Mixed Methods Investigation Research Articles

Examining generative AI–mediated informal digital learning of English practices with social cognitive theory: a mixed-methods study

Abstract This study explores the integration of generative artificial intelligence (GenAI) in informal digital learning of English (IDLE) practices, focusing on its potential to enhance language learning outcomes and addressing the technological challenges language teachers face in utilising AI-based tools to facilitate second language acquisition. Based on the research context of IDLE and holistic learning ecology and drawing on the theoretical frameworks of technological pedagogical and content knowledge and social cognitive theory, we performed a mixed-methods investigation with an empirical experiment to assess the effectiveness of GenAI followed by semi-structured interviews. The results suggest that the GenAI-mediated IDLE practices effectively improve college students’ oral proficiency in English from both technological and humanistic perspectives. However, results also indicate that the GenAI conversational partner alone is not adequate to provoke continuous extramural GenAI-mediated IDLE practices. We discuss the theoretical and pragmatic significance of GenAI-mediated IDLE in educational equity and reformation.

Applying to Lead: A Mixed-Methods Investigation of Prospective Principals’ Job Application Strategies in Two Urban Districts

Purpose: Urban school districts often face challenges in filling principal vacancies with effective leaders, especially in high-needs schools. Prospective principals’ engagement with the job application process may contribute to these challenges. The goal of this study is to better understand the job search strategies and behaviors of prospective principals and how their approaches might contribute to leadership staffing challenges in high-needs schools. Research Design and Methods: We employ a convergent mixed-methods design that draws on data from two urban school systems. We pair analysis of interviews of 36 principals who have recently navigated the districts’ hiring systems with multiple years of applications and other administrative data provided by the two districts. We explored how patterns and themes that emerged from each data source were confirmed or disconfirmed with the other source. Findings: Guided by a job-search model, our analysis uncovers three main findings. First, the typical principal applicant conducted a targeted rather than a wide search, reflecting multiple strategies, preferences, and relational factors. Second, elementary educators showed a strong propensity to apply to the same grade level. Third, leaders applied to schools serving larger proportions of historically marginalized students at similar rates as other schools, reflecting their motivations to work with underserved students. Implications for Research and Practice: Considerations informing prospective principals’ job searches are multifaceted. High-needs schools are desirable to many principal candidates. Identifying and strategically recruiting candidates with preferences for working in such schools can be a strategy for districts seeking to overcome challenges in filling principal vacancies.

A mixed-method investigation of faculty perspectives on the benefits and challenges of engaging in student partnership activities in science

There is a growing interest within higher education to engage with students as partners to reposition students from consumers to producers of knowledge. The purpose of this study was to gather insights into the benefits, barriers/challenges, and best practices for engaging in student-faculty partnership activities for science faculty members. Supervising or working with graduate teaching assistants, working with students on university committees, collaborating with undergraduate or graduate students on a new or existing research project, and co-authoring manuscripts with graduate students were regarded as the most impactful partnership activities. Common benefits of student partnership activities included: collaboration and relationship building, broadening perspectives and gaining feedback, personal satisfaction, and institutional and career-related benefits. Common barriers/challenges reported were interpersonal dynamics and maintaining relationships, student management, and external influences. Best practices consisted of planning and setting expectations, developing students’ agency, using open communication, and facilitating peer-to-peer collaboration and peer mentoring.

"Wow another fake game from YouTube ad": Unpacking Fake Games Through a Mixed-Methods Investigation

Mobile games have become highly popular and profitable. While much work has been done to understand deceptive patterns of games and some unethical practices they apply, little is known about fake games, an emergent phenomenon in mobile gaming. To answer this question, we conducted two studies: a walkthrough method to characterize fake games, and a thematic analysis of user reviews to gain understanding from the user perspective. We found five types of misalignments that render a game fake and identified four primary facets of player experience with fake games. These misalignments act as realization points in the users' decision-making to define games as being fake. We discuss the fakeness of fake games, how the formation of an ecosystem helps with the circulation of fakeness, as well as challenges to governing fake games. Lastly, we propose implications for research and design on how to mitigate and identify fake games.

