Mixed Methods Evidence Research Articles

Interprofessional undergraduate breastfeeding education: A scoping review protocol

Objective To review and summarise interprofessional breastfeeding curricula—educational initiatives involving multiple health professions—that have been proposed for undergraduate or pre-registration health students. This review will help guide the development of future Interprofessional Education (IPE) curricula for undergraduate health students, specifically in the area of breastfeeding care. Introduction Breastfeeding care and support from healthcare professionals are vital for breastfeeding success. To ensure mothers receive high-quality, consistent care, healthcare professionals must receive comprehensive, evidence-based breastfeeding education. However, there is limited understanding of how breastfeeding curricula are delivered across different disciplines in undergraduate health programs, particularly in the context of IPE. Inclusion criteria Primary research designs, including quantitative, qualitative and mixed-method studies and evidence syntheses of primary research including systematic and scoping reviews that meet the inclusion criteria will be considered. Position papers and policy documents will also be considered for inclusion in this scoping review. Methods Medline (Ovid), CINAHL (EBSCO), ERIC (EBSCO), Social Sciences, and Cochrane Databases of Systematic Reviews will be searched with English language and date restrictions (2005-current). Titles and abstracts and full-text articles will be independently screened by two reviewers. The reference lists of the included studies will be searched. A grey literature search will be undertaken on Google scholar, BASE and National Institute for Health and Care Excellence (NICE) website in October 2024. Studies will be screened in Covidence by two independent reviewers. All reviewers will agree on the included studies. Data will be extracted and presented graphically using figures and tables. Narrative summary text will accompany the tables and figures.

Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review.

Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature to map out the evidence on UHC adoption, roll out, implementation, challenges, and opportunities in the African countries. Literature searches of the Cochrane database of systematic reviews, PUBMED, EBSCO, Eldis, SCOPUS, CINHAL, TRIP, and Google Scholar were conducted in 2023. Using predefined inclusion criteria, we focused on UHC adoption, rollout, implementation, and challenges and opportunities in African countries. Primary qualitative, quantitative, and mixed-methods evidence was included, as well as original analyses of secondary data. We employed thematic analysis to synthesize the evidence. We found 9633 documents published between May 2005 and December 2023, of which 167 papers were included for analysis. A significant portion of UHC implementation in Africa has focused on establishing social health protection schemes, while others have focused on strengthening primary healthcare systems, and a few have taken integrated approaches. While progress has been made in some areas, considerable obstacles still exist. Financial constraints and supply-side challenges, such as a shortage of healthcare workers, limited infrastructure, and insufficient medical supplies, remain significant barriers to UHC implementation throughout Africa. Some of the promising solutions include boosting public funding for healthcare systems, strengthening public health systems, ensuring equity and inclusion in access to healthcare services, and strengthening governance and community engagement mechanisms. Successful UHC implementation in Africa will require a multifaceted approach. This includes strengthening public health systems in addition to the health insurance schemes and exploring innovative financing mechanisms. Additionally, addressing the challenges of the informal sector, inequity in healthcare access, and ensuring political commitment and community engagement will be crucial in achieving sustainable and comprehensive healthcare coverage for all African citizens.

Political Patronage and the Labour Market Experience of High-Skilled Workers: Mixed Methods Evidence from Sierra Leone

Political Patronage and the Labour Market Experience of High-Skilled Workers: Mixed Methods Evidence from Sierra Leone

Which factors influence the decision of hospitals to provide procedures on an outpatient basis? –Mixed-methods evidence from Germany

