Mixed Methods Approach Research Articles

Barriers and facilitators of implementing a health literacy-based intervention in Portugal

Abstract Background Despite the effectiveness of cervical cancer screening (CCS) in reducing mortality rates, disparities persist in access to screening among women with low health literacy, often termed ‘hard-to-reach women’. Health literacy-based interventions can help promote screening uptake. Based on a health literacy-based intervention for CCS implemented in Lisbon with the support of community workers, this study explores barriers and facilitators of the implementation process as perceived by these actors. Methods The intervention consisted of educational sessions on cervical cancer and CCS aimed at 246 women, implemented in community settings in 2023-2024. Within a mixed-methods approach, a pre-and post-intervention survey was applied to assess willingness to screen, and two focus groups were conducted with 10 community workers on their implementation experiences. Descriptive analysis and content analysis were performed where appropriate. Results Of the 665 women invited, 37% were enrolled in the sessions; 91% completed the follow-up. Community workers valued the informative content as adequate to raise awareness. Implementation facilitators included women’s trust in collaborating organisations and a complement of peer recruitment. Challenges included the additional workload of community workers, finding creative strategies to engage women, scheduling the sessions that best suited women’s time demands, and limited spaces to accommodate several group sessions. Proposed solutions to overcome barriers included increasing the time availability of community workers to support participants’ recruitment and session delivery, conducting itinerant and open sessions, and integrating the sessions within the organisation’s health-promoting activities. Conclusions Health literacy-based interventions are helpful in raising CCS awareness. Tailored interventions sensitive to context demands may contribute to successful actions. Key messages • Health literacy interventions can be key to promoting cervical cancer screening among hard-to-reach women. • Tailored community-based interventions may help address barriers to cervical cancer screening.

Usability Insights from the BUMPER Cancer Prevention App Pilot Study: A Mixed-Methods Approach

Abstract Introduction As the second leading cause of death in the EU, cancer is expected to see a 55% rise in new cases globally over the next two decades. The European Code Against Cancer (ECAC) and the EU’s Beating Cancer Plan (EBCP) provide resources for understanding and preventing cancer. The BUMPER project aims to develop a cancer prevention App to make the ECAC more accessible to the public. Objectives Understand the factors influencing the use of a cancer prevention app among users with different digital health literacy levels and to evaluate the app’s usability. Methods Mixed-methods approach was used to gather user feedback. FGDs explored user perspectives on app usage, while a cross-sectional survey assessed usability through task completion on an initial app wireframe. The pilot was conducted across seven EU countries in late 2023. Results 77 participants participated in the pilots and FGDs across seven EU countries. The average task completion time was approximately 79 seconds. Participants rated their confidence to complete the tasks at 3.96 and difficulty at 2.28 on a scale of 1 to 5. The average task pass rate was 92.11%. Qualitative findings highlighted the need for evidence-based content, user-friendly design, language accessibility, offline functionality, and data security. Participants also stressed the importance of clear instructions, regular updates, and robust tracking features. Despite some challenges, the app was generally well-received, with users appreciating its educational potential and tracking capabilities. Conclusions The BUMPER project’s pilot study demonstrated the cancer prevention App being developed as a potential tool for cancer education and awareness. Despite navigational and language challenges, the app was favorably received by a diverse user base, underscoring the need for ongoing improvements in user guidance, comprehension, and functionality to enhance accessibility. Key messages • BUMPER project’s cancer prevention app shows promise in pilot study, enhancing cancer education and awareness. • Despite challenges, the app was well-received, highlighting the need for ongoing improvements to enhance accessibility.

The Future of Work: A Human-centric Approach to AI, Robotics, and Cloud Computing

This study investigates the impact of artificial intelligence (AI), robotics, and cloud computing on the future of work, focusing on adoption trends, productivity gains, and ethical challenges. Using a mixed-method approach, data were sourced from the OECD AI Policy Observatory, Pew Research Center, and European Union Open Data Portal. Quantitative analysis included K-Means clustering of industries based on technology adoption, with high adopters like North America and Europe leading in cloud computing (65.87%), and Africa showing stronger AI adoption (63.02%). The analysis also highlighted a 14.5% productivity increase in manufacturing, but a 19.3% risk of job displacement. Sentiment analysis revealed that 75% of public sentiment on algorithmic bias was negative, correlating strongly (0.74) with reported violations. The study affirms the need for improved AI governance and stronger GDPR compliance to address ethical challenges, while prioritizing human-centric strategies that ensure inclusive and sustainable outcomes for the workforce.