Racial and Gender Disparities in Community Mental Health Center Diagnoses of Adolescent ADHD and Comorbidities: A Mixed Methods Investigation

Racial and Gender Disparities in Community Mental Health Center Diagnoses of Adolescent ADHD and Comorbidities: A Mixed Methods Investigation

Inclusion of Individuals With Lived Experiences in the Development of a Digital Intervention for Co-Occurring Depression and Cannabis Use: Mixed Methods Investigation.

Existing interventions for co-occurring depression and cannabis use often do not treat both disorders simultaneously and can result in higher rates of symptom relapse. Traditional in-person interventions are often difficult to obtain due to financial and time limitations, which may further prevent individuals with co-occurring depression and cannabis use from receiving adequate treatment. Digital interventions can increase the scalability and accessibility for these individuals, but few digital interventions exist to treat both disorders simultaneously. Targeting transdiagnostic processes of these disorders with a digital intervention-specifically positive valence system dysfunction-may yield improved access and outcomes. Recent research has highlighted a need for the inclusion of individuals with lived experiences to assist in the co-design of interventions to enhance scalability and relevance of an intervention. Thus, the purpose of this study is to describe the process of eliciting feedback from individuals with elevated depressed symptoms and cannabis use and co-designing a digital intervention, Amplification of Positivity-Cannabis Use Disorder (AMP-C), focused on improving positive valence system dysfunction in these disorders. Ten individuals who endorsed moderate to severe depressive symptoms and regular cannabis use (2-3×/week) were recruited online via Meta ads. Using a mixed methods approach, participants completed a 1-hour mixed methods interview over Zoom (Zoom Technologies Inc) where they gave their feedback and suggestions for the development of a mental health app, based on an existing treatment targeting positive valence system dysfunction, for depressive symptoms and cannabis use. The qualitative approach allowed for a broader investigation of participants' wants and needs regarding the engagement and scalability of AMP-C, and the quantitative approach allowed for specific ratings of intervention components to be potentially included. Participants perceived the 13 different components of AMP-C as overall helpful (mean 3.9-4.4, SD 0.5-1.1) and interesting (mean 4.0-4.9, SD 0.3-1.1) on a scale from 1 (not at all) to 5 (extremely). They gave qualitative feedback for increasing engagement in the app, including adding a social component, using notifications, and being able to track their symptoms and progress over time. This study highlights the importance of including individuals with lived experiences in the development of interventions, including digital interventions. This inclusion resulted in valuable feedback and suggestions for improving the proposed digital intervention targeting the positive valence system, AMP-C, to better match the wants and needs of individuals with depressive symptoms and cannabis use.

A mixed-methods investigation into complex components of multilingual international students' self-regulated learning in English as a foreign language context: A social cognitive perspective

Self-regulated learning serves as a fundamental framework for understanding the cognitive, motivational, and emotional dimensions of learning. Recently, a growing body of studies on such cognitive processes appears in multilingual populations. Applying a mixed-methods approach, this study examined the key components of the self-regulated learning process among 233 multilingual international students in China, specifically within the context of English as a Foreign Language learning. Qualitative data was analyzed through Pearson's correlation analysis, structural equation modeling, and path analysis, while semi-structured interviews were conducted to further confirm the results of the qualitative data analysis. 15 students were purposefully selected through purposive sampling to participate in follow-up interviews. Within the framework of social cognitive theory, the findings revealed that metacognition, motivation, self-efficacy, and feedback loops are the primary components of self-regulated learning. Additionally, path analysis confirmed that the four factors are positive predictors of self-regulated learning proficiency of multilingual international students in China. The interview outcomes further validated the integral role of these primary components in the self-regulated learning process within the context of multilingual study. This study underscores the significance of incorporating translanguaging backgrounds into teaching strategies and language policy. Findings may offer some insights for multilingual international students, language teachers, and language policymakers in the field of Chinese language instruction.

