Mixed-methods Design Research Articles

The impact of the lesson study model on students' mathematics achievement and attitudes: a mixed-methods research

PurposeThis article aims to investigate the impact of the Lesson Study (LS) model on students' mathematics achievement and attitudes toward mathematics.Design/methodology/approachThe study employs a concurrent embedded design, a type of mixed methods design. Within this framework, a quantitative pretest-posttest control group quasi-experimental design is applied for quantitative data, while qualitative data is gathered through interviews and observations. A 2×2 mixed ANOVA is used for the analysis of quantitative data, and content analysis is employed for qualitative data analysis.FindingsThe findings reveal that the LS model has a significant positive impact on the mathematics achievement and attitudes of students in the experimental group. Quantitative analysis shows a meaningful improvement in mathematics achievement for the experimental group, which is notably superior than the control group. Additionally, students in the experimental group found mathematics lessons more enjoyable and easier, and their attitudes toward mathematics improved positively. Students' feedback supports these results, with many expressing that LS-based lessons were more engaging and effective. Observations by the researcher, mathematics expert and teacher in the experimental group also corroborate these positive changes.Originality/valueThe results of the study suggest that the LS model should be more widely implemented in mathematics education. This recommendation highlights the potential of the LS model to enhance the teaching process and improve students' mathematics achievement. Furthermore, the study also indicates that LS has a positive impact on students' attitudes toward mathematics, as evidenced by their increased motivation and more positive outlook toward the subject. These findings underscore the LS model’s effectiveness in both improving academic performance and transforming students' attitudes toward mathematics.

PRevention Intervention and Support in Mental health for people with aphasia (Aphasia PRISM): protocol and mixed methods analysis plan for two feasibility studies

BackgroundPeople with aphasia commonly experience depression and anxiety. The individual therapy program, Aphasia PRevention Intervention and Support in Mental health (Aphasia PRISM) offers low intensity psychotherapeutic interventions using communication supports. Trained stroke clinicians from disciplines other than psychology (e.g., allied health professional, nurse, doctor) can deliver such interventions. The aim of the planned studies is to test the acceptability, feasibility and preliminary effectiveness of Aphasia PRISM for preventing depression and anxiety and supporting wellbeing in people with aphasia after stroke.MethodThis protocol describes two feasibility studies of the Aphasia PRISM using parallel, convergent, mixed methods designs. Participants will be adults with aphasia after stroke from a metropolitan healthcare site (Study A, pre-post case series, approximate n = 6) and two regional/rural sites (Study B, randomised controlled trial, n = 30; random allocation to either: treatment arm Aphasia PRISM + usual care; or attention control of secondary stroke prevention information + usual care) in Victoria, Australia. Eligible participants will be offered 7 weekly intervention sessions (via telehealth or in person). Other participant groups include stroke clinicians / site managers and family members. Feasibility will be assessed with treatment acceptability ratings (primary outcome) and secondary outcomes such as recruitment rate and participant clinical response. Participant clinical responses to intervention will be collected pre-intervention (baseline), concurrently (4 week acceptability measure), immediately post (8 weeks), follow-up (3 months) and follow-up at 6 months (Study B only). Descriptive statistics will be used to analyse quantitative data based on the type and distribution of data. Reflexive thematic analysis, an inductive approach will be used to analyse qualitative data.DiscussionAphasia PRISM offers the potential for trained stroke clinicians to deliver low intensity psychotherapeutic interventions with communication supports to people with aphasia. Studies A and B were registered with the Australian New Zealand Clinical Trials registry under one registration (ACTRN12620000209998) 20th February 2020.

Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study.

University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Our study included 596 students, of which 303 (50.8%) were in the intervention group and 293 (49.2%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8%) compared to the control group (54/293, 18.4%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations.