THE IMPACT OF LANGUAGE IDEOLOGY ON ACADEMIC ACHIEVEMENT CONSIDERING BENGALI LANGUAGE CLASSROOM USERS, AND OTHERS USING THE ENGLISH LANGUAGE IN SOUTHEAST ASIA, WHICH IS A BARRIER TO LEARNING

This paper determines and analyses the problems faced by Bengali Medium students, and how Bengali medium students are treated negatively and thus affect their outcomes, at university. This research paper has been made based on secondary and primary data which the researcher analyzes and graphical representation. The researcher structured a survey questionnaire on a sample size 30. The researcher focused on the actual problems that are being faced by Bengali medium students at university. Also, the researcher tried to find out why Bengali medium students were treated negatively by many faculty members and tried to find out whether these problems are affecting the student’s achievement or not; the researcher also tried to take some suggestions from the students about how can we reduce the problems. A mixed-method approach was considered in writing this paper. With the use of a Likert scale for collecting the primary data from the students was collected. After analyzing these data, the researcher focused on collecting secondary data. Secondary data were collected from different sources i.e. online journals, online articles, and some web pages. KEYWORDS: pedagogical practices, language proficiency, multilingualism, linguistic identity, language barriers

A Critical Study of Psychology of Retail Investors

This research critically examines the psychology of retail investors, focusing on the behavioural finance approach to investment decision-making. Behavioral finance challenges the traditional assumption that investors are always rational, proposing instead that psychological, social, and cultural factors influence financial behaviours. The study aims to explore how demographic factors such as gender, age, and investment experience, along with macroeconomic conditions like interest rates and inflation, shape retail investors' decision-making processes. By analysing both quantitative and qualitative data from surveys and questionnaires, the study seeks to uncover patterns in how emotions, cognitive biases, and social networks affect investment choices across different groups. The scope of this research extends to identifying significant variations in investment behaviour based on demographics and cultural influences. Moreover, the study will test hypotheses related to gender differences in the influence of peers and interest rate changes on investment decisions. Through a mixed-methods approach, this research aspires to provide valuable insights for financial institutions and individual investors, enhancing their understanding of the psychological drivers behind market behaviour and investment strategies.

Enhancing English as a Foreign Language (EFL) learning in Saudi Arabia: the academic contribution of YouTube in EFL learning and cultural awareness

The incorporation of technology in English as a Foreign Language (EFL) classroom has drastically transformed conventional learning models by offering innovative ways to boost students’ engagement and improve learning outcomes. This study investigates the impact of using YouTube as an educational tool to enhance EFL instruction in Saudi Arabia. A total of 200 EFL students were divided into two groups: An experimental group which used You Tube as a source of learning and another group which used normal curriculum. A mixed-methods approach was employed, combining quantitative data from a paired-sample t-test with qualitative feedback from students. The results for paired-sample t-test computations revealed a statistically significant difference (p = 0. 003) across the proficiency level indicating improvement in students’ speaking and listening skills at higher proficiency levels. Of the qualitative answers, motivational and participation enhancement were overemphasized. The research points that the integration of YouTube in EFL classrooms can lead to a remarkable increase in language learning especially in the learning area of listening and speaking abilities among the students. These results offer practical implications for educators seeking to integrate multimedia tools into their teaching strategies to promote more interactive and effective learning experiences.

