Mixed Methods Study Research Articles

Experiences of Inpatient Healthcare Services Among Children With Medical Complexity and Their Families: A Scoping Review.

Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. Forty-nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non-validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision-making, common goal setting, relationship-building, communication, sharing expertise and the hospital setting itself. CMC and families value relational elements of care and partnering through sharing expertise, decision-making and collaborative goal-setting when admitted to hospital. This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co-designed and conducted with the full engagement of the project's parent-partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript.

Clinical decision support systems for maternity care: a systematic review and meta-analysis

The use of Clinical Decision Support Systems (CDSS) is increasing throughout healthcare and may be able to improve safety and outcomes in maternity care, but maternity care has key differences to other disciplines that complicate the use of CDSS. We aimed to identify evaluated CDSS and synthesise evidence of their impact on maternity care. We conducted a systematic review for articles published before 24th May 2024 that described i) CDSS that ii) investigated the impact of their use iii) in maternity settings. Medline, CINAHL, CENTRAL and HMIC were searched for articles relating to evaluations of CDSS in maternity settings, with forward- and backward-citation tracing conducted for included articles. Risk of bias was assessed using the Mixed Methods Assessment Tool, and CDSS were described according to the clinical problem, purpose, design, and technical environment. Quantitative results from articles reporting appropriate data were meta-analysed to estimate odds of a CDSS achieving its desired outcome using a multi-level random effects model, first by individual CDSS and then across all CDSS. PROSPERO ID: CRD42022348157. We screened 12,039 papers and included 87 articles describing 47 unique CDSS. 24 articles (28%) described randomised controlled trials, 30 (34%) described non-randomised interventional studies, 10 (11%) described mixed methods studies, 10 (11%) described qualitative studies, 7 (8%) described quantitative descriptive studies, and 7 (8%) described economic evaluations. 49 (56%) were in High-Income Countries and 38 (44%) in Low- and Middle-Income countries, with no CDSS trialled in both income categories. Meta-analysis of 35 included studies found an odds ratio for improved outcomes of 1.69 (95% confidence interval 1.24-2.30). There was substantial variation in effects, aims, CDSS types, context, study designs, and outcomes. Most CDSS evaluations showed improvements in outcomes, but there was heterogeneity in all aspects of design and evaluation of systems. CDSS are increasingly important in delivering healthcare, and Electronic Health Records and mHealth will increase their availability, but traditional epidemiological methods may be limited in guiding design and demonstrating effectiveness due to rapid CDSS development lifecycles and the complex systems in which they are embedded. Development methods that are attentive to context, such as Human Centred Design, will help to meet this need. None.

Evaluating the feasibility of prehospital point-of-care EEG: The prehospital implementation of rapid EEG (PHIRE) study.

Point-of-care electroencephalography (EEG) devices can be rapidly applied and do not require specialized technologists, creating new opportunities to use EEG during prehospital care. We evaluated the feasibility of point-of-care EEG during ambulance transport for 911 calls. This mixed-methods study was conducted between May 28, 2022 and October 28, 2023. Emergency Medical Services (EMS) clinicians identified eligible individuals, provided emergent treatment, applied EEG, and obtained an EEG recording during ambulance transport. Eligible patients were aged 6 years or older and evaluated for seizure, stroke, or altered mental status. EMS clinicians completed a survey and a brief phone interview following every enrollment. Two epileptologists reviewed EEG recordings for interpretability and artifact. There were 34 prehospital encounters in which EEG was applied. Patients had a mean age of 69 years, and 15 (44%) were female. EEG recordings had a median duration of 10 min 30 s. It took EMS clinicians an average of 2.5 min to apply the device and begin EEG recording. There were 14 (47%) recordings where clinicians achieved a high-quality connection for all 10 electrodes and 32 (94%) recordings that were sufficient in quality to interpret. There were 24 (71%) recordings with six or more channels free of artifact for 5 min or more. All clinicians agreed or strongly agreed that the device was easy to use. Among real-world prehospital encounters for patients with neurologic symptoms, point-of-care EEG was rapidly applied and yielded EEG recordings that could be used for clinical interpretation, demonstrating the feasibility of point-of-care EEG in future prehospital care.

