Multi-method Study Research Articles

Approaching the Complete Basis Set Limit for Spin-State Energetics of Mononuclear First-Row Transition Metal Complexes.

Convergence to the complete basis set (CBS) limit is analyzed for the problem of spin-state energetics in mononuclear first-row transition metal (TM) complexes by taking under scrutiny a benchmark set of 18 energy differences between spin states for 13 chemically diverse TM complexes. The performance of conventional CCSD(T) and explicitly correlated CCSD(T)-F12a/b calculations in approaching the CCSD(T)/CBS limits is systematically studied. An economic computational protocol is developed based on the CCSD-F12a approximation and (here proposed) modified scaling of the perturbative triples term (T#). This computational protocol recovers the relative spin-state energetics of the benchmark set in excellent agreement with the reference CCSD(T)/CBS limits (mean absolute deviation of 0.4, mean signed deviation of 0.2, and maximum deviation of 0.8 kcal/mol) and enables performing canonical CCSD(T) calculations for mononuclear TM complexes sized up to ca. 50 atoms, which is illustrated by application to heme-related metalloporphyrins. Furthermore, a good transferability of the basis set incompleteness error (BSIE) is demonstrated for spin-state energetics computed using CCSD(T) and other wave function methods (MP2, CASPT2, CASPT2/CC, NEVPT2, and MRCI + Q), which justifies efficient focal-point approximations and simplifies the construction of multimethod benchmark studies.

Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice

ObjectivesTo examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and...

Mixed Methods EvAluation of the high-volume low-complexity Surgical hUb pRogrammE (MEASURE): a mixed methods study protocol

IntroductionThe waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs...

'They don't think I can do it': Experiences of self-advocates, employment specialists, and employers on employment of adults with intellectual disability.

A multi-phase Canadian study was conducted as part of a large-scale community and academic research partnership focused on understanding and improving the employment experiences of people with intellectual disabilities. This multi-method study utilized a sequential approach, using findings from qualitative interviews (n = 28) to inform an online survey (n = 149). Participants were invited to share their experiences with paid employment or with persons with intellectual disabilities. Thematic analysis of data across interview and survey findings resulted in six themes: (1) assumptions and attitudes, (2) knowledge and awareness, (3) accessibility of processes, (4) use of accommodations, (5) workplace relationships, and (6) supports and resources. A holistic and systemic approach has the potential to improve inclusive employment experiences of people with intellectual disabilities. Action is needed mainly at the policy and employer level to reduce barriers and improve on facilitating measures reinforced by the themes shared in this study.

Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study.

The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. PRR1-10.2196/50532.

Risky Business: Data-At-Risk in a Dynamic and Evolving Multidisciplinary Research Environment

At-risk data is an unfortunate research reality and can be present in all data formats in a range of research disciplines. This is defined as data that are at risk of loss due to various factors, including deterioration of the media, lack of accompanying documentation and data that exists in non-digital formats, which are often irreplaceable. Continued access to older data has a range of benefits. The factors that place valuable data at risk are therefore a cause for concern. This paper reports on a multi-method case study, comprising a survey and interviews. A web-based questionnaire was distributed to all research group leaders based at a leading South African research institute. This was followed by one-on-one interviews that were held with a sub-section of the same group of researchers. The combined findings of the two methods enabled a picture to be formed regarding factors that jeopardise research data, data rescue obstacles that the researchers encountered and the state of data rescue at the institute. Several recommendations and strategies are put forward to address identified risk factors and challenges. Suggestions include the launch of a data rescue project, awareness training around data at risk, involving the institute’s library and information services (LIS) section in data rescue and launching continued efforts to acquire a dedicated institutional data repository. It is also important to ensure that the scope of project risk management includes data considerations. The combined implementation of recommendations is anticipated to ensure the accessibility and usability of older at-risk data and reduce the chances of current and future data becoming compromised.

Mapping health promotion practices across key sectors and its intersectoral approach at the local level: Study protocol.

This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions. A complementary multi-method study combining survey methods and qualitative interviews will be adopted. Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a 'framework analysis' will be performed. This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building. Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts. Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.