Sustainable Urban Tourism Development in Doha: Balancing Economic Growth and Environmental Stewardship

This study investigates the development of sustainable urban tourism in Doha, Qatar, with a focus on balancing economic growth and environmental stewardship. The research explores the integration of sustainable practices within Doha’s tourism sector, the implementation of key policies such as the Qatar National Vision 2030, and the impact of the FIFA World Cup 2022 on tourism and sustainability efforts. Using a mixed-methods approach, including qualitative interviews with 30 key stakeholders and quantitative data analysis, the findings reveal that while Doha has made substantial progress in areas such as resource management and green infrastructure development, challenges remain—particularly in retrofitting older buildings and enforcing sustainability standards. The FIFA World Cup 2022 acted as a catalyst for sustainable practices, but the long-term success of these efforts depends on continued investment and policy enforcement. This study provides valuable insights for policymakers, urban planners, and tourism officials working to promote sustainable urban tourism in rapidly developing cities.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Project Health Resilience: a health literacy programme for 16–19-year-olds delivered by doctors

Abstract Background Project Health Resilience is an education-setting based health literacy pilot for Londoners aged 16-19. This is a transitional age when young people independently engage with health services. Greater health literacy levels improve use of preventive services, successful management of long-term health conditions and reduce emergency service use. Research during the COVID pandemic also demonstrated the importance of building trust with health professionals to reduce health inequalities. The impact of poor health literacy is observed universally. This intervention was developed to empower young people at a critical time. Methods 3 bespoke modules (healthcare access; medical emergencies; mental health resilience) were co-produced with young people and delivered by doctors. During 2023, 46 sessions were carried out with 712 attendances across 8 London settings. A mixed-methods approach, including questionnaires and interviews, was used for the evaluation. The study explored whether taking part resulted in increased awareness of services, knowledge, confidence and trust in health professionals. Results Participants reported that topics filled a crucial gap in their learning. Awareness and confidence increased for: awareness of different health services (increase of 18%) and mental health services (38%), confidence calling emergency services (13%), confidence dealing with medical (34%) or mental health emergencies (40%). Knowledge questions answered correctly increased across the 3 modules (46% pre vs 60% post). Trust levels increased and findings suggest that doctors delivering sessions was a key component. Conclusions Findings add to the evidence base around education-setting based health interventions improving health literacy. Providing a unique opportunity for adolescents to engage with health professionals can increase trust levels. Doctors delivering health education at this critical age is a pioneering model which can be replicated in other settings. Key messages • Health literacy education is particularly impactful at this critical age of transition; this can contribute to reducing health inequities across the life course. • Trust, collaboration, and co-production were core principles upon which this pilot thrived. Without input from young people, it is difficult to design appropriate and impactful interventions.

Enhancing digital health competencies: insights from european human resources for health

Abstract Background Mixed-skills for digital health transformation are critical for human resources for health (HRH). This study aimed to inform the design of new training programmes that address soft, hard and digital health skills. Methods Using a mixed-methods design science approach, focus groups were conducted by invitation and with informed consent, online or in-person. A script was prepared with key questions for orientation and facilitation, addressing the topics of current situation, desired situation, desired skills, practical and organisational needs to implement continuous training in healthcare. The collected data were analysed using Nvivo. Results Focus groups (14) had 87 participants (Norway, Latvia, Belgium, Italy and Portugal): 26 healthcare professionals (nurses, midwives, nutritionists, pharmacists, assistants and doctors); 27 managers or directors of hospitals and care centres; 34 experts (digital health specialists, researchers, technical officers, members of professional societies and national authorities). Real needs were identified, with 2 direct sub-themes that were best related to each other (Pearson coefficient, p > 0.40 - cluster analysis): 1. ‘Current situation’: Cybersecurity (eg. privacy, law and ethics); Time (work time versus private time, p = 0.69); Type (informal versus formal training, p = 0.32); Programmes (graduation, continuing education and post-graduation levels). 2. ‘Desired situation: Desired skills (eg. digital - basic ICT, data analysis, soft - communication, emotional intelligence, and hard skills - medication administration, catheters, ECG, vital signs, telehealth - digital stethoscope); Learning design and objectives (eg. collective learning, simulations, location - peer-to-peer and hybrid); Emergency care and the link between primary and secondary levels of care were considered important. Conclusions These findings of convergence among HRH inform Program design process to support the training programs and course syllabus design. Key messages • The identified needs and priorities inform Program design further to support Digital Health Transformation training programs and course syllabus design. • Real needs points to Current and Desired situation, where HRH give important insights that need to be considered to engage people to perform training courses.

