Mixed-methods Design Research Articles

A theory-based analysis of the implementation of online asynchronous telemedicine platforms into primary care practices using Normalisation Process Theory

Abstract Background Online asynchronous telemedicine platforms are effective and have been implemented in primary care practices, but it is unclear whether implementation was successful. Implementation has not been studied on a large scale in primary care practice. Normalisation Process Theory is a sociological theory used to understand how complex practices can be embedded into routine practice. We aimed to identify and evaluate factors affecting, and make recommendations for, implementation of online asynchronous telemedicine platforms in primary care practice using Normalisation Process Theory. Methods A systematic search was carried out across four databases. Studies included were empirical research, published between January 2015 and November 2022, of qualitative, quantitative and mixed methods designs, focusing on implementation of online asynchronous telemedicine platforms designed for two-way secure communication between patients and healthcare professionals to give or receive medical advice in primary care. Data extraction was guided by the domains of Normalisation Process Theory: context, mechanisms, outcomes. Results 25 reports from 21 primary studies were obtained. COVID-19 changed the context in which asynchronous platforms were implemented into primary care, due to restrictions on face-to-face contact. Coherence is supported by online platforms providing benefits for patients. Healthcare staff felt confident using platforms and better teamworking added to cognitive participation, however patient ‘misuse’ of platforms hindered this. Collective action was negatively affected by poor usability and integration of platforms into practice systems. Reflexive action through large- and small-scale studies had allowed improvements to be made, but poor response rates inhibit this. Outcomes include changed roles and responsibilities for staff and patients and high patient satisfaction. There are concerns regarding confidentiality and health inequities. Conclusions Increased workload, lack of integration into existing systems and poor usability affect implementation. Widespread implementation of online platforms in primary care practices can be supported by policy-makers through consistent guidelines to improve platforms’ content, functionality and compatibility with clinical systems to try to enable improvements in practice. Further research should explore patient groups or needs for which online platforms are most suitable, reasons why online platforms work better for different patients and how different patient groups can be supported to benefit from asynchronous telemedicine.

The Impact of Parental Involvement on Their Children’s Academic Success

The most significant influencers are parents, who help their kids achieve academically through positive support and encouragement. The performance of their children in school activities and the parents’ involvement in them are consistently correlated; this makes children flourish in education. Parenting style and strategies at home furnish growth and development in every facet of kids’ lives. Hence, analyzing the effects of parental participation (PI) on their kids’ academic development is the goal of this study. This study utilizes a mixed-method research design for collecting data. The answers to the questionnaire were collected from 425 parents and 110 teachers. The interview data was obtained from 37 parents, 32 teachers, and 130 students. NVivo software was used to evaluate the qualitative data, while SPSS software was used to examine the quantitative data that had been obtained. The study findings reveal that PI expands children’s academic performance and motivation, joining in educational activities, intensifying the school attendance rate, decreasing dropout rates, accelerating positive attitudes towards learning, and regulating behaviour and discipline among children. The study result indicates the positive effects of PI on kids’ academic achievement (AS). The novelty of the study resides in its overarching, complete studies on how PI affects parents’ kids’ academic performance. The study contributes to the field of child education by laying out and focusing on the influence of PI over the child’s academic achievement and suggesting making certain of the PI in education for the benefit of the child. The study suggests putting forward the design of the implementing programs to draw the attention of parents in education by demonstrating the PI’s constructive outcomes on a child’s AS.

Words of well-being: language reveals differences in the relational nature of five components of subjective well-being

ABSTRACT This paper explores the differences between five components of subjective well-being: happiness, meaning, harmony, spirituality, and religiosity. This is a pressing question, as growing research suggests that a good life encompasses more than just happiness, underscoring the need to understand the distinctions between subjective well-being components. Quantitative approaches often reveal high correlations between them, making differentiation difficult. To address this, we employed a mixed-methods design, including a quantitative analysis of open-ended responses from 1,084 British participants. Our findings indicate that happiness is primarily oriented toward small communities, while the other components are more broader communities-oriented. These results contribute to a nuanced understanding of human flourishing and lay the groundwork for further research into the distinctions between well-being components.

