Parallel Mixed Methods Approach Research Articles

It Is Never Too Early: Social Participation of Early Childhood Education Students from the Perspective of Families, Teachers and Students

The aim of this study was to delve into social participation in early childhood education classrooms of centres that include students with ASD, considering social participation as a fundamental element to understand inclusion. To this end, we propose a Convergent Parallel Mixed Methods approach. A quantitative study was carried out with the participation of 85 Early Childhood Education students from centres that include students with ASD. Information was gathered through attitude and social support questionnaires. Six families and eight professionals of these centres participated in the qualitative study. In this case, interviews were conducted. The results show the need to attend to the social participation of all students already in the stage of Early Childhood Education as a fundamental part of what is understood as an inclusive classroom. Similarly, this study identifies both the factors that hinder and facilitate the response of teachers to this aspect in relation to the students, teachers, and families.

Lessons Learned from the Pilot Phase of a Population-Wide Genomic Screening Program: Building the Base to Reach a Diverse Cohort of 100,000 Participants.

Background and Objectives: Genomic information is increasingly relevant for disease prevention and risk management at the individual and population levels. Screening healthy adults for Tier 1 conditions of hereditary breast and ovarian cancer, Lynch syndrome, and familial hypercholesterolemia using a population-based approach can help identify the 1–2% of the US population at increased risk of developing diseases associated with these conditions and tailor prevention strategies. Our objective is to report findings from an implementation science study that evaluates multi-level facilitators and barriers to implementation of the In Our DNA SC population-wide genomic screening initiative. Methods: We established an IMPACTeam (IMPlementAtion sCience for In Our DNA SC Team) to evaluate the pilot phase using principles of implementation science. We used a parallel convergent mixed methods approach to assess the Reach, Implementation, and Effectiveness outcomes from the RE-AIM implementation science framework during the pilot phase of In Our DNA SC. Quantitative assessment included the examination of frequencies and response rates across demographic categories using chi-square tests. Qualitative data were audio-recorded and transcribed, with codes developed by the study team based on the semi-structured interview guide. Results: The pilot phase (8 November 2021, to 7 March 2022) included recruitment from ten clinics throughout South Carolina. Reach indicators included enrollment rate and representativeness. A total of 23,269 potential participants were contacted via Epic’s MyChart patient portal with 1976 (8.49%) enrolled. Black individuals were the least likely to view the program invitation (28.9%) and take study-related action. As a result, there were significantly higher enrollment rates among White (10.5%) participants than Asian (8.71%) and Black (3.46%) individuals (p < 0.0001). Common concerns limiting reach and participation included privacy and security of results and the impact participation would have on health or life insurance. Facilitators included family or personal history of a Tier 1 condition, prior involvement in genetic testing, self-interest, and altruism. Assessment of implementation (i.e., adherence to protocols/fidelity to protocols) included sample collection rate (n = 1104, 55.9%) and proportion of samples needing recollection (n = 19, 1.7%). There were no significant differences in sample collection based on demographic characteristics. Implementation facilitators included efficient collection processes and enthusiastic clinical staff. Finally, we assessed the effectiveness of the program, finding low dropout rates (n = 7, 0.35%), the identification of eight individuals with Tier 1 conditions (0.72% positive), and high rates of follow-up genetic counseling (87.5% completion). Conclusion: Overall, Asian and Black individuals were less engaged, with few taking any study-related actions. Strategies to identify barriers and promoters for the engagement of diverse populations are needed to support participation. Once enrolled, individuals had high rates of completing the study and follow-up engagement with genetic counselors. Findings from the pilot phase of In Our DNA SC offer opportunities for improvement as we expand the program and can provide guidance to organizations seeking to begin efforts to integrate population-wide genomic screening.

Caregiver Strategies to Sensory Features for Children With Autism and Developmental Disabilities.

