Mixed-methods Triangulation Design Research Articles

Informing inclusive and affirmative hospital pharmacy services for 2SLGBTQ+ patients.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Two-spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) people disproportionally experience health disparities, and hospital pharmacists, given their accessibility and expertise in medication management, are ideally positioned to provide care to this vulnerable population. This study investigated the barriers and facilitators faced by hospital pharmacists when providing care to 2SLGBTQ+ patients, with the goal of informing enhancement of quality care provided to these patients. A mixed-methods triangulation design was utilized, comprising an online survey and qualitative interviews with Canadian hospital pharmacists. The survey used the lens of systemic oppression as a framework and assessed pharmacists' perceptions and knowledge. Survey data were analyzed using descriptive statistics, and interviews were analyzed using thematic analysis. A total of 129 individuals participated in the survey, and 15 participants were interviewed. Eleven themes were identified, and findings revealed a complex web of individual, interpersonal, and systemic barriers and facilitators. Pharmacists expressed a lack of proficiency and confidence in discussing 2SLGBTQ+ health topics, further compounded by an apprehension to engage and a fear of causing harm. Pharmacists desired support from their leadership teams and organizations in the form of access to resources, time to engage in training, and workplace environments that encourage discussions about 2SLGBTQ+ health. Hospital pharmacists in Canada are willing to provide inclusive care to 2SLGBTQ+ patients but face significant barriers. These findings highlight the need for comprehensive education, supportive workplace cultures, and accessible resources to address health disparities and improve care for 2SLGBTQ+ individuals.

Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study.

Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.

Use of ChatGPT for education by engineering students in developing countries: a mixed-methods study

ABSTRACT Developing countries face challenges in AI integration into learning initiatives. With the widespread use of ChatGPT, many concerns were expressed. Thus, it is crucial to investigate students' attitudes toward ChatGPT and the factors influencing their decision to continue using it in the future. We used a mixed-methods triangulation design based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and collected data based on convenience sampling from N = 195 engineering students in developing countries through semi-structured surveys with open-ended questions. Quantitative analysis included descriptive statistics and logistic regression, while thematic analysis was used for the qualitative part. Most students (89.69%) use ChatGPT, with all the elements of the UTAUT framework being strong predictors of their intention to continue. Most have continuous internet access and feel comfortable using technology. High-frequency usage, perceived benefits, and peer encouragement positively influence students' intention to continue using ChatGPT. However, concerns about accuracy, privacy, and laziness negatively correlate with usage intention. Address personal, institutional, and governmental concerns to integrate ChatGPT safely in educational systems, ensuring equitable access and preparing for future e-learning initiatives.

Bridging Cree knowledge and Western science to understand the decline in hunting success of migratory Canada geese

Canada goose (Branta canadensis) is one of the main waterfowl species harvested by Cree hunters in James Bay, Canada. Land users who hunt geese along coastal Eeyou Istchee (Eastern James Bay, Quebec) report that they are now much less successful in harvesting sub-arctic breeding geese (B. c. interior) than in the 1980s, especially during the fall hunting season. We followed a mixed-methods triangulation design in which we simultaneously gathered Indigenous and scientific knowledge. For the Indigenous knowledge, we conducted semi-structured interviews with Cree land users who shared their knowledge about how the goose populations that stage in Eeyou Istchee have changed within living memory. They attributed their reduced hunting success to fewer migrating geese and modification of their behavior. They also identified many environmental changes, especially the decline of eelgrass (Zostera marina), that may have affected the number, distribution, and migration patterns of Canada geese along the coastal Eeyou Istchee in the past 50 years. We complemented this information using waterfowl study techniques including aerial surveys, band recovery analyses, and GPS tracking of individually marked geese. Habitat changes both at the local scale in Eeyou Istchee and in other parts of the staging and wintering ranges of Canada geese, natural and human disturbances along the coast, and a gradual increase in molt migrant temperate breeding Canada geese (B. c. maxima) likely resulted in changes in habitat use and migration patterns of sub-arctic breeding Canada geese along the James Bay east coast. By bridging Cree knowledge and Western science, we identified the various factors that affect the harvest success of Eeyou Istchee goose hunters. Such an approach should be encouraged when Indigenous peoples rely upon migratory bird or mammal species that spend only a portion of their annual cycle within the hunting territories of land users.

