Mixed-methods Intervention Study Research Articles

Mitigating antibiotic misuse in dairy farming systems and milk value chain market: Insights into practices, factors, and farmers education in Nyabihu district, Rwanda

The widespread misuse of antibiotics to combat bacterial infections in dairy farming is a global concern contributing to antimicrobial resistance (AMR). To gain insights within small-scale dairy farming, a study was conducted in Nyabihu district of Rwanda from September 2021 to April 2023 to assess practices and factors associated with antibiotic use, investigate antibiotic residues in cow milk and undertake a comprehensive training program to improve quality milk production. A mixed-methods approach, combining cross-sectional and longitudinal intervention studies, involved 42 regular dairy farmers from both open and zero-grazing systems delivering milk to the Union pour la Promotion des Cooperatives des Eleveurs en Nyabihu (UPROCENYA) milk collection center (MCC). Standardized questionnaires and farm interviews were conducted to assess antibiotic use practices while bulk tank milk samples from the same farmers were collected and tested for antibiotic residues using rapid tests over 16 months (8 months before and 8 months after training).Out of 451 bulk tank milk samples tested, 27 samples (6%) contained antibiotic residues, primarily tetracyclines (55.3%) and beta-lactams (44.7%). Before farmers training, 5182.75 l of milk were rejected monthly due to antibiotic residues. Following training, milk rejections decreased to 3192.75 l per month, reflecting 38.35% monthly decrease. However, no statistically significant difference was found by independent t-test (t = 1.441; p = 0.173) between milk rejected before and after training. 97.6% of interviewed farmers reported using antibiotics within six months preceding data collection, with 71.4% primarily used for disease treatment, notably targeting tick-borne diseases (34.0%). Alarming practices included administering antibiotics without referring samples for laboratory examination (100%), disregarding withdrawal periods (88.1%) and administering antibiotics without a veterinary doctor's prescription (85.7%). Factors contributing to these practices included limited farmer’s knowledge on antibiotics, easy access to antibiotics in local agro-veterinary shops, and insufficient veterinary services. Antibiotic-laden milk was used to feed calves (38.6%), consumed at home (26.5%), and sold (12.0%).The observed misuse of antibiotics and disregard for antibiotic withdrawal periods pose significant threats to both milk quality and human health. The authors recommend that dairy farmers prioritize animal health monitoring, seek veterinary advice for disease prevention and treatment and implement biosecurity measures to prevent diseases and thus reduce antibiotic usage. Collaborative efforts among stakeholders are highly recommended to enhance capacity building for dairy farmers and support research initiatives. Furthermore, it is strongly suggested to strengthen regulations on the prudent use of antibiotics within the Rwandan food production system to curb antimicrobial resistance across both animal and human populations.

Promoting Awareness and Self-Efficacy for Culturally Responsive Teaching of Pre-Service Teachers Through the Identity Project – a Mixed Methods Study

ABSTRACT Culturally Responsive Teaching (CRT) provides a framework for teachers to include students’ ethnic-cultural identities in class, aiming to tackle issues of educational and societal inequity. This quasi-experimental mixed methods intervention study tested whether pre-service teachers attending a seminar based on an ethnic-cultural identity school intervention, the Identity Project, would show greater CRT self-efficacy and more positive beliefs about teaching in ethnic-culturally diverse classes, compared to a control group. Repeated measures ANCOVAs of survey data from 606 pre-service teachers in Germany indicated a stronger T1-T2 increase in confidence for interacting with ethnic-culturally diverse students and engaging in culture- and ethnic-related conversations in the intervention group. No significant time-by-group interactions emerged for other CRT facets. A content analysis of brief texts of pre-service teachers in the intervention group revealed they became more self-reflective about their own beliefs, learned about CRT practices for their own teaching, and gained confidence for including issues of ethnicity and culture in class. Yet, the complexity of ethnic-cultural diversity-related topics left some pre-service teachers feeling overwhelmed about how to adequately address ethnic-cultural diversity in the classroom. Overall, the Identity Project seminar raised pre-service teachers’ awareness and self-efficacy for engaging in CRT in the future.