Supporting Educators to Co-Design Interdisciplinary Projects Integrating Educational Robotics and Arts

The growing call to foster interdisciplinary learning has found educators struggling to co-design learning across disciplinary boundaries. Aiming to contribute to the area of interdisciplinary learning design, we explored how to support educators in co-designing interdisciplinary projects integrating Educational Robotics (ER) and Arts, hereafter called Artful ER projects. Our research included developing the "FERTILE" Learning Design methodology as a conceptual tool scaffolding the integration of discipline-oriented viewpoints while educators co-design. Acknowledging that one of the challenges in interdisciplinary collaboration derives from educators’ different intentions for students’ learning outcomes, the "FERTILE" methodology introduces Computational Thinking (CT) skills as an Artful ER project’s primary learning outcome. In this line, the “FERTILE” methodology adapts the Creative Computational problem-solving model, which has been reported to cultivate CT skills through its staged process. Furthermore, we developed the "FERTILE" Community Platform as an online environment providing two-fold support to educators as designers of interdisciplinary learning. The "FERTILE" Community Platform incorporates community functionalities that address collaboration practicalities while educators co-design. Additionally, it integrates authoring functionalities scaffolding educators in designing Artful ER projects based on the "FERTILE" Learning Design methodology. This paper explores how the authoring functionalities of the "FERTILE" Community Platform support educators in designing interdisciplinary learning. We report on a pilot study conducted with Greek and Spanish educators. In this study, we applied a mixed-method research design with a quantitative strand adopting indicators from the Usability Metric for User Experience (UMUX) model and a qualitative strand providing insights into participants’ perceptions. The findings indicate that scaffolding disciplinary elaboration (e.g., robot technical requirements and art forms) and systematising interdisciplinary context (e.g., through project categories) may trigger educators’ mutual understanding. The participants endorsed authoring functionalities that adopted high contextualisation levels for learning design representation to communicate their design ideas across disciplinary boundaries. Also, the participants valued CT skills as the primary outcome of interdisciplinary learning, indicating that CT skills’ cultivation may be the broker among disciplines and trigger educators to overcome disciplinary barriers. Finally, we discuss the findings and implications for refining the "FERTILE" Community Platform as an online environment for educators co-designing Artful ER projects.

The impact of a metacognition-based course on school students’ metacognitive skills and biology comprehension

The fast-paced and intricate nature of the current society, coupled with the ongoing changes in educational requirements, calls for the cultivation of higher-order thinking skills. To that end, adopting metacognitive strategies could be instrumental. This paper aimed to evaluate the effects of a 10-week-long metacognition-based biology course on school students’ metacognition and biology comprehension. Employing a mixed-methods quasi-experimental design, the study involved 120 eighth-graders from two public schools. One group was exposed to metacognitive questioning, while the other one continued with regular classroom activities. The results showed that participants who received metacognition-guided instruction achieved higher scores on the biology test and reported improved metacognition as compared to those who followed the standard curriculum. These outcomes were consistent across genders and regardless of whether a student reported a deep or surface learning approach. Qualitative analysis extracted themes of collaboration and understanding among the students. They appreciated the specificity of tasks, which deepened their comprehension, and valued collaborative learning facilitated by metacognitive prompts. These prompts not only enhanced their understanding but also contributed to fostering a positive classroom environment. This research underscores the effectiveness of metacognitive support in enhancing biology education. It advocates for the integration of metacognitive strategies into classroom practices, emphasizing the positive impact they can have on students’ learning experiences and outcomes.

