Mixed Methods Study Research Articles

Co-Occurring Mental Health and Substance Use Research Among Aboriginal and Torres Strait Islander People: A Systematic Review.

Objective: This systematic review describes studies focussed on co-occurring mental health and substance use (MH/SU) conditions among Aboriginal and Torres Strait Islander people, including the: characteristics; co-occurring conditions examined; cultural methodological quality; traditional scientific methodological quality of studies; and study outcomes. Methods: A systematic review examined the literature on co-occurring MH/SU conditions among Aboriginal and Torres Strait Islander people. Four databases were searched, with data from relevant studies extracted for narrative synthesis. Results: Twelve articles (11 studies) were included. Nine studies used cross-sectional designs; one was a qualitative study and one a mixed methods study with a nested randomized controlled trial. Cultural methodological quality was low across the studies, with a maximum of 7 out of 14 criteria met. Thirty-three combinations of co-occurring conditions were examined. Conclusion: Most research to date has been cross-sectional with limited research exploring the effectiveness of treatments for co-occurring MH/SU conditions. Further Indigenous-led research is needed to find culturally safe, responsive and effective solutions in reducing the burden associated with MH/SU conditions and improving wellbeing.

Breakthrough cancer pain management: mixed-methods study of health care professionals

ObjectivesKnowledge gaps in defining, diagnosing, educating health practitioners and treatment options hinder breakthrough cancer pain (BtCP) management. A systematic review revealed a lack of clarity on health professional derived definitions,...

Equity Landscape in Healthcare Quality: A Mixed-Methods Study of Efforts within Surgical Quality Programs.

Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes are needed. Although increasing attention is being devoted to addressing health inequities, the current landscape supporting these efforts remains unknown. We sought to evaluate the presence of frontline resources, organization, and processes for support of health equity efforts in hospitals participating in American College of Surgeons' (ACS) quality programs. Using a mixed-methods design of online surveys and semi-structured interviews, we evaluated hospitals with ACS quality programs. Descriptive analytics were applied to survey results; interview transcripts were coded using an inductive approach. Data and methods were triangulated to report key findings. Of the 44 programs invited, 36% completed the survey. Five site program leaders were interviewed. All program leaders reported having a strategy at the institution level for supporting equity efforts and having processes in place for reporting instances of discrimination, mistreatment, or harassment. Survey results demonstrated deficient workforce capacity, lack of engagement, and insufficient organization - negatively impacting efforts. The key themes from interviews were: 1) implementation occurred primarily and superficially at the institutional level, 2) barriers to implementation included preemptive structure, lack of prioritization, and insufficient disparities data, and 3) opportunities included enhancing leadership and staff buy-in, increasing available resources, developing health equity champions, and defining clear strategies. Efforts aimed at achieving health equity exist but lack the necessary infrastructure, organization, and processes to support effective frontline practices. The findings from this study support consideration of standards development targeting problems and opportunities at both the institutional and program level for advancing equity in quality improvement efforts.

Interpreting Context in Rural and Remote Aged Care Facilities in Readiness for a New Care Model: A Mixed Method Study.

Geographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end-of-life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution. To describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia. A convergent mixed methods design. Qualitative data were collected, in 2022-2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long-Term Care. Data were analysed according to type and integrated. Relational care for residents and families is highly valued but provision of quality is challenging where time-poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings. Identifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt. Context-specific needs extend far beyond a nurse practitioner providing additional expertise in care provision. What problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting. What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements. Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare. The GRAMMS checklist was followed in reporting of this study. Two lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications.

Understanding the current provisions of support for people with an intellectual disabilities and/or autism in crisis: A mixed methods study.

There has been significant reduction in inpatient beds for people with intellectual disability and/or autism (PwID/A) in the UK in the last decade following high profile national scandals in specialist psychiatric hospitals. To reduce inappropriate admissions a new strategy (Blue-Light, an emergency multi-disciplinary meeting to prevent admission to hospital) was introduced. However, there is no research on the influence of Blue-Light on crisis management for PwID/A. To assess Blue-Light's impact on PwID/A's crisis presentations. Co-produced with experts-by-experience, a mixed methods approach using a 13 question Likert based survey of health and social-care professionals along with semi-structured interviews of carers involved with consecutive Blue-Light patient reviews was undertaken in Cornwall UK (population: 538,000). Patient data was accessed to understand the patient journey. All data analysis was descriptive in nature. Semi-structured interviews were transcribed and thematically analysed using Braun and Clarke's six-step process. Ten patient journeys were examined. Staff interviewed had a good understanding of the Blue-Light process, Blue-Light activation practical challenges and considered Blue-Light reactive. Nearly half wanted ID/A specialist beds recommissioned. A majority wanted improved supervision and standards for third sector providers. Semi-structured interviews of 10 patient-carers identified a lack of consistency from professionals, limited infrastructure provision, the prolongation of crises and a lack of definition of crisis as carers did not feel supported by services. Current crisis support systems are not standardised and often leave carers feeling unsupported in crises. An evidence-based debate of crisis support and the inpatient role for PwID/A is required.

