Mixed Methods Analysis Research Articles

Information on HIV and Narration of U=U: a mixed method analysis on social media in Italy

Abstract Background Media play a pivotal role in disseminating accurate information, particularly regarding U=U (Undetectable = Untransmittable), to increase awareness and reduce stigma. This study analyses HIV Italian communication on Facebook and Instagram, with a focus on U=U evidence. Methods A mixed-method analysis examined posts on HIV, with linked articles, from Italian news sources from 01/2009 to 04/2023. News sources were categorised as “reliable” or “unreliable” using independent third-party classification. Topic analysis identified the main topics in the posts, while an inductive content analysis was conducted on linked articles regarding U=U. The language and the accuracy in explaining U=U was evaluated through a checklist. Results A total of 10,539 Facebook and 749 Instagram posts were analysed, with 716(7%) and 18(2%) from unreliable sources respectively. Reliable and unreliable content surged around World AIDS Day(WAD) on both platforms. On Facebook, the frequency of unreliable content increased over time, whereas on Instagram it was rare and recent. On Facebook, topics varied between reliable and unreliable sources. The 3 most frequent topics from reliable sources were WAD, voluntary HIV spread, and public figures with HIV; those from unreliable sources were Death and Migrant People; Luc Montagnier and COVID-19 Conspiracies; Public Figures with HIV. On Instagram, the first 3 topics were the Italian National Institute of Health and Prevention, WAD, and public figures with HIV. A total of 68 articles nominating U=U were found and analysed, revealing 4 main areas: U=U definition, Prevention, Impact on people living with HIV, and Stigma. The accuracy in explaining U=U was generally low, with 6 articles(8.8%) providing only a definition. Conclusions HIV communication in Italy is limited and centered around WAD, with persisting bias. The dissemination of the U=U evidence is lacking. Urgent action is needed to shift the narrative and emphasize this evidence Key messages • HIV communication in Italy is limited and concentrated around World AIDS day. • The U=U evidence is poorly disseminated, often providing only a definition and medical explanation.

Family Functioning and Child Participation Following Early Childhood Traumatic Brain Injury

Family functioning and child participation are critical factors in recovery from traumatic brain injury (TBI) and academic and social outcomes. Using mixed methods, we investigated these factors in children who experienced early childhood TBIs and then entered formal schooling. Caregivers completed interviews and scales of family functioning and child participation. Their scores did not reflect problematic family functioning, but showed participation across settings was below average. Themes from interviews included: (1) early childhood TBIs can affect family functioning even years after the injury; (2) learning, academic, and social-emotional issues impact participation and family functioning following early childhood TBI; and (3) appropriate supports and accessible environments are critical for both family functioning and child participation across settings. Mixed methods analyses indicated convergence, divergence, and expansion between qualitative and quantitative results. Results enhance our understanding of challenges encountered after early childhood TBI and provide directions for future interventions.

Circumstantial Factors Among Kentucky Nurse Suicide Decedents, 2005 to 2019.

Background: Nurse suicide, a complex occupational health concern, is urgently in need of research due to the personal and occupational suicide risk factors experienced by nurses, namely mental health problems (e.g., depression), job problems, and substance misuse. Therefore, the study aims were to determine the contextual characteristics and circumstantial factors associated with nurse suicide in Kentucky. Methods: Secondary suicide data were obtained from the Kentucky Violent Death Reporting System (KYVDRS) from 2005 to 2019. Nurse suicide cases were identified using the Bureau of Labor Statistics Standard Occupational Classification. A mixed-methods analysis using descriptive statistics and qualitative evaluation was conducted to determine the distributions of demographic, injury, and weapon characteristics, followed by a qualitative analysis of the KYVDRS incident narrative text of nurse suicide decedents. Results: There were 88 decedents identified with a nursing occupation. The predominant means of death for male (59%) and female (45%) nurses involved firearms. Thematic analysis showed nurse decedents experienced a mental health problem (51%) and premeditated (50%) suicide preceding death. Incidentally, 51% of all cases experienced multiple circumstantial factors (e.g., relationship problems and premeditation) preceding their death by suicide. Discussion/Application to Practice: Nurse suicide decedents experienced multifactorial risk factors preceding their death by suicide, namely depression, premeditated suicide, and relationship problems. Occupational health practitioners and health care organizations can implement individual and organizational prevention efforts to help prevent nurse suicide.

