Tangshan, China

Industrial heritage is a legacy from the past that we live with today and pass on to future generations. The economic value of this heritage can be defined as the amount of welfare that it generates for society, and this value should not be ignored. However, current research based on economic analysis has mostly focused on qualitative statements instead of quantitative assessment. This study proposes an innovative methodology combining qualitative (field research) and quantitative (willingness to pay and contingent valuation) methods to assess the economic value of industrial heritage. The industrial heritage of Tangshan, China, was chosen as a case study, and the research found that museums and cultural creative parks are effective ways to conserve industrial heritage. The entrance fee can be used to represent the economic value of the heritage site. There was a positive correlation between the influence of economic value and the entrance fees residents would prefer to pay. The results indicate the locals would prefer lower entrance fees for the transformed heritage museums (The average current cost: $2.23). Locals were most concerned about the entrance fees for the Kailuan Coal Mine and Qixin Cement Plant Museums, which have both been renewed as urban landmarks for city tourism. Renewal methods have been applied to six industrial heritage sites in Tangshan; these sites have their own conservation and renewal practices based on city-level development or industrial attributes. Thus, when residents recognize the economic value of a heritage site, they are willing to pay a higher entrance fee. This research demonstrates the economic value of industrial heritage using a mixed methods approach and provides a basis for assessing the value of cultural heritage for urban tourism analysis.

University of Rizal System’s Quality Management System Toward Sustainability Framework

A quality management system (QMS) is considered key to the sustainable development of any institution. Its proper implementation is crucial in planning, implementation, assessment, and development and control of changes in the processes and procedures of the university. This study sought to assess the QMS implementation of the University of Rizal System based on ISO 9001:2015 standard and ultimately propose a sustainable framework based on the data obtained from the selected stakeholders of the university and evaluation results of the certifying body. A mixed method of research employing a sequential explanatory approach was utilized to adequately gather and analyze quantitative data using survey questionnaires and qualitative data through document analysis. Findings revealed that the University of Rizal System has manifested a functional, efficient, and effective quality management system necessary for the delivery of products and services to ensure stakeholders’ satisfaction with their needs and interests. The quality management system of the university has established and maintained an effective system to ensure compliance with its policy and objectives, that is, the organization’s management system complies with, adequately maintains, and implements the requirements of the ISO 9001:2015 standard. However, while the quality management system of the University remains effective, efficient, and compliant with the standard, improvement in its implementation is inevitable particularly in the control of the operation of processes, monitoring and attending to nonconformities and corrective actions, and on needed support to implement QMS. Hence, a proposed sustainability framework is highly recommended. Keywords: Quality Management System, Sustainability Framework, Sequential Explanatory Approach, University of Rizal System – Philippines

Mechanical, thermal, and morphological properties of poly(3-hydroxy butyrate) nanocomposites prepared by melt mixing method

Abstract This research focuses on the preparation of poly (3-hydroxy butyrate) (PHB) nanocomposites using the melt mixing method. Two types of organically modified nanoclay, Cloisite 93A (C93A), and Cloisite 30B (C30B), were incorporated at various weight percentages into the PHB matrix to create the nanocomposites. Comparative analyses were conducted between PHB/C93A and PHB/C30B to assess their tensile and impact properties in relation to the matrix polymer. Between the nanocomposites, the PHB/C93A nanocomposites shows an optimum tensile modulus of 949 Mpa with a 3 wt% clay loading, while PHB/C30B nanocomposites demonstrated improved percentage elongation at break of 5.33 % and enhanced Izod impact strength of 39.67 J/m at 3 wt% of clay load. The thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) signifies the thermal behavior of both the matrix and nanocomposite. The degree of crystallinity is observed to be 47 % in case of the PHB/C30B nanocomposites as compared to the PHB/C93A nanocomposites as 38 %. Again in case of thermogravimetric analysis (TGA), the maximum % char of 5.198 is observed for the PHB/C30B nanocomposites. The enhanced viscoelastic behavior of the PHB/C93A nanocomposites was attributed at a peak of approx. 55–60 °C due to the incorporation of C93A nanoclay into the matrix in the study of dynamic mechanical analysis (DMA). The morphological investigation using WAXD analysis showcased particle clay intercalation and dispersion within the PHB matrix, indicating effective clay-matrix interactions. Overall, this study sheds light on the enhanced properties of PHB nanocomposites with the incorporation of organoclay, offering potential applications in various industries.

