Mixed Methods Investigation Research Articles

OptimalMe Program: A Mixed Method Investigation into the Engagement and Acceptability of a Preconception Digital Health Lifestyle Intervention with Individual Coaching for Women's Health and Behaviour Change.

Preconception interventions, specifically addressing general health, lifestyle behaviours and weight management, are limited despite their importance in optimising women's health. The objective of this study is to evaluate the engagement and acceptability of OptimalMe, a digital preconception intervention. Participants, (n = 298) Australian women aged 18-44 with private health insurance planning to conceive within 12 months, received a standardised intervention, including access to a digital healthy lifestyle platform (educational materials, behaviour change activities, and self-monitoring resources), ongoing text messaging, and remotely delivered health coaching (two appointments) with randomised delivery methods (telephone/videoconference). Engagement and acceptability were assessed through mixed method analyses. The results show that 76.2% attended both coaching sessions, with similar participation rates for telehealth (75.2%) and videoconferencing (77.2%) (p = 0.469). All participants logged into the digital platform, with 90.6% accessing educational materials and 91.3% using behaviour change tools. Digital platform engagement declined over time, suggesting potential benefits from additional health coaching support for ongoing participation. The post-intervention evaluation (n = 217 participants) demonstrated that approximately 90% found the digital module engaging, meeting information needs, would recommend the program, and were satisfied with the support. OptimalMe demonstrated positive acceptability and engagement; however, further research is warranted to explore strategies for sustaining engagement with the digital interventions.

Development of a digital intervention for psychedelic preparation (DIPP)

Psychedelic substances induce profound alterations in consciousness. Careful preparation is therefore essential to limit adverse reactions, enhance therapeutic benefits, and maintain user safety. This paper describes the development of a self-directed, digital intervention for psychedelic preparation. Drawing on elements from the UK Medical Research Council (MRC) framework for developing complex interventions, the design was informed by a four-factor model of psychedelic preparedness, using a person-centred approach. Our mixed-methods investigation consisted of two studies. The first involved interviews with 19 participants who had previously attended a ‘high-dose’ psilocybin retreat, systematically exploring their preparation behaviours and perspectives on the proposed intervention. The second study engaged 28 attendees of an ongoing psilocybin retreat in co-design workshops, refining the intervention protocol using insights from the initial interviews. The outcome is a co-produced 21-day digital course (Digital Intervention for Psychedelic Preparation (DIPP)), that is organised into four modules: Knowledge–Expectation, Psychophysical–Readiness, Safety–Planning, and Intention–Preparation. Fundamental components of the course include daily meditation practice, supplementary exercises tied to the weekly modules, and mood tracking. DIPP provides a comprehensive and scalable solution to enhance psychedelic preparedness, aligning with the broader shift towards digital mental health interventions.

Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh

There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead to an increase in indicated treatment rates for newborns with hyperbilirubinemia. We aimed to investigate the operational feasibility and acceptability of a CHW-led home phototherapy intervention in a rural sub-district of Bangladesh for families and CHWs where home delivery was common and a treatment facility for neonatal hyperbilirubinemia was often more than two hours from households. We enrolled 23 newborns who were ≥ 2 kg in weight and ≥ 35 weeks gestational age, without clinical danger signs, and met the American Academy of Pediatric treatment criteria for phototherapy for hyperbilirubinemia. We employed a mixed-method investigation to evaluate the feasibility and acceptability of home phototherapy through surveys, in-depth interviews and focus group discussions with CHWs, mothers, and grandparents. Mothers and family members found home phototherapy worked well, saved them money, and was convenient and easy to operate. CHWs found it feasible to deploy home phototherapy and identified hands-on training, mHealth job aids, a manageable workload, and prenatal education as facilitating factors for implementation. Feasibility and acceptability concerns were limited amongst parents and included: a lack of confidence in CHWs’ skills, fear of putting newborn infants in a phototherapy device, and unreliable home power supply. CHW-led home phototherapy was acceptable to families and CHWs in rural Bangladesh. Further investigation should be done to determine the impact of home phototherapy on treatment rates and on preventing morbidity associated with neonatal hyperbilirubinemia. Clinical Trial (CT) registration ID: NCT03933423, full protocol can be accessed at https://doi.org/10.1186/s13102-024-00824-6. Name of the trial registry: clinicaltrials.gov. Clinical Trial (CT) registration Date: 01/05/2019.

