Cross-sectional Mixed Methods Study Research Articles

Protocol: Developing a framework to improve glycaemic control among patients with type 2 diabetes mellitus in Kinshasa, Democratic Republic of the Congo.

In Kinshasa, Democratic Republic of the Congo (DRC), between 68-86% of patients with type 2 diabetes present with poor glycaemic control leading to increased risk of complications and high cost of care. Identifying the factors driving glycaemic control is essential for better management. There is lack of data on factors associated with poor glycaemic control and targeted interventions in the DRC. This study aims to determine the factors associated with type 2 diabetes control and develop an appropriate intervention package in Kinshasa. The study will comprise of three sub-studies as follows: the first sub-study being a concurrent parallel mixed-methods cross-sectional study to determine factors driving poor glycaemic control among patients in Kinshasa. A total of 614 patients will be invited to participate in a cross-sectional study and respond to standardized questionnaires. A minimum of 20 purposively selected patients will participate in the qualitative study that will involve in-depth interviews about their perspectives on glycaemic control. In the quantitative study, multivariable logistic regression will be performed to determine factors associated with glycaemic control, after identifying the confounding factors. In the qualitative study, thematic analysis will be performed. Findings of the quantitative and qualitative studies on factors that are associated with glycaemic control will be triangulated. And allow to conduct the second sub-study, a qualitative inquiry with a minimum of 20 healthcare providers and 20 patients, selected purposively, to explore their perspectives about potential interventions to improve glycaemic control. At the last, the findings of both sub-studies will be subjected to an anonymous electronic three-round process Delphi study involving 25 stakeholders on the intervention package to develop a framework to optimise glycaemic control in Kinshasa. The implementation of the intervention package will occur after the completion of this study with expected substantial impact on the patients, healthcare providers, and health system.

Factors influencing the sustainability of homestead vegetable production intervention in Rufiji, Tanzania: A cross-sectional mixed methods study.

There is growing evidence that home vegetable gardening interventions improve food security and nutrition outcomes at the family level. Sustainability of many of these community interventions remain a challenge. This study assessed factors influencing the sustainability of homestead vegetable production intervention in Rufiji district, Tanzania, one year after the cessation of external support. This was a community based cross-sectional study using both quantitative and qualitative data collection methods. A total of 247 randomly selected women from households who participated in the homestead vegetable intervention were interviewed using a structured questionnaire. The study held four focus group discussions with women from households that participated in the intervention, and four In-Depth interviews with two extension workers, one community health worker, and one agriculture district officer. Multiple logistic regression for quantitative data and thematic analysis for qualitative data was conducted. About 20.24% (50/247) of households sustained homestead vegetable production for one year after the intervention phased out. Shortage of seeds (adjusted odds ratio = 0.65: CI = 0.46-0.93, p-value 0.018) and either manure or fertilizers (adjusted odds ratio = 1.62: CI = 1.04-2.46, p-value 0.031) were significant factors influencing the sustainability of homesteads vegetable production. In the Focus Group discussions (FGDs) and In-Depth Interview (IDIs), all participating women and extension workers reported high cost of water, destruction from free-grazing animals, agriculture pests and diseases, poor soil fertility, shortage of seeds, and lack of capital affected homestead vegetable production sustainability. Existing individual, community, and system challenges influence the sustainability of external-funded agriculture and nutrition interventions. The study findings underscore the importance of community authorities, scientists, and policymakers in having a well-thought sustainability plan in all promising external-funded interventions.

Mental health aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives.

Binge eating disorder has high comorbidity with a variety of mental health diagnoses and significantly impairs quality of life. This mixed-methods cross-sectional survey study aimed to collect information from experts in the field about mental health issues pertaining to adult binge eating disorder pathology. Fourteen expert binge eating disorder researchers and clinicians were identified based on history of NIH R01 funding, relevant PubMed-indexed publications, active practice in the field, leadership in related professional societies, and/or distinction in popular press. Semi-structured interviews were anonymously recorded and analyzed by ≥2 investigators using reflexive thematic analysis and quantification. The domains of depression, anxiety, attention deficit disorder (ADD)/attention deficit hyperactive disorder (ADHD), substance-related and addictive disorders (SRADs), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) were addressed in relation to binge eating disorder pathology by 100, 100, 93, 79, 71, and 64% of participants, respectively. Depression and anxiety seem to be the most commonly recognized mental health comorbidities among experts participating in this study. These expert perceptions generally align with the most comprehensive and up-to-date information available on mental health comorbidity prevalence data in adult binge eating disorder, though updated surveys are warranted. The findings from this study highlight the importance of screening for binge eating disorder among individuals with Axis-I mental health diagnoses (e.g., depression and other mood disorders, anxiety disorders, ADD/ADHD, and SRADs). Research on underlying mechanisms that link various Axis-I disorders to binge eating disorder is also warranted and recommended by the experts.