A mixed-methods investigation of weight bias reduction in medical students

ABSTRACT We used a mixed-methods design to test a novel weight bias intervention and understand current attitudes toward people with higher weight and weight-inclusive care among medical students (N = 80). The intervention was embedded in curriculum and uniquely focused on delegitimising the use of weight as a heuristic for health. Almost half of participants (43.8%) responded to both pre- and post-intervention surveys. These participants found the intervention acceptable; and reported significant pre-post reductions in weight bias and endorsement of using weight as a heuristic for health. Less engaged participants reported significantly greater endorsement of using weight as a heuristic for health at pre-intervention. One central theme emerged from pre-intervention qualitative responses, related to how medical students scoped both the problem and the solution. This consisted of three sub-themes: (1) problematizing the system and clinician (and their weight bias), (2) problematizing the patient (who was responsible for their own health), and (3) problematizing the medical condition (weight and health behaviors as problems for the clinician to solve). Participants often showed evidence of several and sometimes contradictory ways of problem-scoping. Problematizing the patient, including weight-stigmatizing assumptions, was particularly pronounced among less engaged participants (i.e. those who did not complete the post-survey). Findings suggest that the intervention may be acceptable and effective in reducing weight bias in medical students who already have lower levels of bias than their peers. Qualitative findings suggest that, even when medical students recognize the harmful impacts of weight stigma and the benefits of weight-inclusive care, approaches to care may remain weight-centric. Together, the findings suggest a key challenge for weight bias reduction among medical students lies in addressing problem-scoping that may encourage weight bias and weight-centric care, and reaching the population most in need of intervention – students with high levels of weight bias.

Current and Future Implementation of Digitally Delivered Psychotherapies: An Exploratory Mixed-Methods Investigation of Client, Clinician, and Community Partner Perspectives.

Following the initial outbreak of the COVID-19 pandemic, mental health clinicians rapidly shifted service delivery from in-person to digital. This pivot was instrumental in maintaining continuity of care and meeting increased mental health service demands. Many mental health services have continued to be offered via digital delivery. The long-term implications of delivering services via digital media remain unclear and need to be addressed. This study aimed to identify current micro (i.e., clinician-patient interactions), meso (i.e., clinician-clinic manager interactions), and macro (i.e., government-policy maker interactions) level issues surrounding the use of digital mental health interventions (DMHI). Such integrated assessments are important for optimizing services to improve treatment outcomes and client satisfaction. Participants were recruited between January 2022 and April 2023. Quantitative data were collected using a survey informed by the Hexagon Tool. Qualitative data were collected from online semi-structured interviews and focus groups and analyzed using rapid thematic analysis. Survey data were collected from 11 client and 11 clinician participants. Twenty-six community partner participants were interviewed for this study. Client and clinician participants expressed satisfaction with the implementation of DMHI. Community partner participants generally agreed, reporting that such services will play an integral role in mental healthcare moving forward. Community partners shared that certain issues, such as uncertainty surrounding policies and regulations related to digital delivery, must be addressed in the future. Participants in this study supported the use of DMHI despite difficulties implementing these programs, asserting that such services are not a temporary fix but a pivotal cornerstone in the future of mental healthcare service delivery.

Exploratory mixed methods investigation of time commitment in youth sport and physical activity: families’ experiences and satisfaction during the pandemic, and intentions for post-pandemic engagement

ABSTRACT Purpose/rationale: The COVID-19 pandemic drastically changed families’ time commitments for youth sport and physical activity (SPA). Guided by Social Ecology Theory, experiences and associated levels of satisfaction with these changes are explored, as well as intentions for post-pandemic engagement. Design/methodology/approach: Interviews with families (n = 14) informed the creation of a questionnaire that was distributed to 550 Ontarian families. Findings: Parents were satisfied with lower time commitment of youth SPA during the pandemic and would have liked to engage in less travel for youth SPA and fewer organized activities post-pandemic. However, families largely intended on increasing or reverting to their travel time for and diversity of activities post-pandemic, compared to pre-pandemic, suggesting that parents intend to support their children’s SPA preferences, regardless of their own. Practical implications: Given that parents intend to support their children’s SPA commitment preferences, tactics to ease the time demands on parents can be developed to provide greater value propositions for families. Research contribution: Two main consumer groups of youth SPA (i.e. parents and youth) can have differing preferences for their experiences. Originality/value: This study revealed conflicting experiences and preferences of two distinct consumer groups for youth SPA.