Knowledge, Attitudes, Beliefs, and Practices Regarding Maternal, Infant, and Young Child Feeding (MIYCF) among Women Living in Tea Estates of Dibrugarh District: A Mixed-Method Study

Abstract Background: Despite global efforts, malnutrition remains a significant contributor to under-five mortality. Current study, aimed to assess knowledge, attitudes, beliefs, and practices related to maternal, infant, and young child feeding (MIYCF) among women with children aged 0-23 months, working in tea estates of the Dibrugarh district. Methods: Community-based cross-sectional study using mixed-method design conducted in 2022. The quantitative study involved 198 women selected through multistage sampling, while the qualitative segment included focus group discussions and in-depth interviews with healthcare providers. SPSS version 25 and Atlas Ti software are used for quantitative and qualitative data analysis, respectively. Results: A discernible gap between knowledge and practices highlighted the necessity for targeted behavioral interventions. Cultural norms, dietary restrictions, and traditional practices affecting MIYCF were documented in a qualitative study. Service providers identified economic conditions, ignorance, and reliance on traditional healers as contributing factors to malnutrition. Conclusion: Holistic, culturally sensitive interventions are pivotal to addressing the intricate interplay between knowledge, societal norms, and MIYCF practices in the tea estates of Dibrugarh.

The role of IELTS teacher’s metapathy in IELTS candidates’ overall band score, language learning orientation, and active/passive motivation

Abstract This study examines the impact of teacher metapathy, or teachers’ capacity to comprehend and sympathize with students’ emotional and cognitive requirements, on the academic outcomes of IELTS applicants, such as total band scores, motivation, and language learning orientation. Ten IELTS teachers from five language training centers and 100 IELTS candidates participated in the mixed methods design. Standardized surveys and official IELTS scores were used to collect quantitative data, and semi-structured interviews were used to acquire qualitative data. The associations between teacher metapathy, student motivation (passive vs. active), learning orientation (integrative vs. instrumental), and band scores were examined using logistic regression, Pearson correlation, chi-square tests, and structural equation modeling (SEM). Thematic analysis was used to explore participants’ perceptions of metapathy in the classroom. Results revealed a significant positive correlation between teacher metapathy and students’ overall IELTS band scores. High levels of teacher metapathy were associated with increased active motivation and integrative learning orientation among students. Additionally, the frequency of teacher-student interaction was found to mediate the relationship between teacher metapathy and students’ motivation levels. Qualitative findings reinforced these results, highlighting the importance of emotional and instructional support in promoting student engagement and success.

Effects of motivation on teaching standards of higher secondary level english teachers of public and private sectors: A comparative study in Sialkot, Pakistan

This study investigates how motivation affects the teaching standards of higher secondary English teachers in the public and private sectors of District Sialkot, Pakistan. The study employs a mixed-method descriptive research design, rooted in Frederick Herzberg's Motivation-Hygiene Theory (1959), to thoroughly examine the motivation and demotivation factors that impact teachers' performance. We gathered quantitative data through questionnaires to gain broad statistical insights and obtained qualitative data from focus group interviews to gain in-depth perspectives. The population consisted of English teachers from eight higher secondary schools, divided equally between the public and private sectors. We selected 30 teachers with at least 3 years of experience using purposive sampling. The research instruments included a self-developed Likert scale questionnaire and structured interview protocols. The theoretical framework is based on Frederick Herzberg’s Motivation-Hygiene Theory, which distinguishes between intrinsic motivators, such as achievement and recognition, and extrinsic hygiene factors, such as salary and working conditions. The researcher used statistical methods to analyse the quantitative data and subjected the qualitative data to thematic analysis. These insights are valuable for educational policymakers and administrators looking to improve teacher motivation and overall educational quality in District Sialkot.

Mapping the future: The current landscape and future directions of evidence-based practice in Saudi radiology departments.