Perspectives of Czech High School Students on Cheating in Remote Education

This study explores the perspectives of Czech high school students on using digital technologies for cheating during remote education, a phenomenon encouraged by the abrupt transition to online learning due to the COVID-19 pandemic. Through a mixed-methods research design, this study collected data via an online questionnaire with 24 questions completed by 316 students from secondary schools and conducted individual interviews with seven teachers. In their study, the authors focus on three questions: How much do high school students know which digital technology they can use for cheating in remote online education? What are their experiences with cheating in remote online education? What are the preventive solutions recommended by students and teachers to eliminate online cheating? The research findings indicate that students perceive online cheating as justifiable, primarily due to their disengagement with the course material and lack of interest in learning under the pandemic's extraordinary circumstances. Students frequently used technical means for cheating, with mobile phones and screen-sharing during online tests being the most popular methods. Additionally, the use of internet resources to find answers was the most commonly reported form of online cheating. To address this issue, students outlined various anti-cheating strategies, categorised into three perspectives: pessimistic, practical, and critical-realistic. The pessimistic perspective indicates scepticism about the feasibility of effectively combating cheating, whereas the practical perspective offers tangible, immediate solutions. The critical-realistic view provides a thoughtful and pragmatic approach to the problem, suggesting a balance between understanding the complexities of cheating and implementing realistic measures. The study highlights educators' critical role and emphasises the importance of aligning assessment methods with students' learning needs and expectations to reduce cheating tendencies naturally. The rise of AI technologies has introduced new dimensions to the problem of online cheating, as AI tools can facilitate academic dishonesty. However, AI can help detect and prevent cheating. The authors suggest using formative assessments and creating an engaging, supportive online learning environment to deter dishonesty and promote academic integrity.

A Workplace Intervention to Strengthen Supervisor Support for Employees With Common Mental Health Problems: A Mixed-Methods Realist Evaluation

The purpose of this study is to obtain insight into whether, how and under which circumstances a novel workplace intervention works. This intervention aims to strengthen the supportive behaviour of Dutch supervisors in promoting the work participation of employees with common mental health problems (CMHPs), provided by occupational health professionals (OHPs). In a mixed-methods realist design, we evaluated changes over time, reasoning that supportive behaviour would be changed through motivation and skills and we explored how mechanisms of change may be triggered by personal, environmental and intervention factors. Compared to baseline (n = 92), self-reported supportive behaviour of supervisors increased post-intervention (n = 65, 3 months) and increased significantly post-follow-up (n = 56, 6 months). A statistically significant regression model (R2 = 0.29) indicated that factors such as increased self-efficacy and skills, being assessed as supervisor on sick leave numbers, previous collaboration between OHP and supervisor, and having dealt with CMHP before were positively related to the changes in supervisors’ supportive behaviour. According to supervisors, working mechanisms on the interpersonal level were the OHPs’ expertise and trust and the co-supervisors collective efficacy. On the individual level, mechanisms were self-efficacy, willing to improve and skills to act. Enabling circumstances to trigger those mechanisms were being given time and structural, low-key access to OHP expertise, in a safe learning climate. This preventive, multifaceted, action-oriented workplace intervention had a positive impact on supervisor support in promoting work participation among employees with CMHP. These findings may encourage employers to invest in supervisors’ capacity, thereby enabling employees with CMHP to keep working and perform well in their jobs.

How Prepared are Ethiopian English Teachers to Teach Early Grade Reading?

Purpose. This paper examines how prepared Ethiopian public primary school English teachers are to teach early grade reading. Methodology. A descriptive research design of mixed methods was employed. A sample of 125 English teachers in 20 randomly selected primary schools in Hawassa City Administration was the source of data. The researchers employed a knowledge assessment test, focus group discussions, and questionnaires to gather the necessary data. The analysis of quantitative data was carried out by using Statistical Package for Social Sciences (SPSS version 25.0). Results. It has been learned from the findings that primary English teacher preparation paid little attention to coursework and practicum to teach early reading. The results also revealed that English teachers felt somewhat prepared to teach early grade reading. There is serious knowledge limitation among English teachers that (12)9.6% of primary English teachers scored 50% and above, whereas (113)90.4% of teachers scored below 50%; the teachers’ average knowledge test score was 36.4%. The results have clearly indicated that it is statistically significant, the direct relationship among teacher preparation coursework emphasis, practicum attention statistically significant, direct relationship among teacher preparation coursework emphasis, practicum attention, and teachers’ felt preparedness at (p=0.001). Conclusions. The results have led to the conclusion that teacher preparation, both in its coursework and practicum, did not pay due attention to teaching early grade reading. That is, primary English teachers were inadequately prepared to teach early grade reading. Based on the results of this study, to improve the practice of early literacy instruction, English teachers’ knowledge and skills gaps need to be duly addressed. Further studies that investigate the current practice of early literacy teacher preparation and professional development should be conducted with a larger sample size and diverse contexts.

