Mixed Methods Study Research Articles

Right out of the gate: a mixed method study on the needs and priorities of individuals with or at risk of breast cancer-related lymphedema.

Clinical practice guidelines aim to standardize care and improve patient outcomes; however, they often lack input from patients themselves. Integrating the perspectives of individuals with lived experience ensures guidelines align with patient needs and priorities. This study is part of the update to the Canadian Clinical Practice Guideline for breast cancer-related lymphedema (BCRL). Our goal was to identify the priority questions of individuals living with breast cancer to inform the development of guideline recommendations. The secondary aims were to identify the concerns, and barriers and facilitators to accessing lymphedema care. A mixed-methods study design was employed using a Canada-wide cross-sectional survey and focus group discussions. Qualitative data were analyzed using inductive thematic analysis. A total of 137 participants with breast cancer completed the online survey, with 112 (81.8%) reporting BCRL. Six priority questions were identified: (i) What is my individual risk for BCRL? (ii) How can I lower my chances of developing BCRL? (iii) Do I have lymphedema? (iv) What are the effective treatment options for BCRL? (v) How can I best self-manage my lymphedema over the longer term? and (vi) How should my lymphedema be monitored over time? Participants expressed concern over developing or worsening of BCRL, and highlighted inconsistencies in care across Canada. Qualitative analyses revealed three themes: empowering patients, supporting self-management, and creating a surveillance plan/roadmap for lymphedema care. The findings will be used to guide patient-level clinical recommendations and knowledge translation tools. Addressing barriers may further a more equitable approach to patient-centered care. Involving individuals with lived experience of breast cancer in guideline development and decision-making ensures that recommendations are truly reflective of the priorities of individuals affected by the condition. The overarching themes will support actionable strategies that align with the needs and priorities of individuals with breast cancer.

Patient, carer and healthcare professional perspectives on deprescribing in surgical wards: A mixed methods study.

The perspectives of patients and healthcare professionals regarding deprescribing in surgical wards within hospital settings are unknown. The aim of this study was to explore current practices, attitudes and the enablers and barriers to deprescribing in hospital for older surgical inpatients from the perspectives of doctors, pharmacists, patients and carers. A mixed methods study was performed. Two surveys were administered Australia-wide (revised Patients' Attitudes Towards Deprescribing questionnaire for patients/carers and Deprescribing Self-Efficacy Survey for doctors/pharmacists). Interviews, focus groups and observations of ward rounds were conducted with participants from five Australian hospitals. Quantitative data were analysed descriptively, while qualitative data were examined using a combined inductive and deductive approach, with results triangulated. There were 109 survey participants (58 doctors/pharmacists and 51 patients/carers), 28 interview/focus group participants (15 doctors/pharmacists and 13 patients/carers) and eight ward round participants. Doctors and pharmacists reported low to moderate levels of confidence in deprescribing. While most patients and carers were satisfied with their medications, they expressed a willingness to consider deprescribing. Five themes were identified from the interviews, focus groups and ward round observations: (1) deprescribing is not a priority, (2) medication review occurs in response to triggers, (3) knowledge about deprescribing is limited, (4) deprescribing requires a team effort and (5) trust, rapport and communication are essential for successful deprescribing. Doctors working on surgical wards are unlikely to proactively deprescribe medications. A collaborative patient-centred approach involving geriatricians, clinical pharmacologists and pharmacists, along with educational interventions may facilitate deprescribing for surgical patients.

Exploring dental faculty awareness, knowledge, and attitudes toward AI integration in education and practice: a mixed-method study

