Mixed Methods Analysis Research Articles

Highs and Lows: A Mixed-Methods Analysis of the Impact of Adult Use Legalization on Medical Cannabis Patients

ABSTRACT Presently, 24 states have legalized adult use (recreational) cannabis, each following medical-only access. Although states that pass adult use laws report substantial declines in the number of registered medical patients, these laws expand the market, potentially enhancing patient benefits. However, research on federal adult use cannabis legislation in Canada suggests that adult use laws negatively impact medical patients. The purpose of this mixed-methods study was to examine medical cannabis patients’ perceptions of the impact of adult use cannabis laws in the US. We conducted an online survey with forced choice and open-ended questions in a convenience sample of 505 medical cannabis patients. Quantitative analysis indicated that adult use laws decreased stress and legal concerns, and that patient perceptions of cannabis product quality and availability were higher, but prices were also higher. Qualitative analysis largely aligned with quantitative findings, however data were somewhat divergent on price and product availability (with some patients reporting lower prices and accessibility issues). Mixed-methods analysis revealed that legalization also reduced patients’ experience of social stigma. Addressing the patient concerns revealed by these data may help to restore or maintain patient access to affordable, medically relevant cannabis products as additional states merge medical cannabis programs into adult use paradigms.

How ChatGPT Changed the Media’s Narratives on AI: A Semi-automated Narrative Analysis Through Frame Semantics

We perform a mixed-method frame semantics-based analysis on a dataset of more than 49,000 sentences collected from 5846 news articles that mention AI. The dataset covers the twelve-month period centred around the launch of OpenAI’s chatbot ChatGPT and is collected from the most visited open-access English-language news publishers. Our findings indicate that during the six months succeeding the launch, media attention rose tenfold—from already historically high levels. During this period, discourse has become increasingly centred around experts and political leaders, and AI has become more closely associated with dangers and risks. A deeper review of the data also suggests a qualitative shift in the types of threat AI is thought to represent, as well as the anthropomorphic qualities ascribed to it.

Teletherapy could miss a distinct group among patients with pain and opioid use disorder

The COVID-19 pandemic highlighted a pre-existing issue related to healthcare accessibility, especially for comorbid chronic pain and opioid use disorder (OUD) populations. Though researchers and practitioners have relied on telehealth to address barriers to healthcare, telehealth services remain inaccessible for many. This study explored the effectiveness of strategies used to continue a clinical trial for comorbid chronic pain and OUD during the COVID-19 pandemic. This study involved the transition of in-person group psychotherapy (Self-regulation Therapy for Opioid use disorder and Chronic Pain–STOP) to telehealth. We completed a mixed-method data analysis to assess the differences between the telehealth and in-person administrations. Though the telehealth group showed higher retention, the in-person group reached more diverse samples. Participants who completed the telehealth group had higher education and income, longer periods of stability on medication for opioid use disorder (MOUD) and were more likely to be White compared to participants who completed the in-person group. Individuals from minoritized and underserved groups who lack access to in-person services may fall through the gaps of healthcare in the shift to telehealth. There is a clear need for additional research on how to best support those who lack access to current comorbid chronic pain and OUD treatment modalities. ClinicalTrials.gov record number:17–1849, registered November 2017.

Inclusive Excellence in Practice: Integrating Equitable, Consequential Learning and an Inclusive Climate in Higher Education Classrooms and Institutions

In education, initiatives aimed at improving diversity, equity, inclusivity, and justice (DEIJ) are often conceptualized and implemented separately from those addressing students’ and faculty’s learning — and the reverse is also true. In this theoretical paper with an empirical illustration, we present a holistic framework based on our experience with a comprehensive change initiative. The I2 Framework posits that DEIJ and learning goals need to be addressed simultaneously and at multiple, intersecting organizational levels. Through a systems approach, I2 integrates change activity across two dimensions: one representing goals of reform (DEIJ and improved learning) and another representing levels of organizational change (classroom and department/organization). I2 integrates the work of creating equitable, consequential learning opportunities in the classroom and the work of creating an inclusive climate at the departmental/organizational level, emphasizing their inherent relatedness. We provide an empirical example based on design-based implementation research and related mixed methods analyses of a multi-year change project in an engineering department at a large, public university in the United States. The example highlights a need to shift the nature of this work, how we do this work, and the environment and culture within which we do this work at both the classroom level and the department level. The example also illustrates ways that elements of the change initiative intersected with existing institutional practices, leading some innovations to succeed and others to be resisted. The I2 Framework provides guidance to practitioners, policymakers, and leaders working towards equitable, consequential learning at the classroom level and an inclusive climate at departmental and institutional levels.