Shifting care from the resource-intensive inpatient setting to the more economically efficient outpatient sector is being promoted internationally by policymakers. Financial incentives are a major focus of such efforts because low levels of hospital outpatient care are attributed to differences in payment for inpatient and outpatient services. In Germany, however, there is significant variation in the extent to which hospitals provide outpatient care despite a uniform payment system. Therefore, other factors must be influencing German hospitals’ strategic decisions whether to offer outpatient care. While most research has focused on specific procedures or lacks empirical support, our study provides a comprehensive analysis of the factors beyond financial incentives that influence the provision of hospital outpatient services in Germany. We employed a mixed-methods approach, first contacting health care experts with in-depth knowledge of the hospital outpatient landscape to identify possible influencing factors and then conducting a comprehensive quantitative analysis of all German hospitals. Our findings suggest that policymakers seeking to promote hospital outpatient care should consider a broad range of factors. We found that a hospital's service mix, size, procedure volume, and emergency care infrastructure significantly affected the proportion of outpatient services it offered. Strategic hospital planning emphasizing specialization and adherence to minimum volume standards might therefore be a valuable policy tool. Our analysis also highlights the importance of demographic and socioeconomic factors, such as the regional share of single-person households, suggesting that a comprehensive policy framework should account for broader population characteristics and not just elements directly related to hospital care.

Does racial impact statement reform reduce Black–White disparities in imprisonment: Mixed methods evidence from Minnesota

AbstractIncreasingly scholars have argued that, if the United States is to reduce Black–White disparities in incarceration, it is necessary to move away from race‐neutral efforts and ensure that policies consider race. Despite this perspective, criminal legal policies have almost exclusively been race‐neutral, with one general exception at the state level: racial impact statement reform. Although racial impact statement reform exists now in 10 states, no scholarship has empirically examined the implications of this approach for racial disparities in imprisonment. Using a mixed methods approach, we begin to fill this gap by examining the implications of Minnesota's racial impact statement reform on Black–White imprisonment rate disparities. Our quasi‐experimental results do not suggest that Minnesota's reform reduced Black–White disparities in imprisonment. Our legislative analysis suggests that the null effects we observed were likely due to the fact that racial impact statements are responses to legislation that has already been proposed, and that the legislation proposed in Minnesota was not sufficient to significantly address Black–White imprisonment disparities, regardless of the extent to which these statements impacted the votes of legislators.

Addressing the intensity of rehabilitation evidence-practice gap: rapid review, stakeholder perspectives and recommendations for upper limb rehabilitation after acquired brain injury

Background/Aims For people living with acquired brain injury from stroke or trauma, clinical practice guidelines recommend high-intensity physical rehabilitation to optimise motor outcomes. There is an acknowledged evidence–practice gap between routine clinical practice and the amount, intensity and type of active upper limb rehabilitation recommended in research-informed guidelines. The aims of this study were to identify methods used to facilitate high doses of upper limb practice in published trials, understand stakeholder perspectives of the barriers and enablers to these methods in hospital settings, and to synthesise findings to form an evidence-based action plan for rehabilitation professionals, service providers and adults living with an acquired brain injury. Methods A rapid systematic literature review and a series of qualitative interviews with service users and rehabilitation clinicians explored the evidence on intensity and the experience of high intensity rehabilitation following brain injury and stroke. Triangulating this mixed method evidence, recommendations were generated on how to increase upper limb rehabilitation intensity during inpatient therapy. Results There was consensus in the literature that high-dose motor training improves a person's ability to move their hand and arm after brain injury and stroke. Trials mostly delivered therapy programmes as a replacement to usual care; however, it was unclear how high-intensity therapy was integrated into usual rehabilitation. Methods employed to increase the intensity of upper limb rehabilitation included strategies to optimise engagement (eg encourage independent practice and more practice); clinician-related processes (eg self-auditing, use of groups); environmental factors (eg equipment, dedicated space); and organisational influences (eg professional development, dedicated research positions and mentoring). Qualitative data showed that barriers and facilitators stem from service user factors (eg cognitive ability, advanced age, cultural mores) as well as clinician factors (eg quality of the therapeutic relationship, type and quality of therapist instructions). Organisational factors such as a strong research culture and a commitment to evidence-based practice positively influenced outcomes. Conclusions There is capacity to increase the intensity of upper limb rehabilitation by optimising organisational support and systems, as well as greater service user engagement in therapy processes. Implications for practice Rehabilitation clinicians have long understood that dose is a critical component of motor training. Findings may assist with structuring upper limb rehabilitation programs and addressing clinician factors to increase the intensity of therapy.

