Mixed Methods Data Analysis Research Articles

Ethiopian EFL teachers’ classroom practice and learners’ view on teaching and learning English speaking skill

Communication capacity (Speaking skill) in English language education is a difficult task that needs effective guidance and sustainable practice. Therefore, this study aimed at exploring the Implementation of Teaching and Learning English Speaking Skills in Ethiopian EFL Classes. The design of the study was descriptive survey. There were 523 students included using a simple random sampling technique and 30 EFL teachers using an availability sampling technique. To collect data, questionnaire for students and Focus Group Discussions for teachers were used. Mixed method data analysis was used. The results showed that EFL teachers were not using different techniques to teach English speaking skills, and they were not making sustainable follow-ups on how learners performed. They also apply the teacher-centered method rather than the learner’s method. Learners face challenges from their mother tongue's influence, lack of confidence, and fear of making a mistake. EFL teachers were also challenged by student-related problems like being disinterested in being involved in the actual teaching and learning actively, uncomfortably of the school compound, absence of well-equipped English mini-media, and the bulkiness of the textbook. Thus, EFL teachers should use various techniques, school administration should avail the resource and students should be participatory in their learning.

Organization resilience and organizational commitment: The roles of emotion appraisal and psychological safety

Purpose: The study examines the mediating effect of self-emotion appraisal and other-emotion appraisal on psychological safety, individual resilience, and organizational commitment at the workplace. Design/methodology/approach: This study generated 140 survey responses from workers in diverse occupations and industries during the COVID-19 pandemic. A mixed-methods data analysis was conducted. Hierarchical regression analysis was employed to test the hypotheses, and process macroanalysis was used to generate the mediation analysis. Qualitative data analysis through thematic coding was adopted to interpret the respondents’ written opinions and narratives. Findings: The results revealed that self-emotion appraisal strongly correlates to resilience, but evaluation of self-emotion has no effect on organizational commitment. Other-emotion appraisal and psychological safety are not significant predictors of resilience at the workplace. Rather, psychological safety is a significant predictor of organizational commitment. The qualitative analysis generated from the respondents’ narratives provides deeper insight into the quantitative results. Additional data that emerged from the qualitative interpretation revealed other factors that are related to emotional appraisal, psychological safety, resilience, and organizational commitment. Practical implications: The findings shed light on the need to understand an individual’s emotional appraisal when instilling workplace resilience. Further, promoting psychological safety, such as by involving employees in the change process, managing fairness perception, and eliciting trust, enhances organizational commitment in the workplace. Integrating open communication, management intervention, and coaching programmes should form part of the employee engagement and development functions to help build organizational resilience and commitment. Originality/value: This research is an original contribution conducted during the global health crisis that led to abrupt changes in the workers’ lives and the workplaces in Singapore. Research implications: This present study demonstrated constructive findings on emotion regulations and perceived psychological safety associated with resilience and commitment amid the disruptive changes in work practices at the workplace. Further, the outcome of the study shows the mediating effect of self-emotional appraisal on psychological safety and resilience. The result draws parallels with past literature that showed that individuals who appraised their emotions tended to recalibrate and recognize their subjective behaviour and take actions to modify it. Social implications: Emotion regulation connotes employees’ emotion coping strategies, and research showed that emotion reappraisal produces a positive effect on workplace relationship quality.

Evaluation of Virtual Prenatal Care for Obstetric Care Delivery During the COVID-19 Pandemic: A Mixed Method Research Study Using the Consolidated Framework in Implementation Research.

Coronavirus 2 (SARS-CoV-2), a novel respiratory virus, rapidly spread, and placed patients at increased risk for short and potentially long-standing medical illnesses. The pandemic necessitated the rapid implementation of virtual prenatal care via telemedicine in obstetrics to maintain social distancing measures. The aim of this study was to assess and understand the patient perspectives of the rapidly implemented virtual prenatal care via a telemedicine model during the Coronavirus disease 2019 (COVID-19) pandemic utilizing the Consolidated Framework in Implementation Research (CFIR). Following the implementation of virtual prenatal care in March 2020, pregnant patients at a large urban clinic in the southeastern United States completed a 19-question anonymous survey that included open and closed-ended questions on their experience receiving virtual prenatal care via telemedicine or in-person prenatal care from May to December 2020. The survey and mixed-methods data analysis was guided by the CFIR framework. A total of 59 patients completed the survey. One-third (31%, n=18) of the patients found virtual prenatal care to be an acceptable alternative model, and half (53%, n=31) found it acceptable only during a pandemic, preferring to return to in-person visits. Qualitative analysis found that some patients were deterred by limited in-person examinations and uncertainty with the virtual platform, while others appreciated the reduced need for transportation, childcare, and time spent. Most patients found virtual prenatal care to be easy to access and an acceptable alternative during the pandemic; however, most would prefer to return to in-person prenatal care visits. Future comparative research studies should examine how, among others, virtual prenatal care versus in-person prenatal care impacts specific maternal and fetal outcomes.