To examine the current application of Evidence-Based Practice (EBP) among radiology professionals, including radiologists and radiographers, in Saudi Arabia and to identify challenges in order to propose suitable future improvement strategies if it is required. A mixed-method design was used in this study. A survey consisting of 23 questions addressing research activities and EBP within radiology departments was sent to radiology personnel. The sample size of the quantitative phase of the study was determined using a formula specific for an infinite or unknown population. The formula used was n = P(1-P)Z2/d2, which resulted in a required sample size of 384 participants. A total of 345 participants; however, 45 did not fully complete the questionnaire and were therefore excluded. The data were analyzed using SPSS version 27. Inferential statistics, including non-parametric tests such as the Mann-Whitney U Test and the Kruskal-Wallis Test, were used to assess the influence of demographic factors on perceptions and challenges related to the adoption of evidence-based practice (EBP) in research within Saudi Arabia. Additionally, 20 semi-structured interviews were conducted with radiology personnel across the country. The sampling technique for the qualitative phase of the study was guided by the study's objectives and the unique characteristics of the research group. The participants were purposively sampled in order to include radiologists and radiographers who work in different types of hospitals (public, semi-public, private) in Saudi Arabia. Responses from the interviews were coded, and key themes were identified following Miles and Huberman's framework. The findings revealed a positive attitude towards research and EBP among Saudi radiology personnel. Over half of the participants (74.3%) strongly agreed that they understood and were familiar with EBP. They also felt confident in their ability to conduct scientific research in radiology (Mean = 4.27) and believed that they should actively initiate projects (Mean = 4.10). Radiologists reported a higher level of agreement compared to radiographers regarding their familiarity with EBP and their ability to critically evaluate the quality of research (P-value = <0.05). However, participants indicated lower level of agreement about their ability to develop their current practice based on EBP and engage in discussions with colleagues about research evidence. Key challenges identified include a lack of training, insufficient support and limited autonomy, which may hinder EBP implementation. This study underscores the need for comprehensive education, ongoing training and a supportive organisational culture to enhance EBP adaption.

Plausibility, Acceptability, and Trustworthiness: The Resonance of Shale Gas Frames in the United Kingdom

ABSTRACT We employ a mixed-method research design to assess the resonance of key frames used in the UK policy debate over shale gas development amongst two distinct public audiences. We elaborate a conceptual framework drawn from argumentative discourse analysis and social movement studies. The framework conceptualises resonance as the result of frame plausibility, acceptability and trustworthiness. We utilise semi-structured interviews to analyse how frames resonate with local “campaigning publics” in the case study region of the Fylde, Lancashire, UK. The plausibility of the frames and trustworthiness of key organisations amongst the general public are also assessed through a nationally representative UK survey. We find that, amongst the general public, the frames of the anti-shale development discourse coalition are viewed as more plausible than those of the pro-shale coalition. This finding offers a partial explanation for the failure of UK shale policy. Our local community interviews identify contrasting views on frame resonance amongst local “campaigning publics”. We illustrate these contrasting views on frame resonance by exploring how pro – and anti-shale development interviewees generally held different perceptions about the trustworthiness of key actors and institutions, the promise of economic benefits, and the framing contests over climate change and risk and regulation.

On the road to Mecca: Branding discourses and national identity on coffee shop signage.

Commercial branding stands as a discursive and cultural facet of the contemporary global era where competing brands construct their own identities. From a discourse perspective, a brand is discursively constructed on commercial signs. Accordingly, this study examines the interplay between coffee shop branding and national identity in Saudi Arabia. In so doing, the study investigates the competing branding discourses associated with coffee as well as the space given to national identity. To achieve this task, the study developed a conceptual framework grounded on critical discourse analysis (CDA) and linguistic landscape (LL). The data consists of 88 commercial signs of coffee shops collected by driving on a road from Najran to Mecca, Saudi Arabia. The research site was then verified through Google Maps. The data built a communicative event for an empirical mixed-method research design. CDA linguistic and multimodal toolbox was utilized. The analysis showed that three names of coffee are found on the road to Mecca: qahwa (Arabic), coffee (English), and kufi (transliteration). With these names, four discourse are in competition. For globalization, English-Arabic glocal discourse (34%), and English global discourse (8%) are competing to construct coffee branding. For national identity, Arabic local discourse (42%) and Arabic-English glocal discourse (16%) are associated with qahwa; something that gives substantial space (58%) for national identity. These findings enhance our understanding of the linguistic and multimodal dimensions of globalized spaces and their discursive construction of branding at the local scale of globalization. The study recommends further research and suggests some cultural and pedagogical implications for authorities, translation, bilingual awareness, teaching, and learning.