BackgroundDentistry is shifting from traditional to digital practices owing to the rapid development of “artificial intelligence” (AI) technology in healthcare systems. The dental curriculum lacks the integration of emerging technologies such as AI, which could prepare students for the evolving demands of modern dental practice. This study aimed to assess dental faculty members’ knowledge, awareness, and attitudes toward AI and provide consensus-based recommendations for increasing the adoption of AI in dental education and dental practice.MethodThis mixed-method study was conducted via a modified version of the General Attitudes toward Artificial Intelligence Scale (GAAIS) and Focus Group Discussions (FGD). Four hundred faculty members from both public and private dental colleges in Pakistan participated. The quantitative data were analyzed using SPSS version 23. Otter.ai was used to transcribe the data, followed by thematic analysis to generate codes, themes, and subthemes.ResultsThe majority of the faculty members was aware of the application of AI in daily life and learned about AI mainly from their colleagues and social media. Fewer than 20% of faculty members were aware of terms such as machine learning and deep learning. 81% of the participants acknowledged the need for and limited opportunities to learn about AI. Overall, the dental faculty demonstrated a generally positive attitude toward AI, with a mean score of 3.5 (SD ± 0.61). The benefits of AI in dentistry, the role of AI in dental education and research, and barriers to AI adoption and recommendations for AI integration in dentistry were the main themes identified from the FGD.ConclusionsThe dental faculty members showed general awareness and positive attitudes toward AI; however, their knowledge regarding advanced AI concepts such as machine learning and deep learning was limited. The major barriers identified in AI adoption are financial constraints, a lack of AI training, and ethical concerns for data management and academics. There is a need for targeted education initiatives, interdisciplinary and multi-institutional collaborations, the promotion of local manufacturing of such technologies, and robust policy initiatives by the governing body.

Advancing higher education with GenAI: factors influencing educator AI literacy

Artificial Intelligence (AI) literacy has emerged as a critical skill across various disciplines and industries, including education. This study aimed to identify the factors that influence educators' AI literacy and to examine the relationships among these factors. A sequential mixed methods approach was used to investigate the factors influencing faculty members' AI literacy, with qualitative data collected from 33 faculty members through focus group discussions and semi-structured interviews. Quantitative data were then gathered using the finalized survey instrument, completed by 538 faculty members from diverse disciplines and higher education institutions in Palestine. Data analysis was conducted using Smart PLS. The findings revealed several key factors that impact educators' AI literacy, including AI competencies, perceived usefulness of AI, ease of use, professional development, and community support. Additionally, prior experience with technology played a significant role in developing AI literacy. While the study's mixed methods design provided depth, one limitation was that the qualitative phase involved a relatively small sample. Future research should further explore the broader implications of AI in education and its integration across various academic fields.

The Multidimensional Factors That Influence the Family Management of Autism Spectrum Disorder: A Mixed Methods Study.

Children with autism spectrum disorder (ASD) have complex health needs and co-occurring medical and psychiatric diagnoses. Using the Family Management Style Framework, this convergent parallel mixed methods (QUAN + qual) study: (a) examined the intersection of Ability and Effort to define family management patterns and (b) evaluated the influence of child (ASD-related behaviors, feeding difficulties, sleep disturbances, gastrointestinal symptoms, aggression, self-injury), caregiver (anxiety, depression), and family (social support, unmet social needs) factors on family management pattern. Fifty-six primary caregivers of children with ASD completed the quantitative strand of the study. A nested sample of 30 caregivers participated in semi-structured interviews. The four patterns of family management were similar to those previously identified. Data from quantitative measures and interviews converged to identify that specific child characteristics (ASD behaviors, sleep disturbances, aggression, self-injury) and the caregiver's perceived social support influence family management. Descriptions of family management patterns and their correlates are important to guiding family nursing for this population.

Evidence of the impact of CLN2 and CLN3 Batten disease on families in the United Kingdom