The Effectiveness of Participatory Governance in Budgetary Monitoring and Evaluation in an Information Age: A Case of Fetakgomo-Tubatse Local Municipality

Deepening participatory governance in budgetary monitoring and evaluation is critical to ensuring that local residents' rights to meaningful engagement in municipal governance are realised. It symbolises a paradigm shift in the relationship between municipalities and local residents, particularly in terms of promoting transparency and accountability in the use of municipal financial resources to achieve positive service delivery outcomes. However, proffering opportunities for residents to meaningfully engage in budgetary monitoring and evaluation processes is often met with mixed reactions within municipalities’ governance structures. This paper evaluates the effectiveness of participatory governance in budgetary monitoring and evaluation in the information age in the case of Fetakgomo-Tubatse local municipality. The objectives were to assess participants' understanding of the importance of participatory governance implementation in budgetary monitoring and evaluation, the scope and purpose of the implementation process, associated benefits and barriers, the efficacy of information dissemination and accessibility relating to the outcomes and impact of the process, and the degree of ICTs use towards enhancing timely dissemination and accessibility of the information. The study used a mixed method case study research design. Face-to-face semi-structured interviews and a self-administered semi-structured questionnaire were used to collect primary research data from a purposive and snowball sample of municipal officials (N=8) and ward committee members (N=10). The data was analysed using a seven-stage mixed method data analysis framework developed by Onwuegbuzie and Teddlie (2003). The paper provides the main findings that led to the conclusion that participatory governance in budgetary monitoring and evaluation is implemented ineffectively in the Fetakgomo-Tubatse local municipality; recommendations on how to strengthen its effectiveness and avenues for future research are provided.

The Application Of The Make A Match Type Of Cooperative Learning Model To Improve Social Studies Learning Outcomes 5TH Grade UPT SPF SDN KIP Bara-Baraya I Makassar City

The problem that lies behind this research is the low learning outcomes of students in social studies subject class V UPT SPF SDN KIP Bara-Baraya I Makassar City. This study aims to describe the application of the make a match type of cooperative learning model to improve social studies learning outcomes in class V UPT SPF SDN KIP Bara-Baraya I Makassar City. The focus of this researchis the application of the make a match type of cooperative learning model and student learning outcomes. The reasearch approach used in this study is a qualitative approach and the type of research used is Classroom Action Reasearch (CAR) which was carried out in two cycle, each cycle consists of two meetings. Each cycle has four stages, namely the planning stage, the implementation stage, the observation stage, and the reflection stage. Data collection techniques and procedures are observation, tests and documentation. This Classroom Action Reasearch (CAR) wa carried out in class V UPT SPF SDN KIP Bara-Baraya I Makassar City with the research subjects being teachers and students totaling 18 people consisting of 13 male atudents and 5 female students. The data analysis technique in this research is qualitative and quantitative (mixed method) data analysis. The results showed that there was an increase in student learning outcomes in social studies subjects with the achievement of completeness of pre action learning outcomes in the less category, in the first cycle obtained 8 students complete with the achievement of mastery learning outcomes was in the sufficient category, while in the second cycle 15 students were obtained trough the achievement of complete learning in the good category. The conclusion in this study is that the application of the make a match type of cooperative learning model can improve student learning outcomes in social studies subjects for class V UPT SPF SDN KIP Bara-Baraya I Makassar City.

Key components of goals of care conversations on determining end-of-life care for advanced cancer patients.