Do eco labels matter for green business strategy and sustainable consumption? A mixed method investigation on green products

AbstractSince the advent of the Industrial Revolution, factories have been spewing out noxious substances at an unmitigated rate, leading to environmental degradation. The need for sustainable consumption has stoked the desire for green products. The study aims to contribute to the existing body of knowledge regarding the use of eco‐labels by firms in order to meet the consumers' green purchasing behaviour. The study employs a mixed‐method approach to investigate the underlying psychological aspects that affect consumers' green purchasing behaviour. The current study used the grounded theory method to identify themes and variables based on the data collected through interviews. These themes and variables were subsequently used to construct the conceptual framework for the qualitative analysis. The conceptual framework was then empirically tested using Partial Least Squares Structural Equation Modelling (PLS‐SEM) statistical analysis (quantitative analysis). The findings unfold potential areas where businesses, through eco‐labels, could transpire information and capitalise on this behavioural shift among consumers for green products. The study eventually offers eco‐labels as a viable green business strategy which clears the haze of ambiguity and make space to safeguard our environment.

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

ObjectivesSexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but...

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Resilient Warriors: A Mixed Methods Investigation of an Expressive Arts-Based Resiliency Small Group Intervention With Rural Children

Upper elementary students in a Title I rural school participated in an expressive arts-based resiliency small-group intervention entitled Resilient Warriors (RWs). This mixed-methods study revealed positive changes in participating students based on teacher ratings on the Strengths and Difficulties Questionnaire. We also found four qualitative themes that emerged from student group interviews: (a) learning resiliency strategies and skills, (b) growth, (c) enjoyment and fun, and (d) future recommendations. We discuss the study implications, limitations, and future recommendations.

Notetaking as validity evidence: A mixed-methods investigation of question preview in EAP listening assessment

Recent scholarship has questioned the cognitive validity of listening tests with preview, in which test-takers can see test questions before listening. This study mined student notes for evidence of cognitive processes in listening tests with and without preview, using a mixed-methods design that explored the effect of test format on notetaking behaviors. Qualitative analysis indicated that students who previewed items were more likely to systematically omit information, highlight previewed keywords, and engage in shallower structural representation. Conversely, Kruskal-Wallis tests revealed that students who listened without preview took more notes, especially of main ideas and details, and had better coverage of the lecture. However, correlation and hierarchical linear regression analyses found these notetaking achievements did not predict higher scores in the no-preview condition, while in the preview condition, only note quantity and focus on minor ideas predicted scores. Both strands of data suggest that students' cognitive processes were shaped by the format of the exam they experienced. These findings may bear on validity arguments for listening assessment and inform the way that language instructors prepare their students for academic listening.

How burnout, resilience, and engagement interplay among EFL learners? A mixed-methods investigation in the Chinese senior high school context

English-as-a-foreign-language (EFL) learning is essential for Chinese senior high school students, but burnout can impair their engagement and performance. Resilience, however, can enhance their engagement and shield them from burnout. This mixed-methods study aimed to investigate the interplay between burnout, resilience, and engagement among 413 Chinese senior high school EFL learners. Using AMOS 24, quantitative analyses with structural equation modeling (SEM) revealed the reciprocity between these three constructs. Specifically, burnout was negatively associated with both resilience and engagement, explaining 28.6% and 33.3% of their shared variance respectively. Besides, resilience and engagement were positively correlated, sharing 70.6% of their variance. Qualitative semi-structured interviews with 15 students, analyzed by MAXQDA 2022, supported this reciprocity by specifying the role of each component of these constructs. This study also discusses the theoretical and practical implications of findings and suggests directions for future research.

Deciphering the Defining Features of Experiential Learning

This paper addresses the call for submissions to provide greater clarity on the defining features of experiential learning. This definition is accomplished with a critical review of literature relevant to experiential learning and reflection on the findings of a mixed method investigation exploring the defining features, canonical works, and theoretical foundations of experiential education occurring in natural settings. Postulations on experiential learning can be organized by foundational literature (ranging from Plato to Dewey) and definitional literature (formation of professional societies, research, &amp; definitions). The sequential qual, qual mixed method study, which gained the perspectives of experiential education experts and practitioners, found the knowledge base to be broad and eclectic. Furthermore, personal experience was found to be valued as a primary source of knowledge and understanding of experiential learning. The following defining features were extracted from this investigation: personal experience, existential engagement, agency, fluid affordances, flexible pedagogy, empirical and conceptual ways of knowing, freedom, and precision. In addition to these new insights on experiential education, this study offers a research methodology that may be useful for gaining greater clarification about how experiential learning occurs within higher education settings and implemented more equitably.