Global citizenship, global access, and world-class education: constructing institutional narratives at the Sino-British universities

PurposeThis study aims to contribute to understandings of how international universities in China construct institutional narratives to attract Chinese students by leveraging themes of global citizenship and international mobility.Design/methodology/approachQualitative analysis of web and other university materials, and mixed-method analysis of social media (WeChat) to identify and quantify recurring themes in the universities’ student-facing presentation.FindingsDespite differing operational models, both universities emphasize Western education’s prestige and global citizenship, primarily appealing to affluent families and positioning themselves as pathways to international postgraduate study.Originality/valueThe research provides new insights into the student recruitment strategies of international universities in China, contributing to the broader understanding of higher education internationalization in non-Western contexts.

Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis

BackgroundThe World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana.MethodsThis was explanatory mixed methods research which started with a document review of Ghana’s WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically.ResultsGhana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana’s implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care.ConclusionGhana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Uptake and acceptability of oral HIV self-testing in the context of assisted partner services in Western Kenya: A mixed-methods analysis.

Integrating HIV self-testing (HIVST) into assisted partner services (APS) has potential to increase identification of people with HIV in the community, but little is known about acceptability of HIVST among partners traced via APS. We assessed characteristics of APS partners testing with HIVST, and factors influencing HIVST uptake and acceptability in a cluster-randomized control trial on APS+HIVST. Using convergent parallel mixed-methods design, we evaluated socio-demographic and behavioral characteristics of APS partners who were offered HIVST or provider-delivered testing, and purposively selected a sub-set of partners for in-depth interviews (IDIs). Descriptive and log-binomial regression analyses were performed controlling for health facility clusters, while IDIs were thematically analyzed applying the theoretical framework of acceptability. Among 3312 partners who were offered HIVST or provider-administered testing through APS, 2724 (82.2%) used HIVST. There was no association between partner demographics and HIVST uptake. HIVST use was less likely than provider-delivered testing among those identified as a casual (adjusted relative risk (aRR) = 0.93; 95% Confidence Interval (CI) 0.88-0.98) or transactional (aRR = 0.90; 95% CI 0.87-0.94) partner compared to those in a defined relationship. HIVST use was slightly lower among those offered the option of an additional kit when compared to those only offered one kit (aRR = 0.93; 95% CI 0.88-0.98). In the IDIs (N = 24), partners reported that HIVST was a viable option for individuals who do not find provider-delivered testing suitable or convenient. For the APS partners, 'intervention coherence', 'self-efficacy', and 'ethicality' presented as most significant theoretical framework of acceptability constructs. APS providers played a critical role in creating HIVST awareness and driving acceptability. Increasing HIVST awareness and providing tailored solutions will empower APS clients optimize their HIV testing decisions. Providers should consider context of the partner's sexual encounter and extend counselling support when recommending HIVST within APS.

Inclusive Design as a Catalyst for Disability Employment: A Multi-Industry Analysis

Despite increasing awareness of workplace diversity, people with disabilities continue to face disproportionately high unemployment rates, with global statistics indicating employment gaps of up to 40% compared to the general population. This article examines how inclusive design principles and accessible technologies can reduce these employment disparities effectively. Through a mixed-methods analysis of 47 organizations across multiple industries, The article investigates the relationship between implemented inclusive design practices and employment outcomes for workers with disabilities. The findings demonstrate that companies adopting comprehensive, inclusive design strategies significantly increased disability employment rates (p < .001), with an average 27% improvement in job retention and a 34% increase in job application rates from candidates with disabilities. Case studies reveal that adaptive technologies, user-centered digital platforms, and modified workspaces facilitated greater workforce participation and yielded measurable improvements in productivity and job satisfaction. Cost-benefit analysis indicates an average return on investment of 186% over three years for organizations implementing inclusive design solutions. These results suggest that systematically implementing inclusive design principles can substantially reduce unemployment among people with disabilities while providing tangible benefits to organizations. The article offers evidence-based recommendations for businesses seeking to create more accessible workplaces and contributes to the growing literature on disability employment initiatives.