Gender health gaps in guideline-based inpatient cardiovascular medical and nursing care and implementation strategies to reduce the gap (HeartGap): A mixed methods study protocol.

A growing body of evidence has demonstrated that a gender-sensitive approach to healthcare is needed in all areas of medicine. Although medical and nursing guidelines include gender-sensitive care (GSC+) recommendations, the level of implementation in health care practice is unknown. This study aims to examine the current level of implementation and acceptance of GSC+ among physicians and nurses and to identify potential gaps between guidelines and practice and barriers and facilitators of GSC+ implementation, taking the perceptions of all relevant stakeholders into account. The overarching aim is to develop holistic recommended actions to strengthen GSC+. This study has a mixed methods triangulation design. The preparation phase consisting of a literature review and a two-part (qualitative and quantitative) data analysis will be conducted in the cardiology department of 9 pilot hospitals in Berlin, North Rhine-Westphalia, Lower Saxony, Rhineland-Palatinate, Germany. 18 focus groups with clinicians and nurses as well as interviews with experts in other relevant fields will be performed. In the national roll-out phase, a questionnaire survey will be conducted with hospital clinicians (n = 382), nurses (n = 386) and patients (n = 388). This study will provide comprehensive insights into the implementation and acceptance of GSC+ in cardiology from the perspective of doctors, nurses, patients, stakeholders and experts in relevant fields, such as policy and education. A focus will also be on the extent to which age or gender of health professionals, region and hospital type influence the implementation of GSC+. The identification of GSC+ implementation barriers and facilitators should help to improve the standard of care for cardiology patients of all genders. The outcomes from this study can be used to develop measures and recommended actions for the successful and sustainable implementation of gender-sensitive care. The study is registered in the German Register of Clinical Studies (DRKS) under study number DRKS00031317.

Are Racial Groups Associated with Recurrence of Adult Protective Services?

Little is known about the recurrence differences among diverse race/ethnic groups in the Adult Protective Services (APS). This mixed methods triangulation design study used data from both administrative databases and interview/focus groups with APS social workers to explore whether race/ethnic groups are associated with different recurrence in APS. The recurrence rate of APS was 21.4% in the sample of 4,426 clients in a county of California. Results from the multiple logistic regression showed that Asian Americans and Pacific Islanders were less likely to have one or more APS reports and investigations within the 12-month follow-up after the case closure of the initial APS investigation when compared with Hispanic Americans. No statistically significant results were found among other racial/ethnic groups. Some co-variates were also found to be associated with the recurrence including marital status, risk level, financial abuse, and self-neglect. Qualitative results provided some support to the main findings from the quantitative analysis results. Both quantitative and qualitative analytical approaches intimated that racial/ethnic differences might not be a prominent factor leading to different APS recurrence. The limitations of this article indicate that there is a need for additional studies to further examine the influence of race/ethnicity on APS recurrence.

A mixed-methods investigation of COVID-19 pandemic-specific stress in college students

Objective To identify pandemic-specific stressors among college students and compare patterns of stressors in samples obtained during early and chronic phases of the pandemic. Method Different undergraduate student samples from a Southeastern university completed an online survey in Spring 2020 (early pandemic; N = 673) and Fall 2020 (chronic pandemic; N = 439). This repeated cross-sectional survey study used a mixed methods triangulation design to validate and expand on quantitative findings using qualitative data. Results Quantitative and qualitative analyses revealed 13 pandemic stressor domains, with academics and lifestyle adjustment among the most stressful in both samples, and more stressful in the chronic pandemic sample. Non-freshmen, female, and first-generation college students were at greater risk for pandemic stress. Conclusions As college students continue to experience stressors related to COVID-19 and encounter future crises, colleges and universities must adapt to meet their unique needs specific to the context.

Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme

BackgroundBRAC (Bangladesh Rural Advancement Committee), the largest NGO globally, implemented a community-based comprehensive social behavior communication intervention to increase community resilience through prevention, protection, and care for COVID-19. We conducted implementation research to assess fidelity and explore the barriers and facilitators of this intervention implementation.MethodsWe adopted a concurrent mixed-method triangulation design. We interviewed 666 members of 60 Community Corona Protection Committees (CCPCs) and 80 members of 60 Community Support Teams (CSTs) through multi-stage cluster sampling using a structured questionnaire. The qualitative components relied on 54 key informant interviews with BRAC implementers and government providers.ResultsThe knowledge about wearing mask, keeping social distance, washing hands and COVID-19 symptoms were high (on average more than 70%) among CCPC and CST members. While 422 (63.4%) CCPC members reported they ‘always’ wear a mask while going out, 69 (86.3%) CST members reported the same practice. Only 247 (37.1%) CCPC members distributed masks, and 229 (34.4%) donated soap to the underprivileged population during the last two weeks preceding the survey. The key facilitators included influential community members in the CCPC, greater acceptability of the front-line health workers, free-of-cost materials, and telemedicine services. The important barriers identified were insufficient training, irregular participation of the CCPC members, favouritism of CCPC members in distributing essential COVID-19 preventive materials, disruption in supply and shortage of the COVID-19 preventative materials, improper use of handwashing station, the non-compliant attitude of the community people, challenges to ensure home quarantine, challenges regarding telemedicine with network interruptions, lack of coordination among stakeholders, the short duration of the project.ConclusionsEngaging the community in combination with health services through a Government-NGO partnership is a sustainable strategy for implementing the COVID-19 prevention program. Engaging the community should be promoted as an integral component of any public health intervention for sustainability. Engagement structures should incorporate a systems perspective to facilitate the relationships, ensure the quality of the delivery program, and be mindful of the heterogeneity of different community members concerning capacity building. Finally, reaching out to the underprivileged through community engagement is also an effective mechanism to progress through universal health coverage.

Ambiguous Loss and Emotional Intelligence in Families of Transgender People: A Mixed-Methods Study

Family can be a supportive and protective mental health context for trans children, yet little research, mainly qualitative, has focused on the experience of parents, who also suffer the impact of minority stress and live a process of meaning-making during gender affirmation process. This research aims to explore the impact of ambiguous loss and its relationship to their emotional intelligence and well-being. A mixed methods triangulation design with cross-sectional observation was used. Eighty-nine parents of transgender people participated in the study. The mean age was 46.37 years (S.D. = 7.15), 86.5% (n = 77) identified themselves as female and 44.4% reported a grieving process, although there were no statistically significant differences on well-being, emotional intelligence or emotional symptoms depending on it. However, parents with loss reported more negative emotions and do not benefit to the same extent from emotional intelligence or the buffering effect of positive emotions (especially pride). Perception of loss increases family distress, encouraging the gender affirmation process to be felt as a rupture and hindering the elaboration of new meanings. Future studies could include different personal, family, and contextual variables to further explore the experience of loss during the process, to assist these families more effectively.

Factors associated with adolescent pregnancy in selected rural municipalities of Lalitpur District: A mixed method study

In
 Introduction: Adolescent pregnancy increases the vulnerability to life threatening consequences in terms of developmental, sexual and reproductive health. This study aimed to find factors associated with adolescent pregnancy in selected rural municipalities of Lalitpur district using mixed methods approach.
 
 Method: Cross sectional study was conducted among 30 adolescent mothers, selected purposively, from Bagmati and Konjyosom Rural Municipality of Lalitpur district. 4 in-depth interviews and 2 key informant interviews were taken for qualitative study. Concurrent mixed-method triangulation design was used. Fisher’s exact test was used to find risk factors whereas Braun and Clarke’s six-step thematic analysis based on socio-ecological model themes was used to explore the reasons of adolescent pregnancy. Results from quantitative and qualitative findings were triangulated.
 
 Result: Out of 30 participants, 15(50%) participants had adolescent pregnancy. Family type, marriage type, age at marriage and unplanned pregnancy were significantly associated with adolescent pregnancy. Many risk factors were identified at different socio-ecological level from qualitative analysis. The results from triangulation of findings identified early marriage, marriage by elopement, unplanned pregnancy and perception regarding contraceptives as convergent risk factor, ethnicity as divergent risk factors and health workers behavior, laws, marriage and pregnancy norms, family pressure, access to media and decision making level as expansion risk factors.
 
 Conclusion: Preventing adolescent pregnancy calls for multifaceted measures at different socioecological level that are focused on the empowerment of girls with interventions tailed to particular subgroups especially the most vulnerable and marginalized ones.