Drought risk and audit pricing: a mixed-methods study

PurposeClimate change has led to a rise in the frequency, intensity and scope of droughts, posing significant implications for businesses. This study examines the impact of local community drought levels on audit pricing. Additionally, it explores the moderating effects of high-tech industries, auditor busyness and the level of local community concern regarding the drought crisis.Design/methodology/approachThis study employs a mixed-methods approach to rigorously test the research hypotheses. The quantitative phase of the study utilizes a sample of 1,278 firm-year observations from Iran’s capital market. For the analysis of the quantitative data, ordinary least squares regression with clustered robust standard errors is used. Additionally, this research supplements its quantitative findings with qualitative evidence obtained through semi-structured interviews with 19 Iranian audit partners.FindingsThe results suggest that firms operating in provinces facing severe droughts experience notably higher audit fees. Furthermore, the positive relationship between drought and audit fees is weakened when auditors are busy, local community concern regarding the drought crisis is high or the firm operates within high-tech industries. These findings are supported by a range of robustness checks and qualitative evidence gathered from the field.Originality/valueThis research contributes to the growing literature on climate change by examining the influence of local community drought levels on audit pricing within an Iranian context. Additionally, our study sheds light on how high-tech industries, auditor workload and the level of local community concern regarding the drought crisis moderate the relationship between drought and audit fees. Importantly, our study pioneers in providing mixed-methods evidence of the association between drought severity and audit fees.

Autistic Women’s Experiences of the Perinatal Period: A Systematic Mixed Methods Review

AbstractThe perinatal period has challenges for autistic women. This review synthesises evidence on the experiences of autistic women during the perinatal period. This mixed methods evidence synthesis followed JBI guidance for mixed methods systematic reviews. The Mixed Methods Appraisal Tool assessed study quality. Thematic analysis was used to synthesise findings. Thirteen studies were included. Themes identified included sensory demands of the perinatal period are frequently overwhelming; experiencing healthcare as an autistic person is challenging; parenting as an autistic mother has difficulties but also rewards; predictability and control are important in labour and birth. Individualised care with reasonable adjustments can make a difference to the perinatal experiences of autistic women. Despite challenges, autistic women also have many strengths as mothers.

The education of experience: Mixed methods evidence demonstrates the benefit of multiparity

ProblemExisting quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AimThis convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. MethodsThirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FindingsPrimiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants’ qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. ConclusionsThe practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.

Inequalities in Healthcare Access, Experience and Outcomes in Adults With Inflammatory Bowel Disease: A Scoping Review.

Inflammatory bowel diseases (IBDs) are incurable diseases that require lifelong access to health services. Accumulating evidence of inequalities in health care access, experience, and outcomes for individuals with IBD is apparent. This review aimed to describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps, and to identify future research priorities in this area. A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from 3 databases (EMBASE, Medline, and CINAHL) published between January 1, 2000, and September 27, 2023. Fifty-one studies met the criteria for inclusion. The majority (42 of 51) focused on IBD health outcomes, followed by healthcare access (24 of 51). Significantly fewer investigated patient experiences of IBD healthcare (8 of 51). Most available studies reported on race/ethnic disparities of healthcare (33 of 51), followed by inequalities driven by socioeconomic differences (12 of 51), rurality (7 of 51), gender and sex (3 of 51), age (2 of 51), culture (2 of 51), literacy (1 of 51), and sexuality (1 of 51). Inflammatory bowel disease patients from Black, Asian, and Hispanic ethnic groups had significantly poorer health outcomes. A lack of research was found in the sexual and gender minority community (1 of 51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism. Further research, particularly utilizing qualitative methods, is needed to understand health experiences of underserved patient populations with IBD. Cultural humility in IBD care is required to better serve individuals with IBD of Black and Asian race/ethnicity. The lack of research amongst sexual and gender minority groups with IBD, and with learning disabilities, poses a risk of creating inequalities within inequalities.

Healthcare workers' perspectives on barriers and facilitators to referral and recruitment to diabetes prevention programmes: a systematic review protocol.