Evaluation of the feasibility of a midwifery educator continuous professional development (CPD) programme in Kenya and Nigeria: a mixed methods study

BackgroundMidwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria.MethodsThis was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the blended CPD programme on teaching methods (theory and clinical skills), assessments, effective feedback and digital innovations in teaching and learning. Pre- and post-training knowledge using multiple choice questions in SDL; confidence (on a 0–4 Likert scale) and practical skills in preparing a teaching a plan and microteaching (against a checklist) were measured. Differences in knowledge, confidence and skills were analysed. Participants’ reaction to the programme (relevance and satisfaction assessed on a 0–4 Likert scale, what they liked and challenges) were collected. Key informant interviews with nursing and midwifery councils and institutions’ managers were conducted. Thematic framework analysis was conducted for qualitative data.Results116 (96.7%) and 108 (90%) educators completed the SDL and practical components respectively. Mean knowledge scores in SDL modules improved from 52.4% (± 10.4) to 80.4% (± 8.1), preparing teaching plan median scores improved from 63.6% (IQR 45.5) to 81.8% (IQR 27.3), and confidence in applying selected pedagogy skills improved from 2.7 to 3.7, p < 0.001. Participants rated the SDL and practical components of the programme high for relevance and satisfaction (median, 4 out of 4 for both). After training, 51.4% and 57.9% of the participants scored 75% or higher in preparing teaching plans and microteaching assessments. Country, training institution type or educator characteristics had no significant associations with overall competence in preparing teaching plans and microteaching (p > 0.05). Qualitatively, educators found the programme educative, flexible, convenient, motivating, and interactive for learning. Internet connectivity, computer technology, costs and time constraints were potential challenges to completing the programme.ConclusionThe programme was feasible and effective in improving the knowledge and skills of educators for effective teaching/learning. For successful roll-out, policy framework for mandatory midwifery educator specific CPD programme is needed.

Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study

ABSTRACT We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.

Influence of Virtual Reality and Gamification Combined with Practice Teaching Style in Physical Education on Motor Skills and Students’ Perceived Effort: A Mixed-Method Intervention Study

This mixed-method study examined the impact of combining virtual reality (VR) and gamification (GAM) with the practice teaching style (PTS) on students’ motor skills and perceived effort in physical education. Participants (n = 75) were divided into three groups: PTS (control), PTS + GAM and PTS + GAM + VR. Each group had two one-hour sessions per week for six weeks. Participants’ motor skills and perceived effort were evaluated quantitatively and qualitatively using tests such as the SportComp Motor, flamingo and plate-tapping tests, as well as the handgrip strength test and the Pictorical Children’s Effort Rating Table. The results indicate that the PTS group reported a higher perceived effort compared to the other groups (p &lt; 0.001). All study groups exhibited improvements in the handgrip strength (p &lt; 0.001) and flamingo (p &lt; 0.05) tests, while lateral jump test improvements were observed only in the two GAM groups (p &lt; 0.001). The VR group showed an improvement in the plate-tapping tests (p &lt; 0.001), while the PTS group exhibited a decline in the displacement with support test (p &lt; 0.05). Participant perceptions suggest that the activity nature, motivation from competition and rewards influenced the perceived effort and motor skills. In conclusion, GAM techniques are effective in reducing perceived effort in physical education programs, and combining GAM with VR enhances improvements in motor skills.

Impact of ChatGPT on ESL students’ academic writing skills: a mixed methods intervention study

This paper presents a study on the impact of ChatGPT as a formative feedback tool on the writing skills of undergraduate ESL students. Since artificial intelligence-driven automated writing evaluation tools positively impact students’ writing, ChatGPT, a generative artificial intelligence-propelled tool, can be expected to have a more substantial positive impact. However, very little empirical evidence regarding the impact of ChatGPT on writing is available. The current mixed methods intervention study tried to address this gap. Data were collected from tertiary level ESL students through three tests and as many focus group discussions. The findings indicate a significant positive impact of ChatGPT on students' academic writing skills, and students’ perceptions of the impact were also overwhelmingly positive. The study strengthens and advances theories of feedback as a dialogic tool and ChatGPT as a reliable writing tool, and has practical implications. With proper student training, ChatGPT can be a good feedback tool in large-size writing classes. Future researchers can investigate the impact of ChatGPT on various specific genres and micro aspects of writing.