Adolescent Preferences for a Pediatric Primary Care-based Sexually Transmitted Infection and HIV Prevention Intervention

PurposeWe sought to elicit perspectives on HIV and sexually transmitted infection (STI) prevention among adolescents with recent STIs in primary care to optimize acceptability and effectiveness in designing a novel HIV/STI prevention intervention. MethodsWe enrolled 13-19 year-olds with recent gonorrhea, chlamydia, trichomonas, and/or syphilis in a multimethods cross-sectional study at two primary care clinics. Participants completed surveys and interviews. We used an integrated analytic approach deductively coding data using the Integrated Behavioral Model, then inductively coding to identify themes not represented in the Integrated Behavioral Model. ResultsParticipants (n = 35) were 85% cisgender female, 14% cisgender male, 1% transgender female; 25% identified as lesbian, bisexual, or queer. Most (97%) identified as non-Latinx Black. None used condoms consistently, 26% were aware of pre-exposure prophylaxis (PrEP), and 31% were never HIV tested. Five key themes emerged. 1) Mental health was central to HIV prevention behavior uptake and coping with STI diagnosis. 2) Youth desired prevention counseling that allowed decisional autonomy and individualized goal setting. 3) Negative social norms around condoms and absent norms around HIV testing and PrEP limited method uptake. 4) Both confidence and concrete skills were needed to initiate prevention methods. 5) Youth desired education at the time of STI diagnosis to improve subsequent prevention decision making. DiscussionKey intervention design considerations included 1) integrating mental health assessment and referral to services, 2) promoting individualized goal setting, 4) building communication skills, 4) providing navigation and material support for PrEP uptake and HIV testing, and 5) augmenting comprehensive STI and HIV prevention education.

Pregnant Women's Experiences of Seeking Treatment for Opioid Use.

The purpose of this study was to describe women's experiences seeking treatment for opioid use disorder during pregnancy. This was an exploratory multi-method study to understand women's experiences seeking treatment for opioid use disorder during pregnancy using surveys and interviews. Women pregnant within the past 5 years while using opioids were recruited from a private Facebook group for mothers on medication for opioid use disorder. Members of this group assisted with the development of the survey. Descriptive statistics were used for the 18-question survey and interviews were recorded, transcribed, and analyzed for themes. Twenty-one women completed an online survey, and six participated in an in-depth virtual interview about their experience. Five themes describing their experiences were identified: (1) fear of child protective services, (2) family and partner support, (3) health care providers' reactions, (4) accessing treatment centers, and (5) awareness of support services during pregnancy . Participants reported an overall negative experience seeking treatment for opioid use disorder during pregnancy. Nurses can improve the outcomes for pregnant women with opioid use disorder by using a non-stigmatizing approach, promoting early identification, and providing information, including harm reduction education. Facilitation of resources for treatment, mother and child programs, and advocating for partner treatment can improve maternal and neonatal outcomes.

Nurses' self-regulated learning in clinical wards: Important insights for nurse educators from a multi-method research study

Central in nurse education curricula stands the preparation of future nurses to work in quickly evolving, dynamic, clinical wards. Learning in the flow of work plays a pivotal role in initial nurse education, but also during continuous professional development. To drive their ongoing development, nurses need competency in self-regulation of learning (SRL). Despite the importance of SRL in the clinical workplace for all (future) healthcare professionals, research on self-regulated workplace learning (SRwpL) of nurses and future nurses in clinical wards is underdeveloped. This study aims to enhance the conceptual understanding of SRwpL strategies and practices in clinical nursing wards and to offer insights for designing effective educational interventions supporting the facilitation and development of (future) nurses' SRwpL in the clinical ward. A multi-actor, multi-method perspective was adopted to qualitatively investigate SRwpL strategies nurses engaged in. Nurses were observed and interviewed, but also professionals responsible for ongoing development in clinical wards (the ward's head nurses and learning counselors) were interviewed. The data collection took place before the COVID pandemic. Results reveal self-regulatory strategies conditional for SRwpL in addition to strategies initiating, progressing, and evaluating the learning process. Head nurses and learning counselors report a lack of these conditional strategies and little variation, and sporadic engagement in all other self-regulatory strategies. To enhance (future) nurses' SRwpL, we suggest that clinical supervisors from educational institutions could exert a lasting influence by not only educating student nurses, but also fostering further professional development of counselors and head nurses to scaffold the SRwpL processes of future nurses in clinical wards.

'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid.

Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specificDDDA; (2) semistructured interviews with ILWDand an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise contentand choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.

