Mixed Methods Data Research Articles

Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia

ABSTRACT Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants’ immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.

Factors Influencing Dementia Care Competence among Care Staff: A Mixed-Methods Systematic Review Protocol.

Dementia care competence is defined as the ability, acquired through practical experience, to deliver high-quality care services to persons with dementia (PWD). However, many studies only focus on one aspect of competence using qualitative or quantitative research design and have small sample sizes of care staff with dementia. This study aims to conduct a mixed-methods systematic review of the factors influencing the competence of dementia care staff, and explore the relationship between these factors and competence. This review was designed following the PRISMA-P 2015 statement and methodological guidance for the conduct of mixed-methods systematic reviews from the Joanna Briggs Institute (JBI). Seven English and four Chinese databases will be searched to systematically review the existing eligible studies. JBI Critical Appraisal Checklist for Qualitative Research and Analytical Cross-Sectional Studies will be used to assess the methodological quality of each study. A JBI Mixed-Methods Data Extraction Form will be applied for data extraction. The JBI convergent integrated approach will be used for data synthesis and integration. The synthesized findings will be graded according to the JBI ConQual approach as high, moderate, low, or very low. The protocol was registered with PROSPERO in October 2023 (CRD42023474093).

Realist process evaluation of occupational performance coaching: protocol

IntroductionA cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation,...

Strategic interventions for bridging the design-reality gap in property conferment rights: a case study of India’s ambitious initiative

PurposeThis research aims to assess how well the e-governance initiative aligns with its design expectations and on-ground realities for property management to redevelop Delhi, the mega-city of India. Additionally, the study proposes strategic interventions to address any gaps identified, aiming to improve the project’s effectiveness and success.Design/methodology/approachThe research employs a singular exploratory case study methodology to scrutinise the e-governance initiative undertaken by the Government of India to confer property rights. Specifically, the study utilises a qualitative research approach known as design-reality gap (DRG) analysis. The study draws from primary and secondary sources using a mixed-methods data collection strategy. Primary data are gathered through a purposeful and snowball sampling method involving direct engagement with respondents, whilst secondary data are sourced from the project portal.FindingsThe investigation reveals a substantial disparity between the planning and execution phases of e-governance projects. This incongruity predominantly manifests in the domains of process, staffing and skills, as well as objectives and values. The study further finds that strategic collaboration amongst stakeholders and the sustainability of decisions are the most critical factors in ensuring the success of e-governance initiatives and bridging the DRG of e-governance projects.Research limitations/implicationsThis research highlights the complex challenges faced by e-governance projects in technical, human and organisational aspects. The successful implementation and sustainability of these projects require effective strategies to overcome challenges, which management should proactively identify and act on. To improve services, beneficiaries should be encouraged to provide feedback and suggestions, as they play a crucial role in service enhancement. A dynamic feedback loop would be established by creating a two-way interaction between beneficiaries and service providers, leading to iterative service improvement. It is important to note that the study’s findings are more illustrative than conclusive due to the moderate sample size, reflecting its limitations.Originality/valueThe research contributes to the scholarly discourse on e-governance and policy implementation by comprehensively examining the alignment between conceptual design and real-world execution. It also introduces a normalised scale for the DRG framework, mapping its dimensions to deduce specific outcomes. This innovative approach enhances the research’s originality and value, offering insights applicable in both academic and practical domains.

Using Dedoose to “Quantitize” Qualitative Data in Mixed Method Analysis: A Case Analysis

This practice note provides a review of Dedoose®, a software analysis platform capable of mixed methods analysis, based on a case application. The software has been used infrequently by the evaluation community but has significant potential, particularly for those interested in “quantizing” qualitative data. The evaluation of the World Federation of Societies of Anaesthesiologists’ Fellowship Program is briefly described, followed by a description and critique of our application of Dedoose. The authors conclude by encouraging evaluation practitioners to seriously consider adding this mixed-methods data analysis platform to their chest of tools.

A STUDY ON EMPLOYEE ENGAGEMENT

Employee engagement has emerged as a critical factor influencing organizational success, productivity, and sustainability in today's dynamic business landscape. This research delves into the context of Samvardhana Motherson Reflectec (SMR), aiming to understand the dynamics of employee engagement within the organization. Through a comprehensive literature review, this study examines the conceptual underpinnings of employee engagement, its dimensions, and its impact on organizational outcomes. Utilizing a mixed-methods approach, including surveys, interviews, and observational data, the research explores the current state of employee engagement at SMR, identifying key drivers and barriers. Furthermore, the study investigates the strategies and initiatives implemented by SMR to foster employee engagement and enhance organizational performance. By synthesizing empirical findings with theoretical insights, this research contributes to the growing body of knowledge on employee engagement and provides practical recommendations for SMR and similar organizations seeking to optimize their workforce engagement strategies. Keywords: Employee Engagement, Employee Performance, Organisational Performance.

Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers.