Stigma trajectories, disclosure, access to care, and peer-based supports among African, Caribbean, and Black im/migrant women living with HIV in Canada: findings from a cohort of women living with HIV in Metro Vancouver, Canada

BackgroundAfrican, Caribbean, and Black im/migrant women experience a disproportionate burden of HIV relative to people born in Canada, yet there is scarce empirical evidence about the social and structural barriers that influence access to HIV care. The objectives of this study is to estimate associations between African, Caribbean, and Black background and stigma and non-consensual HIV disclosure outcomes, and to understand how experiences of stigma and im/migration trajectories shape access to HIV care and peer supports among African, Caribbean, and Black im/migrant women living with HIV in Canada.MethodsThis mixed-methods analysis draws on interviewer-administered questionnaires and semi-structured interviews with self-identifying African, Caribbean, and Black women living with HIV in the community-based SHAWNA (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment) cohort. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were performed to estimate associations between African, Caribbean, and Black background and stigma and non-consensual HIV disclosure outcomes. Drawing on a social and structural determinants of health framework, qualitative analysis of interviews elucidated the interplay between migration trajectories, stigma, racialization, and HIV.ResultsAmongst our participants (n = 291), multivariable GEE analysis revealed that African, Caribbean, and Black participants (n = 15) had significantly higher odds of recently being outed without consent as living with HIV (AOR 2.34, 95% CI 0.98–5.57). Additionally, African, Caribbean, and Black participants had higher odds of recent verbal or physical abuse due to their HIV status (AOR 2.11, 95% CI 0.65–6.91). Reflecting on their im/migration trajectories, participants’ narratives (n = 9) highlighted experiences of political violence and conflict, trauma, stigma, and discrimination associated with HIV in their place of origin and the racialization and stigmatization of HIV in Canada. Fear of disclosure without consent was linked to barriers of accessing care and peer-based supports.ConclusionOur findings indicate that im/migration trajectories of African, Caribbean, and Black women living with HIV are critically related to accessing HIV care and supports in Canada and compound HIV stigma and discrimination. HIV disclosure without consent complicates access to care and social/peer support, underscoring the need for privacy, confidentiality, and the importance of building trust in the context of clinical encounters. The results of this study emphasize the critical need for culturally sensitive trauma-informed care models rooted in peer-based approaches.

A Workshop and Toolkit to Support Late-Career Transitions for Faculty.

Twenty percent of medical school faculty are 60 years or older. These senior-career academic faculty often find a paucity of support for decision-making about late-career transitions. To help fill this professional development gap, we developed and tested an interactive workshop to facilitate deliberation and discussion among mid- and late-career faculty in various stages of career transition planning. The workshop included individual and small-group activities and a takeaway packet/toolkit for career transition planning. We conducted mixed methods analyses of postworkshop survey data to evaluate the workshop content, methods, and toolkit. The workshop was implemented six times, at four national conferences, one state-level conference, and one single institution, for a total of 207 participants. Evaluations were completed by 60% of participants. Thirty-one percent were thinking generally about transition, 40% were making specific plans for transition within 1-5 years, 15% were currently in transition, and 10% had fully transitioned. Perception of workshop objectives met received a median ranking of 4 (rated on a 5-point Likert scale). Participants reported positive outcomes, including taking time to think/reflect, finding starting points for transition planning, and sharing conversations. This highly rated, interactive workshop provides support and practical tools for faculty considering late-career transitions. In addition to providing resources for individual faculty, this workshop has value for an institution to support their senior-level faculty. We encourage the incorporation of this workshop into institutional faculty development programming to ensure a career lifespan approach to faculty development.