Communication Methods Used with Conscious Intubated Patients: Scoping Review

Background Intubated conscious patients often experience communication difficulties. The present narrative review outlines the current evidence on communication methods adopted and the experience of conscious intubated patients in critical care areas. Objectives To our knowledge, studies have attempted to examine communication with conscious intubated patients. The present review had two objectives: (1) to identify the methods adopted by nurses and conscious intubated patients to ease the communication difficulties faced due to intubation and (2) to identify the experience of nurses and conscious intubated patients with the adopted communication methods. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was followed throughout this review. PubMed and ProQuest databases were searched with the terms “intubated conscious patients,” “communication,” and “nurse”, including original research articles published between January 2019 and May 2024 on conscious patients needing intubation. Dissertations, review papers, non-interventional research, and articles written in languages other than English were excluded. Only eight of the original 2,041 studies, which included 137 intubated patients and for 545 nurses, met the inclusion criteria. The authors used the Mixed Method Appraisal tool (MMAT) and the Critical Appraisal Skills Program (CASP) to collect data and assess quality. Results After the first search of generated 2041 papers, only eight articles—representing various studies—were able to meet the inclusion requirements. The included studies were six (6) quantitative, one (1) qualitative study and one (1) mixed-method study. Four communication intervention types were identified, namely: (1) Communication boards/charts (two studies), which improved communication and increased patient satisfaction. (2) Gestures and facial expressions (four studies) were reported to be frequently initiated for communication by the nurses with the patients. (3) Multiple methods (three studies) used were found to be insufficient to communicate with the patients. (4) Digital technology program, including Communicative Digital Technology Program was found to be effective means of communication in three such studies. Conclusion Results imply that communication techniques may be useful in enhancing patient–nursing professional communication with conscious intubated patients. However, in developing countries with fewer resources, a low-cost communication tool addressing both physical and emotional needs may be developed to aid in communication among patients and nurses.

Security and Privacy Protection in Developing Ethical AI: A Mixed-Methods Study from a Marketing Employee Perspective

Security and Privacy Protection in Developing Ethical AI: A Mixed-Methods Study from a Marketing Employee Perspective

Nurses Under Pressure: The Demands of Professional Performance and Their Management Through the Use of Medication

This article discusses the relationship between the demands on nurses’ professional performance and adherence to the use of medicines and supplements for their management. This approach allows us to analyze the transformations of nursing work and how nurses use various natural and pharmaceutical resources to cope with the pressures they face in their professional activities. To understand the interconnection between the transformations in nursing work and what we refer to here as the process of pharmaceuticalisation of work contexts, we use the results of a sociological mixed methods study on the use of medicines and food supplements for managing professional performance. The results show some of the main pressure factors in nursing work and how the increase in professional pressure substantially affects performance-related medicine use, as these become more frequent when nurses perceive their work as more intense, demanding, and exposed to risks.

What Helps or Hinders End-of-Life Care in Adult Intensive Care Units in Saudi Arabia? A Mixed-Methods Study Protocol

Background: In the intensive care unit, many patients are dying despite advanced therapeutic technology and optimized treatment. The critical care team is expected to deliver end-of-life care for the dying patient and their family. However, it is challenging to provide adequate support to families due to the ideas and emotions associated with the end of life. This can be influenced by different beliefs and cultures among patients and healthcare professionals. Added to this, research about end-of-life practices in intensive care units in Saudi Arabia is limited. Therefore, this study protocol aims to examine: (1) What end-of-life care is provided by healthcare teams in adult intensive care units in Saudi Arabia? (2) What helps or hinders effective end-of-life care in adult intensive care units in Saudi Arabia? Method: This study will use a mixed-methods, sequential, explanatory design consisting of two phases. Phase 1 will include a cross-sectional study design with a convenience sample of approximately 400 healthcare providers who will be invited from three military hospitals in Saud Arabia. the Palliative and End-of-Life Care Index (PEOL Care Index) will be used to assess palliative and end-of-life care education, practice, and perceived competence among the staff. Additionally, a questionnaire on the barriers to optimal end-of-life care and the perceived benefit of potential strategies to improve end-of-life care will be applied to obtain the views of managers. Phase 2 of the study will be a qualitative descriptive design involving semi-structured interviews with healthcare providers, managers, and bereaved family members. Conclusion: The study findings will contribute to understanding current practice in relation to palliative and end-of-life care in intensive care units in Saudi Arabia. It will provide valuable insight into barriers to and facilitators of care, which will help to develop strategies and interventions to improve the quality of end-of-life practices in ICUs. In addition, this research will provide significant information regarding family members’ experiences of end-of-life care provided to their relatives.