Impact of body-focused social media on parenting confidence among postpartum moms as tested using an experimental design

PurposeThis study aimed to understand the impact of social media on postpartum mothers’ parenting confidence among participants in the Moms on Media Study, an experimental mixed methods study.MethodsWe used an embedded mixed methods approach among a sample of postpartum mothers of infants aged 0–6 months who were randomly assigned to view either body focused social media posts (experimental group, n = 65) or infant feeding tips (control group, n = 67) over a 5 day period. ANCOVA was used to examine differences between the experimental and control group on parenting confidence at post-intervention and 1 month follow-up. A subsample of mothers in the experimental group (n = 20) took part in semi-structured interviews post-intervention. Thematic analysis was used to identify themes and subthemes generated from the data.ResultsCounter to expectations, ANCOVA results show that at post-intervention mothers who viewed the body-focused posts scored significantly higher for total parenting confidence (mean difference = 1.36), parenting confidence (mean difference = 0.89), and support confidence (mean difference = 0.53). These differences in total parenting confidence (mean difference = 2.03), parenting confidence (mean difference = 1.40) and support confidence (mean difference = 0.50) were sustained at 1-month follow up. No significant differences were found for child development confidence between the experimental and control group at either post-intervention or 1-month follow-up. Qualitative analysis revealed that many mothers described feeling better about their parenting after viewing body-focused social media posts where they felt mothers were overly focused on their own image versus spending time with their child as a “good” mother “should.”ConclusionsBody-focused social media posts may lead to downward social comparison among postpartum mothers. Findings may help inform interventions or clinical care focused on healthy social media exposure and use during the postpartum period.

Organisation of medical care in large scale incidents: a practice-oriented research in Belgium

Abstract Background CBRNe incidents are emergency situations involving the release of chemical (C) or biological (B) substances or radiological/nuclear (RN) contamination, sometimes through an explosion (e). They can result from intentional malicious acts (e.g. terrorism) or unintentional situations (e.g. accidents). In this context, people (victims, care providers, witnesses), equipment (infrastructure, vehicles), animals, objects and/or the environment (buildings, ambulances) may be contaminated by a substance that could pose a threat to health. CBRNe incidents can quickly overwhelm the response capabilities of the affected region and put the healthcare system under great pressure. This research investigated ways of improving the organisation of medical care in CBRNe incidents in Belgium. Methods this study involved a mixed method approach in 2022-2023 with scoping and in-depth interviews with actors at operational and strategic levels (public health, Internal Affairs, army, fire departments), participative workshops with stakeholders, contextual desk search, ad hoc literature review and international comparison completed with interviews with national experts (Norway, The Netherlands, France and United Kingdom, United States of America). Results hospitals need to be distinguished in type 1 specialized hospitals for decontamination, major trauma management and advanced care for severely burned patients and in type 2 hospitals managing spontaneous arrivals of victims and non-specialised care. All hospitals need to have a strict lock-down policy. On the incident site, an emergency medical mobile team needs to manage the decontamination with the firefighters before the transfer to the most appropriate facility. Additional conditions were found to improve the efficiency of medical care. Conclusions this practice-oriented research contributes to a better organization of medical care in case of CBRNe incidents, with the emergence of practical and feasible solutions. Key messages • Hospitals need to be distinguished according to the need for specialised care in case of CBRNe incidents. • On site decontamination needs to be performed by health professionals and firefighters.

Enhancing Digital Education: A Model for Effective Mobile Learning Implementation in Malaysian Higher Education

This study investigates the implementation of mobile learning (m-learning) services in the smart environment at Kolej Poly-Tech MARA (KPTM) in Malaysia, focusing on establishing effective practices for digital education. Despite the potential of m-learning as an educational tool, its adoption in Malaysia remains limited, with the COVID-19 pandemic highlighting the need for innovative approaches to learning. The research employs a mixed methods approach, gathering quantitative data from 365 respondents, including students, lecturers, and administrators, through Likert-scale questionnaires distributed via Google Forms. Qualitative data were obtained through interviews with 10 selected participants. The study identifies existing practices in m-learning, explores its benefits, and examines challenges faced during implementation. Utilizing descriptive analysis, one-way ANOVA, Independent T-Test, and Regression Correlation, the findings reveal a positive perception of m-learning among stakeholders, alongside challenges related to infrastructure and training. The primary contribution of this research is the development of a model of good practice that provides guidelines for KPTM and other higher education institutions aiming to enhance the quality of mobile learning services. This model emphasizes the importance of accessibility, professional development, and stakeholder collaboration, positioning KPTM toward a more effective digital education landscape. Overall, the study underscores the critical role of m-learning in fostering flexible and engaging learning environments while addressing the barriers to its implementation in Malaysia.