Patient influence on general practice service improvement decision making: a participatory research mixed-methods intervention study.

Health policy promotes patient participation in decision making about service organisation. In English general practice this happens through contractually required patient participation groups (PPGs). However, there are problems with the enactment of PPGs that have not been systematically addressed. To observe how a co-designed theory-informed intervention can increase representational legitimacy and facilitate power sharing to support PPGs to influence decision making about general practice service improvement. Participatory action research to implement the intervention in two general practices in the North of England was undertaken. The intervention combined two different participatory practices: partnership working involving externally facilitated meetings with PPG members and staff; and consultation with the wider patient population using a bespoke discrete choice experiment (DCE). To illustrate decision making in PPGs, qualitative data are presented from participant observation notes and photographed visual data generated through participatory methods. The DCE results are summarised to illustrate how wider population priorities contributed to overall decision making. Observational data were thematically analysed using normalisation process theory with support from a multi-stakeholder co-research group. In both general practices, patients influenced decision making during PPG meetings and through the DCE, resulting in bespoke patient-centred action plans for service improvement. Power asymmetries were addressed through participatory methods, clarification of PPG roles in decision making, and addressing representational legitimacy through wider survey consultation. Combining participatory practices and facilitated participatory methods enabled patients to influence decision making about general practice service improvement. The policy of mandatory PPGs needs updating to recognise the need to resource participation in a meaningful way.

Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application.

Older adult care organizations face challenges today due to high personnel turnover and pandemic-related obstacles in conducting training and competence development programs in a time-sensitive and fit-for-purpose manner. Digital microlearning is a method that attempts to meet these challenges by more quickly adapting to the educational needs of organizations and individual employees in terms of time, place, urgency, and retention capacity more than the traditional competency development methods. This study aimed to determine if and how an app-based digital microlearning intervention can meet older adult care organizations' personnel competency development needs in terms of knowledge retention and work performance. This study assessed the use of a digital microlearning app, which was at the testing stage in the design thinking model among managerial (n=4) and operational (n=22) employees within 3 older adult care organizations. The app was used to conduct predetermined competency development courses for the staff. Baseline measurements included participants' previous training and competency development methods and participation, as well as perceived needs in terms of time, design, and channel. They then were introduced to and used a digital microlearning app to conduct 2 courses on one or more digital devices, schedules, and locations of their own choice during a period of ~1 month. The digital app and course content, perceived knowledge retention, and work performance and satisfaction were individually assessed via survey upon completion. The survey was complemented with 4 semistructured focus group interviews, which allowed participants (in total 16 individuals: 6 managerial-administrative employees and 10 operational employees) to describe their experiences with the app and its potential usefulness within their organizations. The proposed advantages of the digital microlearning app were largely confirmed by the participants' perceptions, particularly regarding the ease of use and accessibility, and efficiency and timeliness of knowledge delivery. Assessments were more positive among younger or less experienced employees with more diverse backgrounds. Participants expressed a positive inclination toward using the app, and suggestions provided regarding its potential development and broader use suggested a positive view of digitalization in general. Our results show that app-based digital microlearning appears to be an appropriate new method for providing personnel competency development within the older adult care setting. Its implementation in a larger sample can potentially provide more detailed insights regarding its intended effects.

Bridging the gap between teacher training and society. Sustainable development goals (SDGs) in English as a foreign language (EFL)

ABSTRACT A case study is presented showing the incorporation of Sustainable Development Goals knowledge and awareness-raising in the context of Education for Sustainable Development in a teacher-training pilot programme. The qualitative mixed-method intervention study, grounded in content analysis and comparative methodology, reveals that incorporating SDGs into teacher training programmes is key since there is a significant direct impact on society. The objective was firstly to create an SDG-based didactic proposal including inquiry-based learning as its pedagogical approach for developing critical thinking. Secondly, to study its effect on participants regarding raising awareness of SDGs and their projection to society as future teachers.