Disclosing Past Adult Sexual Assault to Romantic Partners: A Mixed-Methods Analysis

The primary aim of the current mixed-method study was to examine factors that predict adult sexual assault disclosure in romantic relationships and understand how romantic partners respond if survivors choose to disclose their experiences to them. Sexual assault survivors ( N = 330; 93% cisgender women) completed online surveys assessing disclosure and various factors that might be associated with disclosure, and described how their partner responded to their disclosure or what prevented them from disclosing (qualitatively coded). Many victims did not disclose experiences of assault to their partners. Proportional odds logistic regression revealed that survivors who perceived their partners as more responsive were more likely to have disclosed, but partner trust was unrelated to disclosure. Attachment avoidance (but not anxiety) was negatively related to disclosure. Sexual and gender minority victims were more likely to have disclosed to their partners; race was unrelated to disclosure. The most common qualitative response was that partners reacted to disclosures with emotional support, although some responded negatively. Survivors most often chose not to tell their partners because the assault was too difficult to talk about or was not relevant to the relationship. Sexual assault stigma may play out in victims’ disclosure decisions and partners’ disclosure reactions.

“Navigating Risk and Responsibility?”: A Mixed-Methods Study Addressing Stigma and Well-Being Among Men Who Have ‘Sex on Chems’ with Other Men in the English Midlands

Background: Most research on ‘Chemsex’ has been conducted with gay, bi-sexual, and men who have sex with men (GBMSM) in large cities with well-established infrastructures. Therefore, this study aimed to explore the ‘Chemsex’ risks and responsibilities of GBMSM who lived outside of the queer metropolis. This study also aimed to understand how stigma and mental health present in the absence of a well-established community infrastructure. Methods: This study utilized mixed methods in Leicester, Leicestershire, and Rutland, a location in the East Midlands of England. The quantitative component consisted of a survey. The qualitative component comprised three case studies based on in-depth interviews, using interpretative phenomenological analysis. Results: Of the 123 survey respondents, 86% engaged in riskier sex during sessions and 35% no longer enjoyed sober sex. In the interviews, the three men balanced risk management and personal responsibility, positioning themselves as mature, considerate, and well-educated users. All were alienated by the term ‘Chemsex’. The findings are considered using theoretical frameworks, or how discourses of ‘moral threat’ operate within the micro-politics of regulating GBMSM’s pleasure and stigma. Conclusions: The complexities of understanding this practice for researchers and practitioners are discussed and recommendations are made for reframing education and support services for GBMSM.

Eyes on communication: strategies to facilitate uptake of clinical practice guidelines for implementation of eye-gaze control technology by people with cerebral palsy. A mixed methods study

Guidelines for implementation of eye-gaze control technology by people with cerebral palsy were published in 2021. The purpose of this study was to identify barriers and facilitators clinicians perceive exist relating to use of these guidelines for eye-gaze control technology, and to explore potential resources that may be developed to support their implementation. A two-phased mixed methods explanatory sequential design was adopted. In phase 1, an online survey containing quantitative and open-ended questions was completed by 97 health professionals and in phase 2 two online focus groups of five clinicians were conducted. The guidelines for eye-gaze control technology were considered helpful for clinicians new to eye-gaze control technology, useful to provide insight into processes for implementing eye-gaze control technology, were flexible, supported clinical reasoning and professional credibility, and were easy to use. However, time to read the guidelines for eye-gaze control technology, and insufficient funding for time to implement the technology were prominent barriers identified in this study. Through the qualitative findings four themes emerged: (1) Complexity of learning to use and implement the guidelines for eye-gaze control technology; (2) Time and resources in short supply; (3) Takes a dedicated team working together; and (4) guidelines for eye-gaze control technology informing practice. Participants in both study phases identified: case studies and video examples; education and training; and practice in implementing eye-gaze control technology, as facilitators to aligning their practice with the guidelines for eye-gaze control technology recommendations and to optimise outcomes.