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

Triple Helix for Sustainable Development Goals: An Impact Assessment of Shared Service Facility for Micro, Small, and Medium Enterprises Competitiveness in the Philippines

This study investigates the impact and operational challenges of the Shared Service Facility (SSF) for Micro, Small, and Medium Enterprises (MSMEs) in the Philippines, focusing on enhancing MSME competitiveness and sustainability. Through a mixed-methods approach, including surveys, interviews, and data analysis, the study assesses the SSF’s effectiveness in supporting MSMEs and identifies key challenges hindering its operation. The findings reveal significant improvements in MSMEs’ access to resources, innovation capacity, and market competitiveness following SSF assistance. However, logistical, managerial, and resource-related challenges pose significant hurdles to the SSF’s operational efficiency and effectiveness. To address these challenges, a comprehensive Strategic Plan is formulated, outlining key actions to improve logistical efficiency, enhance managerial effectiveness, strengthen financial sustainability, upgrade technological infrastructure, and foster collaboration and partnerships. Implementation of these strategic initiatives is crucial for optimizing the SSF’s operation, enhancing its impact on MSME competitiveness, and ensuring long-term sustainability. Overall, this study contributes valuable insights into the role of the SSF in fostering MSME development and economic growth in the Philippines, highlighting the importance of targeted interventions and collaborative efforts to support inclusive and sustainable development.

Pathways of Indian Students Transition Through Higher Education: Why do they differ?

Differential pathways followed by the students deserve more attention due to the development of school education in general and higher education in particular during the last two decades in India. Due to the consistent efforts by the Indian government at the school education level, students arriving at the doors of higher education institutions are no longer homogeneous. As a result, the diversity of students in higher education institutions leads towards diversification of pathways followed by the heterogeneous segments of students. There is a real shortage of studies which have researched the students’ differential pathways through higher education in general and specifically in the Indian context from the micro perspective. This study examines the decision-making process and differential trajectories followed by the students during the transition from secondary to higher education. The methodology of the present study involves a mixed-method approach and data was collected from a sample of 900 senior secondary students. A Self-structured questionnaire and semi-structured interviews were used for the collection of data. The findings reveal that the decision-making process of transition through higher education is complex and involves different stakeholders and timelines in the Indian context.

Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study

Introduction Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff. Methods This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage. Discussion This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients.

A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project.

This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

Waste to resource recovery at a marina: Empirical evidence of upstream and downstream innovation for circularity

In 2021, an Australian research centre partnered with a regional marina and shipyard where 90 businesses build, refit, and maintain boats in premium condition. Tenants and owners grapple with environmental waste management issues. Since there is a gap in applying action research but numerous calls to co-produce solutions and participate in translating ideas into practice, action research was used in this case study involving upstream and downstream innovation for circularity. Mixed methods data was collected through interviews, stakeholder workshops, and waste audits. A strategic action plan was created for closing the loop on waste. Interventions included tackling toxic, degradable products with natural alternatives, trading and remanufacturing materials to extend product life cycles, testing problematic materials, and pursuing product stewardship. This study is novel because it extends diffusion of innovation theory to real-world impact through a co-innovation process. Results underscore that ongoing achievements depend on properly sorting waste, accessing reprocessing facilities, and maintaining dedicated staff and partnerships, especially legislative support for making continuous improvement.

Swedish massage as an adjunct approach to Help suppOrt individuals Pregnant after Experiencing a prior Stillbirth (HOPES): a convergent parallel mixed-methods single-arm feasibility trial protocol

BackgroundWomen experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress.ObjectiveThis paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data.MethodsHOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists’ private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women’s experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned.DiscussionThe HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth.Trial registration.ClinicalTrials.gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability.

People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.

Input legitimacy of bottom‐up fishery governance: Lessons from community‐led local development in two Nordic EU countries

AbstractIn European Union member states, the community‐led local development (CLLD) approach implemented through Fisheries Local Action Groups (FLAGs) represents different social organisational and democratic traditions. Hence, FLAGs operate and apply local development strategies and strengthen the role of fishing communities and the fishing industry under the influence of nationally contingent factors. Based on document analysis and mixed methods data, this article addresses the role of input legitimacy in FLAGs in Denmark and Finland. The findings show that Danish FLAGs demonstrate input legitimacy, while the fishery sector's interests are relatively weakly represented on FLAG boards. In Finland, the FLAG institutional system is perceived to be more flexible, demonstrating a lower level of input legitimacy, while the fishery sector's interests are substantially represented on FLAG boards. The comparison provides an analytical basis for member states financing CLLD through EMFAF and paves the way for reflexion on the FLAG governance system based on different programming periods and institutional contexts.