Science communication objectives and actual practices of science news websites as a showcase for gaps between theory and practice

This study contributes to the growing body of science communication research showing gaps between theory and practice objectives, focusing on one particular understudied and emerging science communication innovation.The objectives and practices of four Israeli science news websites were analyzed considering three science communication models: “Dissemination”, “Dialogue”, and “Participation.” Using concurrent parallel mixed methods, we examined the perspectives of website administrators (n=8) and readers (n=20) through interviews, a content analysis of news items (n=298), discussion threads (n=507), and reader questionnaires (n=89). Findings indicate limited adoption of two-way communication about how science is applied in society. The scant implementation of the dialogue model suggests its promises are not concretized in practice on these science news websites.

More than 10 years of industry 4.0 in the Netherlands: an opinion on promises, achievements, and emerging challenges

ABSTRACT The concept of Industry 4.0, as a means to move forward in the industrial ecosystem, has reached an important turning point. Where do we stand now in terms of industrial innovation and transition? This opinion paper provides an overview of the situation in the Netherlands, a reflection on what has been achieved by the Industry 4.0 paradigm, and the necessary way forward to solidify its implementation. Tentative results reveal that the pervasiveness of Industry 4.0 applications is sector-specific. This work provides industrial stakeholders and academics with useful suggestions and a possible path to move towards better integration of Industry 4.0 in company reality. In this opinion paper, we employ a mixed methods research methodology to argue that, based on our findings on industrial adaptation in The Netherlands, Industry 4.0 is the outcome of an evolutionary process and not of a revolution, as it is often claimed.

A new approach to understanding involvement: linking involvement to the memorability of experience

AbstractBased on the involvement literature, the current research redefines the involvement theory and proposes a new form of involvement, namely situated involvement. The research, then, develops a scale to measure this involvement employing a mixed methods procedure. Afterward, the relationships between enduring, response, and situated involvements as well as the memorability of experience are investigated using structural equation modeling (SEM). The results from a survey of 317 tourists in Queenstown, New Zealand show that the memorability of experience is only impacted by situated involvement, the type of involvement which occurs during an experience. Enduring and response involvements are found to influence situated involvement, and enduring involvement predicts response involvement.

Patterns of polydrug use among Black Americans who misuse opioids.

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

Exploratory study on the adaptation of online services offered to people with disabilities, in the context of the COVID-19 pandemic

Aim: During the COVID-19 pandemic, many community organizations offering services to people with disabilities (PWD) changed their service delivery, switching from in-person to remote services. However, little is known about what it was like for organizations to quickly pivot their service delivery. The study explored barriers and facilitators to access community services for PWD and identified potential improvements to these services.Methods: The study used a mixed method, multiple case study design, which included a convenience sample of 27 participants recruited from four community organizations delivering services to PWD. Participating staff and members participated in six different focus groups and completed a questionnaire about their level of satisfaction regarding the evolution of the services. Inductive thematic analysis was conducted on the focus group data and the data from the questionnaires were descriptively analyzed.Results: The thematic analyses revealed four themes: “Succeeding in adapting the interventions to continue providing services”, “Enjoying a lot of new things about the new online modality”, “Key elements that have facilitated the transition” and “Facing some difficulties implementing online services”. The median satisfaction score demonstrated that the participants were satisfied with the services. The success of these organizational changes relied on the adoption of new methods and approaches to service delivery.Conclusion: Through this study, barriers and facilitators that the organizations and their beneficiaries have experienced during the pandemic were identified as well as suggestions for improvement. The organizations consider maintaining online services beyond the pandemic to offer PWD easier access to community services.

Political Branding: The use of campaign color as symbolism of platforms among the presidential candidates in the 2022 elections

In a very complex nature of politics, color serves as a low-level heuristic for voters, especially the use of campaign color as a symbolism of platforms. This study sought to determine the level of agreement on the universal meaning of the different colors chosen by the Presidential candidates during the 2022 national elections; the level of agreement if the political colors of the presidential candidates and its representation to their political platforms; and if these chosen political colors correspond to the platforms of the presidential candidates among the students of the School of Teachers and Liberal Arts of the University of Baguio. A mixed method with a self-constructed questionnaire using the Likert Scale to determine the level of agreement among the 143 respondents and an interview with 8 informants among the students was used in this study. The study revealed that the color Red is the most misinterpreted color because of its historical and psychological connotations which led to its negative symbolism. While both Pink and Blue, showed a positive result because of their psychological, cultural, and political aspect. Furthermore, all colors aligned with their platforms except the color Red by Marcos with his platform about Unity. Additionally, the presidential candidates' platforms were based on their personal and political factors. Overall, the research suggests that there’s still no established meaning of political colors in our country and that voters still take issue with what the colors truly represent.