Gender-Typing of Children’s Sports Toys Persists: A Mixed-Methods Investigation

Gender-Typing of Children’s Sports Toys Persists: A Mixed-Methods Investigation

Comparison of Oswestry Disability Index Scores Between Surgical Candidates and General Population: Insights into Evaluation Criteria for Spine Surgery.

A mixed-methods investigation with both retrospective and prospective components. Determine the mean Oswestry Disability Index (ODI) scores for individuals who underwent surgical intervention compared to a non-surgical population and identify threshold values that distinguish between these groups. The Oswestry Disability Index (ODI) quantifies disability in patients with low back pain and commonly serves as a significant determinant in lumbar spine pathology and surgical outcomes. An empirically established ODI threshold can aid in optimizing surgical decision-making processes. This study retrospectively analyzed 557 patients who consulted with a spine surgeon and subsequently underwent lumbar spine surgery from 2019 to 2023. Additionally, ODI scores were surveyed from 797 individuals in the general American population using the CloudResearch Connect platform, with participants matched for age and sex according to US census data. Mean ODI scores stratified by age group and sex were calculated for each cohort. Receiver Operating Characteristic (ROC) analysis was utilized to ascertain ODI cutoff values for different demographics. The retrospective cohort demonstrated a higher disability level with an overall mean ODI of 34.7 (95% CI [33.1, 36.2]) for ages 18-89. In contrast, the general population surveyed had a mean ODI of 14.4 (95% CI [13.3, 15.4]). An ROC-derived ODI threshold of 16.5 within the comprehensive age group of 18-89 exhibited a sensitivity of 0.84 and a specificity of 0.68. The ODI values identified in this study offer benchmarks that can assist in the evaluation process for spine surgery. These findings highlight the importance of considering ODI scores as part of a comprehensive clinical evaluation, rather than as standalone indicators for surgical intervention. Further prospective validation of these findings and their integration into clinical practice is recommended for future research.

Protocol for a mixed-methods exploratory investigation into the role of health information technology for the provision of cancer care in Indonesia

Background Cancer and its management can incur high costs, high risks and high demand. In Indonesia, there remains gap in the availability of national cancer data despite the establishment of a National Committee for Cancer Control. Multiple pilot projects have been developed by the Ministry of Health to improve the delivery of care, including interventions utilising digital health approaches and integrated referral information systems. However, it is not yet clear to what extent these approaches influence patient management or the experience of cancer patients themselves. This research aims to explore the current role of health information technology (HIT) in the provision of services and treatments for patients with cancer from primary to tertiary healthcare centres in Yogyakarta, Indonesia. Methods The study will adopt an observational mixed-methods single case study design of health facilities involved in the delivery of cancer services in a sub-national health system. We will collect data through face-to-face interviews with a range of health professionals involved in the delivery of cancer care. Patients will be interviewed to share their views and experiences of the existing cancer referral system and communication with health facilities. Alongside interviews, we will undertake an analysis of routine data from participating health facilities to assess gaps in existing information systems. Data analysis will include framework analysis for qualitative data alongside descriptive analyses of quantitative data. Findings will be used to inform conceptual maps to be presented as part of Theory of Change workshops focused on understanding how the existing cancer referral system works, why and for whom, with a focus on future refinement and intervention development. Conclusion Our findings will inform critical thinking around the design, implementation, adaptation, and evaluation of existing systems. Through early engagement and participation of key stakeholders and project partners, we intend that findings will have immediate utility.

How does a social belonging intervention affect college students from historically underrepresented groups? A mixed methods investigation.

How does a social belonging intervention affect college students from historically underrepresented groups? A mixed methods investigation.

Prescribing Trends and Associated Outcomes of Antiepileptic Drugs and Other Psychotropic Medications in US Nursing Homes: Proposal for a Mixed Methods Investigation.

Pilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. Using a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. To accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services' (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. Funding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. This study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. DERR1-10.2196/64446.

