Exploratory Mixed Methods Study Research Articles

Teacher Mental Health and District Employee Support in Rural Communities: A Sequential Exploratory Mixed Methods Study

Although existing research explores the need for mental health for students in P-12 schools, scholarship regarding mental health needs and support for teachers is lacking, particularly in rural contexts. This study used sequential exploratory mixed methods to explore mental health needs and support in school districts in a predominantly rural state. Analysis included qualitative survey data from P-12 teachers in school districts about how teaching impacts mental health, and a quantitative analysis of employee assistance programs in participant school districts. Findings demonstrated teachers struggling with mental health, and a lack of employee support available. Implications and exploration of district policy are discussed.

Implementing primary care concepts in higher education: a mixed method study in Flanders (Belgium)

BackgroundThe policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation.MethodsA sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated.ResultsThe results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction.The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies.ConclusionsThe study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.

Exploring medical educators’ perspectives on teaching effectiveness and student learning

BackgroundMedical education in resource-constrained settings such as Pakistan faces significant challenges, including large class sizes, limited resources, and reliance on traditional teacher-centered pedagogies. These factors hinder effective learning and fail to equip students with the critical thinking and practical skills essential for modern medical practice. Educators play a fundamental role in shaping student experiences but often struggle to adopt student-centred methodologies due to insufficient training, resource limitations, and institutional constraints. This study aimed to explore medical educators’ teaching approaches, their perceptions of their effectiveness, and the challenges they face in implementing modern pedagogical techniques.MethodsA sequential explanatory mixed-method study was conducted. First, the Approaches to Teaching Inventory (ATI) was administered to 130 medical and dental educators in Karachi, Pakistan (71% response rate, n = 93), assessing teacher-centered (Information Transmission/Teacher-Focused, ITTF) versus student-centered (Conceptual Change/Student-Focused, CCSF) approaches. Second, semi-structured interviews were conducted with 25 educators purposively selected from the initial sample. Quantitative data were analysed using SPSS and Mann-Whitney U tests. Qualitative data were subjected to thematic analysis to identify key themes.ResultsThe quantitative results demonstrated that educators often use a blended teaching approach. No significant gender differences were found in teaching experience or teacher-centric scores; however, female educators scored higher on the student-centric approach (p = 0.001). Qualitative analysis identified themes: (1) teachers as catalysts for student transformation, emphasising mentorship and practical learning; (2) curriculum challenges and the need for faculty development, highlighting dissatisfaction with outdated curricula and assessments focused on rote memorisation; and (3) teaching practices advocating for interactive methods and continuous assessment aligned with practical clinical skills. Educators expressed a desire for faculty development programs to support student-centered learning.ConclusionsMedical educators recognise the importance of student-centred approaches but face significant challenges due to institutional pressures, outdated curricula, and inadequate assessment methods. There is a critical need for curriculum reform, adoption of continuous formative assessments, and faculty development programs to enhance teaching effectiveness. Institutions should promote environments that value pedagogical excellence and support innovative teaching practices. Aligning educators’ perceptions with actual teaching practices is essential to improve medical education and prepare students for professional practice.

Entrepreneurial Competencies and Succession Planning of Family Business Owners in a Second Class Municipality in Iloilo Province: An Explanatory Sequential Mixed Methods Study

This study investigates the critical interplay between entrepreneurial competencies (EC) and succession planning within Filipino family businesses, which constitute a significant portion of the business landscape. Recognizing the vital role of EC in ensuring business continuity, this research employs a sequential mixed-methods approach. The quantitative phase, involving 218 family business owners, reveals high levels of cognitive competencies and a strong emphasis on succession planning, with a significant correlation between the two. Subsequently, qualitative interviews, analyzed through Lichtman's 3 Cs framework, uncover the challenges entrepreneurs face in translating their strong EC into effective succession plans. This study further identifies age, education, and experience as influential factors in both EC and succession planning. Ultimately, the research emphasizes that robust entrepreneurial competencies are crucial for driving innovative succession strategies and ensuring the longevity and prosperity of Filipino family businesses.