Profiling the status of out-of-field teaching in Western Australia: graduate teacher and principal perspectives

ABSTRACT This paper shows how system-level data can generate useful insights into the profile of first-year graduates who are teaching out-of-field (OOF). Understanding in-school demand and impacts on first-year graduates teaching OOF is important, especially when the first years of teaching are complex, busy, and involve a steep learning curve. A mixed methods sequential explanatory design was used to generate qualitative and quantitative data collected from teacher and principal surveys. This study establishes the prevalence of OOF teaching amongst first-year graduates in Western Australian public schools and develops a profile of their OOF experiences and support needs based on their perceptions and their principals’ perceptions. This study details the supports that will make a difference to teachers’ capability, in particular a reduction in load where the OOF teaching workload is high, and access to formal subject-specific mentoring, both noted in research as important support mechanisms. This paper provokes new research questions, highlights areas for further research, and establishes the need for more large-scale datasets and longitudinal studies to examine change over time and the enduring effects of OOF teaching, both in relation to transitions into teaching, as teachers learn on-the-job, and when teachers undertake formal professional development programmes or courses.

Effect of Digital Transformation on University Brand Image with Ownership as a Moderating Variable

The digital era demands transformation from universities, including private ones. However, the effectiveness of digital transformation on university brand image can be strengthened by ownership. This research investigates the impact of digital transformation on the university's brand image, with ownership as a moderating variable. Using random sampling, we analyzed 45 private universities affiliated with Private Universities in Indonesia Region 2A. This exploratory study employed a quantitative method. The results indicate a significant positive relationship between digital transformation and university brand image, suggesting an enhancement of the university's reputation in the eyes of the public. However, the study also reveals that ownership does not mediate the relationship between digital transformation and university brand image. This suggests that each university may have different Ownership Competencies, especially in decision-making regarding digital transformation. The conclusion of this research indicates that digital transformation affects university brand image. However, specifically in the case of universities in LLDIKTI Region 2, ownership does not moderate the effects of digital transformation on university brand image. It is recommended that this research be continued using mixed methods to explore ownership moderation or test it in other regions' universities.

Gender lens review of adolescent health care services: a mixed methods study in Bangladesh

Background The application of a gender lens enables the identification of gendered power dynamics that are deeply embedded within structures and institutions. This study delved into a comprehensive analysis of gender norms of male and female adolescents in terms of their health needs, the type of health services offered to them, the barriers and facilitators for utilization of health services at the adolescent-friendly health services (AFHS) across different tiers of government health facilities through a gender lens. Methods The study was conducted at 23 health facilities across four districts of Bangladesh from February 2022 to June 2022. The study design was cross-sectional with a mixed methods approach. A total of 304 adolescents completed the survey, and 28 adolescents participated in in-depth interviews (IDI). Key-informant interviews (KII) were conducted with 48 key stakeholders, including parents, teachers, health service providers, facility managers, and health managers. Quantitative data were analyzed using descriptive statistics, and qualitative data was analyzed using thematic analysis. Results Adolescents have different needs for information about services, types of services provided, and use based on gender. There was a significant association between the marital status of adolescents and the need for different types of health services (P<0.05). Female adolescents receive tetanus-diphtheria (TD) vaccinations and iron folic acid (IFA) tablets, while male adolescents can receive them upon request. TD immunization is common among married female adolescents (14.9%) compared to unmarried female adolescents (11.8%) and unmarried male adolescents (1.1%). Unmarried female adolescents (36.1%) seek help more frequently for menstrual problems, while unmarried male adolescents (24%) are more likely to seek services related to puberty. Parents, teachers, and health service providers have different gendered perceptions of male and female adolescents’ health needs and use of health services. These perceptions contribute to understanding male and female adolescents’ utilization of services. Conclusions This study reveals that gender norms influence adolescents’ health needs, types, and utilization of services. This is probably due to differences in gendered perception of the critical stakeholders for adolescents, who sometimes face barriers in the utilization of health services at the facilities.