Exploring AI-mediated informal digital learning of English (AI-IDLE): a mixed-method investigation of Chinese EFL learners’ AI adoption and experiences

Recent advancements in natural language processing and large language models have ushered language learning into the age of artificial intelligence (AI). Recognizing the affordances of generative AI tools, this paper aims to examine the degree to which L2 learners accepted and leveraged large language model platforms (e.g. ChatGPT, Bing Chat) for the informal digital learning of English (IDLE) purposes. Employing an explanatory sequential mixed-method design, this study draws on the technology acceptance model (TAM) and collects data via an adapted TAM questionnaire and an interview guide. A total of 867 Chinese EFL (English as a foreign language) learners answered the online survey, while 20 attended the post-survey interviews. Drawing on a validated structural model that elucidates the inter-factor relationships of perceived ease of use, perceived usefulness, intention to use, and actual use, the quantitative analysis provides statistical accounts for EFL learners’ adoption of Generative Pre-trained Transformer (GPT) technologies. The qualitative findings, derived from the interview data, reveal three key themes: (1) how perceived usefulness of chatbots for IDLE emerges from hands-on experimentation with these tools; (2) how intention to use increases as learners negotiate chatbot affordances and constraints; and (3) how actual use of chatbots for IDLE involves using these tools as tutors or conversation partners. Connections between quantitative and qualitative findings enhance our understanding of how EFL learners negotiate the affordances and constraints of highly capable AI technologies to participate in creative IDLE practices. By understanding these practices, this study draws attention to the attitudes and practices that constitute AI literacies, ultimately offering implications for future classroom practices and research.

The role of teacher assessment literacy in job stress and job burnout in EFL contexts: a mixed-methods investigation

Reviewing the literature reveals that the role of teacher assessment literacy (TAL) in teacher job stress (TJS) and teacher job burnout (TJB) among English as foreign language (EFL) teachers in Iran has remained largely unexplored. As a result, this mixed-methods study investigated the association between TAL, TJS, and TJB in the Iranian EFL context. For the quantitative section, 413 EFL teachers, including 221 males and 192 females, were randomly selected. They completed the Teacher Assessment Literacy Questionnaire, the Teacher Job Stress Scale, and the Teacher Job Burnout Inventory, and the data was analyzed using structural equation modeling. For the qualitative part, 18 EFL teachers who joined the quantitative part participated in a focus group interview, and their responses were analyzed through a content analysis approach. Results indicated that TAL is a strong predictor of TJS and TJB. Specifically, the findings indicated that TAL was positively linked to all the sub-scales of TJS and TJB. Additionally, the complementary qualitative results yielded four themes: TAL promotes job productivity, TAL raises teachers’ social face, TAL enables teachers to manage the class efficiently, and TAL brings positive wash-back. The findings suggest that TAL, TJS, and TJB should be incorporated in pre-service and in-service teacher training courses in EFL education.

A mixed-methods investigation of the factors affecting the use of facial recognition as a threatening AI application

PurposeArtificial intelligence (AI) applications pose a potential threat to users' data security and privacy due to their high data-dependence nature. This paper aims to investigate an understudied issue in the literature, namely, how users perceive the threat of and decide to use a threatening AI application. In particular, it examines the influencing factors and the mechanisms that affect an individual’s behavioral intention to use facial recognition, a threatening AI.Design/methodology/approachThe authors develop a research model with trust as the key mediating variable by integrating technology threat avoidance theory, the theory of planned behavior and contextual factors related to facial recognition. Then, it is tested through a sequential mixed-methods investigation, including a qualitative study (for model development) of online comments from various platforms and a quantitative study (for model validation) using field survey data.FindingsPerceived threat (triggered by perceived susceptibility and severity) and perceived avoidability (promoted by perceived effectiveness, perceived cost and self-efficacy) have negative and positive relationships, respectively, with an individual’s attitude toward facial recognition applications; these relationships are partially mediated by trust. In addition, perceived avoidability is positively related to perceived behavioral control, which along with attitude and subjective norm is positively related to individuals' intentions to use facial recognition applications.Originality/valueThis paper is among the first to examine the factors that affect the acceptance of threatening AI applications and how. The research findings extend the current literature by providing rich and novel insights into the important roles of perceived threat, perceived avoidability, and trust in affecting an individual’s attitude and intention regarding using threatening AI applications.