A triangulation study of young Women's motivations for sending nudes to men

Women frequently send sexualized nude images to men (i.e., nudes), but women's motivations for sending nudes are unclear because there are methodological limitations in the ways that cyber sexual activity has been defined and measured. To address these gaps in the literature, we employed a mixed method triangulation design to assess young women's motivations for sending nudes to men, and how motivations compare when measured qualitatively and quantitatively. Across our qualitative and quantitative data, we found that women endorsed a plethora of motivations for sending nudes to men—far more than any one approach captured. The open-ended responses revealed positive sexual motives otherwise missing from the quantitative scales, which tended to overrepresent negative motivations. We also identified several critical discrepancies between endorsement of similar motivations in the qualitative versus quantitative responses, especially when it came to the idea of sending nudes for fun. Based on these findings, we suggest future researchers consider using more specific, and less stigmatizing language when assessing women's motivations for sending nudes.

Transforming Asynchronous Online Discussions with a Structured Conversation System

Research into asynchronous online discussions (AOD) produced conflicting, contradictory results. A central problem was AOD often did not produce a high level of engagement and critical thinking. Synthesizing best practices, a dialectical framework was developed around concrete, actionable levers to improve thinking in online and remote courses. Using a convergent mixed methods triangulation design, a thematic analysis compared AOD for unstructured, structured response system, and the introduction of a structured conversation system, finding a significant improvement using a structured conversation system which incorporated a social and personal component. Instructors needed to organize three levels: the back, the stage, and the front. Applying a typology analysis to AOD, instructors can improve and maintain high levels of critical thinking, engagement, and social interaction.

A mixed-methods case study on resident thermal comfort and attitude towards peak shifting of space heating

Recent simulation-based studies have indicated that Economic Model Predictive Control (EMPC) of space heating systems can exploit the thermal mass in residential buildings for demand response (DR) purposes in district heating systems. However, there is a lack of studies on residents’ perception and acceptance of the fluctuating indoor air temperature behaviour inherent in EMPC of space heating. This paper reports on a case study featuring the residents of three one-story houses located in Denmark. The houses were equipped with technology enabling remote actuation of radiator thermostats and collection of various indoor environmental data. Four different temperature boost interventions mimicking the typical behaviour of EMPC of radiators were executed while a mixed-methods triangulation design, employing questionnaires and semi-structured interviews, was used to collect subjective data. Data showed that residents accepted the behaviour but only after the benefits of the EMPC were explained. The acceptance was motivated by either the prospect of saving money, environmental benefits, or a combination of both. The results thereby indicate that explaining the benefits of EMPC is important if residents are to abandon their current preferences and practices in favour of an EMPC concept. The explanation should consider the diversity in current preferences, expectations, and level of technological pre-knowledge. In addition, the paper also reports on a range of findings related to technical aspects of realising EMPC in practice.

Rethinking Dating and SEXUAL Violence Prevention for Youth During the Pandemic: Examining Program Feasibility and Acceptability.

Sexual and dating violence (SDV) is a social and health but preventable public issue. Most evidence-based prevention programs have been evaluated using an in-person delivery mechanism. Project Dream, Own and Tell (DOT) is a 13- to 18-week SDV prevention program targeting youth from traditionally underserved communities in New York City that shifted from in-person to online delivery in response to social distancing requirements during the COVID-19 pandemic. The aim of the current study was to understand how youth perceive learning SDV prevention in an online environment (acceptability and feasibility of the online DOT program). A mixed methods triangulation design was used including responses to Ecological Momentary Assessments (n = 25), a brief post survey with Likert-scale items (n = 18), and semi-structured interviews with 12 participants. The sample comprised Latinx/Hispanic, Asian American, Arab American, and African American youth between the ages of 15 and 21 from urban communities. Youth indicated both strengths and challenges of the online format. Strengths included ease of fitting the program into their schedules, avoiding long commutes, and the potential to create a safe online space for participants to engage in sexual violence prevention discussions and thus, feel less exposed. Challenges included internet connectivity issues, difficulties in building trustworthy relationships with other participants when not sharing the same physical space, some characteristics of the program's activities, and the lack of adequate space from which to attend the program (i.e., shared spaces). Findings suggest that synchronous online prevention program delivery is a feasible and acceptable strategy for engaging adolescents in relationship violence prevention.