Differentiated Instruction: Analysis of Elementary School Teachers’ Understanding in Bali Q-Ta School

Differentiated instruction is implemented to support the application of the Merdeka Curriculum. Teachers need to have a good understanding before implementing differentiated instruction. The study aims to determine and analyze the understanding of elementary school teachers regarding differentiated instruction at Bali Q-Ta School (SD Bali Q-Ta), as well as to identify the constraints in its implementation. The research was conducted using mixed methods. The subjects of this study were all elementary school teachers at SD Bali Q-Ta. Research data was obtained using questionnaires and interviews. The data obtained were analyzed descriptively. Findings indicate that the understanding of elementary school teachers at SD Bali Q-Ta falls into the "very good" category, with an average score of 77.9. The constraints faced by elementary school teachers at SD Bali Q-Ta include: (1) the preparation, implementation, and evaluation requiring a significant amount of time; (2) difficulties in preparing diverse teaching aids; (3) errors in diagnosing student needs; and (4) difficulties in developing suitable assessment instruments tailored to student needs
 Highlights:
 
 Differentiated Instruction: Tailoring teaching methods to accommodate diverse student needs.
 Merdeka Curriculum: Framework for Indonesian education emphasizing autonomy and innovation.
 Elementary School Teachers: Key agents in implementing differentiated instruction effectively.
 
 Keywords: Differentiated Intruction, Merdeka Curriculum, Teachers Understanding

Integration of Disability Awareness Improves Medical Students’ Attitudes Toward People with Disabilities

Persons with disabilities (PWD) often require special accommodations and more comprehensive healthcare yet frequently have encounters with physicians who are unprepared to provide tailored and complete care. A multipronged disability awareness curriculum for second-year medical students was implemented, including content on disability etiquette, patient-centered and interprofessional learning sessions for individuals with physical disabilities and intellectual and developmental disabilities, and a debriefing session with physiatrists. The objective of this study was to utilize a mixed methods approach to evaluate the disability awareness curriculum in undergraduate medical education (UME). Assessment was conducted using course evaluations, pre- and post-surveys including the Attitudes and Perspectives Towards Persons with Disabilities (APPD) scale and Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS), and student focus groups. The mean scores from both the APPD (2.11 ± 0.43 pre-score vs. 1.7 ± 0.39 post-score) and MAS (2.45 ± 0.43 pre-score vs. 2.25 ± 0.55 post-score) indicate the curriculum improved medical students’ attitudes toward PWD (p < 0.05), with lower numbers representing more favorable attitudes. After completing the curriculum, medical students’ attitudes were comparable to those of doctor of physical therapy (DPT) students. Qualitative analysis from focus groups highlighted four major themes: education, comfort level, impact on future practice, and disability differences. This curriculum has potential as a valuable framework for delivering effective disability education to medical students to prepare future physicians to serve PWD and their unique needs. It meets core competencies, provides an opportunity to learn in interprofessional environments, and integrates PWD into the educational process.

An implementation strategy postmortem method developed in the VA rural Transitions Nurse Program to inform spread and scale-up.

High-quality implementation evaluations report on intervention fidelity and adaptations made, but a practical process for evaluating implementation strategies is needed. A retrospective method for evaluating implementation strategies is also required as prospective methods can be resource intensive. This study aimed to establish an implementation strategy postmortem method to identify the implementation strategies used, when, and their perceived importance. We used the rural Transitions Nurse Program (TNP) as a case study, a national care coordination intervention implemented at 11 hospitals over three years. The postmortem used a retrospective, mixed method, phased approach. Implementation team and front-line staff characterized the implementation strategies used, their timing, frequency, ease of use, and their importance to implementation success. The Expert Recommendations for Implementing Change (ERIC) compilation, the Quality Enhancement Research Initiative phases, and Proctor and colleagues' guidance were used to operationalize the strategies. Survey data were analyzed descriptively, and qualitative data were analyzed using matrix content analysis. The postmortem method identified 45 of 73 ERIC strategies introduced, including 41 during pre-implementation, 37 during implementation, and 27 during sustainment. External facilitation, centralized technical assistance, and clinical supervision were ranked as the most important and frequently used strategies. Implementation strategies were more intensively applied in the beginning of the study and tapered over time. The postmortem method identified that more strategies were used in TNP than planned and identified the most important strategies from the perspective of the implementation team and front-line staff. The findings can inform other implementation studies as well as dissemination of the TNP intervention.