Barriers and facilitators for implementing ABCs for Mental Wellbeing intervention model in Finland

Abstract Background The ABCs for Mental Wellbeing study aims to improve mental health and wellbeing by adopting, implementing and evaluating a universal, community-based mental health promotion intervention model in Finland. The study gathers information and experiences of the implementation processes, identifies barriers and facilitators, and best practices for the implementation, and the feasibility and contextual adaptability of the intervention in different settings and specific target groups. Methods The implementation took place in four municipality community settings. In total, 40 participants attended the ABC activities. The study employs a mixed methods approach to look at the implementation processes: a quantitative survey before and after the implementation, and qualitative interviews with the employees implementing the model and the participants involved with the ABC activities. Results Based on qualitative analysis, the most identified facilitator is management support alongside the competencies of professionals. The observed effects of group activities aligned with the ABC model on mental wellbeing show that participants not only experienced the benefits of model-compliant activities on their mental wellbeing but also increased their awareness of factors influencing their mental wellbeing. The results of the quantitative analysis will be ready during the spring. Conclusions The study offers fresh insights into the obstacles and enablers affecting the implementation of a mental health promotion intervention model. The best practice strategies and guidelines identified are being shared both nationally and internationally and utilised to enhance future programme implementation and adaptation of these practices in various settings. Key messages • Best practice strategies and guidelines for successful implementation of mental health promotion identified. • The ABCs for Mental Wellbeing increased participants’ awareness of the factors influencing their mental wellbeing.

A national job profile for infection control nurses in public health: the development and content

Abstract Background The COVID-19 pandemic emphasized the crucial role of infection control nurses (ICNs) in public health. ICNs working in multidisciplinary infection control teams face challenges, such as new infectious disease outbreaks and vaccination hesitancy. Recognizing the complexity in this domain, Dutch ICNs in municipal public health services expressed the need for a national job profile describing their tasks and responsibilities. Methods A mixed methods approach was used to develop a job profile. National and international documents on infection control professionals were studied by desk research. Insights from Dutch infection control professionals and experts were collected through a survey (n = 171), two interactive discussion meetings (18-22 participants) and meetings with an advisory group of stakeholders, including representatives of the Dutch nurses’ association. Descriptive statistics and deductive content analysis were used to analyze the data. Results The diverse methods facilitated the development of a job profile for Dutch ICNs. The profile describes that, within infection control teams, ICNs play a key role in coordinating and monitoring infection control measures. They facilitate collaboration among (at-risk) individuals, the infection control team, and the collaborating partners. Additionally, ICNs identify emerging risks for infection control and coordinate infection prevention activities in collaboration with the infection control team. During large-scale outbreaks, ICNs take a leading role and, where appropriate, delegate tasks such as contact tracing to crisis workers. Conclusions We developed the first job profile that outlines the tasks and responsibilities of ICNs in Dutch public health services. It contributes to strengthening infectious control services to face future challenges. Findings emphasize the ICNs’ pivotal role in coordinating and monitoring infection control efforts, while enhancing collaboration, even during large outbreaks. Key messages • In close collaboration with infection control professionals a robust job profile was developed, describing the tasks and responsibilities of infection control nurses in the Netherlands. • The new job profile contributes to strengthening the position of infection control nurses working in municipal public health services and infection control teams.