The creation of culturally responsive school environments in Ireland: Factors that assist in reducing the gap between policy and practice

Ireland’s cultural identity has transformed significantly in the past few decades as a result of large-scale inward migration. Consequently, the creation of culturally responsive school environments has become a major concern in policy discourses in recent years. Despite the prevalence of such discourses, research on the cultural responsiveness of the four major primary school types in Ireland, and what factors influence the gap between policy and practice across these school types has remained sparse. Addressing this lacuna in research, this exploratory multi-method study draws on data collected from teachers, principals, and parents. This study highlights several factors that assist students from culturally and religiously diverse backgrounds to develop a sense of school belonging and explores the challenges associated with implementing policies related to creating culturally responsive classrooms in Irish primary schools. This study holds international relevance as it highlights key factors facilitating schools’ response to the growing migration trend experienced throughout Europe.

How authenticity is negotiated and experienced by clergy and tourists at religious World Heritage sites: taking a closer look into the ‘preserve as found’ strategy

ABSTRACT Drawing on an existing debate regarding the conservation of living heritage, this paper delves into the dissonance and contestation that emerges during the aesthetic treatment of religious wall paintings. The Cypriot UNESCO painted churches open a window for the examination of how policy makers, clergy and visitors negotiate the materiality of religion. This multi-method qualitative comparative case study aims to understand how the ‘material-focused’ Authorised Heritage Discourse retains its hegemony during the conservation of living heritage and how AHD-led practices (‘preserve as found’ strategy) impact visitors’ perceived authenticity and experience. The findings demonstrate that over the years, a centralised decision-making system has been maintained in Cyprus that limits polyvocality, perpetuating AHD-led practices. However, evidence of reconciliation between AHD and living tradition was found, challenging the current assumption that considers anti-restoration (objective authenticity) and living religious tradition as antithetic practices. Interviews showcased that for most social agents, deliberate damage, patina, and graffiti triggered an immersive and highly reflective experience while the prospect of restoration provoked ‘pre-nostalgia,’ a self-awareness that restoration may result in significant cultural loss. The paper concludes that, in future conservation and interpretation strategies, ‘evidence of time’ should be considered a salient quality of ‘heritaged’ churches.

Stigma associated with cutaneous leishmaniasis in rural Sri Lanka: development of a conceptual framework.

There is limited knowledge about the stigma associated with cutaneous leishmaniasis (CL) in Sri Lanka. To ensure that leishmaniasis researchers focus on CL-associated stigma, we provide an evidence-based framework that can be used in future research. We conducted a systematic review on CL-associated stigma using international evidence and carried out a multimethod qualitative study in the Anuradhapura district in Sri Lanka. Based on that, we identified manifestations of stigma, drivers and facilitators that we synthesised to develop a conceptual framework on CL-associated stigma. Our framework consists of drivers, facilitators and self-stigma experienced by people with CL. Stigma drivers included fear, misbeliefs and misconceptions about CL; the belief that wounds are disfiguring; the treatment burden and implied blame. Facilitators that reduced stigma included knowledge of the curability of CL and awareness that CL is not contagious. The nature of social interactions in rural communities enhanced stigma formation. We identified various enacted, felt and internalised stigma experiences of people with CL. We developed a conceptual framework of the stigma associated with CL that can be used to develop targeted interventions to increase CL awareness, address stigma and improve the quality of life for CL patients.

Strategies for Entrepreneurs with Disabilities to Expand Their Businesses: A Multi Method Study

Strategies for Entrepreneurs with Disabilities to Expand Their Businesses: A Multi Method Study

Single-Sex schooling at an Elite Independent School: A Multi-Methods Case Study

This article focuses upon the milieu of single-sex schooling within an elite independent school in a Canadian urban centre. This research served as an exploratory and critical examination of single-sex schooling in a specific context, and considered its relevance, pedagogical effectiveness, and ability to meet its purported goals. Using an interpretative methodological framework, and employing a multi-methods case study design, the purpose of this research was to investigate the strengths, limitations, and possibilities of single-sex schooling in a particular educational context as informed by its students, parents of students, graduates, and teachers. We found little evidence to support the idea that single-sex schooling overwhelmingly impacted student academic or social development. Implications for practice at schools offering single-sex schooling are addressed and focus upon the importance of gender-inclusive schooling; the school as the key, rather than the school’s single-sex classes; and addressing boys’ behaviour. Key words: single-sex, gender, schooling, independent school, private school Cet article se penche sur un milieu de scolarisation non mixte au sein d’une école privée élitiste d’un centre urbain canadien. Cette recherche a permis d’examiner de façon exploratoire et critique la scolarisation non mixte dans un contexte précis, ainsi que sa pertinence, son efficacité pédagogique et sa capacité à atteindre les objectifs escomptés. Par l’utilisation d’un cadre méthodologique interprétatif et le recours à une étude de cas multimodale, cette recherche poursuivait l’objectif d’examiner les forces, les limites et les possibilités de l’enseignement en milieu non mixte, dans un contexte éducatif particulier, comme le décrivent les élèves, leurs parents, les diplômés et les enseignants. À la suite de cet examen, peu de preuves viennent soutenir l’idée que la scolarisation en milieu non mixte a un impact considérable sur le développement scolaire et social des élèves. L’article traite des implications pour la pratique dans les écoles offrant une scolarisation non mixte et se concentre sur l’importance d’une scolarisation inclusive des genres, sur l’école comme étant la clé plutôt que les classes non mixtes, et à considérer le comportement des garçons. Mots clés : non mixte, genre, scolarisation, école indépendante, école privée