Combining music and dance movement therapy for people with dementia living in the community: A mixed methods feasibility study

Dementia is affecting an increasing number of people world-wide and presents a need to find more evidence-based therapies that can improve quality of life and care. Music therapy and dance movement therapy are two forms of arts therapies that share an active, embodied and improvisatory approach, however, maximising the benefits of combining music and dance movement therapy has not been researched with this population. In this feasibility study a convergent mixed methods design was used to evaluate the feasibility of using an intervention that combined music and dance movement therapy drawing on a systematic literature review. A dance movement therapist and a music therapist ran two session blocks involving eight participants in total. The Cornell Scale for Depression in Dementia was used at three assessment points (baseline, 5 weeks and 10 weeks) indicating an overall reduction in scores. Qualitative methods included multiple forms of data (video, reflective tool, journal) and focused on significant moments of connection between thoughts, feelings and physical sensations. It generated three main themes in the therapeutic process: making connections, acknowledging grief and loss, and growth and empowerment. This study contributes original knowledge to arts therapies research in the development of a research-based treatment approach involving a collaborative model of practice, an exploration of new arts-based data collection tools and testing this intervention in a community setting.

International Nurse Migration Experience of the First Two Years: A Mixed Methods Study.

The aim of this study was to explore experiences of internationally educated nurses' first 2 years working and living in England in an age of contemporary migration. Exploratory mixed method design. An online survey collected responses from August 2022 to October 2022. A mixed-methods approach was applied to gain a breadth of understanding through quantitative outcomes integrated with depth of qualitative analysis. Data findings from 773 international nurses identified the recognition of prior professional skills and experiences, induction processes, career development systems and the role of line managers are integral to professional integration and could be improved. Communication barriers were frequently transient and time limited, and participants often had incomplete insight of human resource policies. Personal factors affecting life outside of work revealed compromise and sacrifice with accommodation choices, and participants were often not satisfied with their economic status, housing, cost of living in England, and social support. Mental well-being scores varied by country of origin and participants happier with decision to migrate to England had significantly higher mental well-being scores. International nurses have divergent professional and personal motivations for migration unique to individual circumstances. Recognition for transferable skills and experience, receipt of a comprehensive and warm welcome from organisations, safe and well-maintained suitable accommodation and living conveniently located to shops, work and transportation, improve experience. International nurses must have sufficient financial gains from salaries and opportunity to unite with children and families. Progressing migration experience of international nurses can improve retention and augment improving patient care and outcomes. No patient or members of public contributed to this research.

Psychopathology teaching in residency program – An art losing its shine: Psychiatry trainee residents’ experience

Abstract Background: Teaching psychopathology in a residency program is considered the “heart” of the training program. There is a lack of data on evaluating psychiatry resident training in psychopathology. Aim: The aim of this study was to evaluate residents’ experience and satisfaction in terms of training and teaching psychopathology during the psychiatry residency program. Methods: It was a mixed-method design study and was cross-sectional. A total of 53 psychiatry residents (pursuing postgraduate courses) participated. Participants were assessed using qualitative and quantitative questionnaires. Qualitative interviews consisted of open-ended questionnaires. The student satisfaction questionnaire was quantitative. Results: In terms of dissatisfaction with the teaching specific skills during postgraduation, the most common dissatisfaction reported was with the quality of the clinical environment (35.8%), psychopathology taught during the course of the training period (34.0%), and the teaching of skills of interview technique to elaborate and label the psychopathology during the course of the training period (32.1%). Conclusion: Most of the residents were not satisfied with the teaching of psychopathology. Supervision was not adequate from the seniors and teachers for teaching psychopathology. The most commonly emerged strategy to teach psychopathology was the supervision of clinical interviews with real patients, and the initial 1st year should be more focused on teaching psychopathology in clinical settings. It can be said that there should be some competency-based training programs for the residents.