12130 Background: Early goals of care (GOC) conversations appear to improve end of life (EOL) care in patients with advanced cancer. However, interventions to facilitate GOC conversations may be unsuccessful in changing EOL outcomes due to incomplete understanding of the components of such conversations essential to impacting EOL care. This study seeks to identify the specific components of GOC conversations between patients and oncologists that are associated with less aggressive EOL care. Methods: This was a secondary, sequential mixed-methods analysis of data collected as part of the Values and Options in Cancer Care (VOICE) study, an RCT to improve communication between patients and oncologists. We used qualitative methods to describe and quantify components of GOC conversations occurring in recorded oncology office visits. We then conducted logistic regression analyses to examine the associations between key components identified with less aggressive EOL care. Results: 107 patients who died within 1 year of the recorded visit were included for analysis. Content related to GOC conversations could be found in 80.4% of visits. Most commonly discussed content was related to treatment (72.9%), followed by prognosis (43.9%), EOL care (17.8%), and patient values and preferences (16.8%). In adjusted analyses, discussion of treatment expectation, offer of an alternative to cancer-directed treatment, and mention of hospice were significantly associated with less aggressive EOL care, OR 4.66 (p = 0.047), OR 6.09 (p = 0.008), and OR 7.60 (p = 0.046) respectively. We did not find significant association between discussion of life expectancy and EOL care. Conclusions: GOC conversations may be more effective at impacting EOL care when it includes discussion regarding treatment expectations and offer of an alternative option to cancer-directed therapy, such as hospice.

Chinese Students’ Transcultural Strategies: Intentions to Navigate Identity Conflicts and Expand Their Identities Through Hong Kong Study Experiences

This study investigates Chinese international students’ acculturation strategies and pragmatic intentions to address identity conflicts in Hong Kong study experiences through a developmental lens. We treat conflicts and stressors as indicators of active commitments and the process of engagement as strategic, goal-oriented, intentional investments to become better selves. Undergraduates (N = 95) enrolled in a Hong Kong university participated: 85 completed a Cultural Practices Questionnaire about daily activities; 10 completed semi-structured interviews on their acculturation strategies, identity conflicts, and justifications. Mixed method data analysis highlighted strategies rooted in goals, choices, consistency, and commitment. Several pragmatic intentions were also identified. Participants considered academic study,language learning, club activities, communicating with friends, volunteering, and interacting with diverse people as fundamental active commitments. An alternative definition of “integration strategy” is proposed to better capture students’ transcultural choices and decolonize the view that students are expected to conform to the host culture.

Exploring the usability, user experience and usefulness of a supportive website for people with dementia and carers

Purpose This study explores the usability, usefulness and user experience of the Forward with Dementia website for people with dementia and family carers, and identifies strategies to improve web design for this population. Methods The website was iteratively user-tested by 12 participants (five people with dementia, seven carers) using the Zoom platform. Data collection involved observations, semi-structured interviews and questionnaires. Integrative mixed-method data analysis was used, informed by inductive thematic qualitative analysis. Results Users of Version 1 of the website experienced web functionality, navigation and legibility issues. Strategies for desirable web design were identified as simplifying functions, streamlining navigation and decluttering page layouts. Implementation of strategies produced improvements in usability, user experience and usefulness in Version 2, with mean System Usability Scale scores improving from 15 to 84, and mean task completion improving from 55% to 89%. The user journey for people with dementia and carers overlapped, but each group had their own unique needs in the context of web design. Conclusions The interplay between a website’s content, functionality, navigation and legibility can profoundly influence user perceptions of a website. Dementia-related websites play an important role in informing audiences of management strategies, service availability and planning for the progression of dementia. Findings of this study may assist in guiding future web development targeting this population.

Sustainable Strategy: Analyzing the Role of CSR Communication of Select Companies to the Stakeholders