Improving Self-care Behavior and Removing Barriers by Structured Diabetes Education Program in Primary Health-care Settings of Puducherry: Evidence from a Mixed-method Intervention Study

Context: Diabetes self-management education (DSME) improves patients’ clinical outcomes and quality of life by encouraging self-care behavior. Aims: This study aimed to find out the effectiveness of a DSME by comparing changes in stages of self-care behavior and to explore perceived barriers in diet, exercise, and foot care among patients with type 2 diabetes mellitus in an urban primary health center (PHC) of Puducherry. Settings and Design: A mixed-method intervention study was conducted among 314 patients with type 2 diabetes mellitus in two urban PHCs randomly allocated to intervention and control arm. Subjects and Methods: The stages of behavior change and barriers perceived in the domains of diet, physical activity, and foot care were captured using a pretested questionnaire. Intervention consisted of DSME along with information leaflets and self-care kits for the intervention group. At the end of 6 months, end-line assessment and in-depth interviews were conducted. Statistical Analysis Used: Quantitative data were analyzed in STATA while manual coding and deductive thematic analysis were done for qualitative data. Results: Footcare showed an improvement of 31%, while diet and exercise domains saw an improvement of 5% each from preaction to action stage when compared with control arm. The main barriers perceived in dietary modification and foot care were lack of awareness. For exercise, the main barriers were lack of perceived need and being physically unfit. Foot-care barriers witnessed maximum resolution (27%) following the intervention. Conclusions: DSME intervention helps in improving stages of behavior change while resolving self-care barriers. Culturally-oriented DSME and patient-tailored interventions are key to empower people living with diabetes by improving self-care.

Impact of a school-based nutrition educational intervention on knowledge related to iron deficiency anaemia in rural Karnataka, India: A mixed methods pre-post interventional study.

To understand the extent to which adolescent awareness about anaemia and anaemia prevention can be changed by nutrition messages received at school. Mixed-methods pre-post intervention study. Three government schools in Bagalkot, Belagavi and Raichur districts of Karnataka, India. Students of grade six and seven and teachers involved in implementing the intervention. An educational intervention was co-developed by school teachers and nutrition experts using locally adapted resource materials that consisted of lectures, role play and practical demonstrations. Seven half-hour educational sessions were delivered by school teachers over 7 weeks to 455 students. Pre- and post-intervention tests measured changes in adolescents' knowledge about anaemia. Semi-structured in-depth interviews with teachers and focus groups with students explored their reactions to the intervention. Knowledge score related to anaemia. The percentage of children with correct scores increased by 7.3-49.0 percentage points for the tested questions after implementation of the intervention. The mean knowledge score increased by 3.67 ± 0.17 (p < 0.01). During interviews, teachers and students highlighted high acceptance of the intervention and materials, an increase in awareness, a positive attitude towards changing behaviour around diet, an increase in the demand for iron and folic acid supplements and improved sharing of messages learned with peers and families. Challenges expressed included need for further training, time limitations and hesitancy in teaching about menstruation and pregnancy. Educational interventions carried out for adolescents by teachers in schools are effective in improving awareness and attitude related to anaemia and its prevention.

All professions can benefit — a mixed-methods study on simulation-based teamwork training for operating room teams

BackgroundOperating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants’ reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace.MethodsIn a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team.Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years.Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis.ResultsAll occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one’s profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration.ConclusionSimulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

The Power of Peer Engagement: Exploring the Effects of Social Collaborative Annotation on Reading Comprehension of Primary Literature

In graduate education (GE), critical reading of reading primary literature (CRPL) is the principal method of learning a discipline and its practices, such as discourse about research and preparation for writing. CRPL is inconsistently taught in GE yet essential, forming a hidden curriculum advantaging the best-prepared students. In traditional reading or journal clubs, PL discourse follows a hierarchical social model, where those with the most knowledge and extroversion dominate discussions. This article reports qualitative findings explaining why online peer engagement using social collaboration annotation (SCA) with embedded prompts supported CRPL in a broader mixed-methods intervention study with doctoral participants in spring 2022. The broader study reported elsewhere was an online intervention delivered over four weeks where participants in various fields read science policy research. Qualitative data collection elicited participants’ practices, experiences, and self-perceptions of CRPL in the new field while using SCA for peer-based discourse and collaboration. The findings indicated that when everyone was learning with SCA, they asked questions and learned from seeing each other’s ideas in real time, thereby correcting mistakes, activating various critical strategies, and improving comprehension and confidence. Self-doubt and fear calmed down in a supportive environment without the hierarchy of traditional journal clubs. The implication is that students encountering CRPL need and benefit from explicit instruction and low-stakes peer-based discourse practice with SCA.