Healthy sleep practices for consumers of home total parenteral nutrition: A mixed-methods community-based participatory study

Healthy sleep practices for consumers of home total parenteral nutrition: A mixed-methods community-based participatory study

A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California.

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP. In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP. Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services. Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.

College Women’s Establishing of Peer Social-relationships and Communicating about Pandemic-related Political Identities and Topics

This mixed-methods study examines two research areas concerning whether U.S. women college students, compared with men, enrolled in online classes during the pandemic suffered from stress regarding their ability to socialize and negotiate a community/national political issue(s) affecting them negatively academically in terms of their grade point average and course outcomes, as well as whether the women would experience a sense of belonging and camaraderie with classmates by discussing topics impacting their identities and circumstances in terms of their individual and communal, social-relational, health, and financial pandemic contexts, which might also influence them negatively academically as stressors linked to their course outcomes and progress. Conducted in a rural, geographically marginalized area, the study implements survey and short-answer question instruments and utilizes an exploratory case-study design and a convergent-parallel strategy assessing 188 women and 188 men participants, including racial/ethnic minority and low socio-economic status (SES) women, with women’s median age of 23. of women and men surveyed, the former reported statistically significantly higher stress levels than men connected to the women’s need to socialize and tackle pandemic-oriented community and national political issues affecting their lives and statuses, which subsequently influenced their academic progress. Overall, the pandemic damaged women, especially racial/ethnic minorities, more than men, with women having higher stress rates revolving around their need for socializing (59% versus 33%) and addressing political issues (54% versus 32%), stressors hampering the women’s academic outcomes and status, as well as some experiencing additional stress regarding health and financial concerns. In response to these settings, 21% of women (n = 40) desired to discuss controversial topics, such as their pandemic stressors and related experiences in the classroom, including the pandemic’s political consequences for themselves, to promote self-expression, forge bonds, and seek and provide assistance in addressing all classmates’ academic, personal, and community needs.

The Effectiveness of Graphic Organizers in Fostering the Learning of Chemical Bonding in Chemistry

Graphic Organizers are visual and graphic display that illustrates the correlations between facts, terms, and ideas with a learning task. Integrating Graphic Organizers can enhance the efficiency of the teacher's delivery of lessons and students' learning. However, no study had been conducted in using graphic organizers in the process of teaching and learning. Therefore, this explanatory mixed-method study aimed to investigate the effectiveness of Graphic Organizers in teaching Chemical Bonding to grade nine (n=98) students in Samtse Dzongkhag, Bhutan. The study's main objective was to compare the academic achievement of the control group (n=53) and experimental group (n=45) and also to investigate students' and teachers' (n=6) perceptions of using Graphic Organizers in teaching and learning Chemistry over four weeks. Learning achievement tests (pre-test and post-test), semi structured interviews, and survey questionnaires were used to collect the quantitative data and qualitative data. The independent sample t-test analysis of the post-test scores revealed a statistically significant difference between the control group and the experimental group with a mean difference value of 1.17 (p=0.017), indicating that the use of Graphic Organizers improved the students' learning achievement which was also reflected in the qualitative data gathered through interview and survey questionnaire. As a result, this study strongly suggests the use of graphic Organizers as a teaching and learning tool to improve students' academic performance in Chemistry.

Exploring the Impact of the Production-Oriented Approach on Chinese University Students’ Motivation for English Learning: A Mixed Methods Study

Exploring the Impact of the Production-Oriented Approach on Chinese University Students’ Motivation for English Learning: A Mixed Methods Study

How Does Comprehensive Art Education Facilitate Children’s Creativity? A Mixed-Methods Study in China

ABSTRACT Research Findings: Comprehensive art education (CAE) can be an effective way to develop children’s creativity development. However, little is known about how CAE is implemented in kindergarten classrooms in China. The purpose of this study was to explore the effectiveness of CAE activity implementation. To assess the effectiveness of CAE in terms of early childhood creativity, 64 children in a Chinese kindergarten were assigned to experimental (n=32; 15 boys and 17 girls) and control (n=32; 15 boys and 17 girls) groups. The complete CAE intervention program, including teacher training and CAE activities, lasted for 11 months. Both groups of children took the Torrance Tests of Creative Thinking (TTCT) pretest and posttest to assess their creativity. The findings showed that the experimental group had significantly higher TTCT scores than the control group. In addition, interviews with five teachers echoed the test results and raised the need for related teacher training. Practice or Policy: Results indicated a clear connection between the CAE activities and the enhancement of the children’s creative thinking abilities. These findings suggest that CAE nurtures children’s creativity and should form an essential component of early childhood and teacher education curricula.