Life on the Move: A Mixed-Method Study on Internal Migration and Divorce in China

Life on the Move: A Mixed-Method Study on Internal Migration and Divorce in China

Developing and Testing a Mobile Application for Autistic Children Participating in a Therapeutic Horseback Riding Program at a Midwestern Equine Assisted Service Center: An Exploratory Sequential Mixed Methods Study

A potential approach to translating benefits acquired from therapeutic horseback riding (THR) sessions into the daily routines of autistic children is by involving parents as co-interventionists through the utilization of digital technology. In this three-phase exploratory sequential mixed methods study, we develop and test a parent-mediated mobile application complementing a THR program for autistic children. Qualitative interviews informed the digital tool’s development, followed by a quantitative assessment of usability and social validity. Findings present proof of concept, indicating that participants perceived the parent-mediated mobile application as useful and user-friendly. This article contributes to mixed methods literature a pioneering approach in the field of THR incorporating subjective and objective assessments into the development and evaluation of the parent-mediated mobile application. Clinical trial registration ClinicalTrials.gov ID NCT05689541.

Perception of Childhood Routine Immunisation among Adults in Selected Communities of Ido Local Government Area, Ibadan, Oyo State, Nigeria

Aims: Immunisation is one of the medical achievements of the twentieth century; however, some vaccines are receiving less and less support. Increasing people's understanding of vaccination's direct advantages, beyond avoiding infectious diseases, may aid in regaining vaccine acceptance for children two years and below. The study determines the perception of childhood routine immunization among adults in selected communities of Ido Local Government Area, Ibadan, Oyo State. Study Design: Mixed method study design. Methodology: A mixed-method study design that adopted a multi-stage sampling technique to select 417 respondents for the study was used. Two instruments were used for data collection: a questionnaire and an in-depth interview guide. The questionnaire assessed perceived severity and benefits with 36 items each, and scores below < 19 and score ≥ 19 were categorized as low and high for each variable, respectively. Quantitative data was analyzed using descriptive and inferential (Chi-square) statistics at a significance level 0.05. The qualitative data was analyzed using a thematic approach Results: There were 41(9.8%) men and 376(90.2%) women, totaling 417 adults. The respondents 208 (49.9%) have a Secondary School Certificate, the highest educational qualification among the respondents. Results also revealed that 172(41.3%) of respondents had good knowledge about children's routine vaccinations. About 396(95.0%) had a high severity level of vaccine-preventable diseases. Also, 409(98.1%) had high perceived benefits of immunization uptake. Conclusion: This study showed a high level of perceived benefits of immunization uptake among the respondents. Since respondents perceptions of childhood routine immunization and education level were substantially correlated, the government should encourage and improve maternal education.

Clinical Teaching Learning Trajectory: Exploring Field Supervisor Written Feedback on Clinical Teacher Pedagogy

Field supervisors are central to clinical teaching, but little is known about how their feedback informs preservice teachers’ (PSTs) development. This sequential mixed methods study examines over 3,000 supervisor observation evaluations. We qualitatively code supervisor written feedback, which indicates two broad pedagogical categories and nine separate skills. We quantize these feedback codes to identify the variation in the presence of these codes across PST characteristics, and then use several modeling techniques to indicate that specific feedback codes are negatively associated with evaluation score. Managing student attention was most detrimental to scores in early observations, whereas instructional feedback (e.g., lesson delivery) and verbal corrections were prioritized later in clinical teaching. Findings inform teacher preparation policy on understanding PST development and improving supervisory feedback.

What does it mean to be(come) a professional bilingual education teacher?

ABSTRACT Due to the dual focus of content and language integrated learning on both content and language, bilingual teaching requires a profound level of teacher professionalism. This mixed-methods study aims to capture the beliefs of trainee teachers and educators regarding professional (bilingual education) teachers within the framework of teachers’ professional competence models. We analysed data from a questionnaire (n = 32) and interviews (n = 11) with teacher educators and trainee teachers involved in bilingual training programmes for secondary education in Germany. The findings emphasise the importance of high motivation, additional pedagogical/psychological knowledge, internationally oriented content knowledge and high language proficiency. These results yield important implications for bilingual teacher training.

Examining the Use of Virtual Reality to Support Mindfulness Skills Practice in Mood and Anxiety Disorders: Mixed Methods Study.