BackgroundNeuronal Ceroid Lipofuscinoses (NCLs), also known as Batten disease, are a group of inherited neurodegenerative disorders that mostly arise in childhood. Each of the NCLs is a genetically distinct disease caused by variants in at least 13 different genes (CLN1–CLN14). NCLs are neurodegenerative, and symptoms can include a combination of childhood dementia, epileptic seizures, motor decline and vision loss, and eventually lead to premature death. There is currently no cure for any subtype of NCL, however, enzyme replacement therapy is available for CLN2 disease, and several treatment strategies are being explored for other NCL subtypes. Early diagnosis and initiation of supportive services (e.g. health, education, social services) are essential to preserve quality of life. Only a few studies have investigated family experiences with NCL, many of which are international in scope.MethodsA mixed-method research study was conducted in the UK to understand family experiences in CLN2 and CLN3 disease. It involved an initial literature review, followed by in-depth qualitative interviews. Interview data were analysed using a thematic analysis. Thirteen families (n = 13) participated in the interviews. This represented 16 parents (11 mothers and 5 fathers) of 18 children (10 diagnosed with CLN3 disease and 8 diagnosed with CLN2 disease). Findings were analysed jointly across CLN2 and CLN3 disease.ResultsSix overarching themes emerged from the analysis: difficulty in recognising early symptoms; the shock of a diagnosis; the demands of caring for complex and ever-changing needs; a constant battle to access appropriate and timely support services; the extensive impact on the unaffected sibling; and the all-encompassing impact on the family.ConclusionsThis study contributes novel UK specific data on family experiences and unmet needs in CLN2 and CLN3 disease. More needs to be done to ensure NCLs are diagnosed early, and timely local support services are made available to protect quality of life for both the affected children and their families.

The Influence of Behavioral Finance on Investment Decisions: A Study of Cognitive Biases in Portfolio Management

This academic article examines how behavioral finance can help inform more effective investment decisions, with an emphasis on the impact of cognitive biases on portfolio management. Many principles of traditional finance are based on rational behavior by investors (the person who takes on the investment), with the market being efficient (i.e., the market value reflects all the available information) too, but behavioral finance is a field that helps emphasize the impact of psychological factors on investor behavior. The research explores critical cognitive biases including overconfidence, loss aversion, anchoring, herd behavior, and confirmation bias, and their influence on the decision-making processes in investment strategies. Through a mixed-method study including surveys and interviews with retail and institutional investors, the study reveals the prevalence and influence of these biases on portfolio diversification, risk assessment, and asset allocation. Cognitive Biases: A Real Financial Breaker. The research outcomes show that significant deviations from rational behavior tend to exist, this leads to dysfunctional investments that reduce capital. Similarly, it concludes with suggestions on ways of counteracting these biases through investor education, decision-support tools and behavioral training programs, thus encouraging more rational and informed investment decisions.

What does engagement tell us about low-achieving learners’ motivational changes in a mobile-assisted personalized SRL training program?

Purpose This study aims to investigate low-achieving learners’ motivational changes in a self-regulated learning (SRL) training program featuring a personalized mechanism and an agency-supported design. Learners’ changes in self-efficacy, task value and goal orientations were examined in tandem with engagement to capture the multidimensionality of motivation. Design/methodology/approach This mixed-method study collected both quantitative data (n = 27) via questionnaires and log files, and qualitative data (n = 4) through semi-structured individual interviews and written accounts. Nonparametric tests were used for quantitative analysis while events from the log data were defined and coded as engagement, performance-goal-related behaviors and mastery-goal-related behaviors. Qualitative data went through content analysis in which instances relevant to motivational changes and the underlying factors were identified. Findings For participants whose data revealed aligned changes in motivation and engagement, the interactions between engagement and different goal orientations were highlighted; furthermore, their self-efficacy beliefs and perceived task value were positively influenced by the opportunities for self-management and agency-supported design realized through mobile learning. There were also participants whose data showed a diverging direction of changes between motivation and engagement. Possible factors contributing to this divergence relate to their strong performance goal orientation and hazy metacognitive knowledge. Originality/value Teachers interested in helping increase learners’ motivation for SRL are encouraged to take advantage of learners’ behavioral data as complementary to self-report data. Understanding what contributed to the differences will help teachers pinpoint difficulties low-achieving learners face and optimize the training program. Metacognitive knowledge and performance goal orientations are two particularly important elements needing to be addressed in the future.

Psychological Contract Fulfillment in a Changing Public Sector: a Mixed-Methods Case-Study

ABSTRACT While the public sector has experienced a notable surge in rapid organizational change, scholarly attention to the impact of intense organizational change on psychological contracts of employees has been limited. This mixed-method study explores how change intensity affects psychological contract fulfilment among civil servants, while also highlighting the role of change management. Using survey data from a large Belgian public organization and focus group insights, the study finds that increased change intensity reduces psychological contract fulfilment, while positive change management perceptions enhance it. However, even effective change management strategies may not fully counteract the negative effects of intense change environments.