Effect of using client-accessible youth health records on experienced autonomy among parents and adolescents in preventive child healthcare and youth care: A mixed methods intervention study.

Client autonomy is important in Dutch youth care. It correlates positively with mental and physical health and can be strengthened by professional autonomy-supportive behaviour. Aiming for client autonomy, three youth care organisations co-developed a client-accessible youth health record (EPR-Youth). Currently, limited research is available on how client-accessible records contribute to adolescent autonomy. We investigated whether EPR-Youth strengthened client autonomy and whether professional autonomy-supportive behaviour reinforced this effect. A mixed methods design combined baseline and follow-up questionnaires with focus group interviews. Different client groups completed questionnaires about autonomy at baseline (n = 1404) and after 12months (n = 1003). Professionals completed questionnaires about autonomy-supportive behaviour at baseline (n = 100, 82%), after 5months (n = 57, 57%) and after 24months (n = 110, 89%). After 14 months, focus group interviews were conducted with clients (n = 12) and professionals (n = 12). Findings show that clients using EPR-Youth experienced more autonomy than non-users. this effect was stronger among adolescents aged 16 and older than among younger adolescents. Professional autonomy-supporting behaviour did not change over time. However, clients reported that professional autonomy-supporting behaviour contributed to client autonomy, emphasising that professional attitude needs addressing during implementation of client-accessible records. Follow-up research with paired data needs to strengthen the association between using client-accessible records and autonomy.

NURSING STUDENTS' EVALUATION OF THE OMAHA CARE SYSTEM

Abstract&#x0D; Objective: This study aimed to determine how nursing students' knowledge of the Omaha care plan has changed following their training in the Omaha classification system. Finding nursing students' opinions on the Omaha system utilized in school health practice was another objective of the study. Materials and Methods: This research covers the qualitative part of a mixed-method intervention study. Students from the Faculty of Health Sciences, School of Higher Education, Bursa Uludağ University were interviewed for the study between June and July 2019. The population of the study consisted of 153 students taking public health nursing courses at Bursa Faculty of Health Sciences, Faculty of Health Sciences, and 52 students who agreed to participate in the study were sampled. Numbers, percentages, and a Wilcoxon sign test analysis were utilized to examine the data in the SPSS 23.0 program. To evaluate qualitative data, thematic analysis was employed. Results: The Omaha system total score (p &lt; 0.001), problem classification score (p &lt; 0.001), intervention scheme score (p = 0.016), and problem assessment scale score (p = 0.006) of the students after the training were higher and statistically significant compared to their pre-training scores (p = 0.05). Some students evaluated the Omaha system as a difficult, complex, time-consuming, different, important, professional system that allows evaluation of each stage and questioning of causality; while some students evaluated it as a system that they could not understand at all. Conclusion: As a result of the study, students' knowledge levels increased before and after the training. Keywords: Omaha, Nursing, Student, Evaluation.

The Effect of Structured Reflection on Nurse Practitioner Students’ Diagnostic Reasoning Within Simulation: Qualitative Outcomes of a Mixed Methods Experiment

BackgroundMedical learners who use structured reflection demonstrated improved diagnostic accuracy. This has not been explored in nurse practitioner students. MethodsThe qualitative purpose of the mixed methods intervention study was to understand how nurse practitioner students experience cognitive bias and their perception of structured reflection's utility to explain any diagnostic reasoning competency and accuracy changes within simulation. Qualitative description was used to explore themes. ResultsStructured reflection users noted its utility was diagnostic justification. Control participants did not identify using structured reflection but did note using its disconfirming elements for why they changed their initial diagnosis. ConclusionStructured reflection education and application may build competency.

The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study.

Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.