Diabetes is a growing global health problem. International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing type 2 diabetes. Diabetes prevention programmes (DPPs) can prevent type 2 diabetes in those at high risk, however many eligible participants are not referred to these programmes. Healthcare workers (HCWs) are pivotal to the referral and recruitment processes. This study aims to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCWs. A "best fit" framework synthesis method will synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCWs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus will be searched for primary studies published in English. Year of publication will be restricted to the last 26 years (1997-2023). Quality will be assessed using the Mixed Methods Appraisal Tool. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCWs' perspectives on referral and recruitment to DPPs. Sensitivity analysis will be carried out on this conceptual model. Confidence in the synthesised findings will be assessed using the GRADE-CERQual approach. One author will screen, extract, appraise the literature while a second author will independently verify a 20% sample at each stage. Participation in DPPs is key for programme impact. HCWs typically identify those at risk and refer them to DPPs. Understanding HCWs' perspectives on the barriers and facilitators to referral and recruitment will inform future implementation of DPPs.

Active rejection or passive indifference? Mixed-methods evidence on national (dis)identification

Much of the research on national identity investigates its negative aspects through the form of nationalism. However, what happens at the opposite end of the spectrum, when someone does not glorify the national ingroup but actively rejects it? Across two studies conducted in Serbia ( Ns = 349 and 554), we investigated national identification and disidentification, their antecedents, and consequences. We found no evidence to distinguish between (low) national identification and disidentification. Regarding antecedents of national identification, we found that self-stereotypes (positive and lack of negative) were the most important contributors, followed by right-wing social ideology. Regarding consequences, low national identifiers endorsed wider identities (e.g., European, world citizen) and had higher intentions to migrate. Most strikingly, low identifiers blatantly dehumanized ingroup members, even more so than high identifiers dehumanized (high-status) outgroups. In analyzing qualitative data, we contextualized the quantitative findings by showing that low identification is mainly articulated as a mismatch between self and ingroup prototype, consequently leading to dehumanization. We conclude that low national identification can have detrimental effects, but that more research in the non-Western context is necessary to properly understand this phenomenon.

P018 Inequalities in healthcare access, experience and outcomes in adults with Inflammatory Bowel Disease: A scoping review

Abstract Background Inflammatory Bowel Diseases (IBD) are long-term conditions requiring lifelong access to, and interactions with health services. Accumulating evidence of inequalities in health care access, experience and outcomes for individuals with IBD is apparent. However there is no existing review that systematically maps these inequalities.The purpose of this review was to map and describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps and future research priorities in this area. Methods A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from three electronic databases (EMBASE, Medline and CINAHL). English written articles published between 2000 and 2023 were systematically searched using a search strategy. The Joanna Briggs Institute protocol for scoping reviews was followed to perform data extraction and analysis. Results 1343 records were identified. 51 studies met the criteria for inclusion. Studies addressed ethnic disparities of healthcare (33/51), inequalities driven by socioeconomic differences (12/51), rurality (7/51), gender (3/51), age (2/51), culture (2/51), literacy (1/51) and sexuality (1/51). The interrelationship of disparities relating to outcome, access and experience is illustrated in Figure 1. Poorer health outcomes (42/51 studies) were described in those from Black, Asian, and Hispanic ethnic groups in relation to hospital admission, readmission, emergency room attendance, length of stay, IBD-related complications, post-operative complications, treatment delay and length of stay. Deprivation, insurance status in US populations, rural location and age also affected outcome. Access inequalities (24/51 studies) were described to services, therapies and surgery but also to educational opportunities. Poor experience of care (8/51 studies) included appointment issues, lack of cultural understanding and fragmented care. A lack of research was found in the LGBTQIA+ community (1/51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism. Conclusion Inequality affecting a wide range of population characteristics affects outcomes, access and experience in IBD care. Services need to be organised and delivered in a way that addresses this. Further research, including qualitative methods, is particularly needed to understand health experiences of underserved patient populations with IBD. The lack of research amongst LGBTQIA+ individuals, and with learning disabilities, poses a risk of creating inequalities within inequalities.