Abstract PR012: Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi

Abstract Background: Native Hawaiians and Pacific Islanders (NHPI) are hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities, often masked by aggregated data with Asian Americans. An average of 7,393 Hawai‘i residents are diagnosed with invasive cancer yearly, and rates are disproportionate ethnically; . Native Hawaiians and Micronesians suffer higher mortality rates for breast cancer (24.9 and 21.6 per 100,000) than White women (17.0). This study aims to investigate social drivers of health behaviors among NHPI in Hawaiʻi by examining social factors that influence cancer screenings through mixed methods. Methods: This mixed methods study is a follow-up to a cross-sectional survey administered in 2018 to 3 Pacific Islander ethnic subgroups: Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling within public housing (N=1,010 NHPI). Disparate cancer screening practices were uncovered within these groups when compared to Hawaiʻi state data. Logistic regression was used to analyze predictors of colon, breast, and cervical cancer screenings. The Gelberg Behavioral Model for Vulnerable Populations and socio-ecological model served as the theoretical models. To triangulate the findings, 16 semi-structured interviews with adults living within the communities first surveyed were conducted in 2023 to uncover any additional drivers of health behaviors that the regression missed. Results: Quantitative findings include cultural/linguistic misunderstandings between NHPI and healthcare providers. Participants who indicated difficulty understanding a provider’s instructions because of language were 51% less likely to be screened for cervical cancer (p = .04). Individuals who hold neutral acculturation to both their ethnic and American culture are less likely to be screened for cancer. Those whose responses fell in a neutral category were 40% less likely than those with a high ethnic identity to have had a colon cancer screening (p = .02). Qualitative findings demonstrate differing views among Pacific Islander groups including competition for resources between groups within public housing. All of the interviewees highlight the role of God and faith in decision making. Informational exchanges take place mainly within the family and cohabitants. From triangulating the findings, there is a lack of strong social ties/networks that could facilitate health-based resources and knowledge. Families are not discussing self-care or family histories of disease, which are instrumental in the early detection of cancers and missed within the regression. Conclusion: This study provides insight into the social drivers of cancer screenings for NHPI communities in Hawaiʻi. Novel insights for the fields of medical sociology and public health are highlighted by influential social processes to NHPI cancer screening behaviors. Recommendations include further research and programs that focus on and foster social dynamics of these communities in relation to cancer screenings. Citation Format: Mark L. Willingham Jr., Kevin Cassel, Wei Zhang, Tressa P. Diaz, Angela Sy, Ian Pagano, Munirih R. Ta'afaki, Angelina G. Mummert. Social and Structural Influences of Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults in Hawaiʻi [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR012.

Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study

Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study

Pharmacist supply of non-prescription sildenafil in Norway: a simulated patient mixed-method study

Pharmacist supply of non-prescription sildenafil in Norway: a simulated patient mixed-method study

Modification of childcare’s outdoor setting for toddler physical activity and nature-based play: A mixed methods study

Modification of childcare’s outdoor setting for toddler physical activity and nature-based play: A mixed methods study

Receiving a pathogenic variant in a population breast cancer screening trial: a mixed method study

Receiving a pathogenic variant in a population breast cancer screening trial: a mixed method study

Factors Affecting Job Satisfaction Among Medical Postgraduate Trainees In A Tertiary Hospital, Imphal, Manipur : A Mixed Method Study

