Mixed Methods Assessment Research Articles

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

A Mixed Methods Assessment of an Online Mental Health and Resilience Program for Agricultural Sector Students

ABSTRACT Financial, environmental, and socio-cultural challenges affect the mental health and wellbeing of those working and living on-farm. Education programs can help in improving mental health and overall wellbeing, but most of these programs are offered to established farmers in a face-to-face format, leading to a gap in offerings to many subgroups, including young agricultural entrants. To address these gaps, this paper assesses the value of an online mental health and resilience education program for young agricultural entrants. An explanatory sequential mixed methods approach was applied. Firstly, a quantitative survey was conducted with 172 first year agricultural tertiary students, aged 18–20, to assess the knowledge and skills gained due to program participation. Regressions and propensity score matching were used to determine the effect of program participation. Subsequently, seven interviews were conducted with program participants to provide insights into their experiences of the program. Thematic coding was applied to analyze the qualitative data. Findings from the quantitative survey show a significant increase in mental health knowledge and skills amongst program participants compared to participants in the control group. The qualitative interviews show the ability to work through the material in their own time and space, creates a safe environment for online students. Other mechanisms contributing to learning are using “normal language”, a peer voice in communicating wellbeing, and building on learnings in previous education. This paper addresses a gap in literature by being the first study to evaluate online mental health education for agricultural tertiary students. It provides educators and other program designers with valuable information for future program design to support the wellbeing of young agricultural workers.

Interventions for left-behind children in Mainland China: A scoping review

BackgroundAs the discussion of Chinese left-behind children (LBC) continues, intervention programs dedicated to this population increase and diversify. While reviews have summarized intervention programs promoting LBC’s health and psychological wellbeing, there is no synthesis depicting a comprehensive picture. This scoping review systematically examines interventions tackling LBC’s various issues and identifies their design and foci. MethodWe performed a systematic literature search to extract intervention studies from four English (i.e., Web of Science, Scopus, Embase, & PsycINFO) and one Chinese (i.e., CNKI) database. The quality of the studies was assessed using the Mixed Methods Assessment Tool (MMAT). Two main rounds of deductive coding were performed on Nvivo 12 plus to identify the design and foci of the interventions. ResultsThirty-three articles were identified for our final review. Twenty-six were published in Chinese and seven in English. Existing interventions have tackled multiple psychological, social, physical, developmental, and sexual problems or needs of Chinese rural left-behind children. Among them, LBC’s psychological wellbeing has drawn the most attention. The majority of the reviewed studies performed a randomized controlled trial (N=20). Quantitative evaluation is prevalent, with only one study applying a purely qualitative evaluation. In addition, only two studies adopted validated interventions, while the others are self-designed. ConclusionsThe review results indicate several gaps in intervention studies for LBC. First, many existing interventions have considered LBC’s psychological and social wellbeing, while little effort has been paid to address their educational and intellectual development. Further, while existing interventions are concerned with LBC’s temporary needs, their long-term life planning, as well as their current self-efficacy and self-concept driving their actions towards future self, were neglected. As for the intervention design, empirically validated interventions are recommended for future studies for their verified efficacy and evidence-based standardized practice. In addition, a qualitative evaluation should be considered because it might be more powerful in eliciting realistic and viable solutions to improve the effectiveness and reliability of the interventions from the participants.

Teachers’ experiences of enacting pedagogical models and models-based practice: a systematic mixed study review