BackgroundCaregivers of children with autism spectrum disorders (ASD) and developmental disabilities (DD) implement myriad strategies to support their children during daily activities and routines, which are laden with sensory stimuli. Children’s sensory features are often characterized by three patterns of response (i.e., hyperresponsiveness, hyporesponsiveness, sensory seeking), and little is known about how caregivers’ strategies differ among these patterns. Therefore, we used a mixed methods analysis to examine the complex interplay between children’s sensory response patterns, child characteristics (diagnosis, chronological age, mental age), and caregiver strategies. Specifically, we examined how children’s sensory response pattern scores were associated with caregiver strategies within sensory response pattern and at the item level. Lastly, we described the differential strategies implemented by caregivers of children with ASD and DD by sensory response pattern.Materials and MethodsParticipants included children with ASD (n = 77) and DD (n = 40) aged 2–10 years. Caregivers completed the Sensory Experiences Questionnaire-2.1. A convergent parallel mixed methods approach was used to analyze data.ResultsChildren’s sensory response pattern scores were significantly, positively associated with caregiver strategies within each sensory pattern (hyperresponsiveness, hyporesponsiveness, seeking); however, child mental age, and chronological age were not significantly related to the rate of caregiver strategies across patterns. While caregivers of children with ASD reported using more strategies, child diagnosis did not moderate the association between child sensory response pattern scores and the rate of caregiver strategies used. Item analysis demonstrated specific child behaviors in response to sensory stimuli that elicited high rates of strategies among caregivers. Qualitative analysis revealed distinct themes characterized caregiver strategies within each sensory pattern for children with ASD and DD.ConclusionOur findings demonstrated specificity of caregiver strategies to children’s sensory response patterns in the context of families’ everyday lives, which were not contingent on child diagnosis, mental age, or chronological age, thereby highlighting universal qualities of caregiving for young children who experience varying levels of sensory challenges. Targeted intervention approaches may differentially incorporate types of strategies based on sensory response patterns to more optimally facilitate children’s activity participation.

The impact of the Caremongering social media movement: A convergent parallel mixed-methods study.

Public health responses to the COVID-19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began. We used a convergent parallel mixed-methods approach that included semi-structured interviews with group moderators from 16 Caremongering groups and survey data from 165 group members. We used a constant comparative approach for thematic analysis of interview transcripts and open-ended text responses to the survey. We used source theme tables as joint displays to integrate interview and survey findings. Our results revealed five major themes: providing food, sharing information, supporting health and wellness, acquiring goods and services (non-food), and connecting communities. Respondents of our survey tended to be 35-65 years of age range, but reported helping adults of all ages. Our findings illustrate the potential of using a social media platform to connect with others and provide and access support. The Caremongering initiative demonstrates a community-driven, social media solution to issues such as isolation, loneliness and community health promotion.

FIRST High-School Students and FIRST Graduates: STEM Exposure and Career Choices

<italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Contributions:</i> The study contributes to the social cognitive career theory (SCCT) by explaining high-school students’ career choices and finding possible relations between self-efficacy, interpersonal skills, what inspires them to choose a career, and their actual choices. The practical contribution of this research lies in understanding the impact of the For Inspiration and Recognition of Science and Technology (FIRST) program on its participants and graduates. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Background:</i> The FIRST program incorporates project-based learning that fosters the design and production of innovative robotics by teams of students who compete annually. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Research Questions:</i> 1) Do the FIRST program activities increase STEM exposure and encourage STEM career choices, and if so, how? 2) What are the factors that affect these choices? Are there correlations between those factors? If so, what are they? 3) Is the effect of the FIRST program on FIRST high-school students’ exposure and career choices different from that effect on FIRST graduates? If so, what are the differences and does gender play a role in these differences? <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Methodology:</i> The research participants included 119 FIRST high-school students and 297 FIRST graduates. The research applied a convergent parallel mixed-methods approach, with data collected both qualitatively via interviews and quantitatively via questionnaires. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Findings:</i> Analysis of the data showed that the FIRST program increased participants’ STEM exposure and career choice in STEM domains. A significant, positive, strong correlation was found between interpersonal skills, STEM exposure, career choice, family and school support, and external motivation.