07 Partnering with patients with living and lived experience of eating disorders to improve inpatient care on an acute paediatric medicine unit

Abstract Background Since the COVID-19 pandemic, hospitals nationally are seeing a growing number of adolescent patients with eating disorders requiring acute medical stabilization, which is often a time of crisis in the trajectory of this ego-syntonic disorder. The complexity of these admissions often lead to safety events for patients and moral distress for clinicians. Medical admissions can also be an opportunity to engage youth and families. Patient partners are a pillar in healthcare quality improvement, but historically we have not engaged adolescent patient partners in improving acute eating disorder treatment. We gathered the experience of patients and families with living and lived experience of eating disorder treatment to improve their quality of care in an acute paediatric medicine unit. Objectives We aimed to describe the experience of patients and families with living and lived experience of eating disorder treatment, specifically acute medical stabilization, through a quality improvement patient engagement project. Design/Methods We used a mixed-methods design of semi-structured interviews and a focus group with adolescents with eating disorders and their caregivers in an acute medical unit at a tertiary paediatric hospital in British Columbia. We employed opportunity sampling by distributing recruitment flyers through patient experience councils, outpatient clinics, other non-acute units, and to all patients admitted with a medically unstable eating disorder at our hospital during the study period. The interviews consisted of open-ended questions, yes/no questions, and Likert scales related to four categories: admission process, inpatient experience, team communication, and discharge process. Two reviewers analyzed the qualitative data using thematic analysis, and the quantitative data was analyzed descriptively. Quality improvement projects are exempt from Research Ethics Board approval. However, we utilized the "A Project Ethics Community Consensus Initiative" (ARECCI) Ethics Guideline and Screening Tool and presented our proposal at the hospital's quality improvement and research oversight committees. Results We completed 8 interviews with patients with current living experience admitted to our acute medical unit. We also completed 1 interview with a patient with past lived experience and 1 focus group with patients and caregivers. Primary themes identified included uncertainty about their overall treatment journey and stress due to the sudden new expectations on the inpatient unit, such as activity restriction, meal plans by the hospital, and bathroom access after meal times. Patients identified the importance of relational care, inclusion in treatment planning, acknowledgement of the demanding nature of eating disorders, and individualized care. Due to variability in training, resource allocation, and gaps in communication, these patient-identified priorities are not always met. While 100% of participants stated they understood the reasons and goals for admission, participants averaged 3.7 on a 1 (lowest) to 5 (highest) Likert scale when asked to rate their satisfaction with the information they received. Five out of eight adolescents felt that there was consistency in communication within the team. Conclusion We demonstrate the complex needs of patients with eating disorders who require acute medical stabilization. Targeted knowledge mobilization initiatives through admission orientation documents and family-centered rounds could better meet those needs. We are currently developing an admission pamphlet and journal for patients admitted with a new eating disorder to our medical unit. Patient partners exhibited a high willingness to participate in our study and readily acknowledged the importance their contributions could hold for other patients.

Exploring Academic Emotions Using Design Thinking Applied to Elementary School Learning Stress Adaptation

Background: Students’ learning stress adaptation is crucial. Research on design thinking in stress adaptation and academic emotions is still lacking. Methods: This study developed “Stress Relief Design” instructional activities using a mixed-method research design, including student academic emotion journals and a stress relief agreement survey for data collection. This study was approved by the Human Research Ethics Committee and conducted in accordance with ethical guidelines. Participants were 24 students, aged 10 to 12, recruited through open enrollment. The instructional activities were conducted in a holiday workshop format, consisting of fifteen sessions over 5 days, with three sessions per day. Results: The results indicated that students predominantly experienced positive academic emotions (joy, pride, hope, and relaxation), with negative emotions (anxiety and boredom) being less common. Students reported that the course helped them relieve psychological stress. Conclusions: Therefore, design thinking is suitable for application in stress adaption courses and creates a learning environment that supports students’ academic emotions, making it a critical learning focus for modern students. This study contributes to the academic research on the application of design thinking in elementary school health education and learning stress adaptation, as well as on academic emotions.