Impact of Nurse Practitioner Role in Emergency Departments

Background Overcrowding and long wait times in the emergency department (ED) have resulted in decreased patient satisfaction and quality of care. One of the solutions proposed to address wait times is the introduction of the nurse practitioner (NP) role in the ED. We present a systematic mixed studies review protocol that aims to gather and analyze available knowledge on the impact of the NP role in the ED on patients, other healthcare providers, and organizations. Methods The review will employ a mixed studies analysis approach. Data will be gathered from peer-reviewed and grey literature in English with no time limit. All international publications on the impact of NP role implementation that meets the inclusion criteria in the ED setting will be included. Each study will be appraised for quality using the mixed methods appraisal tool and data extracted by two independent authors. In the presence of conflict, a third author will provide a resolution. Study characteristics and findings will be synthesized using descriptive analysis, meta-analysis, and a three-stage thematic analysis approach. The review results will be presented using the PRISMA checklist for systematic reviews. Conclusions The systematic review will present current evidence on the impact of NP role implementation in the ED setting. The results are anticipated to support decisions and policymakers in their quest to decrease ED wait times and improve the quality of patient care in healthcare settings. Keywords: Nursing, Nurse Practitioner, Emergency Department, Patient Care, Systematic Review

Promoting Diversity in the Biomedical Sciences with the Teen Science Ambassador Program.

Mental health and substance use fields suffer from underrepresentation of racially and ethnically minoritized, first-generation college student, and female members. The homogeny of the current workforce can impede scientific productivity, creativity, and problem-solving in addressing health-related issues. Our team developed the Teen Science Ambassador Program (TSAP) to provide underrepresented minoritized (URM) high school students with science-focused education, research opportunities, and mentoring within their community. The goals of the current study were to describe the logic model and structure of TSAP, provide access to a resource bank to facilitate replication across communities, and present preliminary mixed-methods outcome data to guide development of the program. Qualitative and quantitative results from our first two cohorts (N = 18; 89% girls; 72% Black or African American; 22% Hispanic or Latino; 40% of parents did not have a college degree) indicated TSAP contributed to sustained interest, increased confidence, and enhanced sense of belonging in science-related fields, especially those pertaining to mental health and substance use. These findings highlight the program's promise to facilitate entry and sustainment of URM and female youth within the biomedical sciences. Given the urgent need to promote diversity in the mental health and biomedical workforce, we provide readers with a resource bank to facilitate replication across communities.

An Empirical Study on Motivating and Inhibiting Factors for Adoption of E-Vehicles Compared to Fuel Based Vehicles in Region of Gujarat

This empirical study aims to investigate the motivating and inhibiting factors influencing the adoption of electric vehicles (E-Vehicles) compared to traditional fuel-based vehicles in the region of Gujarat. The shift towards sustainable transportation is essential to mitigate the adverse environmental impacts of fossil fuels and reduce carbon emissions. The study is driven by the growing global awareness of the need for green technologies and the urgency to combat climate change. The motivating factors for adopting E-Vehicles include environmental concerns, potential cost savings on fuel, government subsidies and incentives, technological advancements, and the desire to be early adopters of innovative transportation solutions. On the other hand, inhibiting factors may include the high upfront cost of E-Vehicles, limited charging infrastructure, range anxiety, lack of awareness about E-Vehicles, and concerns regarding battery life and maintenance. Gujarat, known for its rapid industrial growth and progressive policies, serves as an ideal location to study the transition to E-Vehicles. The region's unique geographical and economic characteristics present both challenges and opportunities for the adoption of electric mobility. By understanding the specific factors that drive or hinder the adoption of E-Vehicles in Gujarat, policymakers, industry stakeholders, and consumers can develop strategies to accelerate the transition towards sustainable transportation. The study will employ a mixed-methods approach, combining surveys, interviews, and data analysis to gather comprehensive insights into the factors influencing the adoption of E-Vehicles in Gujarat. The findings of this study are expected to provide valuable information for designing targeted interventions, policy recommendations, and awareness campaigns to promote the widespread adoption of E-Vehicles in the region. Ultimately, this research aims to contribute to the development of a cleaner and more sustainable transportation system in Gujarat, paving the way for a greener and healthier future for its residents.

Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study.

The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.

Implementation of a Supervisor-Led Resilience Training Extension in the Royal Military College

Resilience training offered to military personnel often fails to reinforce training practices into routine military activities. We describe the implementation of a supervisor-led after action review designed to provide personnel with frequent opportunities for the supervisor reinforced application of resilience training skills at work. This paper provides a roadmap for engaging supervisors to support this program and details strategies used across its design and their contribution to implementation fidelity. Strategies included iterative stakeholder engagement in co-design and the use of mixed-methods data collection, including field observational ratings, open ended survey questions, and focus group interviews. The design and implementation process are reported in two phases: initial and re-implementation phases. Chi-square analyses and t-tests of initial phase data indicated that the after action review designed to guide the application of resilience training skills was distinct from preexisting after action reviews of tactical skills and drills. Reflexive interpretations of instructor feedback guided refinement to the extension and subsequent re-implementation phase data indicated implementation fidelity. When engaging leaders and resilience non-specialists in activities that support military resilience training, we recommend involving stakeholders in the design and implementation process, responding flexibly to their concerns, and balancing their experienced work change demands with appropriate resources.