In This Issue: Mixed Methods Systematic Methodological Reviews, Pillar Integration Applications, Mixed Methods Analysis of Video Interaction Data, Intersectional Mixed Methods Research, Mixed Methods Analysis of Witness Statements, and Combining Community-Based Participatory Approaches to Study Neighborhoods

In This Issue: Mixed Methods Systematic Methodological Reviews, Pillar Integration Applications, Mixed Methods Analysis of Video Interaction Data, Intersectional Mixed Methods Research, Mixed Methods Analysis of Witness Statements, and Combining Community-Based Participatory Approaches to Study Neighborhoods

Abstract 4147628: A Mixed Methods Analysis of Patient Knowledge in Peripheral Artery Disease

Introduction: Patient knowledge of lower extremity peripheral artery disease (PAD) is low compared to other cardiovascular diseases. Research Questions/Hypothesis: We hypothesize that demographic and socioeconomic factors impact patient knowledge of PAD. Goals/Aims: To obtain qualitative description of and identify factors associated with patient knowledge of PAD. Methods/Approach: We performed a convergent parallel mixed methods study of participants with an established PAD diagnosis. Participants completed an 87-item survey assessing demographics, awareness of PAD diagnosis, and PAD knowledge. Functional health literacy (FHL) was measured using the short Test of Functional Health Literacy Assessment. Multivariable linear regression was used to identify factors associated with PAD knowledge scores. Semi-structured interviews were used to describe understanding of PAD. Transcripts were analyzed with inductive and deductive coding, and a constant comparative approach was used to identify themes. Results/Data: There were 91 participants (77.2% response rate, 49.5% female, 29.7% Black, mean age 68.6 years). Most participants (51.7%) had chronic limb-threatening ischemia and 17.6% had a previous major amputation. While 21.3% had poor FHL and 24.4% were unaware of their PAD diagnosis, the average knowledge score was 79.1%. On bivariate analysis, non-White race, non-ambulatory status, poor FHL, lack of awareness of PAD diagnosis, and not knowing the chronicity of diagnosis were inversely associated with knowledge score. Multivariate linear regression showed that poor FHL, non-White race, and not knowing the chronicity of PAD diagnosis were independently associated with low PAD knowledge. Qualitative analysis of 22 participants revealed that patients have difficulty understanding the name “PAD”, confuse PAD with other comorbidities, and have incorrect beliefs about PAD despite high knowledge scores. Conclusions: Knowledge of PAD is associated with health literacy. However, patients have incorrect beliefs and difficulty understanding the terminology associated with PAD despite a high average knowledge score. Knowledge scores may not adequately reflect understanding. Future research will focus on optimizing patient education, identifying strategies to appropriately gauge patient understanding, and understanding the association between knowledge and behavior in PAD.

Transforming Cybersecurity Infrastructure : A Multi-dimensional Approach to Risk, Culture, and Technological Integration

The rapid acceleration of digital transformation has exposed critical limitations in traditional cybersecurity approaches, particularly in their reactive nature and disconnection from broader organizational strategies. This article critically examines current cybersecurity practices in IT infrastructure management, identifying significant gaps in the integration of security measures with business objectives, organizational culture, and emerging technologies. Through a mixed-method analysis of industry practices and empirical data from multiple case studies, The article proposes a comprehensive framework that transcends conventional security paradigms. The article introduces a proactive, risk-based approach that integrates cultural transformation, emerging technologies, and resilience building while fostering strategic partnerships across stakeholder groups. Initial implementation across various organizational contexts demonstrates significant improvements in security posture, incident response times, and overall business alignment. The findings contribute to both theoretical understanding and practical application of integrated cybersecurity management, offering valuable insights for practitioners and researchers in the field of IT security and organizational resilience. This article addresses a critical gap in current literature by providing a holistic approach that aligns cybersecurity initiatives with organizational transformation while considering human factors and technological evolution.

Collaboration strategies affecting implementation of a cross-systems intervention for child welfare and substance use treatment: a mixed methods analysis