Prevalence, types, patterns and risk factors associated with drugs and substances of use and abuse: A cross-sectional study of selected counties in Kenya

The increasing trend of drugs and substances abuse (DSA) by different age groups and gender in parts of Kenya is not only a socio-economic problem but a public health concern. There is a need to determine prevalence, types and patterns of DSA by age and gender in order to develop all-inclusive and long-term strategies to prevent and manage the DSA within different communities. In this study we determined the prevalence of DSA, types and patterns of drugs and substances being abused and risk factors associated with this abuse. A descriptive cross-sectional mixed methods study was conducted in four counties; Isiolo, Kajiado, Murang'a and Nyamira, all purposively selected from the 47 counties of Kenya based on the review reports of the Kenya Medical Research Institute's County Cluster Coordinators which indicated that DSA was a priority health concern in the selected counties. From each county, two sub-locations each from two locations in one sub-county were purposively selected. In each sub-location, 225 households were systematically selected. Hence, a total of 3,600 participants were systematically sampled for quantitative data collection using an interviewer-based questionnaire to gather information on magnitude and causes of DSA. Additionally, in each county, qualitative data through in-depth interviews (IDIs) with 16 opinion leaders, 16 healthcare personnel, 16 previous DSAs, at least 5 county personnel, 32 current DSAs; and through 16 focus group discussions (FGDs) were concurrently collected to elicit more information on types, patterns and causes of DSA. The observed overall prevalence of DSA was calculated using binomial logistic regression model and factors associated with DSA analyzed using multilevel logistic regression model. Qualitative data was analyzed using QSR NVIVO version 10, thematically by types, patterns and causes of DSA by age and gender. Prevalence of DSA was 86.0% (95%CI: 84.9-87.2) with the highest prevalence being observed in Nyamira County, 89.8% (95%CI: 87.9-91.7). Age-wise, the highest prevalence was observed in persons aged between 45 to 53 years, 89.4% (95%CI: 86.9-92.0), followed by those aged 36 to 44 years, 88.0% (95%CI: 85.4-90.6). Majority of those who abuse drugs and substances were males; 94.5% (95%CI: 93.6-95.4). The most abused drugs or substances were packaged/legal alcohol at 25.2% (745), cigarettes 20.3% (600), local brew (chang'aa) 16.3% (482), and khat (miraa) 10.5% (311). Risk factors analysis revealed that DSA was significantly higher among males (adjusted odds ratio (aOR) = 7.02 (95%CI: 5.21-9.45), p<0.001), government employees (aOR = 2.27 (95%CI: 1.05-4.91), p = 0.036) and unmarried (aOR = 1.71 (95%CI: 1.06-2.77), p = 0.028). These study findings are useful in informing development of specific control programmes which will address age, gender and county needs of DSA in Kenya in order to comprehensively respond to this public health problem. This study was conducted in line with the Kenya National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) mandate to promote use of research on drugs and substances abuse.

Finnish students’ conceptions of giftedness and intelligence in basic education

ABSTRACT There is a lack of research on students’ conceptions of giftedness and intelligence, despite recognition of their influence on real-life factors such as achievement and motivation. This paper presents a cross-sectional mixed methods study that investigated Finnish students’ (age 6–16 years; N = 1282) implicit conceptions of giftedness and intelligence and the mindsets underlying such conceptions. More particularly, the study aimed to investigate how giftedness and intelligence are constructed and understood in the minds of students and how students’ mindsets are actualized in their descriptions of giftedness and intelligence. The results indicated that, from very early on, students differentiate between the two concepts. Giftedness and intelligence were both seen as malleable, but views on giftedness were more fixed than were conceptions of intelligence. Both age- and school-related differences were found in students’ conceptions. Furthermore, the study demonstrated differences in conceptions of giftedness and intelligence between growth- and fixed-mindset students.

Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study.

BackgroundChallenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare.ObjectivesTo examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these.MethodA cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis.ResultsMedian duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options.ConclusionWe observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.

Assessment of Inventory Management Practice and Associated Challenges of Maternal, Newborn, and Child Health Life-Saving Drugs in Public Hospitals of Southwest Ethiopia: A Mixed-Method Approach.

IntroductionMaternal, newborn, and child health is a global priority, while most countries in sub-Saharan Africa have a poor implementation of maternal, newborn, and child health programs.ObjectiveTo assess inventory management practice and associated challenges of maternal, newborn, and child health life-saving drugs in public hospitals of Jimma zone and Jimma city.MethodsHospital-based mixed-method cross-sectional study was conducted from October 1 to 30, 2020. The quantitative data was collected using physical inventory and document reviews. Thus, seventy-eight bin cards and annual report and resupply forms were reviewed, and the collected data was analyzed using SPSS |Version 24| software. Statistical significance was determined at p < 0.05. Twelve semi-structured in-depth interviews were conducted to collect qualitative data and analysed manually using a thematic analysis technique.ResultsAbout half of the evaluated drugs experienced 22 stock-outs per year with a stock-out rate and mean stock-out duration of 83.3% and 1.69 months, respectively. All hospitals placed at least one emergency order. The wastage rate of products was 13.1%. The data quality of report and resupply forms such as the average data accuracy of 396 (84.61%) had a significant association with the increasing level of education, X2 (16, N = 13) = 297.7, p = 0.019. Thirty-five (97.22%) reports and resupply forms were complete, while 24 (66.67%) of them were submitted to suppliers as per the predetermined timeline with an annual reporting rate of 94.44%.ConclusionData quality of bin card records was more promising than report and resupply form reports. All hospitals encountered at least one stock-out and one emergency order per year. The wastage rate was twice more than the national normal. Storage management, human asset, and capacity building challenges were identified as inventory management challenges.

COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

IntroductionFrench nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these...

Burnout Syndrome Among Staff of Emergency and Trauma Department Hospital Tuanku Fauziah, Kangar, Perlis

Burnout Syndrome (BOS) is a complex chronic occupational stressor, defined by Maslach and Jackson (1981) as a Syndrome of Emotional Exhaustion (EE), Depersonalisation (DP) and reduced Personal Accomplishment (PA) among workers in human service environment, towards job demand that is beyond their mental, emotional and physical capacity. The Emergency and Trauma Department (ETD) were regarded as the busiest human service environment, in local and international literature. Cross-sectional mixed method study, which involved 122 operational staff of ETD HTF and a total of 12 ETD operational supervisors and administrators from HTF and Hospital Sultanah Bahiyah (HSB). The objective of this study is to confirm the existence and measure the current level and risk to develop BOS among staff of ETD HTF, determine significant work stressor and develop an interventional manual based on the pre-intervention Maslach Burnout Inventory-Human Service Survey Medical Personnel (MBI-HSS MP) scores. The SPSS Version 24 and Thematic analysis was performed in this study. Result from the semi-structured interviews, established human resource insufficiency as the main work stressor. The Mind Refresher was developed as a primary intervention through Participatory Action Research. The Mind Refresher had strengthened the personal resources and created mindfulness towards the job demands in ETD HTD, which was statistically proven significant by Paired t Test during the study period.This study concludes that, there were no significant BOS among the staff of ETD HTF and it is hoped that this study will contribute some knowledge for policy makers in the government and private sector to formulate a preventive BOS framework towards their employee job demands.

Current situation and future development of the biopharmaceutical industry in China: A mixed-method study