Preliminary mixed-methods investigation: Impact and acceptability of a combined life skills and adventure therapy program for adolescents.

Meaningful occupational therapy interventions for neurodivergent, transition-age adolescents are understudied, and novel intervention approaches that are motivating to this population are needed. Accordingly, in this study we explored the acceptability and impact of a combined life skills/adventure therapy (LS/AT) intervention program for addressing self-identified goals for adolescents with regulation- and sensory-based challenges. We used a convergent mixed-methods design. All adolescents accepted into the intervention program were invited to participate. We described our sample using data from the Child Occupational Self-Assessment. Participants created and rated goals through a modified Canadian Occupational Performance Measure interview before intervention, after intervention and 3 months post-intervention and participated in semi-structured interviews pre- and post-intervention. We calculated COPM change scores, analysed qualitative interview data, and integrated findings into a joint display for interpretation following recommended procedures for mixed-methods data. Ten adolescents consented to participate (n = 6 males, n = 4 females; mean age 13.92 years, SD = 0.54). Mean COPM performance change scores were 3.72 (SD = 1.39) from pre- to post-intervention and 2.40 (SD = 1.19) from pre- to 3months post-intervention, with the largest change scores for goals related to life skills. Data from semi-structured interviews expanded on these findings, revealing that participants made changes related to being in the moment, finding a sense of purpose and achieving a sense of belonging. Participants reported high acceptability of the intervention. This exploratory research supports the use of combined LS/AT intervention with transition-age adolescents experiencing sensory and regulation-based limitations on participation. Preliminary data shows positive changes in performance and satisfaction in self-identified goal areas as well as changes related to mindfulness, a personal sense of competence and relatedness. In practice, occupational therapists should consider integrating elements of this LS/AT intervention to support this population, including addressing life skills through engagement in unique and motivating activities.

Including English learners in multi-tiered systems of support (MTSS) in reading: A CHAT-informed mixed methods investigation

Effective inclusion of English Learners (ELs) in multi-tiered systems of support (MTSS) is necessary for this growing subset of students to access the intended outcomes of MTSS, specifically improved academic outcomes. Facilitating MTSS systems that are appropriately responsive to the heterogeneous needs of ELs may be particularly challenging. In the current study, Cultural Historical Activity Theory (CHAT) guided survey and interview data collection and analysis of elementary teachers’ current experiences with including ELs in MTSS for reading. Quantitative findings indicated inclusive practices were common and that teacher perceptions about including ELs in MTSS were generally positive. Qualitative findings identified several sources of tension; these tensions are described and used to guide the identification of changes that have the potential for further improving MTSS for ELs.

Can ChatGPT effectively complement teacher assessment of undergraduate students’ academic writing?

The integration of ChatGPT as a supplementary tool for writing instruction has gained traction. However, uncertainties persist regarding how ChatGPT complements teacher assessment and the overall effectiveness of this combined approach. To address this, we conducted a mixed-methods investigation involving 46 undergraduate students from a research university in southern China, engaging them in a Chinese academic writing task. The intraclass correlation coefficient results revealed ChatGPT’s efficiency in scoring students’ writing, showing moderate to good consistency with teacher evaluations. A paired sample t-test unveiled significant differences in feedback quantity and types between ChatGPT and teacher assessments. Drawing from both interview data and quantitative findings, the study uncovers three ways in which ChatGPT complements teacher assessment, benefiting students with various writing proficiency levels: (1) fostering deeper comprehension of teacher assessments among students, (2) encouraging students to make judgments regarding feedback, and (3) promoting independent thinking about revisions. This study contributes to a more comprehensive understanding of the role of ChatGPT within the context of a combined assessment approach. It underscores that certain inherent weaknesses in ChatGPT’s functioning can paradoxically lead to favorable outcomes. By shedding light on the synergy between ChatGPT and teacher assessments, this research seeks to inform and enhance writing instruction in higher education.