Purpose: The purpose of this study is to examine how companies reach their stakeholders through their website for communicating their sustainable practices and also identify the effectiveness of website communication. Better communication of CSR policies and adopting technologies for implementation would make the company’s sustainability policy stronger (Gayathri S, J.V, 2019) Theoretical Framework: This research paper deals with the concept ,as per signaling theory, which states that CSR communication through the corporate website (CSRccw) largely contributes to building corporate image (Hetze, K., & Winistörfer, H.,2016).From the list of top 100 CSR companies in India for the year 2020 listed in the futurescape webpage available online at:https://www.futurescape.in/responsible-business-rankings/indias-top-100-companies/,four companies have been chosen for the analysis. This is the research paper in the process; thus it was intended to study two sectors initially and in the future study other sectors are decided to be included. The respective company website section of CSR (Corporate Social Responsibility) was assessed, and the report was analysed using NVivo software. Design/methodology/approach: Website of the organizations were analyzed using Nvivo (Nvivo 12 – Trial Version). It is a mixed-method data analysis tool with text analysis capabilities. The method employed in this study is a word cloud and text analysis. This analysis adopts a quantitative approach looking at word frequency, word co-occurrence, and the clustering of documents based on word similarity. Findings: Organizations aims at adopting sustainable practices and above all they focus and intent to communicate the same to their stakeholders. The Results of this research paper indicates that, organizations predominantly use website among other CSR communication strategies. Most of their focus areas were youth, education. Community development. Words used prominently helped the stakeholders to relate the words which reflected in brand building. Research, Practical/social implications: The study has analyzed only four companies as a starting point and future studies can be rigorously done using a larger set of sample date set.. a sentimental analysis can be done. Since social media is becoming an effective communication platform, corporations should pay more focus on using social media especially through its website. The corporations should encourage stakeholders’ views related to CSR communication on social media. Originality/value: The value of this research is that, it helps us understand the way companies use their website for CSR communication, since the majority of these type of studies were conducted are in the developing countries like US and Europe. Limited research and insights are found in the emerging markets. This study focuses on the emerging markets.

Lessons Learned from a Mixed-Method Pilot of a Norms-Shifting Social Media Intervention to Reduce Teacher-Perpetrated School-Related Gender-Based Violence in Uganda

Background: Violence against children (VAC) is a global epidemic rooted in gender norms. One of the most common forms of VAC is school-related gender-based violence (SRGBV). Research has shown the promise of social media to shift norms underlying abusive behaviors, but, to-date, no studies have reported on social media norms-shifting interventions to prevent SRGBV by teachers. This study describes lessons learned from a pilot social-media intervention to shift social norms among Ugandan teachers to promote gender equity and reduce SRGBV. Methods: We extracted information on group size, posts, engagements, and teachers’ comments from intervention Facebook and WhatsApp social media groups and conducted mixed-methods data analysis. The study and program team met weekly to review findings and adjust the approach. Results: We found many teachers voiced social norms and attitudes upholding SRGBV in online groups, highlighting the need for intervention. Social media groups were largely acceptable to teachers, reached many teachers throughout Uganda, and often promoted active discussion. The program team carefully monitored online engagement, identified needed shifts, and performed mid-course adjustments in response to emerging challenges. Lessons learned included focusing on positive norms instead of harmful norms, engaging peer-influencers to shift norms, and including educational resources to inform behavior change. Conclusions: This study offers learnings on application of social and behavior-change communication and social norms principles to future online violence prevention initiatives.

A Quality Assessment of Goals of Care Forms in a Sample of Older Patients in Various Care Settings in Quebec, Canada.

The objective of this study is to assess the completion and content of the Goals of Care (GOC) forms in three care settingsinthe province of Quebec, Canada. This is a retrospective, cross-sectional, mixed methods analysis of data extracted from the charts and GOC forms of patients aged over 65 who received services during the year 2018 in one of the three following care settings: (i) long-term care facility, (ii) acute care hospital, and (iii) home support services of a regional healthcare and social services center. The completion of the GOC form includes six essential sections. If one or more of the sections were not fulfilled, we considered the form incomplete. We used descriptive analysis to look at the information in the six sections and a thematic analysis to assess the information in an open-ended section. We audited 589 charts, of which 67% contained a GOC form and only 96 (16%) a completed one. The most popular goal of care was ensuring comfort as a priority over prolonging life, selected on 40% of the forms. The majority of the included patients (89%) did not want cardiopulmonary resuscitation (CPR) to be attempted in the case of cardiac arrest. There was no indication of the use of advance medical directives, and scarce indication of the use of former GOC forms (18%) and living wills (2%) in completing the forms. Comments were included in 65% of the open-ended sections. The most frequent themes related to the use or non-use of interventions and to potential transfers to the hospital or to an intensive care unit. We found that the open-ended section was used on 24 forms to specify a different goal of care applicable in the eventof further health deterioration. A significant proportion of charts (84%) did not contain a completed GOC form; key aspects of advance care planning were rarely considered in establishing the patient's goal of care, and the form itself lacked utility given the frequency and nature of qualitative comments. As a final product of serious illness communication and decision-making, our findings suggest that there are significant quality issues, that patients are at risk of intensification of care at the end of life, and that more needs to be done to improve serious illness decision-making and documentation.