Introduction: The biomedical industry has grown significantly both globally and in China; however, there are still challenges. This study aimed at evaluating the biopharmaceutical sector of China, in terms of ability to innovate, current sales volume, investment, and R&D expenditure, as well as providing a case study detailing the progress and challenges of the industry in Shaanxi province. Method: A cross-sectional mixed-method study design was used to generate a comprehensive profile of the nature of biopharmaceutical innovation capacity and development in China by triangulating country-wide survey and interview data from Shaanxi province. Only biopharmaceutical companies that are currently marketing or conducting research and development were eligible for inclusion, and Shaanxi province was selected for conducting the interviews. Categorical and continuous variables were analyzed descriptively. Interviews were thematically analyzed by using NVivo version 12. Results: The analysis includes responses from 77 biopharmaceutical enterprises; the majority (36, 46.8%) are in Eastern China, followed by 26 (33.8%) in Central China. In 2018, the total sales of biological products amounted to 26.28 billion yuan, and in 2019, a slight increase was observed (30.34 billion); the amount doubled in 2020 to about 67.91 billion yuan. The top three biopharmaceutical products on sale in 2020 were Camrelizumab (5.14 billion yuan), human albumin (4.56 billion yuan), and human immunoglobulin for injection (3.78 billion yuan). Expenditure on R&D has also increased; it amounted to 1657.7 million yuan in 2018, which more than doubled in 2019 to 3572.1 million yuan and further increased to 5857.7 million yuan in 2020. Nonetheless, the progress is not uniform across all provinces, as shown from the results from Shaanxi province, because of lack of local government policies that will impact on the funding, incentives, and market share that motivate the producers. Conclusion: China’s biopharmaceutical industry has expand significantly. The increase in sales indicates that there is an increase in demand for biologicals; moreover, R&D funding is increasing. These are key indicators that influence innovation and development. However, the sector’s capacity to innovate and develop needs to be improved, particularly in the western region, where research and production are relatively weak.

What influences graduate medical students’ beliefs of lower back pain? A mixed methods cross sectional study

BackgroundLow back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner’s management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student’s beliefs of LBP and what influences them.MethodA cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis.ResultsFifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements.ConclusionsThe HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex.

Care home workers experiences of stress and coping during COVID-19 pandemic: A mixed methods study.

AimThe aim of the study was to explore the stress and coping experiences of healthcare workers (HCWs) in care home settings in Scotland during the COVID‐19 pandemic.DesignA cross‐sectional mixed methods study was conducted using an online survey and interviews.MethodsMean scores were calculated for both stress and coping and t‐tests used to explore possible links to demographics. Qualitative data were analysed thematically using Braun and Clarke's method.ResultsFor 52 survey participants, the mean score for the PSS was M = 39.75 and CSE‐M = 150.6 indicating high stress and medium coping skills. From the t‐test, only absence of health issues was associated with higher levels of coping. Thirteen HCWs participated in one‐to‐one interviews. Qualitative data analysis generated four themes contributing to stress: 1. personal factors, 2. changed care environment, 3. amplified scrutiny and 4. psychological responses. Coping was represented as three main themes: 1. personal factors, 2. organizational culture and 3. safety and security. There is a critical need for a strategic approach to provide psychological support to care home staff both during and beyond the context of the pandemic.

Health extension workers contribution on tuberculosis case notification in Tigray region, Northern Ethiopia: A concurrent mixed method study.

BackgroundDespite the emphasis placed on Community Based Tuberculosis Care (CBTC) implementation by Health Extension Workers (HEWs) within the National Tuberculosis Program (NTP) in Ethiopia, there is little evidence on contribution of HEWs on TB case notification. Therefore, this study aimed to describe the contribution of HEWs on TB case notification and its associated factors in Tigray region, Northern Ethiopia.MethodsA concurrent mixed method (quantitative and qualitative) cross-sectional study design was conducted in three randomly selected districts in Tigray region, Northern Ethiopia. Quantitative data were collected using a pre-tested semi-structured questionnaire. Qualitative data were collected using Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs) to further describe the community participation and presumptive TB identification and referral system. For the quantitative data, binary logistic regression analysis was done and all variables with P-value of < 0.25 in bivariate analysis were included in the multi-variable model to see predictors of HEWs contribution to TB notification. The qualitative data were thematically analyzed using Atlas.ti version 7.ResultsIn this study, a total of 68 HEWs were included. From March 1, 2017 to February 28, 2018, a total of 427 TB cases notified in the study areas and one-third (34%) of them were notified by the HEWs referral. Provision of Community Based-Directly Observed Treatment Short course (CB–DOTS) (Adjusted Odds Ratio (AOR) = 3.63, 95% Confidence Interval (CI) = 1.18–11.19) and involvement of community volunteers on CBTC (AOR = 3.31, 95% CI = 1.10–10.09) were significantly associated with the contribution of HEWs on TB case notification. The qualitative findings indicated that high workload of HEWs, inaccessibility of TB diagnostic services at nearby health facilities, and transportation and investigation costs were identified as factors affecting for presumptive TB referral by HEWs.ConclusionsProvision of CB-DOTS and involvement of community volunteers in CBTC activities should be strengthened to improve the HEWs contribution on TB case notification. Additionally, HEWs should be empowered and further interventions of TB diagnostic services at diagnostic health facilities are needed to improve presumptive TB referral by HEWs.