Work readiness of student nurses voluntarily supporting NHS during COVID-19 pandemic: a mixed methods investigation into students’ experiences

Background: Transition from education to the workforce has been recognised as difficult and linked to ‘reality shock.’ Due to the unprecedented circumstances of the COVID-19 pandemic, many student nurses opted in for NHS emergency placements and prematurely transitioned to the workplace, which calls for an in-depth investigation of the work readiness and transition experiences of this cohort. Aim: The aim of this study was to investigate self-perceived work readiness, the effectiveness of support provided by the universities and the NHS as well as explore the experiences of student nurses who responded to the COVID-19 crisis to understand the impact of this early transition to the clinical workforce. Design: A mixed methods study was conducted. It included two stages: (1) an online survey consisting of a work readiness questionnaire and close- and open-ended questions about received support; and (2) online semi-structured interviews that were thematically analysed. Methods: Participants were nursing students from Scottish universities who took on emergency NHS placements. Thirty-three (30 females and 3 males) participants completed the survey and 8 of them (all female) participated in semi-structured interviews. The Work Readiness Scale for graduate nurses along with questions about the support received were completed in the first stage of the study. Results: Organisational acumen was perceived by participants as higher than social intelligence, work competence and personal work characteristics. Three superordinate themes emerged: (1) participants expressed appreciation of and need for coordination of support from the university and the NHS as a key factor in easing into their role; (2) they indicated the sense of obligation as the key driver for taking up this placement; (3) placement was seen as an opportunity to understand their role and develop their professional identity. Conclusions: The findings found the importance of support from the clinical placement and academic teams to help with the integration and application of theory into practice.

What good emotional care for miscarriage looks like: A mixed-methods investigation in an Australian private hospital setting.

Miscarriage is a common medical occurrence which can be associated with significant psychological distress. Patients and partners are frequently disappointed by aspects of their care, especially with regard to emotional support. Although most published studies investigated the experiences of patients and partners in emergency departments (EDs) of public hospitals, miscarriage is also frequently diagnosed in non-emergency settings, such as during sonography or antenatal appointments, and approximately 25% of Australian women receive maternity care in private hospitals. Because the experience of miscarriage is known to be setting-dependent, it is important to understand how patients and partners experience care outside the ED. Here, we addressed this gap by investigating the experiences of patients and partners who attended a private maternity hospital for miscarriage using a mixed-methods approach. Eighteen patients and six partners who had recently experienced a miscarriage were recruited at a private maternity hospital to take part in both semi-structured interviews and online surveys. Overall, patients and partners were highly satisfied with the emotional care they received. Thematic analysis of semi-structured interviews allowed us to identify a total of ten themes that contributed to satisfaction with emotional care. We provide the first specific insights into the experiences of women and partners who received care for miscarriage in an Australian private hospital setting, and the first example of a healthcare setting that achieves high satisfaction with emotional care around miscarriage. The ten themes we identify provide a framework for improving satisfaction with care also in other settings.

Supplemental Material for How Does a Social Belonging Intervention Affect College Students From Historically Underrepresented Groups? A Mixed Methods Investigation

Supplemental Material for How Does a Social Belonging Intervention Affect College Students From Historically Underrepresented Groups? A Mixed Methods Investigation

Predictors of university students’ intentions to enroll in computer programming courses: a mixed-method investigation

Students in technology majors such as Computer Science and Information Technology need to take a series of computer programming courses to graduate. Yet, not all students will persist in taking programming courses as required, and little is known about the factors influencing their enrollment intentions. Research is needed to better understand which factors predict students’ enrollment intentions for programming courses. Based on Expectancy-Value Theory, we surveyed three hundred university students in China to measure their intentions of enrolling in future programming courses and factors influencing their enrollment intentions. Mediated Multiple Indicators Multiple Causes models were run to identify the relationships between these factors and enrollment intentions. Expectancies, intrinsic value, attainment value, and utility value of the courses directly predict enrollment intentions. Peer comparison, quality of teaching, and programming experiences were found to influence enrollment intentions through expectancies and values indirectly. No gender difference was found in expectancies and enrollment intentions. Qualitative data analysis confirmed the findings from the quantitative data analysis and further revealed that course difficulty is another major factor influencing enrollment intentions. These findings have implications for supporting students' expectancies and values in computer programming and curriculum design.

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

ObjectiveWorkplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.MethodsSequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.ResultsThe average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.ConclusionThe study’s results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.