Remembering beloved objects from early childhood, middle childhood, and adolescence and the role of the five senses

ABSTRACT Beloved objects are cherished and valued possessions that we feel attached to. Previous research has demonstrated that the functions of beloved objects change across a lifespan. However, beloved objects may not only be appreciated because of their functions but also because of their sensory qualities. We hypothesised that the sensory experiences with beloved objects show a developmental trajectory and that the proximal senses (touch, taste, smell) become less important across childhood and adolescence, while the distant senses (vision, hearing) become more important. Moreover, we assumed that the observed changes in the sensory experiences are associated with the corresponding changes of functions across life stages. Building on the idea that those (perceptual) aspects of our environment that are particularly important to us are preferentially stored in memory, we hypothesised that this developmental trajectory would also be reflected in retrospective accounts. Hence, participants (N = 225) were asked to remember beloved objects from early childhood, middle childhood, and adolescence, to describe their functions and to answer questions regarding their sensory experiences with the objects. The mixed methods data analyses confirmed our hypotheses. Taken together, our study illustrates and underlines the importance of beloved objects for thinking, behaviour, memory, and identity.

Zero carbon refurbishment for existing buildings: A literature review

The need to mitigate climate change calls for the construction industry to achieve net-zero greenhouse gas (GHG) emissions for new and existing buildings by 2050. Zero carbon refurbishment (ZCR) for existing buildings is a significant area of interest, as many existing buildings will still be there in 2050. This paper investigates the global development, knowledge structure and gaps in the research field by conducting a systematic literature review. The final selection of 147 up-to-date journal articles was analysed using mixed-method data analysis, including quantitative (science mapping) and qualitative (thematic) analysis. Quantitative results reveal evolving research topics including energy performance and efficiency, life cycle environmental impacts, energy resources and policy, and decision-making with multi-objective optimisation. Research in ZCR is well-established in European countries and there is much interest and activity around the world. ZCR research on residential and office buildings provokes much consideration compared to other building types. The qualitative findings discuss the mainstream research areas (e.g. decision-making with multi-objective optimisation), determines research gaps (e.g. carbon impact), and recommends the future research agenda. The study offers academics a comprehensive understanding of ZCR research to link current research areas into future trends. It also provides construction professionals with current practices and an interdisciplinary guide to better deliver ZCR projects.

Struggling, helping and adapting: Crowdfunding motivations and outcomes during the early US COVID-19 pandemic.

During the early months of COVID-19, many people in the US turned to charitable crowdfunding to seek and provide assistance. Little is known about the needs, hopes or experiences that motivated US pandemic crowdfunding and how these were correlated with campaign success. This study uses a mixed-methods data analysis of a randomised cluster sample of 919 US GoFundMe campaigns during the first 7months of the pandemic. Overall, most campaigns performed poorly, and 38% got no donations at all. The largest proportion of campaigns aimed to address individual, acute financial struggles, often arising from considerable challenges accessing or qualifying for government assistance. These campaigns, as well as those involving campaigners and beneficiaries of colour, tended to be least successful. Qualitative thematic analysis revealed three key crowdfunding motivations that reflect individualistic, agentive responses to the pandemic: struggling, helping and adapting. These motivations reveal a shift away from social suffering and collective mobilisation and towards largely individualised efforts of survival as digital crowdfunding becomes a key domain of crisis response. Crowdfunding platforms are playing an increasingly important role in mediating and influencing individual and collective responses to crisis, which has important political ramifications for how societies perceive and address health emergencies.