Discovering the effectiveness of climate finance for Somalia’s climate initiatives: a dual-modeling approach with multiple regression and support vector machine

IntroductionThis research investigates into the complex dynamics of climate finance in Somalia, a vulnerable region facing the dire consequences of climate change. The study aims to assess how financial inputs for climate-related projects align with the actual needs and identify critical factors that influence funding effectiveness.MethodsA dual-methodological approach was employed, integrating both multiple regression analysis and Support Vector Machine (SVM) techniques. This mixed-method analysis facilitates a robust examination of climate finance data to dissect the relationships and impacts of various determinants on funding effectiveness.ResultsThe results indicate that adaptation finance, robust governance, and the scale of financial interventions significantly enhance the effectiveness of climate finance flows. However, mitigation finance and aspects related to gender equality displayed less significant impacts. Notably, the study identifies a pervasive underfinancing of climate projects in Somalia, illustrating a significant gap between the needed and actual funds disbursed.DiscussionThe findings underscore the need for enhanced governance frameworks and targeted large-scale financial interventions to optimize the allocation and impact of climate finance in vulnerable regions like Somalia. By quantifying the influence of adaptation finance and governance, this study contributes new insights to the literature on climate finance effectiveness and suggests practical strategies for policymakers and practitioners to improve climate resilience initiatives.

Investigating social streaming app dependency: a mixed-methods analysis

PurposeThere is a dearth of knowledge regarding how user dependency offers valuable resources to develop the intellectual capital of social streaming apps (SSAs) companies. This study aims to integrate major conceptual components of the UandD model, identify contextualized goal-oriented SSA dependency and empirically evaluate their interrelated user-dependency relationships in the SSA context.Design/methodology/approachA mixed-methods approach was utilized in this study. First, user gratifications were elicited through a qualitative approach, considering the exploratory stage of the SSA phenomenon. Second, statistical methods were applied to investigate and extract the sub-dimensions of SSA dependency. At last, a research model was developed grounded on the UandD model and empirically validated using the quantitative approach.FindingsThe results validated the gratification-dependency-attitude-behavior relationships hypothesized by the UandD framework in SSA. The role of user-SSA dependency in enhancing intellectual capital in the social media industry has been highlighted in this study.Research limitations/implicationsThis research not only provides an opportunity for the UandD model to realize its theoretical potential as envisioned by scholars but also contributes to the scholarship on social streaming apps and media dependency theory by conceptualizing goal-oriented dependency in SSAs.Practical implicationsThe research results will guide digital media practitioners to a more nuanced understanding of the relationships between their users and modern digital media apps and thus empower the practitioners to better manage their intellectual capital based on the facilitation of their users’ dependency.Originality/valueThis work is one of the pioneers in contextualizing the UandD model in the SSA field, refining and measuring the SSA dependency and its distinct subdimensions and employing mixed-methods to offer a comprehensive understanding of how user dependency boosts intellectual capital in the SSA industry.

Social and ecological dimensions are needed to understand human‐wildlife conflict in subsistence farming context

Abstract This study explores the social, economic and environmental dimensions of human‐wildlife conflict (HWC) in four districts of Bhutan. Looking beyond the common unidimensional approach to the evaluation of HWCs, it documents the multifaceted nature of HWCs through a social‐ecological system (SES) lens. We carried out a mixed method analysis of HWC based on 96 interviews consisting of qualitative and quantitative data and eight focus group discussions conducted in four districts representing four regions of Bhutan. Our case study finding reveals that HWC scenarios are complex and there is spatial variation in both social and ecological factors that contribute to HWC. In some areas, ecological aspects such as the composition and behaviour of wildlife species exacerbate the conflict, while in other regions the co‐occurrence of wildlife and livestock in the same ‘wild’ landscape drives HWC. The socio‐economic dimensions of HWC are largely driven by attitudes, tolerance, and behaviour of individuals underpinned by multiple factors. We propose that the SES approach improves our understanding of key social, economic and ecological factors, their interactions, and the feedback that either exacerbates or ameliorates HWC in contested landscapes. Read the free Plain Language Summary for this article on the Journal blog.

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.

The experiences of local communities in ecotourism businesses: A mixed-methods analysis of four local municipalities

The experiences of local communities in ecotourism businesses: A mixed-methods analysis of four local municipalities

Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysis.