Mixed-method usability investigation of ARROWS: augmented reality for roadway work zone safety

This article explores the usability and user experience challenges of ARROWS, a novel augmented reality (AR) and wearable technology (WT) safety system for roadway work zones, an area with limited existing usability research. We utilized a mixed-method approach with two complementary experiments in indoor and outdoor settings, using the Wizard of Oz methodology and a high-fidelity prototype. We focused on identifying usability challenges, factors contributing to user experience and the distinct needs of highway workers, documenting results using the system usability scale (SUS), the rating scale mental effort (RSME) and a trust score. Participants rated the usability of ARROWS above average in both settings, while making a reasonable level of mental effort. The findings also indicate a significant correlation between perceived trust and usability, highlighting the importance of trust in user experience.

Using Ethno-Epidemiology in a Prospective Observational Study to Increase the Rigour of Nested Qualitative Research

Ethnographic-epidemiological (“ethno-epi”) research methodologies are increasingly being used to examine health-related issues, including the experiences of people who use drugs. However, the complementary application of random sampling from a well characterised cohort and qualitative data collection methods in a single study has not been described. We address this gap by sharing insights from the implementation of a novel random stratified sampling technique to recruit participants from two large prospective observational studies of people who use drugs into a qualitative study about impacts of the COVID-19 pandemic on their lived experience. We aim to describe how an ethno-epi approach we used can enhance the validity, reliability and generalizability of research findings in mixed methods investigations. We do so by providing a step-by-step description of the process we used to determine participant eligibility and recruitment into the qualitative study. Although the approach is not without limitations, findings underscore how ethno-epi random sampling approaches can increase the credibility and trustworthiness of qualitative findings without compromising data depth and integrity. Our study makes an important contribution to the growing number of new creative approaches being developed in the mixed methods research field and we hope that by sharing our account it will encourage and support others to consider the use of ethno-epi approaches in health-related research.

Evaluating Students’ Perception of Visual Mathematics in Secondary Geometry Education: A Mixed Methods Investigation

The present study aimed to assess the perspectives of female secondary school students on the integration of visual mathematics in engineering lessons. Employing a mixed-methods approach, specifically a convergent parallel design, qualitative data were gathered through observations and interviews (both individual and focus groups), while quantitative data were collected using a questionnaire. Video clips of engineering unit lessons were utilized as educational materials. The study included 135 female students in the first year of secondary school, with 74 participating in qualitative segments, divided into focus groups and individual interviews. SPSS was employed for quantitative data analysis, calculating means and standard deviations, while thematic analysis was applied for qualitative data. Key findings indicate that visual displays significantly contributed to enhancing female students’ comprehension of mathematical concepts, facilitating the understanding of inter-concept relationships and their application in engineering. The incorporation of visual aids also positively impacted the mathematical coherence abilities of female students, establishing connections between mathematics, other subjects, and real-life situations. Furthermore, visual presentations in engineering topics were found to improve female students’ attitudes toward learning mathematics, fostering increased self-confidence and enjoyment in learning various engineering subjects. Recommendations from the study include the need for training both male and female teachers in designing effective visual presentations for teaching mathematical concepts.

Middle School Students’ Team Cohesion Development Within a Sport Education Season: A Mixed Methods Investigation

Purpose: The purposes of the study were to examine the longitudinal changes of team cohesion within a Sport Education season among female students and to identify facilitators and barriers underlying cohesion development. Method: A longitudinal, concurrent, mixed methods design was employed. Students from sixth to eighth grades (all girls; n = 55) in small teams (n = 15), and their physical education teacher, from one convenience private school in a southern U.S. state, participated in this study. All students completed the validated Youth Sport Environment Questionnaire across three time points. Regular field observations, focus group interviews with students, and individual interviews with student leaders and the physical education teacher were conducted to capture the facilitators and barriers. Results: No significant time effect was observed for team cohesion, but student leadership significantly moderated cohesion development from Time 2 to Time 3 and from Time 1 to Time 3, but not from Time 1 to Time 2. Qualitative data unraveled four facilitators and three barriers underlying cohesion development. Conclusion: The findings are informative for future Sport Education-based curricular and instructional practices to nurture team cohesion.