ABSTRACT Background The shift from traditional, teacher-led methods towards more student-centred approaches in many countries has positioned pedagogical models and Models-based Practice (MbP) as a potential future for physical education pedagogy. Over the last 10–15 years there has been a surge in publications reporting on teachers’ experiences of enacting models. These studies have not, until now, been synthesised. Such a synthesis would allow a richer, more nuanced and holistic understanding of teachers’ experiences of enacting pedagogical models in physical education. This understanding helps to provide a robust evidence base from which to consider the usefulness of pedagogical models and MbP as a future physical education pedagogy. Purpose The purpose of this review is to explore and synthesise teachers’ experiences of enacting pedagogical models in literature from 2010 to 2022. In doing this we set out to answer the question: What are teachers’ reported experiences of enacting pedagogical models and/or models-based practice? Methods This study employed a systematic mixed study approach to analyse empirical examples of qualitative, quantitative, and mixed methods research published between 1st January 2010 and 31st October 2022. The selection process involved a comprehensive search strategy across four databases (SportDiscus, ERIC, Web of Science, Scopus), title and abstract screening, full-text evaluation, the use of the mixed methods assessment tool and a synthesis of the findings from the 91 included studies. Results The findings highlighted five themes related to teachers’ experiences of enacting pedagogical models: (1) developing democratic classrooms through pedagogical models, (2) enacting pedagogical models for professional growth, (3) strengthening student learning within and beyond the physical domain, (4) aligning curricula through pedagogical models, and (5) challenging the current state of physical education through pedagogical models. Results reveal teachers’ efforts to democratise the classroom environment where students, regardless of their ability, were given equal opportunities. This democratisation occurred alongside teachers’ pedagogical growth but was not without its challenges. The review underscores the multifaceted challenges of integrating pedagogical models into diverse educational contexts. Teachers report on the need for investment in professional development and the garnering of other professional support to be able to negotiate and adapt pedagogical models to the curricular aspirations in local contexts. Importantly, the review highlights how many teachers reported that their use of pedagogical models allowed them to extend student learning beyond the physical domain. Discussion The review makes an important, original and innovative contribution to understanding and knowledge in the field by highlighting the potential of pedagogical models to enrich physical education pedagogy by fostering more inclusive, reflective, and dynamic learning environments. It critically examines the barriers in the enactment of pedagogical models, ranging from infrastructural limitations to the intricacies of using pedagogical models in practice. The paper, therefore, highlights the need for supportive frameworks for teachers implementing pedagogical models that emphasises continuous learning and collaboration. In conclusion, we ask if pedagogical models are destined to remain a lofty ideal, or if there is a need to recalibrate our scholarly compass, broadening our research horizons to envisage a more inclusive and diverse future for physical education?

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Moving milk and shifting risk: A mixed methods assessment of food safety risks along informal dairy value chains in Kisumu, Kenya

Animal sourced foods (ASF) are important for global food security and in mitigating the impact of undernutrition. Across Sub-Saharan Africa, demand and urbanization continue to increase, creating a greater divide between farm-level production and consumption. Food safety residues including antibiotics and aflatoxin residues often originate at the production site, and risk can shift as milk is transported. In 2022, milk samples (n = 190) were collected from eight milk vendors in Kisumu, Kenya and tested for betalactams and aflatoxins with cut off values of 300 parts per billion (ppb) and 200 parts per trillion (ppt), respectively. Data was collected on the origin and containers of each sample, and the eight vendors responded to an open-ended questionnaire regarding the structure and challenges in their milk business.Aflatoxin residues were detected in 7 % (13/190) of samples with no samples (0/190) testing positive for antibiotic residues. Overall, 80 % samples were collected from metal transportation containers, and no milk containers >20 l tested positive for aflatoxins. The origin location(s) of milk was not significantly associated with residues (p = 0.44). Vendor questionnaire data were summarized into three themes: 1) Physical properties of milk are understood to influence quality, 2) Fluctuating availability of milk impacts profits and is the main influence on choice of supplier, and 3) Trust and rapport among value chain actors are key to mitigating business challenges.Our results indicate that farm-level practices around antibiotic use is not posing a major milk safety risk to urban consumers. Use of large 50-l containers for transporting milk may be protective as risk of aflatoxin residues is diluted below key thresholds. We recommend supporting existing relationships and identifying drivers that build trust among informal value chain actors which could strengthen collaboration and allow actors to move towards a shared goal of reliable and safe milk available for urban consumers.