About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Detailed analysis of how this safety-critical care can be improved has not been undertaken. Understanding context, contributory factors and events leading to incidents is essential. (1) Understand continuous subcutaneous infusion safety incidents and their impact on patients and families; (2) Identify targets for system improvements by learning from recurrent events and contributory factors. Following systematic identification and stratification by degree of harm, a mixed methods analysis of palliative medication incidents involving continuous subcutaneous infusions comprising quantitative descriptive analysis using the PatIent SAfety (PISA) classification system and qualitative narrative analysis of free-text reports. Palliative medication incidents (n = 7506) reported to the National Reporting and Learning System, England and Wales (2016-2021). About 1317/7506 incidents involved continuous subcutaneous infusions with 943 (72%) detailing harms. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%). Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care. Training is needed to improve incident descriptions so these pinpoint precise targets for safer care.

Students With LD and Decision Making for After High School: Emotions and Basic Psychological Needs

Little is known about how grade 12 students with learning disabilities (LD) face the complex and emotional task of deciding what to do after high school. To expand on current research, we explored the experiences, emotions, and support of students with LD from the theoretical perspective of basic psychological needs (BPNs). We conducted a triangulation mixed-method study that included survey data and interviews. Participants were asked to identify their emotions, and if their BPNs of autonomy (e.g., feeling in control), competence (e.g., feeling capable), and relatedness (e.g., feeling connected to others) were satisfied or frustrated. Based on survey questions, participants indicated high satisfaction with their BPNs during decision-making and low levels of negative emotions. We used a deductive analysis to link participant interviews to BPNs and found greater satisfaction with these needs than frustration. Moreover, the mixed-method analysis integrating the results in a joint display uncovered that participants identified more positive emotions when their BPNs of autonomy and relatedness were satisfied, and more negative emotions when their BPNs of relatedness and competence were frustrated. We discuss the emotional experience of making decisions after high school. Limitations and future research directions are discussed.

Medical student use of practice questions in their studies: a qualitative study

Practice questions are highly sought out for use as a study tool among medical students in undergraduate medical education. At the same time, it remains unknown how medical students use and incorporate practice questions and their rationales into their studies. To explore this heavily relied upon study strategy, semi-structured interviews were conducted with second-year medical students to assess how they approach using practice questions. Qualitative thematic analysis revealed several recurrent themes: (1) Medical students use practice questions for primary learning, (2) Medical students place more importance on the rationale of a practice question versus selecting the right answer, and (3) Medical students view practice questions as being designed to be used once or having a single-use. Together, these themes provide insight into how medical students use practice questions to study, which may guide medical educators in their creation of practice questions with appropriate rationales and provide foundational data for future mixed methods analyses seeking to generalize these findings.

The language of religious and secular practices: A mixed method analysis.

The language of religious and secular practices: A mixed method analysis.

Maximizing the "Functional" in the Functional External Memory Aid Tool for Patient-Centered Treatment Planning in Mild Cognitive Impairment.

The Functional External Memory Aid Tool (FEMAT) is an 11-item performance-based measure that simulates everyday tasks (e.g., medication management) to measure one's use of compensation (e.g., pill organizer). The FEMAT is not a norm-referenced diagnostic tool; rather, it is designed to provide clinicians with information about a patient's function and compensation in a standardized format. To provide further evidence for validity of the FEMAT, the purpose of this study was to conduct a mixed-methods analysis of FEMAT responses to operationalize the types of behaviors elicited during test administration. We adopted an embedded single-case study design to analyze the FEMAT administrations of 12 community-dwelling female participants, ages 73-90 years, who met criteria for mild cognitive impairment. These participants were part of the original validation sample during which they completed the FEMAT (Version 1.0) in a single session with an assessor. Sessions were video-recorded and transcribed. We analyzed the data qualitatively in two phases using theme and subtheme codes and then quantitatively analyzed the data for response trends. Our thematic analysis revealed four themes to operationalize participants' verbal and behavioral FEMAT responses: (a) used an external memory aid (EMA), (b) described using a strategy, (c) discussed memory and comprehension, and (d) discussed functional information. While completing the FEMAT, most participants described using a strategy (85%) and discussed their self-perceived memory and comprehension (33%). Several subthemes also emerged within each theme (e.g., self-perceived memory strengths and barrier). Our analysis suggests that beyond a 4-point item score, the FEMAT elicits behavioral (e.g., used an EMA) and verbal (e.g., discussion of health information) content that may be useful for person-centered treatment planning. This study is part of a comprehensive research agenda establishing the evidence for the validity of the FEMAT to support its use to inform person-centered treatment approaches.