Sponsorship of the Tokyo 2020 Olympic Games and the FIFA World Cup Qatar 2022 on X and Instagram: A comparative analysis of digital activation and content type

Introduction: The aim of this study was to perform a comparative analysis of the activation of sponsorship of the Tokyo 2020 Olympic Games and FIFA World Cup Qatar 2022 on social media. Methodology: A mixed-method study design was conceived, combining an analysis of the quantitative and qualitative content of posts on the global and Spanish X and Instagram accounts of 16 sponsors. These were International Olympic Committee and Spanish Olympic Committee sponsors, as well as official FIFA World Cup 2022 sponsors. Results: After analysing a sample of 4,791 posts, the results revealed interesting findings regarding the volume of posts about these two mega-events on the one hand, and the thematic types of post on the other. In general terms, it was concluded that the Olympic sponsors had devoted efforts to promoting their links with the Olympic Games, while the FIFA World Cup sponsors had generated a higher number of posts. At the same time, it was found that cross-pollination had only been partially used in the brands’ stories: some did not interconnect their global and national communication strategies, and the brands’ stories on X and Instagram did not match. Conclusions: The most common themes of the activation of both sponsorships were informing and interacting, which stood out much more than other types such as entertaining or rewarding.

Reaching American Indian Parents Through Online Divorce Education

Evaluative research on the effectiveness of divorce education continues to grow, but research is still limited on programmatic impacts for historically underserved groups. Using a mixed-methods design, this study analyzed data from divorcing American Indian parents ( n = 153) who took part in a court-mandated, online divorce education program. The study examined participants’ reasons for divorce, understanding of divorce and coparenting plans, and participant experiences in the course. Quantitative analyses revealed that mothers reported more problems than fathers in terms of what influenced their decision to divorce, which included emotional, psychological, and verbal mistreatment, childrearing differences, extended family issues, and physical violence. Both mothers and fathers demonstrated an improved understanding of divorce-related topics and positive coparenting practices. Qualitative analyses demonstrated parallels with quantitative analyses, as an increased awareness of the effects of divorce on children was most frequently mentioned as the greatest benefit to participation. Participants also noted their appreciation for the program's online content and delivery method, while acknowledging how the program helped them learn more about coparenting. Implications for facilitating divorce education programs with American Indian parents are discussed.

Is It Real Enough? A Mixed-Methods Study of Realism, Engagement and Counterargument in Transmedia Edutainment for Sustainable Behaviors

Advancements in technology have driven media convergence, paving the way for innovative storytelling formats like Transmedia Edutainment (TE-E), a new promising strategy for advocating prosocial behaviors. However, there is limited research on narrative processing and the persuasive outcomes of TE-E, particularly in environmental contexts. Therefore, this paper examines TE-E as a new communication strategy that leverages storytelling across multiple platforms to promote pro-environmental messaging. Drawing on entertainment-education literature and narrative persuasion theories, specifically the narrative engagement model and perceived realism as theoretical frameworks in this study, to help understand the role and influence of TE-E. Using a mixed-method design, five focus group discussions were conducted with college students to gain deeper insights into their attitudes and impressions towards TE-E. Additionally, an online experiment with (N=441) college students examined the role of perceived realism, narrative engagement, and counterargument, as message mechanisms responsible for promoting pro-environmental behaviors. Thematic analysis of the focus groups discussions revealed two emerging themes: (1) “The triple R effect of TE-E” and (2) “Is it real enough?” The experiment shows that the counterargument plays a key role in understanding and shaping the message mechanisms of TE-E. Results found that TE-E successfully encourage adopting sustainable behaviors and directly reduces counterarguments. However, it had slightly lower perceived realism compared to the video, leading to reduced narrative engagement. Overall, this paper contributes to the expanding literature on TE-E within the context of environmental communication. Practical implications for message development and environmental advocacy are also discussed.

The EU’s depoliticized approach to deliberative democracy and its implications for climate policy: The case of the Conference on the Future of Europe

ABSTRACT The Conference on the Future of Europe (CoFoE) was the ‘first transnational, multilingual and interinstitutional exercise of deliberative democracy’ at the EU level, aiming to give citizens the opportunity to shape the Union’s future. This paper critically reflects on how the deliberative process was designed, framed and implemented, and its implications for climate policy. Methodologically, I follow a mixed-method qualitative design, including a document review of the official reports, nine semi-structured interviews with key actors, and observation during two related events. The research findings indicate that depoliticization accompanied the entire process, especially unfolding via the broad and neutral framing of the European Citizens Panels and the scarce presence of civil society during the process. As a result, the resulting proposals are mostly in line with current climate policies, therefore rather serving as a legitimacy tool. In addition, this prevented citizens from developing a holistic understanding of the climate and environmental crises, overlooking its connections with global justice and the political economy, and without opening up the space for contesting the EU’s main discourses and trajectories.