Abstract C132: Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles

Abstract Introduction: Multilevel barriers to screening and follow-up contribute to persistent disparities in cervical cancer burden, particularly in marginalized communities receiving care in safety-net healthcare settings. While evidence-based interventions (EBIs) exist for improving cancer screening and follow-up, building capacity to identify effective strategies for implementation and alignment of EBIs to the context of safety-net settings and the diverse communities they serve is critical. Methods: Supported by the HRSA Accelerating Cancer Screening Program, Chinatown Service Center, a multi-site Federally Qualified Health Center (FQHC) serving Chinese and Latino/a populations in Los Angeles, and USC Norris Comprehensive Cancer Center established a new partnership to identify multilevel factors that impact cervical cancer screening, follow-up and referral and inform the implementation of EBIs to improve care. We conducted a mixed methods assessment June-December 2023 to understand care processes through surveys and qualitative interviews (20-30 minutes, guided by the Consolidated Framework for Implementation Research) with providers and clinic staff and medical chart reviews of patients with ≥ 1 cervical cancer screening order January 2020-March 2023. Results: Surveys (n=23) showed higher knowledge of screening guidelines (p<0.05) and more confidence discussing cervical cancer with patients (p<0.05) among providers compared to clinic staff, indicating opportunities for staff training. Qualitative interviews (n=23) identified inner setting barriers such as limited system-level implementation of cervical cancer screening guidelines and limited technology supports to track patients requiring follow-up. At the individual level, older patients and those not sexually active often declined testing and requested gender concordant (female) providers. Motivation for building cervical cancer care capacity within the FQHC were noted, with clinic members highlighting FQHC strengths in addressing cultural barriers, social needs, and community outreach. Several outer setting barriers emerged for referral and follow-up care, including long wait times for referrals, trouble finding language concordant specialists, transportation barriers, and difficulty accessing specialists through their managed care network. Medical chart abstractions (n=1,428) identified opportunities to improve closed-loop communication with specialists and limited ease for clinic staff identify high and low risk screening results for further treatment. Discussion: By establishing a new FQHC-NCI cancer center partnership, we advanced our combined capacity to address cervical cancer care equity in marginalized communities. We identified patient-level (cultural, logistic, social determinants), provider/clinic staff-level (training needs, patient tracking), and system-level (access to and communication with specialists) barriers that will require selection of EBIs and implementation strategies via a partnered approach with local specialists, health systems, payers, and policymakers. Citation Format: Jennifer Tsui, Samantha Garcia, Emily Dang, Alejandra Ramos, Allison Oh, Kathy Lui, Angela Ching, Eugene Hui, Chanita Hughes Halbert, Lourdes Baezconde-Garbanati, Jack Cheng. Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles [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 C132.

Remote Exercise Engagement Among Individuals With Cardiovascular Disease

Purpose: To systematically review the literature regarding barriers and facilitators to remote exercise among individuals with cardiovascular diseases (CVD). Review Methods: Six databases were searched (inception—December 2023). Studies including barriers and facilitators for remote exercise reported by individuals living with CVD were considered. Quality was rated using the Mixed Methods Assessment Tool (MMAT). Results were synthesized following a thematic analysis approach. Characteristics of interventions were reported using the Template for Intervention Description and Replication (TIDieR). Summary: From an initial pool of 8543 records, 18 studies met the inclusion criteria. Among these, 13 were qualitative studies, with individual interviews being the most frequent data extraction method. Nine studies received 5/5 MMAT scores (ie, high quality). Twelve studies reported remote exercise interventions, mostly delivered within cardiac rehabilitation, by physiotherapists, nurses, and dietitians, predominantly via telephone calls or videoconferences, with only one study incorporating text messages. Five key themes influencing remote exercise interventions were identified: technology (encompassing access and literacy, self-monitoring/motivation, and security concerns), individual health considerations (health/personal aspects and coronavirus disease-2019), social factors (support from health care team and family/social support), environment (facilities), and logistical factors (time and displacement). Several themes served as both facilitators and barriers. Key insights for remote exercise interventions included mobile accessibility, interactive chat sessions, minimal click interactions, short sessions, personalized feedback, and flexible timing. Results emphasize the importance of promoting social interaction and support between participants and health care teams to mitigate barriers and enhance facilitators in remote exercise interventions for individuals with CVD.

Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study.

Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders' perceptions of the usability and use of the CTH dashboards for decision-making. We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders' perceptions of the dashboard's usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939.

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.

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

Rural healthcare workers' well-being: A systematic review of support interventions.