The Power of Story Slams: A Mixed-Method Analysis of Narrative Medicine Connecting, Encouraging and Comforting Healthcare Trainees and Professionals

Background: Narratives convey information and emotion, evoke understanding, empathy, and connection. Healthcare professionals can use narratives to reduce burnout, benefiting them, patients, and colleagues. Story slams are narrative sharing events used for group reflection, providing an opportunity for participants and listeners to improve their well-being by processing complex emotions and identities. Story slams have traditionally been popular with creative writers and nonprofit organizations. Methods: Following a local event hosted by The Moth, the Temple University Lewis Katz School of Medicine (LKSOM) Narrative Medicine program hosted nine story slams over five years with 93 presenters including students and health systems staff. Through a mixed-method analysis, the authors examined the stories for thematic patterns and surveyed presenters to investigate how the experience had impacted markers such as job satisfaction, stress levels, and connection to patients. Eleven presenters were interviewed to provide additional information about the impact they experienced. Results: Patient-centered care, resilience, and the value of learning comprised over half of all themes presented. Following the event, many presenters experienced improved connections with patients, and everyone reported feeling neutral or increased satisfaction with their profession. The interviews conveyed participation, created a lasting impact, fostered a sense of community, and increased appreciation for diversity. Conclusions: Overall, story slams nourish humanity and promote diversity, enthusiasm, and encouragement. This study and others suggest that story slams are inexpensive and effective events that can help reduce burnout and provide academic medical centers with a way to restore and cultivate community among students, physicians, and staff.

OCCUPATIONAL THERAPY PRE-ASSESSMENT OF LOW GRADE GLIOMA PATIENT WITH COMPLEX NEEDS ALMOST HALVES POST-OPERATIVE LENGTH OF STAY

Abstract AIMS Due to tumour eloquence, patients with low grade gliomas (LGGs) often have complex Occupational Therapy (OT) needs post-operatively. This need can impact length of stay and OT resource. Limited studies have focused on pre-assessment for this patient group. To address these challenges, we aimed to identify the impact of a newly-introduced Occupational Therapy (OT) pre-surgical assessment service for low grade glioma patients. METHOD Patients (n=16, prospective, consecutive, Jan-Jul 2023) planned for LGG surgery at Leeds Teaching Hospitals NHS Trust were offered an OT pre-assessment. Mixed methods analysis. Assessments and data collected included existing needs and deficits, length of stay, and OT sessions (number/contacts, time spent). Comparison was made to patients (n=16, retrospective, consecutive, Jun-Dec 2022) planned for LGG surgery who had not received this service. Complexity was defined using standardised, clinically-accepted factors (social, cognitive and/or physical deficits). RESULTS Patients with complex needs (4 in each group) benefitted significantly from OT pre-assessment with reductions in: length of stay (11.9 v 6.5 days, 45.4% decrease), median time spent (134 v 95 mins, 29.1% decrease), median number of contacts (5.4 v 3.4, 37.0% decrease). Patient, surgeon, CNS and other AHP feedback was overwhelm-ingly positive. CONCLUSION Patients with complex needs undergoing surgery for low grade gliomas significantly benefit from pre- assessment; reducing length of stay and liberating occupational therapy resource. This also reduces costs and increases productivity/efficiency. Further work in more LGG patients, other brain tumour patients, and the identification of key pre-assessment variables and interventions will guide the development of the service.

How is autism portrayed in news media? A corpus-based, mixed-methods analysis in China

IntroductionNews media play an important role in shaping public perceptions of and attitudes toward people with autism. This study examines news reports about autism in China Daily over the past 20 years, from 2003 to 2022.MethodsThis study employed both quantitative and qualitative analyses.ResultsThe findings reveal that news coverage on autism predominantly centers on children, with a significant shift in focus from support by family members and schools to support at the broader societal and governmental levels. Further, the overall representation of autism remains predominantly negative and rooted in prejudice. In terms of gender representation, autism is often depicted more frequently as male-oriented. However, a more diverse representation of age groups has emerged. Finally, while news media subtly convey negative attitudes toward autism, they also demonstrate a concurrent concern for the condition, reflecting a complex and nuanced attitude toward people with autism.DiscussionOur study indicates that corpus-assisted critical discourse analysis allows researchers to compare news over time, thus offering insights into changing discourses. The analysis can also reduce bias and uncover the implicit attitudes of news media toward autism by analyzing patterns of words and discourses.