Pain Management in Geriatric Hip Fracture Patients - Are There Barriers to Performing Ultrasound Guided Femoral Nerve Blocks?

Ultrasound-guided femoral nerve blocks (UGfNB) are an effective alternative to opiates for hip fractures, yet few are performed in the Emergency Department (ED). To augment implementation of UGfNB at our institution, we used convergent, parallel mixed-methods approach to explore barriers to closing this evidence-to-practice gap. Considering all the stakeholders for UGfNB, we started by recruiting emergency medicine physicians and residents practicing in a large academic medical center to discuss barriers and facilitators to UGfNB adoption. Guided by the Consolidated Framework for Implementation Research, we developed an interview guide for our qualitative (focus group) and quantitative approach (survey). To develop comprehensive understanding, we distributed the quantitative survey to focus group participants regarding current practice, knowledge, and attitudes regarding UGfNB. This data was entered into Redcap®, anonymized, and collated for thematic analysis to supplement our focus group data. Twenty-two physicians participated in the quantitative survey. All participants reported weekly or monthly exposure to geriatric hip fractures yet only 27% (N=6) ever performed UGfNB. The most difficult aspect of controlling pain in geriatric hip fractures was that "typical IV/PO medicines have a lot of negative side effects" and that "the effects of pain control methods do not last long enough" thus requiring "frequent reassessments". Strong influencers of UGfNB included supportive hospital policy and multi-specialty agreement. Most (64%) reported that UGfNB offers "superior pain control, are safe, and have fewer side effects". Respondents were least comfortable with ultrasound anatomy, including identifying the femoral nerve and fascia iliaca. The most cited barriers to performing UGfNB in the ED were "too much time to perform" and "lack of procedural comfort". Though advantages for UGfNB exist in the ED, only a minority of physicians perform them in geriatric hip fractures. We identified barriers and facilitators towards implementation that serve as context for more in-depth focus group discussion.

Role of schools in community mobilisation to improve IYCF practices in 6-24-month-old tribal children in the Banswara district, India: findings from the qualitative PANChSHEEEL study.

ObjectiveIndia has been struggling with infant malnutrition for decades. There is a need to identify suitable platforms for community engagement to promote locally feasible, resource efficient Infant and Young Child Feeding (IYCF) interventions. This study aims to explore if and how schools could represent a site for community engagement in rural India, acting as innovation hubs to foster positive change in partnership with the Angawadi centres.DesignFive-phase formative study; A parallel mixed methods approach structured by a socioecological framework was used for data collection at individual, household and community levels. This paper focuses on the qualitative findings.SettingThis study was undertaken in nine villages within two blocks, ‘Ghatol’ and ‘Kushalgarh’, in the Banswara district of Rajasthan, India.Participants17 schools were identified. Interviews were conducted with local opinion leaders and representatives in the education sector, including principals, schoolteachers, block and district education officers. Across the nine study villages, information was gathered from 67 mothers, 58 paternal grandmothers using Focus Discussion Groups (FDGs) and 49 key respondents in Key Informant Interviews.ResultsSchools were considered an important community resource. Challenges included limited parental participation and student absenteeism; however, several drivers and opportunities were identified, which may render schools a suitable intervention delivery site. Enrolment rates were high, with schools and associated staff encouraging parental involvement and student attendance. Existing initiatives, including the mid-day meal, play opportunities and education on health and hygiene, further highlight the potential reliability of schools as a platform for community mobilisation.ConclusionsSchools have been shown to be functional platforms frequently visited and trusted by community members. With teachers and children as change agents, schools could represent a suitable setting for community mobilisation in future wider scale intervention studies. Expanding the supportive environment around schools will be essential to reinforce healthy IYCF practices in the long term.