Integrating Quantitative Data and Qualitative Insights to Understand 30-Day Readmission Rates: A Mixed-Methods Study.

The rate of patients readmitted to hospitals within 30 days of discharge is a critical indicator of healthcare quality. This study explored the factors contributing to 30-day hospital readmission rates nationally and at Arrowhead Regional Medical Center (ARMC) through a mixed-methods research design. Quantitative analysis utilized data from the Centers for Medicare & Medicaid Services (CMS) database, focusing on patient demographics, principal diagnoses, length of stay, and hospital characteristics. Multivariate regression and descriptive statistics were employed to identify predictors of 30-day readmission. The qualitative analysis sought to understand the specific medical conditions and patient profiles linked to higher readmission rates. The findings revealed that older age, specific principal diagnoses (e.g., heart failure, pneumonia, chronic obstructive pulmonary disease (COPD)), and longer initial hospital stays were associated with an increased likelihood of 30-day readmission. Gender disparities and hospital size/type also influenced readmission rates. These results provide valuable insights into the complex interplay of individual patient characteristics and hospital attributes in driving readmissions. The study's mixed-methods approach yielded a comprehensive understanding of the quantitative patterns and qualitative factors contributing to 30-day hospital readmission rates, offering important implications for healthcare quality improvement initiatives.

Teaching health disparities on the road: An experiential educational intervention for doctor of nursing practice students

AimThis analysis was conducted to understand the nuanced and underlying benefits and challenges of an experiential educational intervention for DNP students learning how neighborhoods and health disparities may be related. BackgroundPoor social and environmental conditions in many low-income urban neighborhoods are linked to deleterious health outcomes. Many of the structural and political influences are unknown to health providers, which can inhibit their understanding of the social effects on health. One aspect of a new DNP social determinants of health curriculum is a guided community bus tour in economically disadvantaged neighborhoods to enhance understanding of health disparities. DesignA concurrent mixed methods design, including comparison surveys and thematic analysis, was used to analyze student responses to the experiential educational intervention. MethodA community-based bus tour implemented in socially disadvantaged neighborhoods in an urban environment was the study focus. New DNP students (n=91) in a midwestern university introductory course agreed to provide feedback following an experiential learning activity. The analysis of responses to the educational intervention was completed using a systematic thematic analysis alongside descriptive statistics and paired t-tests in a convergent mixed methods analytical approach to answer the research aim. ResultsStudents expressed confidence in naming and addressing health disparities after the bus tour activity. Analysis showed: (a) A visual tour can impact new learning, (b) Policy can explain inequity and is new to students, (c) Students do not well articulate racial disparities and (d) Understanding racial history requires attention and conversation. ConclusionA community bus tour met our expectations for teaching DNP students concepts related to health disparities as it illustrated real-life situations in actual neighborhoods. However, there were unusual student responses that prompted us to reflect on the activity and consider improvements. More emphasis needs to be placed on cultural wealth and on discussion planning for such experiences. Our results lay the groundwork for curriculum development. Setting goals and targets in line with the 2022 CDC’s Core Health Equity Science and Implementation Strategy is essential.

Treatment-seeking behaviours of patients with tungiasis in endemic areas of Homa Bay County, Kenya: a mixed-methods study

BackgroundTungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents’ treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting.MethodsA cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants—410 adults who had experienced tungiasis—using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya.ResultsFactors significantly correlated with using non-guideline-listed treatments for tungiasis were ‘not knowing the causse of tungiasis’, ‘not seeking treatment from healthcare facilities and traditional healers’, and ‘wait and see to prevent infection in non-affected members’. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was ‘Someone else’s idea’. The most frequently mentioned reason for choosing the best self-treatment option was ‘Effectiveness’. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was ‘Supply situation’.ConclusionsResidents’ socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents’ tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis.