Developing and Testing a Mobile Application for Autistic Children Participating in a Therapeutic Horseback Riding Program at a Midwestern Equine Assisted Service Center: An Exploratory Sequential Mixed Methods Study

A potential approach to translating benefits acquired from therapeutic horseback riding (THR) sessions into the daily routines of autistic children is by involving parents as co-interventionists through the utilization of digital technology. In this three-phase exploratory sequential mixed methods study, we develop and test a parent-mediated mobile application complementing a THR program for autistic children. Qualitative interviews informed the digital tool’s development, followed by a quantitative assessment of usability and social validity. Findings present proof of concept, indicating that participants perceived the parent-mediated mobile application as useful and user-friendly. This article contributes to mixed methods literature a pioneering approach in the field of THR incorporating subjective and objective assessments into the development and evaluation of the parent-mediated mobile application. Clinical trial registration ClinicalTrials.gov ID NCT05689541.

Experiences of Pregnant and Parenting Adolescents and Young Women During COVID-19 Pandemic: A Mixed-Methods Study Among Girls and Women in Kenya

PurposeThis study examines the experiences of pregnant/parenting adolescents and young women during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. MethodsThis explanatory sequential mixed-methods study leverages quantitative data collected among a cohort of adolescents and young people aged 15–22 years in three Kenyan counties; Nairobi, Kisumu, and Kilifi at three time points (2020, 2021, 2022), and two rounds of qualitative interviews in the same settings conducted in 2020 and 2022. ResultsAmong 2337 (2020), 1438 (2021), and 1669 (2022) respondents, pregnant/parenting adolescents and youth comprised 140 (6%), 101 (7%), and 83 (5%) individuals, respectively. Across the three time points, the experience of depressive symptoms was similar between pregnant/parenting adolescents and those not pregnant/parenting. Pregnancy and parenting was associated with twice the odds of skipping health services (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.43–3.35), in 2020, and 85% higher odds (aOR 1.85, 95% CI 1.14–3.02) in 2021, and 90% higher odds of skipping meals (aOR 1.90, 95% CI 1.19–3.03) in 2022. Qualitative findings indicated experiences of psychological distress, food insecurity, and inadequate access to health care services among pregnant/parenting young people during the pandemic. DiscussionThe pandemic increased pre-existing challenges associated with adolescent and young people's health, predisposing young pregnant/parenting women to greater adversity than their nonpregnant/parenting counterparts. Targeted and responsive approaches during emergencies and crises such as social protection, food security, and mental health programs for this group of vulnerable people are required and need to be integrated into disaster response plans.

Sequential exploratory mixed-method research of an eHealth intervention on blood pressure, sleep quality and physical activity in obstructive sleep apnoea: rationale and methodology of the Moore4Medical trial protocol

IntroductionThe management of a chronic and frequent pathology, such as obstructive sleep apnoea (OSA), requires personalised programmes that implement new technology-based tools to improve the comprehensive treatment of the patient...

Knowledge Families Hold: Co-Production and Co-Research With Mental Health Family Carers in Understanding Experiences During the COVID-19 Pandemic.

Through an in-depth exploration of mental health family carers' experiences during the COVID-19 pandemic in Australia, this co-produced study identified recommendations for advocacy, practice and policy implications to uphold family carer wellbeing. Government-enforced restrictions, changed service availability and difficulties accessing hospitals, led to additional anxiety, depression and elevated distress, especially for people experiencing mental health challenges before the pandemic. The National Mental Health Consumer and Carer Forum alongside two academic researchers aimed to discern the impact of care provision, levels of distress, unmet needs, challenges and benefits of providing support, across geographic locations and diverse communities. This article reports on the survey component of a co-designed mixed-methods exploratory study of family carer experiences. A project steering group worked with two academic researchers, members of SWITCH Research Group, Monash University, to develop the 71-question online survey across 9-domains. Family carers were relied upon to provide support and care when mental health services changed or closed. Carers support more than one person and typically people with daily and high-level needs. Caring levels increased from 26-h to an average of 40-h a week of support provision, with changed roles and increased complexity. Heightened demands became stress-inducing to the point of mental ill health and suicidality for some family carers. Government policy and pandemic responses failed to address the financial, practical or emotional resources needed to fulfil the role of care provision and support to unwell and extremely distressed people with new or ongoing mental and psychological ill-health. From its inception, this project was co-produced and co-designed with mental health family carers and service users based on their expertise in understanding their experiences and ways to best explore these to the benefit and wellbeing of families in distress. The academic research partners both have active experience of supporting people with mental health challenges. Through each of the identified phases, lived experience expertise (family carers and service users) co-designed and co-facilitated the process. At times leading the process, such as in recruitment strategies, and at other times acting as guides. Guidance was provided by lived experience expertise in reflecting upon the literature review to understand what had been researched internationally and what would be important to understand in Australia. The academic partners advised on the possible processes for data collection, and the lived experience experts decided on the methodology based on that advice. Both the focus group and survey questions were developed and scrutinised from the perspective of the service users and carers in the project team. Difficult conversations were handled with respect, service users within the project team gently addressed areas of enquiry that may suggest stigma or feed into societal stereotypes of people with mental health challenges. Carers were able to consider the wording of questions to still be able to address areas of concern including domestic violence within the family unit and suicide. Dissemination strategies were planned together with the carer and service user representatives being co-presenters at conferences. The report for submission to the National Mental Health Commission (Australia) was written and reviewed with all partners. A committee of service users and carers, alongside the academic partners, planned the launch of the report in August 2023. The co-authorship of peer-reviewed articles has included family carers and service users from the National Mental Health Consumer and Carer Forum.