A mixed-methods cross-cultural study of teacher care and teacher-student rapport in Iranian and Polish University students’ engagement in pursuing academic goals in an L2 context

A convergent parallel mixed-methods approach was used to explore teacher care, teacher-student rapport, and engagement in pursuing academic goals in a foreign language (L2) context, as perceived by 223 Iranian and 208 Polish L2 students. Quantitative data were obtained through three scales, the cross-cultural validity and factor structure of which were ensured through testing measurement invariance and confirmatory factor analysis, respectively. The structural equation modeling results obtained through running Mplus approved that care and rapport predicted Iranian and Polish students' engagement in pursuing academic goals in an L2 context. For checking the equality of the structural path coefficients, the Omnibus Wald test was employed. Group differences in factor means were tested, showing that Iranian and Polish students differed significantly regarding their levels of engagement. Qualitative data, obtained through running interviews with 30 Iranian and 24 Polish students, selected from the initial sample, approved the predictive links of care and rapport with Iranian and Polish students' engagement in pursuing academic goals in an L2 context. However, the students' qualitative reports revealed how their perceived country's cultural and instructional contexts influenced their engagement, empirically supporting the supposition that engagement is the by-product of the dynamic interaction between the individual factors and the instructional context, necessitating the examination of the role of sociocultural values and home culture in accomplishing this educational objective.

Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research

BackgroundImplementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR).MethodsThis was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data.ResultsQualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points).ConclusionsThe nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.

Using local and indigenous knowledge in selecting indicators for mapping flood vulnerability in informal settlement contexts

Floods have been projected to increase due to climate change and informal settlements in developing countries will be the most affected. This study presents results of using Local and Indigenous Knowledge in selecting indicators for mapping the vulnerability of people to flood hazards in an informal settlement context. Using Quarry Road West informal settlement, the study employed a convergent parallel mixed-methods approach which involved a household survey (n = 359), interviews with key informants (n = 8) and a focus group discussion (n = 1). The study findings reveal that flood vulnerability in the study area is not only a result of the proximity of the houses to the Palmiet River, the M19 freeway and Quarry Road, but also as a result of the nature of the soil and the type of materials people use to build their houses. Furthermore, findings reveal that using both Local and Indigenous Knowledge possessed by community members, a minimal number (sixteen) of context-specific indicators for mapping flood vulnerability in the study area were selected. The study also finds that flood vulnerability in the study area is a result of physical, socio-economic and institutional problems. Therefore, using Local and Indigenous Knowledge to select indicators for mapping flood vulnerability helps to provide a better understanding of flood vulnerability in an informal settlement and this gives decision-makers and other stakeholders a glimpse of adaptive measures that can be implemented to increase people's resilience.

Exploring Online Writing Assessment Amid Covid-19: Challenges and Opportunities from Teachers’ Perspectives

Remote online second language (L2) writing instruction, in general, and remote online L2 writing assessment, in particular, require a holistic structural approach that results in improving students’ L2 writing, as well as offering an authentic and fair assessment of students’ L2 writing performance. The study described in this paper employed a convergent parallel mixed methods approach where the Covid-19 pandemic, as well as the purpose of the research, necessitated the adoption of this research design since it can provide the basis for answering the question: What impact did full mode online teaching have on L2 education. In the survey part of the research, 241 English as a Foreign Language (EFL) teachers working in Saudi Arabia participated in a custom-designed 30-item questionnaire utilizing a five-point Likert scale. In the qualitative part of the study, nine EFL teachers (four males and five females) participated in a semi-structured interview which lasted from thirty-five to fifty minutes. A detailed analysis of both the quantitative and qualitative primary data indicated that EFL teachers are aware of the importance of rubrics and standardized assessment procedures in awarding fair grades to students. Teachers also highlighted several important advantages of teaching online L2 writing remotely. However, the vast majority of teachers questioned the accuracy of online writing assessment, indicating the need for a more developed model for the post Covid-19 era. Recommendations included the adoption of unanimously suggested practices (by participating teachers) in teaching remote online L2 writing as well as mandating the presence of the students onsite during the sitting of the writing exams, thus providing the assurance of authenticity of students’ performance in the writing exams as well as the possibility to monitor all the students while they sit the exams.