Game over too soon: early specialization and short careers in esports

IntroductionEsports has become a global phenomenon, offering considerable professional opportunities, enhanced cognitive abilities, and strong social capital for young competitors. However, these benefits are often counterbalanced by significant challenges, including burnout, exploitation, and inconsistent governance, particularly for its predominantly young talent.MethodsIn this convergent mixed-methods study, we examine the factors influencing career longevity in esports by integrating a longitudinal analysis of 15,021 players’ records (1998–2023) and in-depth qualitative interviews conducted with ten key stakeholders in the Korean esports ecosystem.ResultsOur quantitative findings reveal an exponential increase in tournaments, prize money, and active competitors yet also expose a concerning trend: newer birth cohorts, especially those born after 1998, exhibit markedly shortened careers—with median durations approaching just 2 years. Complementary qualitative insights elucidate how early specialization, exploitative contractual practices, intense training regimens, and fragmented governance contribute to burnout and rapid career turnover.DiscussionTogether, these results underscore the urgent need for comprehensive policy reforms, including standardized contractual frameworks, holistic athlete support systems, and centralized regulatory oversight, to safeguard young talent and ensure the long-term sustainability of esports.

Perspectives of men and women working in vector control in Africa regarding barriers and opportunities for achieving gender inclusivity

BackgroundGender-inclusive strategies are crucial for tackling vector-borne diseases in Africa, but most programs still overlook the lived experiences of local practitioners regarding cultural norms, power imbalances, gender stereotypes, and workplace dynamics. This study investigated the gender-related perspectives of men and women working in vector control in Africa and their recommendations for effective gender inclusivity.MethodsAn exploratory mixed-methods study was conducted, starting in Tanzania with 22 in-depth interviews with team leaders, seven focus group discussions with scientists and vector control practitioners and two group discussions with vector control students. This was followed by an online survey of 150 researchers, academics, technicians, students, and vector-control staff from 16 African countries. Data on gender distribution, inclusivity, divergent male–female perspectives, and related experiences, including sexual harassment, were analysed thematically for qualitative responses and descriptively for survey responses.ResultsThe study revealed significant gender disparities in staffing and leadership of vector control programmes in Africa, with 70.3% of men and only 40.7% of women having held leadership roles. Men occupied most vector-control roles, except in acadaemia where parity is maintained until master's degree level but biased towards men at PhD levels. Marriage weighed more heavily on women, with 44.1% of female staff remaining unmarried, compared to only 18.7% of men. Most respondents said mixed-gender teams strengthen community engagement, but they differed on effects for creativity, cost and morale, with some insisting that merit alone matters, while others seeing diversity as essential for better results. Women were more likely than men to dismiss the claims that inclusivity is ineffective or disruptive. Challenges to gender inclusivity included cultural norms limiting women's participation in overnight fieldwork, work-family pressures, and scant workplace accommodations. Men recognized the benefits of working with women but noted challenges related to societal expectations and workplace accommodations. Majority of participants (84.1%) reported had never experienced gender-based violence, but women were more likely than men to report sexual harassment. Over half of respondents believed their manager's gender significantly impacted their work environment; and some women preferred female leaders for relatability and support, while others were indifferent.ConclusionThe study reveals wide gender gaps in African vector-control staffing and leadership and provides key insights for stakeholders to develop fairer workplace practices. Although the value of inclusivity is broadly recognized, cultural norms, family demands, and social expectations still weigh more heavily on women. These challenges can be addressed by incorporating a gender lens considering the perspectives of both men and women in vector control.

COVID-19, Involvement in Activities, and School Delinquency: A Mixed Methods Study

ABSTRACT This study examined how involvement in school activities may have affected school delinquency after the COVID-19 lockdown. It used a sequential explanatory mixed methods design and three data sources: Quantitative surveys with public school principals, in-depth qualitative interviews, and official school delinquency statistics. Contrary to expectations, school delinquency decreased after the lockdown. However, interviews with principals revealed that the types of delinquency changed. Although quantitative analysis found no significant relationship between school activities and delinquency, principals stressed the importance of these activities and other bonds to school. The findings suggest that bonds to teachers and parents may have provided a protective factor against delinquency when students did not have access to school activities.