“Empathy for children is often missing”: a mixed methods analysis of a German forum on COVID-19 pandemic measures

BackgroundThe pandemic and its preventive measures disrupted daily routines and posed unforeseen obstacles for families. Users of public online forums chronicled these challenges by freely expressing their sentiments in unrestricted text-length formats. We explored a German COVID-19 forum to understand family perspectives and experiences of pandemic measures, particularly in terms of testing and vaccinating children. Our findings aim to inform future epidemic health policies.MethodsWe retrieved all 11,207 entries from a COVID-19 forum during its lifespan (June 2020 - December 2021), posted during the height of the pandemic. We classified the entries into topic clusters including general pandemic situation, testing, or vaccination using state-of-the-art text embeddings and clustering algorithms. The clusters were selected based on the research’s aims and analysed qualitatively using a health policy triangle framework.ResultsUsers generally appreciated pandemic public health safety measures for everyone’s protection, yet voiced concerns about inconsistent policies and disproportional disadvantages for children compared to other societal groups, like the elderly. Non-compliers were overwhelmingly regarded with skepticism and critiqued. Users found COVID-19 (exit) strategies and information about the benefits of vaccination unclear. This created hurdles for parents and caregivers in navigating their children’s school and social life. Users endorsed vaccinating children mainly for “normalising” children’s lives rather than for their physical health benefits. Some users suggested prioritising teachers and early childhood educators on the vaccination eligibility list to speed up a return to “normality”.ConclusionsDuring pandemics, governments should prioritize addressing the societal and mental health needs of children by implementing participatory and family-oriented public health measures for schools and kindergartens. Clear communication coupled with consistent design and implementation of safety measures and regulations, would be crucial for building trust in the general population and for ensuring compliance regarding testing and vaccination. Communicating the benefits and risks of vaccinating children is of paramount importance for informed decision-making among parents. In future epidemics, computer-aided analysis of large online qualitative data would offer valuable insights into public sentiments and concerns, enabling proactive and adaptive epidemic responses.

Supplemental Material for The Language of Religious and Secular Practices: A Mixed Method Analysis

Supplemental Material for The Language of Religious and Secular Practices: A Mixed Method Analysis

A Mixed Methods Analysis of General Education Candidates’ Knowledge, Perceptions, and Application of Universal Design for Learning

Thirty general education candidates from elementary education, middle/secondary education, and arts education in multiple sections of one course engaged in a series of discussion posts and lesson plans related to creating inclusive general education lessons. Using candidate posts, rubric scores, feedback on lesson plans, and course evaluation ratings, a mixed methods approach was used to understand candidate knowledge, perceptions, and applications of Universal Design for Learning. The results from our research have important implications for policy, practice, and research. Policy makers must be aware of the lack of UDL in general education programs and IHEs need to do more than the cursory coverage of these principles. Additional research is needed for the implementation of lessons designed using UDL by general education candidates.

“Leave me out of it and raise my salary”: Invisible work in the labor market and the gender wage gap

While the literature shows that “invisible work” – work that is neither defined nor recognized as labor – persists in the workplace, its relation to labor market outcomes, especially wages, remains relatively underexplored. This study examines the connection between invisible work and wages through a gendered perspective. Utilizing mixed-methods sequential analysis, we conducted 12 group interviews with employed women and men in Israel, uncovering four types of invisible work: physical care work, emotion labor, administrative work, and teamwork. Subsequently, we surveyed a representative sample of the Israeli labor force (n = 964). Regression analyses revealed significant relations between three types of invisible work and wages: doing physical care work correlated negatively with wages for all, while performing emotion labor and administrative work rewarded men more than women. Insights from the interviews elucidated gendered mechanisms linking wages to each invisible work type. The study emphasizes the need for gender-sensitive measures to address labor market inequality.