An Assessment of Biomedical Waste (BMW) Production and Management and its Impact on the Environment and Disease Transmission Amidst the COVID-19 Pandemic in the Philippines

The study aimed to analyze the impact of pandemic-related BMW production and management in the Philippines and its potential role in transmitting the COVID-19 virus via a mixed-methods analysis of data from surveys of different sectors (consumers of medical waste, deliverymen, and medical workers) and using secondary sources. The results revealed that the most common types of PPE used in the country are disposable face masks and face shields, wherein all respondents reported an increase in the consumption of medical materials. An improper disposal of an estimated 85 million disposable face masks and 50 million face shields in the Philippines poses a serious threat to the environment and health in the Philippines, a biodiversity hot spot. There was a strong correlation between the increased exposure to BMW and laxer degrees of implementation of proper BMW disposal practices. The paper also established an estimated consumption of ≈ 120.5 million face masks, ≈ 71.4 million face shields, ≈ 38 million disposable gloves, and ≈ 4.1 million full-body suits per day in the Philippines. The actual output of biomedical waste in the country drastically increased in a year, comprising an average daily output of 3,390 tons of BMW (≈ 482 tons for face masks, ≈ 2,544 tons for face shields, ≈ 198 tons for disposable gloves, and ≈ 167 tons for full-body suits which is an important discovery regarding the biomedical waste in the country. These estimates were found to be higher than those reported by the Asian Development Bank in 2020. All sectors reported low awareness levels and confidence in the country's effectiveness in implementing current BMW management practices.

Practical strategies to identify and address discordant findings in mixed methods research

Integration of qualitative and quantitative data in mixed methods research generates confirmed, discordant, and expanded findings. Guidance is available about the methods and strategies for the meaningful integration of data. However, little has been written about strategies for managing discordant findings in mixed methods. This paper describes and illustrates practical strategies for managing and integrating discordant findings in mixed methods analyses based on researchers reflections and experiences of managing and integrating discordant findings in convergent and sequential exploratory mixed methods studies. Two strategies, namely, comprehensive case and variable analysis and sociocultural exploration are proposed. Comprehensive case analysis involves identifying discordant findings in quantitative data, identifying supportive data in qualitative data, and selecting variables for mixed analysis and interpretation. Sociocultural exploration comprises qualitative code and quantitative data matrix for themes, identification of discordant findings under each theme, and development of sociocultural profile. Identifying and addressing discordant findings in mixed methods is an essential step of rigorous mixed methods analysis. The comprehensive case and variable analysis and sociocultural exploration strategies emphasize the need to examine discordance in data at an early stage of analysis. Further use and evaluation of these strategies are warranted to expand the body of knowledge about practical methods of mixed methods data analysis.

Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center

IntroductionHispanic Americans receive disproportionately fewer organ transplants than non-Hispanic whites. In 2018, the Hispanic Kidney Transplant Program (HKTP) was established as at the University of Colorado Hospital (UCH). The purpose of this quality improvement study was to examine the effect of this culturally sensitive program in reducing disparities in kidney transplantation.MethodsWe performed a mixed-methods analysis of data from 436 Spanish-speaking patients referred for transplant to UCH between 2015 and 2020. We compared outcomes for patients referred between 2015–2017 (n = 156) to those referred between 2018–2020 (n = 280). Semi-structured phone interviews were conducted with 6 patients per time period and with 6 nephrology providers in the Denver Metro Area. Patients and providers were asked to evaluate communication, transplant education, and overall experience.ResultsWhen comparing the two time periods, there was a significant increase in the percentage of patients being referred (79.5% increase, p-0.008) and evaluated for transplant (82.4% increase, p = 0.02) during 2018–2020. While the number of committee reviews and number waitlisted increased during 2018–2020, it did not reach statistical significance (82.9% increase, p = 0.37 and 79.5% increase, p = 0.75, respectively. During patient and provider interviews, we identified 4 themes reflecting participation in the HKTP: improved communication, enhanced patient education, improved experience and areas for advancement. Overall, patients and providers reported a positive experience with the HKTP and noted improved patient understanding of the transplantation process.ConclusionsThe establishment of the HKTP is associated with a significant increase in Spanish-speaking Hispanic patients being referred and evaluated for kidney transplantation.

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South. To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders. Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV. This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.