Background: Doctors’ dissatisfaction with their jobs can have significant public health implications as it may adversely affect the clinical management of patients and it may affect their health as well. Objectives: To assess job satisfaction and explore the perceived barriers and facilitators of job satisfaction among postgraduate trainees in a tertiary hospital, Imphal. Materials and Methods: A mixed-method study was conducted among postgraduate trainees. For the quantitative component, all the postgraduate trainees (430) enrolled in a tertiary hospital were included. For the qualitative part, participants were approached for in-depth interviews using purposive sampling till the saturation point was reached. Data was summarised in mean, standard deviation, and percentage. Chi-Square test and ANOVA, followed by Bonferroni for comparison were applied. Thematic analysis was done for qualitative data. Results: Overall, 89.1% of the participants were not satisfied with their jobs. Out of 405 respondents, 96 persons disagreed, and 42 persons strongly disagreed on being satisfied with their working hours. Participants were most satisfied in domains of teamwork, leadership, empowerment and participation. Among postgraduate trainees of different departments, PMR was the most satisfied and Obstetrics and Gynaecology was the least satisfied. Conclusion: Most participants experienced burnout due to increased working hours and lack of work- life balance. They also expressed the need for rewards and recognition.

Uncovering the Complexity of Perinatal Polysubstance Use Disclosure Patterns on X: Mixed Methods Study

Background According to the Morbidity and Mortality Weekly Report, polysubstance use among pregnant women is prevalent, with 38.2% of those who consume alcohol also engaging in the use of one or more additional substances. However, the underlying mechanisms, contexts, and experiences of polysubstance use are unclear. Organic information is abundant on social media such as X (formerly Twitter). Traditional quantitative and qualitative methods, as well as natural language processing techniques, can be jointly used to derive insights into public opinions, sentiments, and clinical and public health policy implications. Objective Based on perinatal polysubstance use (PPU) data that we extracted on X from May 1, 2019, to October 31, 2021, we proposed two primary research questions: (1) What is the overall trend and sentiment of PPU discussions on X? (2) Are there any distinct patterns in the discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies? Methods We used X’s application programming interface to extract >6 million raw tweets worldwide containing ≥2 prenatal health- and substance-related keywords provided by our clinical team. After removing all non–English-language tweets, non-US tweets, and US tweets without disclosed geolocations, we obtained 4848 PPU-related US tweets. We then evaluated them using a mixed methods approach. The quantitative analysis applied frequency, trend analysis, and several natural language processing techniques such as sentiment analysis to derive statistics to preview the corpus. To further understand semantics and clinical insights among these tweets, we conducted an in-depth thematic content analysis with a random sample of 500 PPU-related tweets with a satisfying κ score of 0.7748 for intercoder reliability. Results Our quantitative analysis indicates the overall trends, bigram and trigram patterns, and negative sentiments were more dominant in PPU tweets (2490/4848, 51.36%) than in the non-PPU sample (1323/4848, 27.29%). Paired polysubstance use (4134/4848, 85.27%) was the most common, with the combination alcohol and drugs identified as the most mentioned. From the qualitative analysis, we identified 3 main themes: nonsubstance, single substance, and polysubstance, and 4 subthemes to contextualize the rationale of underlying PPU behaviors: lifestyle, perceptions of others’ drug use, legal implications, and public health. Conclusions This study identified underexplored, emerging, and important topics related to perinatal PPU, with significant stigmas and legal ramifications discussed on X. Overall, public sentiments on PPU were mixed, encompassing negative (2490/4848, 51.36%), positive (1884/4848, 38.86%), and neutral (474/4848, 9.78%) sentiments. The leading substances in PPU were alcohol and drugs, and the normalization of PPU discussed on X is becoming more prevalent. Thus, this study provides valuable insights to further understand the complexity of PPU and its implications for public health practitioners and policy makers to provide proper access and support to individuals with PPU.