Feasibility and Reliability of the Adapted Kagan Scales for Rating Conversations for People With Acquired Brain Injury: A Multiphase Iterative Mixed-Methods Design.

Rating the quality of conversations can assess communication skills in both people with acquired brain injury and their communication partners. This study explored the clinical feasibility and reliability of two conversation rating scales: the Adapted Measure of Participation in Conversation (MPC) and the Adapted Measure of Support in Conversation (MSC). Raters were final-year speech and language therapy students (n = 14) and qualified clinicians (n = 2). Raters attended training on the Adapted MPC and MSC, watched 5 or 10 min of videotaped conversations (n = 23), and then scored them on the MPC and MSC scales. Data were collected over four phases, which varied according to the length of the training, sample length, number of samples rated, and level of clinical expertise. Feasibility data (time taken to score conversations and ease of use) were collected. Interrater reliability was assessed using intraclass correlations (ICCs: absolute agreement, single measures). Raters took 30-45 min to score a 10-min sample, and they took 20-30 min to score a 5-min sample. Ease of use was rated highly across all phases. Overall reliability for rating 5 min of conversation (ICC = .52-.73) was better than for 10 min of conversation (ICC = .33-.68). Reliability for the MPC was moderate for both students (ICC = .69) and clinicians (ICC = .55), and for the MSC, it was moderate for both students (ICC = .73) and clinicians (ICC = .58). Reliability was better for students compared with clinicians. Rating a 5-min conversation in under 30 min was feasible, with more reliable results for 5-min compared with 10-min conversations. Implications for assessing conversation in the future are discussed.

An Examination of an Online, Asynchronous Social Justice Program With Undergraduate Communication Sciences and Disorders Students

Purpose: The study aimed to determine whether an online asynchronous program can positively influence undergraduate communication sciences and disorders students' attitudes, beliefs, and actions toward advancing social justice. Method: The study employed a mixed-method design. Participants included 18 undergraduate students from two state universities and one private university, with 14 completing the program. Participants completed the program over 12 weeks via the CANVAS platform. Quantitative data were collected using the Social Justice Scale (SJS), which assesses attitudes, perceived behavioral control, subjective norms, and intentions to act toward social justice. Wilcoxon matched-pair signed-ranks tests were used to analyze pre- and postprogram SJS scores. Qualitative data were gathered from students' responses to discussion prompts within the program, and thematic analysis was conducted to identify emerging views of social justice. Results: A significant difference with a large effect size was observed for the Subjective Norms subscale. Item analysis indicated a significant difference in one of four subscale items (i.e., “Other people around me are engaged in activities that address social injustices”). Qualitative analysis revealed three themes: (a) importance of social identity, equity, justice; (b) spark of action; and (c) we are all in it together. Conclusions: The Social Justice program shows promise in enhancing students' recognition of how professionals in their environment play a role in social justice activity and in sparking a commitment to action among some participants. However, program modifications are needed to increase students' action orientation to social justice.

Advanced Practice Nurses' Roles and Responsibilities in Advance Care Planning for Older Persons-A Mixed Methods Systematic Review.

To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP. Mixed-methods systematic review. Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by 'qualitising' quantitative findings into text, enabling integration and thematic analysis to synthesise the results. Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs. The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities. APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes. APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. No patient or public contribution.

We Just Leave It as "Other”: Undocumented Student Policy and Practice in Hispanic-Serving Institutions

This pilot study uses a mixed-method convergent design to explore what formal policy and informal practices exist at Hispanic-serving institutions (HSIs) and emerging Hispanic-serving institutions (eHSIs) in states with restrictive, ambiguous, or no undocumented student legislation. These policies and practices can be used to increase equity access in a biased political environment. Data was collected in two phases. Student-facing staff and administration at HSIs and eHSIs in states with restrictive/ambiguous or no policies completed a mixed-methods survey. Individuals could then choose to participate in a semi-structured interview. Initial results reveal that formal policies are limited to clarifying federal or state legislation. In contrast, informal practices provide ways to provide information and support, professional development, or ways to manage student disclosure of status. Of special interest are “don’t ask, don’t tell” practices that exist when a student’s status is disclosed and the number of respondents who believe no undocumented students are enrolled at their institution. Recommendations include policy and professional development considerations.