Towards integration of care in Portugal: Expansion of a new management model for the NHS

Abstract Introduction In 1999, the first Local Health Unit (LHU) was created in the Northern region of Portugal to improve management, share resources and integrate care. The LHU integrated a National Health Service (NHS) hospital and primary healthcare (PHC) services located within the same geographic area and became responsible for public health activities and the provision of care. Over the next few years, 7 LHUs were created, the last one in 2012. In 2024, the government expanded this model to the entire territory, creating 39 LHUs. This research analyses the objectives, characteristics and expected outcomes of the scale-up of LHUs. Methods This study utilised a mixed methods approach based on the 6 Ps - Problem, People (policy stakeholders), Process (policy development), Price tag (Resource allocation), Paper (policies, laws, regulations), Programmes (policy implementation); and the political, social and economic setting of the Policy Circle Framework. Findings A 2015 assessment revealed that LHUs did not differ from non-LHUs in terms of access, waiting times, clinical excellency, patient safety or patient centeredness. The degree of integration of care in LHUs seemed lower compared with non-LHUs. However, there was no systematic evaluation of the creation of the first LHU. Despite this, the government announced the intention to expand LHUs to the entire national territory, which culminated with the creation of 39 LHUs in 2024 to deliver integrated care, with an emphasis on the proximity and continuity of health services and promotion. Conclusions Despite the existing knowledge gap on the impacts of LHUs in health outcomes and management efficiency, LHUs can provide opportunities to advance integrated and patient-centred care and develop strategies for managing scarce resources, including the health workforce. Nevertheless, the integration of hospitals and PHC can threaten the centrality of primary health care both in terms of delivery of care and resource allocation.

Navigating Crisis: Resilience and Mental Well-being in Post-COVID Cyprus Students

Abstract Background The mental health of university students is identified as a major challenge in public health, exacerbated by the COVID-19 pandemic. The pandemic and its aftermath have brought forth several stresses, which have had a substantial influence on university students’ mental health. Understanding how resilience, which is crucial in coping with adversity, influences students’ responses to these difficult circumstances is critical. Objectives This study aims to examine the relationship between resilience and mental health outcomes among university students in the Republic of Cyprus after the COVID-19 pandemic. Methods Using a parallel embedded mixed methods approach, resilience was measured using the Conner-Davidson Resilience Scale (CD-RISC) while mental health outcomes were assessed using the Symptom Checklist 90-Revised (SCL 90-R) among a preliminary sample of 470 students. The association between the two was assessed by linear regression analysis, adjusting for potential confounders, and also stratifying by gender. Results Preliminary findings from this ongoing study revealed a significant inverse relationship between resilience and mental health (beta= -0.58, 95% CI -0.88, -0.29), regardless of gender, age, or socioeconomic status. Stratifying by gender revealed for males, the association between resilience and mental health is (beta= -0.50, 95% CI -0.98, -0.32), whereas for females, it is (beta= -0.63, 95% CI -1.04, -0.22). In short, the influence of resilience on protecting mental health appears to be slightly more prominent in women than in males. Discussion This study enriches our understanding of the intricate interplay between the COVID-19 pandemic, resilience, and mental health outcomes among university students. By prioritizing the psychological well-being of this population group, our findings resonate with the World Health Organization’s advocacy for heightened mental health awareness during crises. Key messages • Prevalence of mental health issues post pandemic era among university students. • Resilience as a buffer for mental health crisis in young adults.

A mixed method approach to evaluate a vaccine hesitancy assessment among parents in Dutch language

Abstract Vaccine hesitancy (VH), as a driver for falling vaccine uptake rates, is a significant public health challenge. It is important to monitor this phenomenon and compare results in a unambiguous manner. However, in Dutch and possibly other languages, there is no unequivocal translation for VH. Therefore, we aimed to develop and cross culturally validate a method to assess VH in a simple and self-reported manner, using five differently worded alternatives reflecting ‘doubt’, ‘reluctance’, ‘uncertainty’, ‘concerned’ and ‘indecision’. We designed a mixed method study with a quantitative and qualitative evaluation. In the quantitative evaluation, parents were asked to rate experienced vaccine hesitancy in their decision about vaccinations on a 10-item Likert scale, using the five differently worded alternatives. We analyzed internal consistency with Cronbach’s alpha and correlation with the short parental attitudes about childhood vaccination (PACV-5) scale. A total of 532 parents participated in the survey. We found that the five worded alternatives measured the same construct, indicated by a Cronbach’s alpha of 0.95. The wording resembling ‘doubt’ had the highest correlation with the PACV score (coefficient -0.525, p < 0.001). We subsequently conducted cognitive interviews with 12 parents with lower education levels to evaluate their interpretation of the five wording alternatives and the comprehensibility of the question itself. The wordings resembling ‘doubt’ and ‘uncertainty’ were viewed as most clear and reflecting VH, although some participants had a negative association with ‘uncertainty’. Overall, the question was well understood and minor suggestions were provided to improve comprehensibility. Based on the integrated results of both studies, we conclude that using the word resembling ‘doubt’ in Dutch language is the best instrument to assess VH. We encourage uniform translation of vaccine hesitancy in other languages to enable comparison of results across countries. Key messages • Uniform translation of the term vaccine hesitancy in other language is important to enable comparison of results across countries. • In Dutch language, the word resembling ‘doubt’ is the best instrument to assess vaccine hesitancy.