Virtual reality (VR) has been proposed as a technology to support mindfulness practice through promoting increased engagement and presence. The proposed benefits of this technology have been largely unexamined with clinical populations. Further research is required to understand its clinical potential and utility in improving and managing mental health symptoms. This study aims to investigate the proximal impacts of a single, brief, VR-supported mindfulness practice for individuals with a mood or anxiety disorder and to understand user experiences, which may affect the acceptability and efficacy of VR mindfulness for this population. This mixed methods study recruited 28 participants with a primary diagnosis of major depressive disorder, bipolar disorder, or anxiety disorder. Participants completed a mindfulness practice wearing a VR headset that was presenting an omnidirectional video of a forest scene, which was overlaid with a guided audio voiceover. Before and after the practice, measures were completed assessing state mindfulness (Toronto Mindfulness Scale), affect (Positive and Negative Affect Schedule), and anxiety (State-Trait Anxiety Inventory Y-1; n=27). Semistructured interviews were then held inquiring about the user experience and were analyzed using thematic analysis (n=24). After completing the VR-supported mindfulness practice, both measures of state mindfulness on the Toronto Mindfulness Scale, mean curiosity and decentering, increased significantly (Cohen d=1.3 and 1.51, respectively; P<.001). Negative affect on the Positive and Negative Affect Schedule (Cohen d=0.62; P=.003) and State-Trait Anxiety Inventory Y-1 state anxiety (Cohen d=0.84; P<.001) significantly reduced. There was no significant change in positive affect (Cohen d=0.29; P=.08). Qualitative analysis of interviews identified 14 themes across 5 primary theme categories. The results suggested that being mindful during the use of the app was experienced as relatively effortless because of the visual and immersive elements. It was also experienced as convenient and safe, including when compared with prior traditional experiences of mindfulness. Participants also identified the uses for VR-supported mindfulness in managing emotions and symptoms of mental illness. The results provide preliminary evidence that VR-supported mindfulness can improve emotional states and manage mental health symptoms for those with mood or anxiety disorders. It offers some potential clinical applications for those with mood or anxiety disorders for exploration within future research.

(L2) grit, emotions, and motivated learning behavior: The case of English majors in Hungary

Although the number of studies into grit in second/foreign language (L2) learning is on the rise, available empirical evidence is still scant, particularly in relation to links between the two facets of (L2) grit (i.e. perseverance and interest), positive (i.e. enjoyment, curiosity) and negative (i.e. in-class and after-class boredom, anxiety) emotions as well as motivation. In addition, most research has been quantitative in nature and has mainly targeted Asian contexts. In order to fill these gaps, a mixed-methods study was undertaken among English majors and English student teachers in Hungary. It aimed to: (1) characterize the participants in terms of the variables under investigation, (2) identify their profiles in relation to general grit and L2 grit, and (3) determine the differences between the identified clusters with respect to different emotions and motivation. Quantitative data were collected from 331 students by means of a composite questionnaire while semi-structured interviews with nine participants were employed to gather qualitative data. Among other things, cluster analysis allowed identification of four distinct groups of participants while analysis of variance indicated that, overall, higher levels of (L2) grit were accompanied by higher levels of positive emotions and motivated behavior, and lower levels of negative emotions. Content analysis of the interview data, however, testified to the complexity of (L2) grit, its potential malleability, complex interactions with other variables, and context-dependence.

Healthcare waste management knowledge, attitudes and practices of laboratory workers at a regional hospital, Lesotho

Background: Safe management of healthcare waste (HW) safeguards laboratory biosafety and biosecurity. Knowledge and attitudes influence HW practices, presenting a need for evidence of the current status.Objective: This study assessed the knowledge, attitudes and practice of laboratory workers towards waste management at a regional hospital laboratory in Lesotho.Methods: The study was conducted from March 2023 to June 2023 using a mixed-methods descriptive case study design. The entire population (n = 30) of technical and non-technical laboratory workers and generated waste were sampled. A structured questionnaire and an observational checklist were used to collect data. Waste generation was assessed by weighing and measuring waste volumes. Data were analysed using descriptive statistics.Results: All respondents (26/26; 100%) can define HW and (3/3) laboratory assistants (100%) gave correct responses for three questions, namely: risk associated with HW, waste container colour-coding, and disposal requirements. Knowledge on waste management responsibilities ranged between 0% (0/4) for cleaners and 54.5% (6/11) among laboratory technicians. Attitudes were mainly positive, and practices conformed in part to standard operating procedures. Infectious solid waste comprised 77% of solid HW, while 63% of chemical liquid waste emanated from the full blood count area.Conclusion: Knowledge exists among workers and attitudes are predominantly positive; however, some unsafe practices continue, thus knowledge is not fully translated to safe practices. Regular training and measuring and recording of HW were recommended.What this study adds: The study contributes understanding of the status of HW knowledge, attitudes and management practices, highlighting the need for compliance monitoring.