Future Public Health Anti-trafficking Training: An Exploratory Inquiry among Public Health Graduate Students to Understand their Levels of Awareness, Knowledge, and Self-efficacy in Order to Prevent, Identify, and Assist Survivors of Human Trafficking

ABSTRACT Human trafficking (HT) is a violation of human rights and a serious public health concern. Recently, efforts have focused on training frontline personnel, among others, to identify, intervene, and assist survivors of HT. Yet, there is scant research among public health students and practitioners about their awareness, knowledge, and self-efficacy in addressing HT. Training the future public health workforce is essential for addressing this problem. This cross-sectional mixed-methods study collected data utilizing a 33-item survey among current graduate students (N = 85) of public health enrolled at a U.S. Northeastern University. The primary aim of this study was to assess public health graduate level students’ awareness, knowledge, and self-efficacy regarding HT intervention. A secondary aim was to gather students' recommendations for curricula development purposes. Statistical analyses included univariate and binary analysis of quantitative data and a thematic two-step coding process for the analysis of the qualitative data.. Findings revealed study participants had a strong awareness of HT, but a low level of knowledge and self-efficacy in identifying and assisting victims. Most study participants desired to integrate HT-related training into current courses. Results may be used to inform the development of curricula at higher level education and public health institutions.

The accessibility to oral health services in Lesotho’s public health sector

Lesotho is a land-locked mountainous country in Southern Africa. Both geography and poverty impact on dental health in low-income patients. Information on the number and function of dentists and dental therapists in public hospitals, are lacking. The aim was to investigate accessibility to oral health services. Objectives were to investigate the number and geographical distribution of oral health personnel and document the availability of dental services in Lesotho. A cross-sectional mixed methods study design was used. Four dental therapists of the six employed by the government, participated in in-depth interviews. Questionnaires about access to oral health services were administered to government employed dentists. The Lesotho National Department of Oral Health provided information regarding dental patient statistics between 2017 and 2019. It was found that 20 dentists and 10 dental therapists provided limited dental services in public facilities. In 2017, 2018 and 2019; the annual numbers of dental patients were 85 776, 75 148 and 97 425 respectively. Approximately 40% of patients visited two hospitals in Maseru. It was concluded that there was a shortage of oral health personnel, resulting in inadequate access to dental services, particularly in rural areas.

The accuracy and feasibility of respiratory rate measurements in acutely ill adult patients by GPs: a mixed-methods study.

Tachypnoea in acutely ill patients can be an early sign of a life-threatening condition such as sepsis. Routine measurement of the respiratory rate by GPs might improve the recognition of sepsis. To assess the accuracy and feasibility of respiratory rate measurements by GPs. Observational cross-sectional mixed-methods study in the setting of out-of-hours (OOH) home visits at three GP cooperatives in The Netherlands. GPs were observed during the assessment of acutely ill patients, and semi-structured interviews were performed. The GP-assessed respiratory rate was compared with a reference measurement. In the event that the respiratory rate was not counted, GPs were asked to estimate the rate (dichotomised as ≥22 breaths per minute or <22 breaths per minute). Observations of 130 acutely ill patients were included, and 14 GPs were interviewed. In 33 patients (25%), the GP counted the respiratory rate. A mean difference of 0.27 breaths per minute (95% confidence interval [CI] = -5.7 to 6.3) with the reference measurement was found. At a cut-off point of ≥22 breaths per minute, a sensitivity of 86% (95% CI = 57% to 98%) was found when the GP counted the rate, and a sensitivity of 43% (95% CI = 22% to 66%) when GPs estimated respiratory rates. GPs reported both medical and practical reasons for not routinely measuring the respiratory rate. GPs are aware of the importance of assessing the respiratory rate of acutely ill adult patients, and counted measurements are accurate. However, in most patients the respiratory rate was not counted, and the rate was often underestimated when estimated.

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar.