Coordinating Standard Procedures of Disciplinary Actions to Conflict Resolution Techniques to Facilitate Conducive Working Environment in Zamboanga Sibugay Division

Ensuring a productive and happy work environment in educational institutions requires effective management of employee discipline and conflict resolution. This study fills in the knowledge gap about how Zamboanga Sibugay school administrators handle conflicts and use disciplinary measures. It aims to provide insights into better administrative tactics by assessing the efficacy of these practices and their effects on the workplace. This study uses a mixed-methods approach to evaluate how school administrators handle disciplinary measures and resolve conflicts. Structured questionnaires were utilized to gather quantitative data, and interviews with school officials yielded qualitative insights. The data was analyzed using statistical methods such as t-tests and z-tests, which revealed significant differences and correlations in the use of these practices. Results of the study showed that formal written warnings, formal disciplinary sessions, and verbal warnings are routinely used by school administration as forms of discipline, and the most common disciplinary action is suspension or loss of privileges, whereas termination is the least common. Furthermore, the most often used conflict resolution strategies include compromise, problem-solving teamwork, and compromise. Lastly, there were minimal relationships between the two sets of data, but significant variations were observed in the implementation of disciplinary actions and dispute-resolution strategies. The study concludes that although Zamboanga Sibugay school administrators generally follow established disciplinary procedures and conflict resolution strategies, there are variances in how they implement them. The most common disciplinary measure is suspension or loss of privileges, while the most common method of resolving conflicts is compromise. The results emphasize the necessity of a more coordinated strategy to improve company culture and successfully resolve conflicts. The study thus recommends modifications to improve organizational culture and offers insights into the effectiveness of present methods.

Sustainable Marketing Communication in the Digital Age of Advert Blocking: Implications for Telecommunication Service Providers in Nigeria

The advent of digital technologies has revolutionised marketing communication, offering unprecedented opportunities for brands to engage with their target audience. As consumers increasingly seek to control their online experiences and mitigate interruptions, the adoption of advert-blocking techniques has surged, posing significant challenges for organisations, thereby inhibiting their sustainable marketing communication plans. This paper explores the implications of advert blocking on sustainable marketing communication practices. It examines the factors driving the adoption of ad-blocking and the strategies organisations can employ to navigate this phenomenon for marketing communication sustainability. Anchored on the Selectivity Factor and the Uses and Gratification theories, the study deployed a mixed-method approach, incorporating qualitative analysis of service providers and consumer perceptions as well as quantitative data on advert-blocking trends from a sample size of 163 internet users in Southwest, Nigeria. Findings reveal the pervasive nature of intrusive advertising practices and the growing apprehensions surrounding privacy and data security, driving the widespread adoption of advert blocking. Moreover, analysis indicates a correlation between ad-blocking behaviour and heightened levels of brand scepticism and avoidance tendencies among consumers. Based on findings, organizations are advised to adopt sustainable brand communication strategies, Alternative approaches such as other below-the-line channels, native advertising, branded content, and influencer marketing emerge as promising avenues for engaging audiences while circumventing advert-blocking barriers. The research work accentuates the necessity of adjusting marketing communication strategies to align with evolving target audiences’ preferences, thereby promoting sustainability in the digital era's marketing landscape.