BackgroundCollaboration strategies refer to policies and practices used to align operations and services across organizations or systems. These strategies can influence implementation of cross-system interventions focused on improving integration of care, but remain under-specified and under-examined. This study identifies collaboration strategies and the conditions under which they affected implementation of Sobriety Treatment and Recovery Teams (START), an evidence-based intervention focused on integrating child welfare and behavioral health services for families involved with both systems.MethodsOur study sample included 17 county child welfare agencies that implemented START. Data on collaboration strategies and organizational context were obtained from key informant interviews, frontline worker surveys, and contracts. Contextual data were drawn from secondary data, and fidelity data were drawn from an administrative database. Qualitative and quantitative data were integrated using coincidence analysis, and used to identify combinations of conditions that uniquely differentiated agencies with higher and lower fidelity to START.ResultsFidelity was lower for intervention components requiring cross-system collaboration. Although key informants acknowledged the importance of collaboration for START implementation, few agencies used formal collaboration strategies other than staff co-location or reported high communication quality between frontline staff in child welfare and behavioral health. In coincidence analysis, four conditions differentiated agencies with higher and lower fidelity with 100% consistency and 88% coverage. We found that either strong leadership support or, in high need communities, third-party resource support from local behavioral health boards were sufficient for high fidelity. Similarly, in high need communities, absence of third-party resource support was sufficient for low fidelity, while in low need communities, absence of communication quality was sufficient for low fidelity.ConclusionAdministrators, frontline workers, and interested third parties (i.e., other stakeholders not directly involved in implementation) can use collaboration strategies to facilitate implementation. However, the effectiveness of collaboration strategies depends on local context. In agencies where internal leadership support for implementation is low but need for intervention is high, third-party resource support may still be sufficient for high fidelity. Further research is needed to test effectiveness of collaboration strategies in different conditions and on a broader range of process and implementation outcomes.Trials registration ClinicalTrials.gov, NCT03931005, Registered 04/29/2019, https://classic.clinicaltrials.gov/ct2/show/NCT03931005.

“That Percentage of Safer”: A Mixed-Methods Analysis of Homeschool Parents’ Perspectives of School Safety

ABSTRACT School safety has been widely studied from the perspectives of administrators, teachers, and students in traditional education settings. However, parents’ perceptions of school safety have been largely overlooked. Moreover, it is unknown how homeschool parents conceptualize safety in educational settings despite school safety being a known motivator for homeschooling. This mixed-methods study uses two years of national-level survey data from 2,124 respondents and four focus groups with thirteen participants to investigate homeschool parents’ school safety concerns. Supporting existing literature, we find that homeschool parents are likely to also be parents of special-needs learners. Findings suggest homeschool parents are not concerned with physical as much as psychological and academic safety. Moreover, homeschool parents tend to frame the concepts and concerns of school safety through the lens their own or their children’s prior traditional school experiences. Study limitations, practitioner implications, and future directions for research are discussed.

The Concept of Healing Waterscapes in Public Open Spaces to Construct the Positive Psychology of Visitors

Public open spaces contain various features that have psychological effects on human mental health. Water, as one of the key elements in landscape design, not only enhances aesthetics but also provides sensory stimulation, social interaction, and psychological benefits. It possesses therapeutic qualities that promote relaxation and reduce stress. Given the rising prevalence of mental health issues among adolescents in Bali, public open spaces incorporating waterscapes play a crucial role. The concept of a "healing waterscape" can be applied in such spaces, where environmental elements are strategically designed to improve mental well-being through psychological approaches. However, no clear criteria for healing waterscape design have been formulated, and it remains unclear whether such criteria are being applied in the waterscapes of public open spaces in Denpasar City and Klungkung Regency. This study aims to establish criteria for healing waterscape design in public open spaces and assess the extent to which these criteria are implemented in Denpasar City and Klungkung Regency. Using a mixed-methods data analysis with JMP software, the study identifies four key variables in healing waterscape design: social, behavioral, cognitive, and emotional factors. The design criteria that should be considered for public space waterscapes in Denpasar and Klungkung include activity diversity, site characteristics, spatial variety, acoustics, water shape, movement, flow, lighting and signage, and both biotic and abiotic components.

"Here's Your Evidence": False Consensus in Public Twitter Discussions of COVID-19 Science

The COVID-19 pandemic brought about an extraordinary rate of scientific papers on the topic that were discussed among the general public, although often in biased or misinformed ways. In this paper, we present a mixed-methods analysis aimed at examining whether public discussions were commensurate with the scientific consensus on several COVID-19 issues. We estimate scientific consensus based on samples of abstracts from preprint servers and compare against the volume of public discussions on Twitter mentioning these papers. We find that anti-consensus posts and users, though overall less numerous than pro-consensus ones, are vastly over-represented on Twitter, thus producing a false consensus effect. This transpires with favorable papers being disproportionately amplified, along with an influx of new anti-consensus user sign-ups. Finally, our content analysis highlights that anti-consensus users misrepresent scientific findings or question scientists' integrity in their efforts to substantiate their claims.