Background Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objectives This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives. Methods In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi-disciplinary efforts are needed to advance ETAT+ implementation in Madagascar. Conclusion Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar. Contributions of the study This study aims to evaluate an updated Malagasy version of the Emergency Triage Assessment and Treatment Plus (ETAT+). The training met the participants’ needs and was adapted to the clinical realities in Madagascar relating to transmitted knowledge, skills and competencies.

Adverse COVID-19 vaccination effects in Finnish patients with Ménière's disease: a cross-sectional study.

Background: The association between reporting adverse coronavirus disease 2019 (COVID-19) vaccination effects and those with a history of audiovestibular difficulties is unknown. The aim of this research is therefore to investigate adverse vaccination effects in adults with a history of Ménière's disease. Specifically, the incidence of adverse effects, the factors associated with those reporting adverse effects and the relationship between the reporting of audiovestibular and other adverse effects. Methods: A mixed-methods exploratory cross-sectional survey study design was used. Data were collected from 333 members of the Finnish Ménière Association. The survey was designed to obtain demographic information that may be associated with having adverse effects or not, vaccination-specific information and adverse vaccination effects. Both health and audiovestibular adverse events were identified. Data analysis included comparing those reporting and not reporting adverse vaccination effects. Results: The mean age was 63 years with 81% being female. Of the 327 respondents who had one of the COVID-19 vaccinations (Comirnatry/ Pfizer, Astra Zeneca, or Moderna), 203 (62%) reported no adverse effects. The type of or number of vaccinations were not related to the reporting of adverse effects. The most frequently reported adverse effects were injection site tenderness (38%), arm pain (21%), fever (15%) and headaches (15%). Post-vaccination tinnitus and vertigo (both 7%) were the most frequently reported audiovestibular-related symptoms, followed by aural fullness (6%) and hearing loss (4%). Those reporting previous pre-vaccination vertigo were more likely to have post-vaccination vertigo. The presence of post-vaccination tinnitus, hearing loss, and aural fullness, predicted the presence of post-vaccination vertigo. Conclusions: A small proportion of patients with a history of Ménière's disease may experience adverse post-vaccination effects. Further research is required to explore whether adverse post-vaccination audiovestibular effects are more prevalent in those with a history of otological disorders compared with the general population.

Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed-method study.

IntroductionZimbabwe adopted differentiated HIV care policies in 2015 to promote client‐centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption.MethodsWe undertook a cross‐sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi‐structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow‐up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes.ResultsTwenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast‐track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16–62). Participants in fast‐track had the shortest visit durations (18 minutes, IQR: 11–24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients’ views on differentiated ART delivery. Fast‐track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group‐ and community‐based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility‐based group models, such as CARGs.ConclusionsDifferentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients’ diverse preferences. A minority offered fast‐track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care.

"I Want to Be Safe and Not Still Half Asleep": Exploring Practical Countermeasures to Manage the Risk of Sleep Inertia for Emergency Service Personnel Using a Mixed Methods Approach.

PurposeThe aim of this exploratory cross-sectional mixed methods study was to determine 1) whether sleep inertia, the temporary state of impaired vigilance performance upon waking, is perceived to be a concern by emergency service personnel, 2) what strategies are currently used by emergency service workplaces to manage sleep inertia, 3) the barriers to implementing reactive sleep inertia countermeasures, and 4) what strategies personnel suggest to manage sleep inertia.Participants and MethodsA sample (n = 92) of employed and volunteer Australian emergency service personnel (fire and rescue, ambulance, police, state-based rescue and recovery personnel) completed an online survey. Data collected included demographic variables and work context, experiences of sleep inertia in the emergency role, barriers to sleep inertia countermeasures, and existing workplace sleep inertia countermeasures and recommendations. Quantitative data were analysed using descriptive statistics, and qualitative data were thematically analysed.ResultsApproximately 67% of participants expressed concern about sleep inertia when responding in their emergency role. Despite this, there were few strategies to manage sleep inertia in the workplace. One major barrier identified was a lack of time in being able to implement sleep inertia countermeasures. Fatigue management strategies, such as reducing on-call periods, and operational changes, such as screening calls to reduce false alarms, were suggested by participants as potential strategies to manage sleep inertia.ConclusionSleep inertia is a concern for emergency service personnel and thus more research is required to determine effective sleep inertia management strategies to reduce the risks associated with sleep inertia and improve personnel safety and those in their care. In addition, future studies could investigate strategies to integrate reactive sleep inertia countermeasures into the emergency response procedure.