A programme to facilitate mentoring of community service nurses in rural province, South Africa

BackgroundThe gap exists regarding a structured formal programme to facilitate mentoring of newly qualified nurses performing community service. Despite the pronouncement of the need to mentor the Community Service nurses (CSNs), there is paucity regarding mentoring the programme. This article, present the development of a programme to facilitate mentoring of CSNs in rural province of South Africa. MethodsThe study was conducted in two phases, namely empirical and programme development. The empirical phase employed convergent parallel mixed method approach to describe the CSNs’ and nurse managers’ perceptions regarding mentoring of CSNs. Data collection during the empirical phase was achieved through self-administered mentoring questionnaires by 174 nurse and 224 CSNs. Simultaneously, semi- structured interviews were used on 28 CSNs and 27 nurse managers. The programme development phase followed data obtained from the empirical phase, literature review and application of Kellogg’s Logic Model (KLM). ResultsThe mentoring programme was developed pronouncing a sequential KLM components required for mentoring the CSNs in this rural province. The components entailed the problem to be addressed, mentoring needs; mentoring resources; activities; expected outcomes and assumptions. ConclusionThe KLM components described in this study, clearly demonstrate the sequence of events that need to be followed facilitate the mentoring of CSNs. The programme amalgamated empirical evidence pertaining to the problems associated with inadequate mentoring, mentoring needs of both CSNs and managers, required mentoring resources, outputs and the expected outcomes. It is recommended that this programme should be applied to enhance the mentoring of the CSNs.

Collective Perceptions of Aging and Older Persons Held by Students From Eight Healthcare Professions.

In order to increase the number of students entering the geriatric workforce, an understanding of factors influencing career preference and what may prevent students from pursuing geriatric careers is necessary. Using a convergent parallel mixed methods approach, the aim of this study was to provide insight for geriatric educators regarding the collective perceptions of aging and older persons held by 864 students from eight healthcare professions. Quantitative questions assessed students' attitudes (Geriatric Attitudes Scale). Student responses to four open-ended questions were assessed using conventional content analysis. Results included rich narrative examples of healthcare professions students' perceptions and understanding of the aging process, as well as myths and misconceptions of aging and older persons that can be used to inform geriatric curricula across multiple health professions training and education programs. Geriatric education is a critical avenue to correct misperceptions, quell ageism and address the current shortage in the geriatrician workforce.

“Slowed for several months”: A mixed methods comparison of minor, moderate, and extreme speeders

Speeding remains a major and consistent contributor to motor vehicle fatalities in the U.S. Using a parallel convergent mixed methods approach, we compared minor, moderate, and extreme U.S. speeder types (N = 293) to gain a better understanding of why U.S. drivers speed to the degree that they do. An online survey collected quantitative data on self-reported characteristics, speeding behaviors, and roadway behaviors after key events (collisions, speeding tickets) and given passenger presence. Analysis of qualitative data from participants explaining their roadway behaviors and beliefs identified several speeding-related themes. Themes shared to the same extent by all speeder types include not typically citing speeding a cause of a collision and good drivers not needing to change speeding behaviors (i.e., perceived mastery). However, the permanence and extent of speed reductions after key events and with passengers did vary by speeder type, with minor speeders making more extensive and permanent changes. Qualitative and quantitative data both underscore the perception that speeding is not a high priority threat to roadway safety. Findings suggest continued research using conservative and nuanced definitions of speeding is warranted to understand how similar perceptions result in a spectrum of speeding behaviors.

High School Students’ Reasons for disliking Mathematics: The Intersection Between Teacher’s Role and Student’s Emotions, Belief and Self-efficacy

The study presented here depicts the reasons for high school students to have a negative attitude toward mathematics. The students were asked to rate mathematics in comparison to other subjects like history, physics, or computer science. In addition, they were asked about their attitude, beliefs, and motivations toward mathematics. To this end a convergent parallel mixed-method approach was implemented using a questionnaire that combines open-ended, closed-ended (e.g., forced ranking scale, or multiple and single responses), and liker-scale items. One of the main reasons for student’s reluctancy toward mathematics is their lack of understanding and self-perception of low content knowledge, which let them to have a negative perception. Students stated that their negative perception was not new, but instead something they knew since elementary.