Although there is increased awareness about healthcare workers' (HCWs') stress and burnout after the COVID-19 pandemic, support interventions should be tailored according to the needs of HCWs. Given the unique challenges rural HCWs face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of HCWs practicing in rural settings. We conducted a comprehensive search of the existing literature through electronic databases to identify quantitative, qualitative, and mixed-methods studies describing supportive interventions for rural HCWs with well-being-related outcomes between January 1, 2023 and March 31, 2023. We used the Effective Public Health Practice Project, Mixed Methods Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist to evaluate the study quality. Out of 1,583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized and only six included controls. Included interventions were generally well- accepted. Quantitative and qualitative themes identified shared decision making, effective supervision, and proactive cultural change as promising interventions that warrant further exploration. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. There is limited research in support interventions for rural HCWs. Larger, well-designed studies are needed to explore promising interventions to promote well-being of rural healthcare workforce. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dyadic concordance and other considerations for matching pairs for peer support diabetes prevention interventions: A mixed methods assessment

ObjectivesDyadic peer support helps patients make health behavior changes for improved outcomes, yet the impact of matching dyads on demographic characteristics such as race or gender is unknown. Therefore, we investigated associations of concordant characteristics with peer outcomes in a diabetes prevention intervention and qualitatively examined participant perspectives on matching. MethodsBinary variables for peer-supporter concordance on 6 demographic characteristics were created for 177 peers and 69 supporters. Regression models compared changes in weight, HbA1c, perceived social support, patient activation, and formal diabetes prevention/education program participation for concordant and non-concordant dyads. Semi-structured qualitative interviews were conducted with 39 peers and 34 supporters. ResultsConcordance on demographic characteristics was not significantly associated with outcomes. Qualitatively, peers and supporters emphasized that more important than shared demographic characteristics was a supporter's empathic, non-judgmental communication style. ConclusionsDemographic characteristics for matching supporters with adults with prediabetes are less important than ensuring high-quality coach training in goal setting and communication style, supporting prior research on the necessity of autonomy supportive communication for effective behavioral change interventions. Practice implicationsExisting peer support programs should incorporate fidelity assessments into practice to ensure peer supporter skill in motivational interviewing-based, autonomy supportive communication and brief goal setting.

The effect of pre-operative exercise training on post-operative cognitive function: a systematic review.

With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.

A Mixed-Methods Approach to Assess Fidelity in the Delivery & Receipt of an Occupation-Based Wellness Program for Caregivers

Abstract Date Presented 03/23/24 An intervention’s fidelity allows confidence in the program’s outcomes and is needed for dissemination. This poster describes a mixed-methods fidelity assessment of an occupation-based wellness program for caregivers and its delivery and receipt. Primary Author and Speaker: Elizabeth Larson

Livestock keeping, mosquitoes and community viewpoints: a mixed methods assessment of relationships between livestock management, malaria vector biting risk and community perspectives in rural Tanzania

BackgroundLivestock keeping is one of the potential factors related to malaria transmission. To date, the impact of livestock keeping on malaria transmission remains inconclusive, as some studies suggest a zooprophylactic effect while others indicate a zoopotentiation effect. This study assessed the impact of livestock management on malaria transmission risks in rural Tanzania. Additionally, the study explored the knowledge and perceptions of residents about the relationships between livestock keeping and malaria transmission risks in a selected village.MethodsIn a longitudinal entomological study in Minepa village, South Eastern Tanzania, 40 households were randomly selected (20 with livestock, 20 without). Weekly mosquito collection was performed from January to April 2023. Indoor and outdoor collections used CDC-Light traps, Prokopack aspirators, human-baited double-net traps, and resting buckets. A subsample of mosquitoes was analysed using PCR and ELISA for mosquito species identification and blood meal detection. Livestock's impact on mosquito density was assessed using negative binomial GLMMs. Additionally, in-depth interviews explored community knowledge and perceptions of the relationship between livestock keeping and malaria transmission risks.ResultsA total of 48,677 female Anopheles mosquitoes were collected. Out of these, 89% were Anopheles gambiae sensu lato (s.l.) while other species were Anopheles funestus s.l., Anopheles pharoensis, Anopheles coustani, and Anopheles squamosus. The findings revealed a statistically significant increase in the overall number of An. gambiae s.l. outdoors (RR = 1.181, 95%CI 1.050–1.862, p = 0.043). Also, there was an increase of the mean number of An. funestus s.l. mosquitoes collected in households with livestock indoors (RR = 2.866, 95%CI: 1.471–5.582, p = 0.002) and outdoors (RR = 1.579,95%CI 1.080–2.865, p = 0.023). The human blood index of Anopheles arabiensis mosquitoes from houses with livestock was less than those without livestock (OR = 0.149, 95%CI 0.110–0.178, p < 0.001). The majority of participants in the in-depth interviews reported a perceived high density of mosquitoes in houses with livestock compared to houses without livestock.ConclusionDespite the potential for zooprophylaxis, this study indicates a higher malaria transmission risk in livestock-keeping communities. It is crucial to prioritize and implement targeted interventions to control vector populations within these communities. Furthermore, it is important to enhance community education and awareness regarding covariates such as livestock that influence malaria transmission.