Arts on prescription intervention for primary healthcare patients with poor mental health or social isolation: a mixed-method study

BackgroundPrimary healthcare providers are increasingly challenged in supporting patients with psychosocial needs. Arts on Prescription (AoP) has been shown to improve primary healthcare patients’ mental health wellbeing. The aim of the current study is to understand the psychosocial effect of participating in an Arts on Prescription programme.MethodsA total of 112 primary healthcare patients from 18 primary healthcare centres in Scania with mental health diagnoses depression and anxiety or social isolation participated in a 10-week group-based arts programme, twice a week for 2 h. A questionnaire with the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), the Salutogenic Health Indicator Scale (SHIS) (for baseline and follow-up) and 14 sociodemographic and self-rated health covariates were collected as baseline. We also conducted 28 semi-structured interviews. We analysed data using paired t-test and a general linear regression model for change in SWEMWBS and SHIS. Qualitative data was analysed using a thematic approach.ResultsThe paired t-test showed highly significant results (p < 0.001) for increase in both SWEMWBS and SHIS. The general linear regression.models show that women and participants with poorer self-rated health (SRH), more contacts with the healthcare system, other referrals from the primary healthcare centre, and no previous arts and culture engagement displayed significantly stronger associations with increase in SWEMWBS but not SHIS. Qualitative results highlight use of other interventions and difficulties navigating the health system.ConclusionsOur findings support a proportionate universalism (scale and intensity proportionate to the degree of need) approach indicating that AoP programmes could be valuable additions to healthcare pathways enhancing wellbeing for vulnerable populations. Findings should be interpreted with caution due to small sample size.

The perspectives of high-performance athletes on mental health assessment: a mixed-methods exploratory study

ABSTRACT Epidemiological evidence has reinforced the importance of psychological screening and mental health assessment (MHA) of high-performance athletes for early identification and prevention of mental ill-health. However, there is variation in worldwide implementation of MHA. It is unclear what assessment is available to athletes and how this assessment is perceived by those within the high-performance environment in Aotearoa/New Zealand. This study sought to identify experiences Aotearoa/New Zealand high-performance athletes had with MHA, the effects of MHA, and how MHA might be improved. Seventy-four athletes answered an online, mixed-methods survey investigating this topic. Over half of all participants reported having experienced no MHA monitoring, 55% reported current screening approaches were insufficient, and 89% indicated assessments could be improved. Of those whose mental health was actively screened, 22% believed current approaches were sufficient, 47% believed that current approaches were partially sufficient, and 31% believed current MHA approaches were insufficient. Participants reported that MHA facilitates access to support, addresses mental health stigma, and has a bidirectional association with sporting and personal culture. Participants differentiated between formal and informal assessments, discussing the positive and negative features of both.

Project-based Learning in a Short-duration Chemistry Workshop in the Developing World: Insights from Teacher Engagement

Enhancing the effectiveness of short-duration teacher workshops is critical for improving science teaching and learning, particularly in the developing world. While project-based learning is known to enhance knowledge usability, its feasibility and optimal design within short-duration teacher workshops in the developing world is unclear. This study employed a pragmatic, mixed-methods convergent parallel case study approach to examine teacher engagement as a proxy for learning during an 8 hour chemistry workshop in South Africa. The workshop used a form of project-based learning that prominently included direct instruction to help teachers represent, describe, and explain atmospheric chemical reactions relevant to Grades 8 and 9 natural sciences. Data were collected from 85 participants through the researcher’s reflective field notes, participants’ written work and their questionnaire responses. Descriptive statistics were used for quantitative analysis, while qualitative data were analysed using deductive coding. The teachers demonstrated high engagement in collaborative group discussions and hands-on simulations but limited interaction with the assigned readings on atmospheric gases and dissenting discussions, consistent with the communal learning culture prevalent in many developing world contexts. The findings suggest that the form of project-based learning used here is feasible in short-duration workshops in the developing world. However, structured scaffolding of individual learning activities is essential to deepen engagement.