Equal access to hospital care for children with learning disabilities and their families: a mixed-methods study

Background To our knowledge, there has yet to be a comprehensive review of how well hospital services are meeting the needs of children and young people (hereafter referred to as children) with learning disability and their families. The extent to which their experiences differ from those of parents of children without learning disability is not known. The views and experiences of children with learning disability are almost non-existent in the literature. Aims To identify the cross-organisational, organisational and individual factors in NHS hospitals that facilitate and prevent children with learning disability and their families receiving equal access to high-quality care and services, and to develop guidance for NHS trusts. Design A four-phase transformative, mixed-methods case study design comparing the experiences of children with and children without learning disability, their parents and health-care staff. Methods Phase 1 comprised interviews with senior managers (n = 65), content analysis of hospital documents and a staff survey (n = 2261) across 24 hospitals in England, including all specialist children’s hospitals. Phases 2–4 involved seven of these hospitals. Phase 2 involved (a) interviews and photography with children and their parents (n = 63), alongside a parent hospital diary and record of safety concerns; (c) hospital staff interviews (n = 98) and community staff survey (n = 429); and (d) retrospective mapping of hospital activity. During phase 3, children (n = 803) and parents (n = 812) completed satisfaction surveys. Phase 4 involved seeking consultation on the findings. Data analysis A model for mixed-methods data analysis and synthesis was used. Qualitative data were managed and analysed thematically, supported with NVivo (QSR International, Warrington, UK). Quantitative data were analysed using parametric and non-parametric descriptive statistics. Results Nationally, there is considerable uncertainty within hospitals and variation between hospitals in terms of the policies, systems and practices in place specifically for children with learning disability. Staff are struggling to individualise care and are being let down by an inadequate system. Attitudes and assumptions can have a lasting impact on parents and children. The findings serve as a useful guide to trusts about how best to meet the Learning Disability Improvement standards that have been set. Conclusions Safety issues and quality of care affect all children in acute hospitals and their parents, but the impact on children with learning disability and their parents is much greater. Individualising care is key. Our findings suggest that staff may need to undertake training and gain experience to build their skills and knowledge about children with learning disability generally, as well as generate knowledge about the individual child through proactively working in partnership with parents before their child’s admission. The findings also suggest that we may need to address the impact of children’s hospitalisation on parents’ health and well-being. Future work The greatest need is for the development and validation of an instrument for the assessment and management of risk in children with learning disability in hospital. Limitations We cannot say with certainty that the sites selected are representative of all services caring for children with learning disability. Study registration The study has been registered on the National Institute for Health and Care Research (NIHR) Clinical Research Network portfolio as 20461 (phase 1) and 31336 (phases 2–4). Funding This project was funded by the NIHR Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 13. See the NIHR Journals Library website for further project information.

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability.

Numerous studies have tested school-based interventions promoting healthy behaviors in youth, but few have integrated dissemination and implementation (D&I) frameworks. Using D&I frameworks can inform if and how an evidence-based intervention is implemented and maintained and provide strategies to address contextual barriers. Such application is necessary to understand how and why interventions are sustained over time. We evaluated a school wellness initiative called SWITCH® (School Wellness Integration Targeting Child Health) to (1) assess implementation outcomes of adoption, fidelity, and penetration, (2) discern implementation determinants through the Consolidated Framework for Implementation Research (CFIR), and (3) examine differences among inexperienced and experienced schools and influential factors to sustainment. A total of 52 schools from Iowa, United States enrolled in the 2019-2020 iteration of SWITCH (22 inexperienced; 30 experienced). The CFIR guided the adaptation of mixed methods data collection and analysis protocols for school settings. Specific attention was focused on (1) fidelity to core elements; (2) adoption of best practices; and (3) penetration of behavior change practices. Determinants were investigated through in-depth qualitative interviews and readiness surveys with implementation leaders. A systematic process was used to score CFIR domains (between -2 and +2) indicating positive or negative influence. Independent t-tests were conducted to capture differences between samples, followed by a cross-case analysis to compare determinants data. Inductive coding yielded themes related to sustainment of SWITCH beyond formal implementation support. Experienced schools had higher scores on fidelity/compliance (t = -1.86 p = 0.07) and adoption (t = -2.03 p = 0.04). CFIR determinants of innovation source, culture, relative priority, and leadership engagement were positive implementation determinants, whereas tension for change and networks and communications were negative determinants. Distinguishing factors between experienced and inexperienced schools were Readiness for Implementation and Self-efficacy (experienced significantly higher; p < 0.05). Strategies to enhance sustainability were increasing student awareness/advocacy, keeping it simple, and integrating into school culture. Findings provide specific insights related to SWITCH implementation and sustainability but more generalized insights about the type of support needed to help schools implement and sustain school wellness programming. Tailoring implementation support to both inexperienced and experienced settings will ultimately enhance dissemination and sustainability of evidence-based interventions.