Rethinking the consultation paradigm: Validity evidence for a new framework, a multimethods study.

In-hospital consultation is essential for patient care. We previously proposed a framework of seven specific consultation types to classify consult requests to improve communication, workflow, and provider satisfaction. This multimethods study's aim was to evaluate the applicability of the consult classification framework to real internal medicine (IM) consults. We sought validity evidence using Kane's validity model with focus groups and classifying consult requests from five IM specialties. Participants attended five 1 h semi-structured focus groups that were recorded, transcribed, and coded for thematic saturation. For each specialty, three specialists and three hospitalists categorized 100 (total 500) random anonymized consult requests. The primary outcome was concordance in the classification of consult requests, defined as the sum of partial concordance and perfect concordance, where respectively 4-5/6 and 6/6 participants classified a consult in the same category. We used χ2 tests to compare concordance rates across specialties and between specialists and hospitalists. Five major themes were identified in the qualitative analysis of the focus groups: (1) consult question, (2) interpersonal interactions, (3) value, (4) miscommunication, (5) consult framework application, barriers, and iterative development. In the quantitative analysis, the overall concordance rate was 88.8% (95% confidence interval [CI]: 85.7-91.4), and perfect concordance was 46.6% (95% CI: 42.2-51.1). Concordance differed significantly between hospitalists and specialists overall (p = .01),with a higher proportion of hospitalists having perfect concordance compared to specialists (67.2% vs. 57.8%, p = .002). The consult classification framework was found to be applicable to consults from five different IM specialties, and could improve communication and education.

Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study.

The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.

A multi-method study of interpersonal complementarity and mentalization

Research finds cross-sectional relationships between mentalizing impairments and maladaptive personality traits. The current study connects mentalizing impairments to dynamic interpersonal processes using a multi-method design. A sample of 218 participants completed the Movie for the Assessment of Social Cognition (MASC; Dziobek et al., 2006) to assess mentalizing ability. Subsequently, participants rated their agentic and communal behavior and their perception of interaction partners’ agentic and communal behavior over 21-days. Mentalizing ability moderated the within-person relationship between behavior and perception for both agency and communion. Worse performance on the MASC was associated with weaker interpersonal complementarity, suggesting that mentalizing impairments lead to deviations from expected patterns of behavior and perception across interpersonal situations. These findings confirm the assumption of Contemporary Integrative Interpersonal Theory that mentalization impairments can disrupt normative interpersonal processes (Cain et al., 2024; Pincus & Hopwood, 2012).

Integrating Perceptions, Physical Features and the Quality of the Walking Route into an Existing Accessibility Tool: The Perceived Environment Walking Index (PEWI)

Perceptions of the environment shape individual mobility decisions and represent the ‘lived reality’ of accessibility and walkability. Yet recent common walkability analyses and instruments try to include perceptions of different population groups without integrating them into practical tools. However, there is a need for a holistic tool as a basis for transport planners and researchers to integrate the various aspects of walkability into one instrument. This paper investigates multiple relations between different walkability concept parameters and presents the development of the Perceived Environment Walking Index (PEWI). To achieve this, we used a multi-method study design and developed and tested the PEWI in two urban neighbourhoods in Hamburg in three steps. First, we calculated the objective walking accessibility using GIS based on the well-known Walk Score®. Second, we integrated 18 indicators representing physical features and the quality of the walking route, alongside subjective perceptions of walking accessibility broken down into the categories of functionality, safety and security as well as pleasantness and attractiveness. Key results imply that integrating these indicators into an existing accessibility tool is a promising, nuanced method for an improved picture of walkability and accessibility whereas indices focusing only on distances or travel times are not sufficient to represent the lived reality. The implications of our results are discussed with regard to future research gaps and policy.