Ask Your Relative: A mixed method analysis of the Sexual Health and Healthy Relationship Q&As submitted by American Indian Alaska Native young adults

BackgroundDisparities in sexual health outcomes persist among American Indian and Alaska Native (AIAN) youth due to intersectional challenges accessing youth-friendly health services. AIAN youth have an increased prevalence of STIs and teen pregnancy. To address disparities in sexual health outcomes, the Ask Auntie/Ask Your Relative (AYR) Q&A service has been used by AIAN youth and young adults for over seven years as a trusted resource for information on sensitive health topics. There is a continued need to better understand the health-seeking behaviors of AIAN youth, especially those related to healthy relationships and sexual health, to improve the alignment of health resources to their needs.MethodsThis mixed-method study began with two phases. Phase 1 involved an analysis of all AYR data using Google Analytics and basic frequency counts. Phase 2 reviewed all questions and answers related to sexual health and healthy relationships (N = 240) using thematic analysis, NVivo 12.0, and intersectionality, guided by the social determinants of health. All AYR answers were coded based on type, name/location, number of times viewed, and examples. The final step of the analytic process was to utilize an intersectional approach and socioecological model (Individual, Community, Tribe/Nation, and World) to create a visual model with results.ResultsPhase 1—Since We R Native began tracking AYR data, the service has been utilized by 2.37 M users, with 1.16 M unique pageviews. The average time on the page was 4 min and 46 s. The number of AYR questions submitted varied by year, and were most frequent in 2016, then decreased in subsequent years. In Phase 2, the main themes identified in AYR questions were (1) Reaching Out for Help, (2) Identity and Physical Development, and (3) Healthy Relationships. Analysis of the Q&A answers identified 244 resources, and of these, 100 were Native-specific. The context-specific resources represented 21 uniquely coded health topics, ranging from women's health to behavioral health.ConclusionsThe broad range of healthy relationship and sexual health questions submitted to the AYR service reflects the types of health information that AIAN young adults want to know about. Resources provided in response to their questions connected Q&A viewers to a wide variety of organizations and programs designed to support AIAN young adults in their health and wellness journey. Findings from this study may be useful for creating additional culturally tailored resources.

Veterinary medicine under COVID-19: a mixed-methods analysis of student and practitioner experiences in Austria.

This study aimed to provide a detailed analysis of the pandemic's impact on the veterinary profession and education in Austria. Two online surveys were conducted from November 2022 to January 2023, inviting all veterinarians and veterinary students in Austria to share their experiences on the impact of the pandemic on their veterinarian work and education in a free text question. A total of n = 289 veterinarians and n = 272 veterinary students provided an answer. In summary, 39.8% of veterinarians reported no impact by the pandemic, while others experienced changes in workload (19.7%), changes in client behavior (14.9%), implementation of safety measures (13.1%), and organizational changes (13.1%). Additional impacts included effects on mental health, private life, finances, as well as physical health. Changes were more frequently mentioned in veterinarians working with pets compared to those working with livestock. In the student panel, only a minority reported no significant impact (8.1%) but 44.9% reporting changes due to online and hybrid learning. Key issues included impaired learning conditions (34.9%), and social distancing (34.6%) leading to social isolation. Some students appreciated increased flexibility and reduced commuting (10.7%), while others experienced mental health challenges (10.7%). Further impacts were related to the implementation of safety measures (5.5%), organizational changes (4.8%) and impaired physical health due to infection (1.1%). Negative changes related to distance learning were mainly reported by students in the final study phase, whereas those in the first study phase reported more positive aspects related to online/hybrid learning. Overall, this study highlights the significant impact of the COVID-19 pandemic on veterinary education and professional practice in Austria, revealing diverse challenges for students and relatively lower but still notable effects on practicing veterinarians. Future research should monitor these impacts longitudinally and explore the integration of beneficial practices into standard veterinary education and care, such as effective digital learning platforms and appointment-based systems.

Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador

BackgroundPoverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.MethodsWe conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.ResultsWe developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.ConclusionsThis study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.