Educators’ Perception of Artificial Intelligence as Instructional Tool

With artificial intelligence technologies disrupting status quo of many technologically advanced national economies, educators should face the challenge to harness their potentials without risks to learners. This exploratory mixed-method study aims to add to the growing volume of research that focuses on educators’ attitude towards AI, their views on its applicability in education and necessity to develop AI competences. The research involved 132 in-service and pre-service educators who completed a questionnaire; nine of the participants also took part in follow-up interviews. The results revealed that the majority of educators perceive AI as a promising and useful tool, albeit sometimes complex, risky and not very smart. Most educators report low level of competence and infrequent usage of AI but readiness to undergo training. The research findings speak for the urgent need to design and implement professional development and teacher training courses that debunk myths about AI and build practical skills for applying AI affordances in all levels of education.

Key factors for inappropriate supplement intake in risk-taking users: An exploratory sequential mixed-methods pilot study in Japan.

This study identified the control factors of inappropriate supplement intake to support public agencies in preventing health problems. We used an exploratory sequential mixed-method design with the integrated behavioral model (IBM). Control factors in the IBM were identified with 95 participants. The highest impact behavioral change was established for the following two out of 19 control factors: "I trust others' blogs as a source of information when they post the bad as well as the good" (r = -0.324, p < 0.001) and "I can control any health problems by adjusting the amount and frequency of my supplement intake" (r = -0.308, p < 0.001). The findings suggest that when providing safety information on supplement use, it is important to: (1) disseminate information to online communities of supplement users who share knowledge based on real experiences and (2) effectively demonstrate the risks associated with continued supplementation.

Assessing research culture and capacity amongst faculty at a North American chiropractic institution: an explanatory mixed methods study

BackgroundResearch enables a profession to establish its cultural authority, validate its professional roles and ensure ongoing improvement in the quality of its academic programming. Despite the clear importance of research, a mature research culture has eluded the chiropractic profession. A fostering institutional culture that enables, values, and supports research activity is essential to building research capacity. Our study aimed to collect information about the existing research capacity and culture at the Canadian Memorial Chiropractic College (CMCC) and explore the views, attitudes and experiences of faculty members regarding research.MethodsWe conducted a sequential explanatory mixed methods study with quantitative priority between April and July, 2023. Quantitative data were collected using the Research Capacity and Culture (RCC) tool. Survey results guided the qualitative data collected from four faculty focus groups with varying levels of research experience. Quantitative data were analyzed using descriptive statistics by domain and stratified by research education and workload. The qualitative data were thematically analyzed and then integrated with the quantitative results to provide deeper meaning to the results.ResultsThe faculty survey response rate was 42% (59/144). Attributes at the organization or department level were consistently rated as either moderate or high; however, research skills at an individual level were more variable and influenced by factors such as research workload and highest research-related academic qualification. Qualitative focus group data were categorized under four themes: institutional factors, resource allocation, career pathways and personal factors. Lower scores for survey items related to mentorship, research planning and ensuring faculty research career pathways, as well as the identified workload and time-related barriers (e.g., other work roles and desire for work/life balance) for engaging in research were supported by each of the four themes. Research motivators included keeping the brain stimulated, developing skills and increasing job satisfaction.ConclusionThe quantitative and qualitative information in this study provides a baseline evaluation for RCC and identifies key factors impacting RCC at the CMCC. This information is critical for planning, developing, implementing, and evaluating future interventions to enhance research capacity. Ultimately, these efforts are aimed at maturing the research culture of the chiropractic profession.