What Factors are Contributing to Increasing Numbers of ‘Care Orders at Home’ in Northwest England?

ABSTRACTThere is increasing understanding of the challenges associated with rising numbers of children entering England's public care system. Yet, commentators continue to overlook cases where children are ostensibly placed ‘in care’ of the local authority, but then simultaneously remain living at home with their parent(s)—a practice referred to as a ‘Care Order at home’. The purpose of this study was to look for evidence of increasing numbers of ‘Care Orders at home’ within northwest England, and to explore with frontline social workers what they considered to be contributing to this phenomenon. The study adopted an iterative mixed method design comprising of focus groups, online questionnaire, and individual interviews, supplemented by 57 ‘Freedom of Information’ requests. Findings highlighted a substantial increase in ‘Care Orders at home’ in northwest England since 2011 and identified the longstanding national government policy of ‘austerity’ and a ‘malfunctioning’ placement market as key factors contributing to this. Implications are of the importance of reinvestment in preventative services so as to reduce the demand on England's child protection system, and reappraisal, and reform of the children's social care placement market, so that the placement of children can be consistently based on the needs of the individual child.

The engagement of healthcare providers in implementing the selfBACK randomised controlled trial - A mixed-methods process evaluation.

People with low back pain (LBP) are often recommended to self-manage their condition, but it can be challenging without support. Digital health interventions (DHIs) have shown promise in supporting self-management of LBP, but little is known about healthcare providers' (HCPs) engagement in implementing these. We aimed to examine HCPs' engagement in patient recruitment for the selfBACK app clinical trial and explore their perceptions of the app. In a mixed-methods design, we conducted a process evaluation alongside the selfBACK trial, triangulating quantitative data from trial recruitment logs and a vignette-based survey, and qualitative data from trial procedure documents, interviews with HCPs, and survey free-text responses. From 2019 to 2020, we recruited 57 HCPs from Norway and 39 health clinics in Denmark and collected quantitative and qualitative data in parallel. Results were integrated using displays. Overall, 825 patients were recruited by the HCPs. The vignette-based survey showed high agreement among HCPs (n = 62) with the self-management plans generated by the app (84.1-88.9%) but also highlighted concerns about tailoring and content. Interviews with HCPs (n = 19) revealed challenges with recruitment due to busy schedules, competing tasks, and varying levels of interest and engagement in the study. The study identified factors that impact HCPs' engagement in recruiting patients for the selfBACK trial and highlighted overall positive views of the selfBACK app, although some concerns about the content and tailoring of the app were raised. Understanding HCP motivations and workload is crucial for the successful implementation of DHIs in clinical practice.

Student negotiated syllabus and students' engagement and academic procrastination: A mixed-method study.

Participatory approaches in education, such as syllabus negotiation, have been suggested to enhance student autonomy, engagement, and self-regulation. However, their impact on academic procrastination and engagement still needs to be explored. The main objective of the study was to investigate the impact of the negotiated syllabus on EAP learners' engagement and procrastination in a higher education context. It also aimed to explore the learners' perceptions of the effectiveness of the negotiated syllabus. A mixed-method research design was used. For the quantitative phase, six EAP classes were divided into an experimental group (n=139), which used a negotiated syllabus, and a control group (n=169), which followed a traditional syllabus. For the qualitative phase, 26 students from the experimental group were selected using theoretical sampling. Quantitative data were analyzed using Multivariate Analysis of Covariance (MANCOVA), while qualitative insights were thematically analyzed. Quantitative results revealed significant engagement improvements and reductions in procrastination for the experimental group. Students reported more significant interest in course materials, increased participation, and enhanced time management. Qualitative findings supported these outcomes, highlighting the development of reflective learning and psychological flexibility among students involved in the syllabus negotiation process. These results align with self-determination, suggesting that a negotiated syllabus fosters intrinsic motivation and self-regulation. Syllabus negotiation demonstrates the considerable potential to enhance academic behaviours and support the development of essential lifelong learning skills. It can be concluded that learners' participation in the syllabus promotes student autonomy, engagement, and adaptive learning behaviours. Findings have theoretical implications for educational psychologists and applied linguists and practical consequences for EAP teachers and learners.