Assessment of gestational diabetes mellitus knowledge, attitudes, and practices and associated factors among pregnant women at a district hospital in Coastal Kenya

BackgroundGestational diabetes mellitus (GDM) is any degree of glucose intolerance first recognized during pregnancy. GDM awareness among pregnant women translates into GDM prevention and early diagnosis.ObjectiveTo establish the underlying factors influencing GDM Knowledge Attitude and Practices (KAP) among pregnant women at Kinango District Hospital.MethodAn explanatory mixed-methods design was implemented by initially assessing GDM KAP quantitatively [QUAN], followed by the qualitative [qual] exploration of contextual factors behind quantitative results. In the [QUAN] strand, 354 pregnant women were interviewed from January to February 2019. Thereafter, in the [qual] strand, key informant interviews were conducted among four pregnant women and three healthcare workers; a focus group discussion was held among nine pregnant women, from May to June 2019. STATA V15 software package was used to analyze the quantitative data. Qualitative data were analyzed manually using thematic analysis.ResultAmong 354 pregnant women, 29.0% were knowledgeable, 46.98% had good attitude and 60.17% had good practice. Attending at least one antenatal clinic visit and having heard about diabetes mellitus were associated with good GDM attitude and practices. Among the knowledgeable pregnant women, one-third (33.33%) obtained GDM information from a health facility. Discussions with pregnant women and the interviews with healthcare workers highlighted that daily health talks during antenatal clinic, included GDM and diabetes mellitus information. Furthermore, attendance of at least one antenatal clinic visit was low (85.88%), among pregnant women (87.86%) who were expected to have attended at least one antenatal clinic visits.ConclusionDespite low GDM knowledge, pregnant women had relatively good GDM attitudes and good GDM practices. Daily health talks conducted during antenatal clinic as well as indigenous knowledge among pregnant women, influenced the latter. Hence, GDM information dissemination needs to be enhanced for the improvement of GDM KAP among pregnant women for GDM prevention.

The impact of Philosophy for Children (P4C) activities on enhancing the speaking skills of gifted students.

The aim of this study was to investigate the impact of Philosophy for Children (P4C) activities integrated into Turkish lessons on the speaking skills of gifted students. Both quantitative and qualitative data were collected through interviews and various scales, employing a mixed-method design. The results indicated that students had positive feelings about P4C, including appreciation, curiosity, surprise, excitement, self-confidence, and empathy. They believed that P4C enhanced their problem-solving, creativity, questioning, effective speaking, and collaboration skills. However, some students also expressed negative views, tough less frequently, citing issues such as nonsense, limited time, the necessity of prior knowledge, and lack of idea diversification. Quantitative data revealed that P4C activities significantly improved the speaking skills of gifted students and notably reduced their speaking anxiety. Additionally, sex and program variables showed no significant effect on speaking skills and speaking anxiety.

Outcomes of the Together for Life Program in Community-Dwelling Older Adults Living Alone: A Pilot Study.

The current study developed and tested selected effects of the Together for Life (TFL) program for community-dwelling older adults using an embedded mixed methods design. Nine community volunteers participated in the training program, and 14 people aged ≥65 years, living alone, enrolled in the study. Home visits were conducted by home health nurses every 2 weeks, supplemented by weekly home visits and phone counseling provided by volunteers, for a duration of 20 weeks. This mixed methods study used quantitative and qualitative approaches. Quantitative data were gathered through a questionnaire survey to assess the intervention's effects on health-related quality of life (HRQOL), loneliness, and depression. The qualitative component focused on participants' evaluation of the program. Significant changes were noted in HRQOL scores with an effect size of 0.6 (p = 0.01). Results indicated the positive impact of the TFL program on HRQOL among older adults as their health status was continuously monitored by volunteers who provided care and home health nurses who assisted with health management during the coronavirus disease 2019 (COVID-19) pandemic. In a pandemic, personalized health management, such as regular health check-ins provided by home health nurses and home or phone visits provided by volunteers, is crucial for isolated older adults. This pilot program enhanced participants' HRQOL through continuous health monitoring, volunteer care, and nurse support, even during the COVID-19 pandemic. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women. The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34). In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P =.001; SES: b, 2.18; SE, 0.60; P <.001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P <.001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P <.001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9). Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.