Medication-related Burden and Experience With Medications in Indonesian Older Adults With Chronic Diseases: A Mixed-method Study.

This study explored the specific medication-related burdens experienced by older adults with chronic disease and the contributing factors. An exploratory mixed-method study was conducted at a teaching hospital in Surakarta City, Central Java, Indonesia. Combining the Indonesian version of the Living with Medicine Questionnaire (LMQ) and semi-structured interviews allowed for a comprehensive understanding of the medication-related burden. Differences in LMQ scores related to patient characteristics were analyzed using the t-test, F-test, or other alternatives. Quantitative and qualitative data triangulation was used to derive trustworthy and dependable results. The overall LMQ mean score was 90.4 (n=129), indicating a moderate burden. The average LMQ scores varied significantly based on the number of medications, treatment duration, and the presence of cardiovascular disease (CVD), diabetes mellitus (DM) and stroke. The qualitative study found 3 themes in the chronic medication use of older adults: experiences, challenges, and motivation. Despite their limited understanding of a medication's name and indication, some patients managed their medications based on the physical look and packaging of the medication. The study also found that patient motivation and familial support could effectively counteract the fatigue and dissatisfaction associated with taking medication. Older adults with chronic diseases faced medication-related burdens associated with the presence of CVD, DM, stroke, a treatment duration >5 years, and the use of >10 medications. Effective communication with healthcare professionals is required to understand patients' needs and concerns, thereby helping manage the challenges of medication-related burdens.

Coping strategies and perceptions of mental health services among women in South India

Objectives Lack of engagement with mental health services is a challenge for Global Mental Health research and intervention in lower- and middle-income settings. In India particularly, there is a significant treatment gap for people experiencing common mental disorders. This exploratory mixed-method study investigated women’s attitudes toward mental healthcare in Mysuru, India, and investigated what distress copings strategies they used in their everyday lives. Methods We conducted qualitative interviews and administered a depression symptom screener with a community-based sample of 54 adult women. Interviews asked women to comment on their own distress experiences and stress management techniques, as well as their dispositions toward seeking mental healthcare for themselves or others. Results Nearly 65 percent of the study sample screened for any level of depression risk, but only 5 had ever received mental healthcare. Around 20 percent of women stated that they would hypothetically be open to receiving such care. Yet, there was strong agreement across the study sample that mental healthcare was not an appropriate resource for addressing their own distress. Most women who rejected mental healthcare mentioned concerns about stigma and lack of perceived need or treatment inadequacy as their main reasons. Women described a broad range of coping strategies they used for dealing with distress, and which they reported as being effective. Many of these approaches resemble behavioral and talk therapies used in psychology and psychiatry. Conclusions Women in this study generally did not view clinical mental healthcare as an appropriate treatment for their distress. Many already had effective strategies for managing their distress and analogous to existing psychological behavioral and talk therapies. A better understanding of why people reject mental healthcare is necessary for increasing the success of mental health interventions, and for developing new intervention approaches that support coping outside of clinical encounters.

Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study.

China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents' self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the "i Active Health" applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents' risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents' health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients' BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Our digital health platform can effectively achieve theinterconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice.

Who Wrote It? News Readers’ Sensemaking of AI/Human Bylines

This exploratory mixed methods study analyzes readers’ sensemaking of artificial intelligence’s role in journalistic writing. In this study, participants were randomly assigned to a byline condition that varied the stated role of AI in a news story. Regardless of condition, participants detailed various explanatory stories—or “folk theories”—to explain AI’s involvement in the writing process, ranging from AI primarily conducting the writing to AI assisting in specific tasks to optimize the writing. Overall, most participants did not view AI as an independent actor. The findings suggest newsrooms should be transparent about their AI use, given inconsistencies in readers’ interpretation.