Implementation, mechanisms of change and contextual factors of a complex intervention to improve interprofessional collaboration and the quality of medical care for nursing home residents: study protocol of the process evaluation of the interprof ACT intervention package

BackgroundTo improve interprofessional collaboration between registered nurses (RNs) and general practitioners (GPs) for nursing home residents (NHRs), the interprof ACT intervention package was developed. This complex intervention includes six components (e.g., shared goal setting, standardized procedures for GPs’ nursing home visits) that can be locally adapted. The cluster-randomized interprof ACT trial evaluates the effects of this intervention on the cumulative incidence of hospital admissions (primary outcome) and secondary outcomes (e.g., length of hospital stays, utilization of emergency care services, and quality of life) within 12 months. It also includes a process evaluation which is subject of this protocol. The objectives of this evaluation are to assess the implementation of the interprof ACT intervention package and downstream effects on nurse–physician collaboration as well as preconditions and prospects for successive implementation into routine care.MethodsThis study uses a mixed methods triangulation design involving all 34 participating nursing homes (clusters). The quantitative part comprises paper-based surveys among RNs, GPs, NHRs, and nursing home directors at baseline and 12 months. In the intervention group (17 clusters), data on the implementation of preplanned implementation strategies (training and supervision of nominated IPAVs, interprofessional kick-off meetings) and local implementation activities will be recorded. Major outcome domains are the dose, reach and fidelity of the implementation of the intervention package, changes in interprofessional collaboration, and contextual factors. The qualitative part will be conducted in a subsample of 8 nursing homes (4 per study group) and includes repeated non-participating observations and semistructured interviews on the interaction between involved health professionals and their work processes. Quantitative and qualitative data will be descriptively analyzed and then triangulated by means of joint displays and mixed methods informed regression models.DiscussionBy integrating a variety of qualitative and quantitative data sources, this process evaluation will allow comprehensive assessment of the implementation of the interprof ACT intervention package, the changes induced in interprofessional collaboration, and the influence of contextual factors. These data will reveal expected and unexpected changes in the procedures of interprofessional care delivery and thus facilitate accurate conclusions for the further design of routine care services for NHRs.Trial registrationClinicalTrials.gov NCT03426475. Registered on 07/02/2018.

Micro-credentials in leveraging emergency remote teaching: the relationship between novice users\u2019 insights and identity in Malaysia

Micro-credentials have gained much popularity in recent years, and their popularity has skyrocketed due to emergency remote teaching instigated by the pandemic. It has been defined as a platform that provides credentials based on validated competencies. Nevertheless, in Malaysian HEI, such a concept is still novel and identifying insights on the benefits, challenges, and application are still scarce. Similarly, it was observed that there is a lack of observation on how students’ digital learning identity and their perception of professional relevance are influenced by such platform. Henceforth, based on the adapted enriched virtual model approach, a micro-credentials course was implemented to complement the new “normal” classes for a pre-service teacher’s instructional design course. A mixed-method triangulation design was used to explore the qualitative findings operationalized by open-ended questions (N = 74) with data obtained from the Digital Learning Identity Survey (DLIS) and Constructivist On-Line Learning Environment Survey (COLLES) (N = 72). The findings indicated that respondents had an overall positive perception of the use of micro-credentials to complement and overcome online learning challenges mainly due to substandard internet connectivity; nevertheless, they are unaware of the value of such credentials in their future profession. Conversely, their new identity as digital learners and experiences with a blended approach of online learning, especially with micro-credentials, was successful in shaping their identity as aspiring educators that embrace technology for teaching and learning.

'Weighing' Losses and Gains: Evaluation of the Healthy Lifestyle Modification After Breast Cancer Pilot Program.