Implementing learning into practice from continuous professional development activities: a scoping review of health professionals’ views and experiences

PurposeContinuing professional development (CPD) is an approach for health professionals to preserve and expand their knowledge, skills, and performance, and can contribute to improving delivery of care. However, evidence indicates that simply delivering CPD activities to health professionals does not lead to a change in practice.This review aimed to collate, summarize, and categorize the literature that reported the views and experiences of health professionals on implementing into practice their learning from CPD activities.MethodsThis review was guided by the Joanna Briggs Institute Reviewers’ Manual methodology for scoping reviews. Three databases, PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL), were systematically searched in February 2023 for articles published since inception. Two independent reviewers screened the articles against the inclusion criteria, and completed the data extraction. Data were summarized quantitatively, and the findings relating to views and experiences were categorized into challenges and facilitators.ResultsThirteen articles were included. Implementation of learning was not the primary focus in the majority of studies. Studies were published between 2008-2022; the majority were conducted in North America and nurses were the most common stakeholder group among Healthcare Professionals (HCPs). Five studies adopted qualitative methods, four quantitative studies, and four mixed-methods studies. The reported barriers of implementation included lack of time and human resource; the facilitators included the nature of the training, course content and opportunity for communal learning.ConclusionThis review highlights a gap in the literature. Available studies indicate some barriers for health professionals to implement their learning from CPD activities into their practice. Further studies, underpinned with appropriate theory and including all relevent stakeholders are required to investigate strategies that may facilitate the integration of learning from CPD into routine practice.

The Role of Elements of Text Analysis in Consecutive Interpreting Performance: A Mixed-Methods Study

Despite the theoretical importance of text analysis in translation process, there is a paucity of experimental research into the role that the elements of the text can play in enhancing interpreting performance. The present study, adopting a mixed-methods design, aimed to investigate whether knowledge of text elements enhances consecutive interpreting performance. In so doing, a sample of 36 homogeneous undergraduate translation students participated in this study based on convenience sampling, and a pool of six students participated in the qualitative phase of the study based on purposive sampling, following the data saturation method. Following Nord’s guidelines for text analysis, the experimental group was exposed to the elements of text during the intervention. A validated assessment rubric was utilized to measure students’ interpreting performance, taking the inter-rater reliability of the scores also into consideration. The results of one-way ANOVA confirmed that there was a statistically significant difference between the control group and the experimental group; the experimental group outperformed the control group. Having calculated the inter-coder reliability of the responses emerged from the interviews, the number of common factors included six themes, namely unique, new information, message analysis, motivating, general lexis, and semiotics. In the end, some practical implications are offered for interpreting students and teachers.

Developing an Individualized Patient Decision Aid for Chronic Coronary Disease Based on the ISCHEMIA Trial: A Mixed-Methods Study

BACKGROUND: Pursuing initial invasive or conservative management of chronic coronary disease (CCD) is a preference-sensitive decision that should include shared decision-making. Communicating the benefits of either approach is challenging, as individual patients rarely achieve the population-averaged outcomes reported in clinical trials. Our objective was to develop a patient decision aid (PDA) with patient-specific estimates of outcomes for initial invasive versus conservative management of CCD, based on the ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches). METHODS: This was a multiphase mixed-methods study using focus groups of outpatients with CCD, caregivers, clinicians, and researchers. Focus groups were held in Kansas City, MO and New York City, NY between September 2021 and June 2022. Patients with CCD were included if they had a positive stress test within 1 year. Phase 1 focused on patient priorities for outcomes to guide treatment decisions. Phase 2 involved PDA development and refinement. Phase 3 involved further refinement and member checking. Key themes involving shared decision-making and treatment preferences were elicited from focus groups using a deductive approach to develop a PDA representing the outcomes most important to patients. RESULTS: Of 46 patient and caregiver participants, the mean age was 63.5 years, 53% were female, 61% were White, 24% were Black, and 9% were Hispanic. When deciding between treatments, participants valued shared decision-making but generally deferred decisions to clinicians. The outcomes most important to participants were survival and quality of life, followed by physical functioning and symptoms. To represent these outcomes, participants favored simple visualizations, such as a speedometer or health meter. When deciding between treatment options, participants preferred to use the PDA collaboratively with a clinician instead of as a stand-alone tool. CONCLUSIONS: Our novel, patient-centered approach to developing a PDA for CCD with patient-specific outcomes has the potential to rapidly translate clinical trial results to individual patients and support shared decision-making.

Emotional and psychological safety in the context of digital transformation in healthcare: a mixed-method strategic foresight study

BackgroundPerceived safety has received attention in the digital transformation of healthcare. However, the impact of perceived safety on the future of digital transformation has not been fully elucidated.AimTo investigate perceived...