Prevalence, associated factors, barriers and facilitators for oral HIV self-testing among partners of pregnant women attending antenatal care clinics in Wakiso, Uganda

BackgroundOral HIV self-testing (HIVST) among men is relatively low and still inadequate in Sub-Saharan Africa. Delivering HIVST kits by pregnant women attending antenatal care to their partners is a promising strategy for increasing HIV testing among men. However, even amidst the HIV testing interventions, most men do not know their HIV status. This study, aimed to determine the proportion of partners who received and used oral HIVST kits delivered by pregnant women, associated factors, barriers, and facilitators for uptake.MethodsWe conducted an exploratory sequential mixed methods study among 380 sampled partners. Lists of partners from HIVST logbooks whose women picked an HIVST kit were obtained and systematic sampling was done to recruit participants. Fourteen (14) male partners were purposively selected for in-depth interviews to identify barriers and facilitators. We used modified poison regression to determine factors associated with oral HIVST. We used an inductive thematic analysis for qualitative analysis.ResultsOut of 380 participants, 260(68.4%) received an oral HIVST kit from their pregnant women, and 215(82.7%) used it for HIVST. Oral HIVST was associated with; Information Education and Communication like availability of HIVST guiding materials (aPR = 1.64, 95%CI: 1.48–1.82), being reached at home (aPR = 1.04, 95%CI 1.01–1.08), and being aware of the woman’s HIV status (aPR = 1.04, 95%CI 0.99–1.09). In-depth results identified barriers to uptake as, lack of trust in the HIVST kit results, fear of test outcome in the presence of their partner and inclination that the HIV status of their women is the same as theirs; Facilitators included convenience, ease of use, prior awareness of their HIV status, and fear of relationship consequences and breakup.ConclusionDelivery of oral HIVST kits to men through pregnant women reached a high number of men and achieved high uptake. Accessing information, education, communication and the kit’s convenience were major reasons for uptake among men who received the kit as; trust issues affected its use among partners. Scaling up the delivery of oral HIVST kits at all departments of hospitals through women seeking health services is paramount to support HIV screening among men to reach the UNAIDS 95 strategy.

Experiences of gender-affirming healthcare among transgender and gender diverse (TGD) people during the COVID-19 pandemic: an explanatory sequential mixed methods study

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

Abstract 4112589: Typology of Self-Care in Adults with Type 1 Diabetes and Impaired Awareness of Hypoglycemia

Introduction: Individuals with type 1 diabetes (T1D) complicated by impaired awareness of hypoglycemia (IAH) are at significantly increased risk for severe hypoglycemia: a marker of high risk of CVD. Tailoring interventions to promote hypoglycemia avoidance is difficult due to self-care heterogeneity among those with T1D. Aims: Map self-care heterogeneity among adults with T1D into behavioral phenotypes and identify common barriers to hypoglycemia avoidance within each phenotype. Methods: An explanatory sequential mixed methods study was performed in 200 adults with T1D. Participants reported personal, clinical, and social determinants of health, hypoglycemia awareness, and self-care of diabetes (Self-Care of Diabetes Inventory, scored 0-100, adequate ≥70) . Cluster analysis was performed to identify self-care clusters. Then, directed content analysis was applied to individual, semi-structured interviews performed in a subsample from each cluster with IAH ( n =20). Findings were integrated to develop a typology of self-care and identify barriers to hypoglycemia avoidance within each phenotype. Results: Three self-care phenotypes were identified. Experts ( n =70; mean age: 45±17 years; 24% Black; T1D duration: 25±16 years; HbA 1c : 7.36±1.67%; IAH: 20%) performed all aspects of self-care adequately (Maintenance: 84.9±8.8; Monitoring: 85.1±8.8; Management: 72.5±10). Yet, Experts with IAH reported purposefully delaying treatment of hypoglycemia due to lack of concern. Those with Inconsistent self-care ( n = 112; mean age 37±14 years; 20% Black: T1D duration: 21±13 years; HbA 1c : 7.26±1.16%; IAH: 30%) performed only self-care maintenance adequately (Maintenance: 78.6±8.9; Monitoring: 65.6±9.8; Management: 56.8±10.1). Those with Inconsistent self-care and IAH reported passive self-care monitoring that inhibited effective hypoglycemic management. Novices ( n = 18; mean age 27±7 years; 50% Black: T1D duration: 16±8 years; HbA 1c : 8.97±2.80%; IAH: 28%) reported difficulty performing all aspects of self-care (Maintenance: 51.9±7.7, Monitoring: 56.9±12.9, Management: 44.5±6.3) due to economic and psychosocial barriers. Conclusions: Self-care heterogeneity mapped onto three phenotypes that can be used to better understand patient barriers to hypoglycemia avoidance and hypoglycemia awareness restoration. This typology provides a framework for investigating how best to tailor IAH treatment considerate of self-care.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.