Mental Health Peer-Led Cafés—A Complementary Approach to Traditional Crisis Care: A Protocol for a Systematic Scoping Review

Introduction: Psychiatric services are gradually becoming more recovery-orientated. With such orientation came the peer movement, a process which began during the civil rights movement of the 1960s and 1970s and has grown exponentially since. In June 2020, the Irish Department of Health released ‘Sharing the Vision’, a policy which envisioned the implementation of crisis cafés as part of mental health service provision. In addition to this, recovery and peer support movements allowed for the timely establishment of peer-led services, thus raising the question: can such crisis cafés as posited in current Irish mental health policy be peer-run? Methods and Analysis: A systematic scoping review is proposed within this paper, the aim of which is to investigate the effectiveness of peer-led cafés on an individual’s recovery journey along with its impact on mental health, safety, and coercion-based outcomes within mental health crisis care. To ensure a transparent and empirically sound approach to the search and reporting of this systematic scoping review, the PRISMA guidelines will be adhered to in this review. Additionally, Arksey and O’Malley’s original framework will be employed to support the adherence to the relevant methodological processes when reporting on this kind of review. Arksey and O’Malley’s original framework presents scoping reviews through a five-step process, which includes stating search terms and searching databases (CINAHL, psycINFO, psycARTICLES, and PubMed) and repositories (Google, Cochrane Online Library, and ETHos), for papers to be included, based on a pre-determined inclusion/exclusion criteria. Discussion: This protocol is the first, to the authors’ knowledge, that reports the qualitative, quantitative, and mixed method evidence into peer-run cafés for mental health crisis management. The use of the PRISMA guidelines and Arksey and O’Malley’s methodological framework enhances the methodological rigour, transparency, reproducibility, and accuracy of this review. The review is limited, as it does not report on study quality or risk of bias. This will not occur in order to maintain its adherence to Arksey and O’Malley’s original framework. The preprint protocol was added to the OSF Registries and is freely available. It will be updated once the paper is published.

Do private health providers help achieve Universal Health Coverage? A scoping review ofthe evidence from low-income countries.

Universal Health Coverage (UHC) is the dominant paradigm in health systems research, positing that everyone should have access to a range of affordable health services. Although private providers are an integral part of world health systems, their contribution to achieving UHC is unclear, particularly in low-income countries (LICs). We scoped the literature to map out the evidence on private providers' contribution to UHC progress in LICs. Literature searches of PubMed, Scopus and Web of Science were conducted in 2022. A total of 1049 documents published between 2002 and 2022 were screened for eligibility using predefined inclusion criteria, focusing on formal as well as informal private health sectors in 27 LICs. Primary qualitative, quantitative and mixed-methods evidence was included, as well as original analysis of secondary data. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of the studies. Relevant evidence was extracted and analysed using an adapted UHC framework. We identified 34 papers documenting how most basic health care services are already provided through the private sector in countries such as Uganda, Afghanistan and Somalia. A substantial proportion of primary care, mother, child and malaria services are available through non-public providers across all 27 LICs. Evidence exists that while formal private providers mostly operate in well-served urban settings, informal and not-for-profit ones cater for underserved rural and urban areas. Nonetheless, there is evidence that the quality of the services by informal providers is suboptimal. A few studies suggested that the private sector fails to advance financial protection against ill-health, as costs are higher than in public facilities and services are paid out of pocket. We conclude that despite their shortcomings, working with informal private providers to increase quality and financing of their services may be key to realizing UHC in LICs.

Improving community health message reception through digital journalistic practices: Mixed-method evidence on health preventive behaviors and health podcast framing for emerging health issues

Health issues stemming from the public’s lack of access to scientific and health information prompted mounting concerns about public health responses. A growing amount of digital journalism scholarship has indicated the relevance of podcasts in health communication through reaching and engaging audiences in more significant preventive behaviors. Integrating digital journalistic practices in health podcasts as a practical and low-cost communication strategy can augment public adherence to addressing widespread health issues. However, the role of health podcasts in media framing in promoting preventive health behaviors is largely unknown. This study used a mixed-method approach (e.g., content analysis and quasi-experiments) to uncover the effectiveness of health podcasts’ framing practices (scientific vs. health frames). The content analysis results demonstrated that the health podcasts mainly used carrier and normal frames, while problem definitions and treatment were leading scientific frames. In a series of quasi-experiments comprising 640 respondents from the UAE and Pakistan, this research manipulated eight frames employed in health podcasts (i.e., two leading sub-frames for each scientific and health frame) to examine the causal mechanism that affects preventive health behaviors (hereafter PB). The findings established that the message-consistent effects of media frames manifesting scientific evidence and health orientation made audiences adopt PB. Theoretically, this research addresses the call for a more comprehensive “community digital journalistic practices model,” further delivering novel evidence on the health podcast framing approaches to offer more eloquent community health campaigns to raise public health issues.