Maximizing learning in online courses using critical thinking, project-based learning, and flipped classroom approaches

Introduction: In this article, we present our findings regarding the lessons learned by using critical thinking, project-based learning, and flipped classroom educational approaches in an online course. The course, "Systems Thinking," was delivered to 20 graduate students during the Covid pandemic, in the second semester of 2020. The students worked in project teams to create short videos that analyzed the dynamics present in different real-life systems. The objective is to determine the effects of combining critical thinking, project-based learning, and flipped classrooms to maximize learning. Methods: We followed a convergent parallel mixed-method approach. The quantitative data was collected through two multiple-choice tests (pre-test and a post-test). The qualitative data was collected from students' discussion forums and students' projects. We also collected data employing one questionnaire sent at the end of the course. The data were analyzed following a systemic approach. Results: The course design led to the development of five interconnected dynamics that favored the learning. The flipped classroom made the synchronous meetings more effective. The way the synchronous meetings were conducted (using different learning tools, tests as extrinsic motivators, and praising the students' achievements) kept the students motivated to learn. The discussion forum fostered critical thinking and the project-based learning approach gave opportunities to the students to learn by doing. Conclusions: The combination of critical thinking, project-based learning, and flipped classroom can be a very effective way of enhancing the learning experience in online courses. Keywords: critical thinking, project-based learning, flipped classroom, systems thinking, learning

An Exploration study into Good Governance and Equity Aspects of JKN Program in Cardiovascular Care Services in Central Java, Indonesia

To achieve equitable access of its citizen to health care, since 2014, the Government of Indonesia has implemented the national health insurance scheme, namely JKN. However, equal access to specialistic health care is still challenging. Using a convergent parallel mixed-method approach, and the utilization of cardiovascular services as an example, this study aims to evaluate the good governance and equity aspects of the JKN program in Central Java, a province in Indonesia which records a high poverty rate above the national rate. Based on IHME, Central Java has the highest proportion of mortality associated with cardiovascular diseases among the provinces in Indonesia. This study found that most of the districts in this province are struggling to achieve the 2019 JKN roadmap target in terms of JKN participation coverage. Unequal distribution of health facilities and human resources is recorded affecting access to and utilization of cardiovascular care services. More contribution from the district and provincial government as well participation from private sectors (the employers) to fund the JKN program is essential to ensure the availability of specialistic care services in rural areas to narrow the gaps in cardiovascular care services.

Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study.

Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.

Understanding tenants’ motivations for co-living arrangements: a case study of Klang Valley, Malaysia

PurposeThe purpose of this study is to fill a knowledge gap by analyzing the motivations of tenants to co-living spaces in Klang Valley, Malaysia as the motives of co-living spaces are related to how well that space supports their needs.Design/methodology/approachTenants’ behaviors were examined using a convergent parallel mixed-method approach, which included a survey and an in-depth interview. A total of 175 respondents were interviewed using purposive sampling.FindingsThe results show that the preference for co-living attributes has changed during the pandemic. User ratings of preference for physical and leasing attributes of co-living spaces are significant in terms of co-living motivations. The findings also revealed that tenants prefer twin-sharing and master bedrooms when choosing a co-living space to stay in.Research limitations/implicationsIdentifying the factors that influence such motivations is critical for housing developers and co-living service providers to pay close attention to improving tenants’ living experiences.Originality/valueThere is interest in the co-living spaces that are available for rent. However, very little research is based on an understanding of how the tenants in Klang Valley, Malaysia perceive this type of living arrangement. A better understanding and prediction of tenants’ needs and preferences may lead to a better understanding of the attributes that influence their motivations for using co-living spaces.

Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study.

BackgroundAt the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020.ObjectiveWe compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020).MethodsWe used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes.ResultsPrior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted.ConclusionsTechnological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.