Exploring the attitudes and beliefs of Saudi female nursing students towards sexual healthcare: mixed method study

ObjectivesThis study aims to explore the attitudes and beliefs of Saudi female nursing students towards sexual healthcare.MethodsA mixed-methods research design was employed on a sample of 247 Saudi female undergraduate nursing students using a non-probability sampling technique that incorporated a combination of purposive and snowball sampling. The participants completed an online questionnaire covering sociodemographic characteristics and the Sexual Attitudes and Beliefs Scale (SABS), two open-ended questions asking about the reasons for denying sexual healthcare and related issues.ResultsThe study found that nursing students had a poor attitude towards discussing sexuality as essential to patients’ health outcomes, with a mean score of 2.3 (SD = 1.4). Correlational analyses revealed a significantly high positive correlation between age and year of the program (r = 0.828, p &amp;lt; 0.001), a significant but very low positive association between age and Grade Point Average (GPA) (r = 0.198, p = 0.046), and a significant negative correlation between the belief that “discussing sexuality is essential to patients’ health outcomes” and nursing students’ GPA (r = −0.173, p = 0.006).ConclusionThe exploration of Saudi female nursing students’ attitudes and beliefs towards sexual healthcare reveals a nuanced landscape where attitudes vary across different aspects of sexual health discussions.

Addressing the Stigma of Mental Illness in Black Families and Communities in Ontario, Canada: Protocol for a Mixed Methods Study.

Racism and discrimination are among the factors perpetuating the persistent disparities within the Canadian health sector and related social and community services. Addressing issues of racism in Canada is crucial to reducing the mounting mental health disparities that subsequently impact the psychological well-being of diverse groups of people, particularly racialized and Black individuals. While some research has been conducted on mental illness-related stigma, very few peer-reviewed studies have attempted antistigma interventions to address mental health disparities in Black families and communities in Canada. This study aims to generate critical knowledge to reduce mental health disparities and mental illness stigma experienced by Black families and communities and engage them in cocreating a best-practice model to guide policy and programming. Our study intends to engage individuals living with or affected by mental illness, service providers, and community leaders in Black communities who are interested in stigma reduction activities and advocacy in Ontario, particularly in the Greater Toronto Area (GTA), including Durham and York Regions, London, Ontario, Brampton, and Ottawa. Informed by population health promotion approaches, critical race theory, and an intersectionality framework underpinned by social justice principles, this mixed methods study will engage individuals of Caribbean and African descent in 5 cities in Ontario. We will use online self-reported surveys with Black individuals (335/431) to assess depression, anxiety, stress, mental health knowledge, racial discrimination, and mental health stigma. We will also engage Black individuals (40/431) and service providers and community leaders (16/431) in focus groups and individual interviews (10/431). Results from the survey and focus groups will inform concept mapping activities with cross-sector leaders, decision makers, and community advocates (30/431) to cocreate a best-practice model to improve mental health outcomes in Black families and communities. Quantitative data will be analyzed using descriptive and inferential analyses through SPSS (IBM Corp). Qualitative data will be transcribed verbatim, and NVivo software (Lumivero) will be used for data management. We will apply Braun and Clarke's framework of 6 phases in thematic analysis. As of September 2024, the study has received ethical approval in Canada. We have completed data collection for phase one of the study and plans are far advanced to start recruitment for phases 2 and 3. Results from the study are expected in the last quarter of 2025 and the first quarter of 2026. This project will generate a novelty of knowledge to contribute to effective ways of addressing mental illness stigma and promoting mental health literacy in Black families and communities and other vulnerable populations. In addition, the knowledge gained from this study will be taken back to Black communities to empower affected individuals and their families. DERR1-10.2196/66851.