What Determines AI Adoption in Companies? Mixed-Method Evidence

ABSTRACT Artificial Intelligence (AI) is among the emerging technologies that offer potential competitive advantages, but there is insufficient evidence regarding its use in B2B SMEs in India. This study uses empirical methods to investigate the factors that lead to the successful adoption of AI practices by B2B SMEs in India, as well as the outcomes of this adoption. A conceptual model is formulated using the technology-organization-environment (TOE) framework, which examines how AI enablers and AI readiness influence the competitive advantage with due acceptance of AI practices. To test the theoretical framework, the study used a mixed-method approach; survey data was gathered from 866 employees (managers) of SMEs. The findings suggested that all the AI enablers except perceived benefits and role clarity significantly impacted AI readiness. Further, AI ethics, the moderator of the study, was found to be significant between perceived benefits, role clarity, perceived trust, and competitive advantage.

Healthcare workers’ perspectives on barriers and facilitators to referral and recruitment to diabetes prevention programmes: a systematic review protocol

Background: Diabetes is a growing global health problem. International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing type 2 diabetes. Diabetes prevention programmes (DPPs) can prevent type 2 diabetes in those at high risk, however many eligible participants are not referred to these programmes. Healthcare workers (HCWs) are pivotal to the referral and recruitment processes. This study aims to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCWs. Methods: A “best fit” framework synthesis method will synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCWs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus will be searched for primary studies published in English. Year of publication will be restricted to the last 25 years (1997–2022). Quality will be assessed using the Mixed Methods Appraisal Tool. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCWs’ perspectives on referral and recruitment to DPPs. Sensitivity analysis will be carried out this conceptual model. Confidence in the synthesised findings will be assessed using the GRADE-CERQual approach. One author will screen, extract, appraise the literature while a second author will independently verify a 20% sample at each stage. Discussion: Participation in DPPs is key for programme impact. HCWs typically identify those at risk and refer them to DPPs. Understanding HCWs’ perspectives of the barriers and facilitators to referral and recruitment will inform future implementation of DPPs.

Delivering the Vote: Community Politicians and the Credibility of Punishment Regimes in Electoral Autocracies

How do authoritarian regimes punish ordinary opposition voters? I argue that elected community politicians help make "punishment regimes," which discourage opposition support, credible. Strengthened by decentralization reforms, community politicians have information and leverage necessary to identify and punish opposition supporters. When the regime wins community elections, these politicians extend the regime's reach deep into communities. When opposition parties win, their reach is constrained weak- ening their electoral control. Using mixed-methods evidence from Tanzania, I show regime-loyal community politicians use their distributive and legal-coercive powers to "deliver the vote" leading voters in these communities to fear individual reprisals for opposition support. In contrast, voters fear individual punishment in opposition-run communities significantly less. This study demonstrates the importance of local institutions and elections when understanding regime durability.

The Efficacy and Implementation of Michigan’s Partnership Model of School and District Turnaround: Mixed-Methods Evidence From the First 2 Years of Reform Implementation

The recent Every Student Succeeds Act (ESSA) requires states to identify and turn around their lowest performing schools, but it breaks somewhat from prior policies by granting states significant autonomy over how they identify and turn around these schools. This mixed-methods study, which draws on administrative, qualitative, and survey data, examines the effectiveness of Michigan’s approach to school turnaround under ESSA. We find that students in turnaround schools experienced significant achievement gains in math and to a lesser extent in English language arts (ELA), with effects concentrated among the lowest achieving students. Analyses of qualitative and survey data suggest that these outcomes were influenced by state-level supports, strategic planning, the threat of accountability for continued low performance, and improved leadership quality in turnaround schools.