ObjectivesThis pilot study sought to develop and evaluate a novel online group-based intervention (Healthy Lifestyle Modification after Breast Cancer; HLM-ABC) to help breast cancer survivors (BCSs) make healthy lifestyle changes intended to yield not only beneficial physical outcomes (i.e., weight loss, reduced body mass index) but also greater behavioral (e.g., increased physical activity, healthier eating), and psychosocial well-being (e.g., self-efficacy, motivation, body image).MethodsAn exploratory single-arm, mixed-method triangulation design was employed to evaluate the feasibility and preliminary effectiveness of the HLM-ABC intervention for overweight BCSs. Fourteen women participated in the 10-week intervention and completed quantitative measures of the above-mentioned outcomes at baseline, post-treatment, 6-month, and 12-month follow-up time points. Qualitative data were obtained post-treatment via semi-structured interviews and a treatment satisfaction questionnaire.ResultsParticipants lost an average of 2.83% of their baseline weight (M = 196.65; SD = 38.59) by 1-year follow-up (M = 191.29; SD = 33.91), equal to a small effect size (d = –0.37). Despite achieving only modest weight loss, participants achieved meaningful gains in the form of increased physical activity (d = 0.2), discovery of gratifying movement, more intuitive eating habits (d = 1.12), greater bodily and emotional awareness, and positive shifts in beliefs about being able to make healthy choices regarding food (d = 0.63) and physical activity (d = 0.38). Furthermore, they demonstrated a slight improvement in body image (d = 0.36) and described feeling more self-compassionate, empowered, and acknowledging of variables beyond control (i.e., hormonal therapy, unsatisfactory surgery) that can present barriers to change.ConclusionAfter completing a 10-week online program, participants achieved meaningful and lasting changes on a number of healthful indicators, even when this did not correspond with a significant reduction in weight. Findings highlight the complex, multifaceted nature of “health” and lend support for promotion of healthier lifestyle following cancer treatment that encompasses not only physical weight, but also behavior, psychosocial well-being, and (often unmodifiable) circumstances such as life-preserving hormonal treatments.

What, how, when and who of trial results summaries for trial participants: stakeholder-informed guidance from the RECAP project

ObjectiveTo generate stakeholder informed evidence to support recommendations for trialists to implement the dissemination of results summaries to participants.DesignA multiphase mixed-methods triangulation design involving Q-methodology, content analysis, focus groups and...

Influence of Child Protection Benchmark on Management Outcomes in Child Friendly Schools of Makueni County, Kenya

The influence of child protection as a child-friendly school benchmark on the management outcome in public primary schools has been of interest. Schools in Makueni County (Kenya) have had their share of reported cases of child insecurity with children having been physically violated within the school community, sometimes with corporal punishment cases by teachers to an alarming level. The sought to answer the question: what is the influence level of the child protection internal school benchmark on the management outcome in Child Friendly Schools (CFS) of Makueni County? To answer the question, a mixed-method triangulation design was applied with a convergent model that inculcates regression and correlation models. The study findings establish that schools partially put in place and managed child protection measures as an important benchmark to strengthen management outcomes in CFS. Results from the study determined that there were established rules for visitors to identify themselves (82.1%), rules not to allow people under the influence of illicit drugs at school (85.5%), rules against bullying and corporal punishment (91.8%), not to allow pits in the school compound (65.5%), and buildings at school to be earthquake resistant (27.9%). School management used UNICEF’s child-friendly school child protection model as a benchmark on which to provide protection as a child right, thus making the schools more child-friendly.

Evaluation of a school-based dissemination of the movement guidelines for young children in Hong Kong: Study protocol

BackgroundHealthy movement behaviors in early childhood are believed to track to adulthood, potentially imparting protective benefits against non-communicable diseases. Highlighting the collaborative and complementary roles of parents and educators in promoting health of young children, this study aims to enable parents and teachers to successfully promote healthy movement behaviors in young children. Guidelines for physical activity, sedentary screen time, and sleep of children aged 2 to 6 years will be systematically disseminated to parents and teachers of children enrolled in early childhood education centers (ECECs) in Hong Kong. An evaluation will be conducted to assess the implementation process and the outcomes of the dissemination of said guidelines.MethodsThe evaluation will include formative and summative components to examine the implementation (i.e., process evaluation) and the outcomes (i.e., outcome evaluation). Participants include teachers, parents, and children from ECECs in Hong Kong. The process evaluation will be guided by the RE-AIM framework (i.e., reach, efficacy, adaptation, implementation, maintenance). Data gathering and analysis will take a mixed-methods triangulation design - convergence model. The outcome evaluation consists of a non-randomized observational study, using quantitative data from questionnaires and accelerometers. The primary outcome to be measured is the extent to which children meet the guidelines for physical activity, sedentary screen time, and sleep; the secondary outcome is teachers’ and parents’ knowledge and awareness of the guidelines.DiscussionYoung children who engage in healthy movement behaviors are likely to become adults who will have the disposition to engage in behaviors that have protective effects against non-communicable diseases. The findings of this evaluation are expected to contribute to improving the strategies of systems and government agencies that aspire to promote healthy movement behaviors of young children.