Relationship between eating behavior of children with their nutritional status based on their bmi among 6 -12 year children: a mixed method study

Relationship between eating behavior of children with their nutritional status based on their bmi among 6 -12 year children: a mixed method study

Client perspectives and satisfaction with integrating facility and community-based HPV self-sampling for cervical cancer screening with family planning: a mixed method study

BackgroundInvasive Cervical cancer is a largely preventable disease through screening, but access to cervical cancer screening (CCS) remains a challenge in Malawi. Integration of CCS with family planning (FP) services through Human papillomavirus (HPV) self-sampling may increase screening coverage. We aimed to evaluate women’s perceptions, motivations, and satisfaction with integration of HPV self-sampling with family planning in Malawi.MethodsIn this mixed-methods study, we purposively sampled and interviewed 29 women who underwent HPV self-sampling for CCS through one of two different CCS-FP integration models in Malawi. We also completed 766 Client Exit Surveys with CCS patients from both models. Model 1 involved only clinic-based HPV self-sampling, while Model 2 included both clinic-based and community-based HPV self-sampling supported by community health workers. In-depth interviews (IDIs) were conducted using a semi-structured guide, audio-recorded, transcribed, and translated into English for analysis. Qualitative data were analyzed using NVivo 12.0 software and thematic analysis, and quantitative data were analyzed using statistical software.ResultsWomen screened in both models reported reduced transport costs for screening. Those clinic-based valued the convenience of accessing both CCS and FP services in a single visit while those screened in the community appreciated accessing services within their communities. Many found HPV self-sampling easy to use and ensured privacy, especially in the community model where samples were mainly collected within their homes, rather than public toilets or clinic consultation rooms. Women were motivated to undergo CCS due to the perceived risks of cervical cancer, particularly among those living with HIV, the availability of services within the community, and the experience of gynecological symptoms. IDI women expressed satisfaction with being able to make decisions without consulting their spouses, and none reported experiencing social harm following the disclosure of HPV results. The client exit survey data showed that 92.5% of women in both models were very satisfied with the procedure.ConclusionOur findings highlight that women were satisfied with HPV self-sampling, valuing its convenience, privacy, and cost-effectiveness, which enhanced their willingness to undergo CCS. These findings suggest that integrating CCS self-sampling into FP services could potentially improve CCS uptake in Malawi.

Assessing the Impact on Electronic Health Record Burden After Five Years of Physician Engagement in a Canadian Mental Health Organization: Mixed-Methods Study.

The burden caused by the use of electronic health record (EHR) systems continues to be an important issue for health care organizations, especially given human resource shortages in health care systems globally. As physicians report spending 2 hours documenting for every hour of patient care, there has been strong interest from many organizations to understand and address the root causes of physician burnout due to EHR burden. This study focuses on evaluating physician burnout related to EHR usage and the impact of a physician engagement strategy at a Canadian mental health organization 5 years after implementation. A cross-sectional survey was conducted to assess the perceived impact of the physician engagement strategy on burnout associated with EHR use. Physicians were invited to participate in a web-based survey that included the Mini-Z Burnout questionnaire, along with questions about their perceptions of the EHR and the effectiveness of the initiatives within the physician engagement strategy. Descriptive statistics were applied to analyze the quantitative data, while thematic analysis was used for the qualitative data. Of the 254 physicians invited, 128 completed the survey, resulting in a 50% response rate. Among the respondents, 26% (33/128) met the criteria for burnout according to the Mini-Z questionnaire, with 61% (20/33) of these attributing their burnout to EHR use. About 52% of participants indicated that the EHR improves communication (67/128) and 38% agreed that the EHR enables high-quality care (49/128). Regarding the physician engagement strategy initiatives, 39% (50/128) agreed that communication through the strategy is efficient, and 75% (96/128) felt more proficient in using the EHR. However, additional areas for improvement within the EHR were identified, including (1) medication reconciliation and prescription processes; (2) chart navigation and information retrieval; (3) longitudinal medication history; and (4) technology infrastructure challenges. This study highlights the potential impact of EHRs on physician burnout and the effectiveness of a unique physician engagement strategy in fostering positive perceptions and improving EHR usability among physicians. By evaluating this initiative in a real-world setting, the study contributes to the broader literature on strategies aimed at enhancing physician experience following large-scale EHR implementation. However, the findings indicate a continued need for system-level improvements to maximize the value and usage of EHRs. The physician engagement strategy demonstrates the potential to enhance physicians' EHR experience. Future efforts should prioritize system-level advancements to increase the EHR's impact on quality of care and develop standardized approaches for engaging physicians on a broader Canadian scale.