Using evidence‐based decision‐making and cognitive apprenticeship approach to develop students' entrepreneurial mindset

AbstractDeveloping one's entrepreneurial mindset is important for all students, regardless of discipline. Evidence‐based decision‐making (which has the potential to lower costs and improve quality of life) is one approach for applying entrepreneurially minded learning in the undergraduate classroom. This approach allows students to understand trends related to data, in general, and big data, specifically. Furthermore, it better prepares graduates to evaluate and identify effective data science‐based solutions. The purpose of this study is to report on one pedagogical approach to developing the entrepreneurial mindset through integrating evidence‐based decision‐making into the engineering and technology classroom using Microsoft Power BI Desktop (a freely available tool released by Microsoft in September 2013, where “BI” implies Business Intelligence). A mixed methods assessment was conducted including a rubric to measure students' effectiveness in applying the entrepreneurial mindset and a metacognitive reflection to better understand student motivation, awareness of learning, and engagement. First, the rubric was applied, and students were categorized by performance group (e.g., high, mid, low). Second, each performance group was analyzed to identify themes within the reflections. Our findings suggest that students in the high‐performing group communicated overall high levels of motivation, while students in the low‐performing group shared overall moderate levels of motivation. The relationship between performance and motivation among students in the mid‐performing group was inconclusive. Findings from our study suggest that there may be a relationship between students' performance and motivation. The key study implications relate to the use of new literacies, such as technological literacy, data literacy, and human literacy, as practices for promoting the development of an entrepreneurial mindset. Our findings suggest that our approach was effective in accomplishing this goal, but there is also room for improvement. Lessons learned and recommendations are provided.

Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review.

The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. Mixed studies systematic review. PubMed, Scopus and Web of Science were sourced from 2018 and 2023. Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years. studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA). No patient or public contribution.

Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi.

There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment. We audio-recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021-June 2022. All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres. Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing training and professional development are needed to (1) improve HCWs' skills in tailored action plans, and (2) sensitize HCWs to the need for self-compassion within male clients to promote holistic sexual health.

A mixed-methods assessment of the Australasian Society of Genetic Counselors (ASGC) Mentor Program

PurposeIn Australia and New Zealand, one third of genetic counselors have less than 5 years’ experience. Sharing experienced practitioners’ professional knowledge is needed as the profession grows. Formal mentoring is an important facilitator of career progression and shared knowledge. In 2022, the Australasian Society of Genetic Counselors developed a 6-month mentor program, matching mentees with experienced genetic counselors (>10 years). We aimed to evaluate and assess the overall satisfaction and acceptability of the program, the matching process, and barriers to participation. MethodsWe used an explanatory mixed-method design with cross-sectional surveys deployed at baseline and follow-up and opt-in semi-structured interviews. Interview transcripts were analyzed using codebook thematic analysis, and data were integrated in a narrative approach. ResultsFifteen mentors and 15 mentees (N = 30) from 17 dyads were included in the analysis (response rate 83%). Eighteen completed the postprogram survey, and 12 were interviewed. The majority were female (93%), European (90%), and worked clinically in public hospitals (63%). Mentors’ main reason for participating was “to give back to the next generation,” whereas mentees sought “help with career progression.” Time was a barrier to participating. The majority (89%) achieved their goals, and all participants would recommend the program. Most (61%) found the mentor/mentee matching to be excellent, and 44% believed they would continue the relationship after the program. ConclusionThe Australasian Society of Genetic Counselors Mentor Program filled a gap in professional development within the Australian and New Zealand genetic counseling community and highlighted a general desire to share knowledge with new members of the profession.