Dyslexia and English as a Foreign Language in Norwegian Primary Education: A Mixed Methods Intervention Study

Τhe current study explored the effect of specific teaching accommodations for English language learners with dyslexia in a Norwegian primary school. Specifically, this single group intervention project investigated the impact of a range of multisensory techniques on spelling skills and motivation. Participants included a special education teacher and five dyslexic pupils from the fifth and sixth grades. Pre- and post-tests were administered to observe development in spelling, while data were also collected via a pupil evaluation questionnaire and a teacher interview after the intervention. The findings revealed that the intervention was quite successful. The group exhibited substantial differences in mean scores between the pre- and post-test. However, there were individual differences in scores and comorbid disorders appeared to impact the effectiveness of the intervention. Nonetheless, all of the pupils reported gains in their motivation and improvement in their attitude towards learning English, which was confirmed by their special education teacher. The paper concludes by offering specific didactic suggestions regarding accommodations for English language learners with dyslexia.

Burden of informal caregivers of people without natural speech: a mixed-methods intervention study

BackgroundPeople with disabilities and without natural speech often rely on care provided by informal caregivers. The caregiving situation of these informal caregivers has been poorly researched. The objectives of the study are 1) to identify stressors, resources, and coping strategies among informal caregivers of people without natural speech and 2) to examine whether a complex intervention in augmentative and alternative communication (AAC) that is not primarily tailored to the needs of informal caregivers can reduce care-related burden.MethodsThe main components of the AAC intervention were (1) initial counselling session, (2) 4 AAC training sessions, (3) 20 AAC therapy sessions and (4) accompanying case management. The control group received only the initial counselling session. Within a quasi-experimental intervention study, survey data on self-perceived burden (Burden Scale for Family Caregivers, BSFC-s) from n = 154 informal caregivers of people without natural speech were collected at three time points between June 2018 and April 2021 from a postal survey. Qualitative interviews with n = 16 informal caregivers were conducted.ResultsCaregivers reported various stressors such as limited communication with the cared-for person and concerns about the living situation in adulthood. Diverse resources and effective coping strategies, which the caregivers refer to when dealing with stressors, could also be identified. Burden was significantly reduced in the intervention group compared to the control group. According to the results of the qualitative study, AAC use led to better communication skills and a reduction in behavioural problems and thus a decreased burden.ConclusionsThe AAC intervention seems to have a positive impact on self-perceived burden. Linkages between intervention components and burden reduction as well as stressors and coping strategies could be identified and provide an evidence-based foundation for developing future holistic interventions for families with individuals without natural speech.Trial registrationGerman Clinical Trials Register (DRKS); ID: DRKS00013628 (registered on 05/02/2018).

Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility intervention study

BackgroundTo help address the issue of inappropriate antipsychotic prescribing to nursing home residents with dementia, the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention was developed, comprising staff education and training, academic detailing and a novel resident assessment tool. ObjectivesThe primary objective was to assess the feasibility and acceptability of the RAPID complex intervention in a nursing home setting. The secondary objective was to describe associated trends in psychotropic prescribing, falls, and behavioural symptoms. MethodsA mixed-methods feasibility intervention study in one large nursing home in Ireland was undertaken between 07/2017 and 01/2018. Focus groups and semi-structured interviews were conducted with nursing home staff and GPs at the end of the 3-month follow up period to assess participants' experience of the intervention. Quantitative measurements included pre- and post-course evaluation and psychotropic prescribing rates. ResultsSixteen nursing home staff members attended the two education and training days (21% attendance rate), and four GPs participated in the academic detailing sessions (100% attendance rate). Participants of the focus groups and interviews (n = 18) found the education and training beneficial for their work and expressed a desire to continue educating new staff after the study's completion. However, there was limited usage of the resident assessment tool. Participants also offered recommendations to enhance the intervention.The proportion of dementia residents prescribed at least one regular antipsychotic was stable over the 3-months pre-intervention at 45% (n = 18), and at baseline at 44% (n = 19) but decreased slightly to 36% (n = 14) at 3-months post-intervention. At the same time the absolute number of ‘PRN’ psychotropics administered monthly to dementia residents decreased substantially from 90 at baseline to 69 at 3-months post-intervention. ConclusionThe RAPID complex intervention was broadly feasible to conduct and may be acceptable to stakeholders. However, before it can be evaluated in larger scale studies, certain protocol modifications and further exploratory work are required to improve implementation.