Sequential Explanatory Approach Research Articles

Implementasi Kebijakan Tatalaksana HIV di Puskesmas Kabupaten Sleman

Background: HIV AIDS is still a global and national challenge. The government is trying to control it by expanding access to HIV treatment at the Puskesmas, including 4 Puskesmas in Sleman Regency. However, efforts to expand access to treatment have not yet reached the target of 95% of people living with HIV who are receiving ART and 95% of people living with HIV who are viral loadsuppressed. WHO in 2017 recommended the immediate initiation of diagnosed HIV-positive people regardless of CD4 cell count and followed by changes in the national HIV management policy through a fast-track strategy in 2018 to provideimmediate initiation of ARVs, provision of Tuberculosis Preventive Therapy, and viral load monitoring. The rapid change in HIV management strategies raises the question of whether the Puskesmas in Sleman Regency can carry out HIVmanagement according to the latest policy recommendations in achieving the target of 90% of people living with HIV who are suppressed by viral load. Objectives: Measuring the suitability of the implementation of HIV management at the Puskesmas based on regulations and finding the supporting factors and obstacles in the implementation of HIV management at the Puskesmas.Methods: This is mixed-method research with a sequential explanatory approach. The location of research was carried out in four health centres in Sleman Regency, which had organized the HIV Treatment Support Care Service Program. Data was collected in May-June 2022. Quantitative data was secondary data on cases of people with HIV who accessed PDP services registered at the Puskesmas from 2019 until July 2021. Qualitative data were taken from 9 informants, selected by the purposive sampling method, through in-depth interviews. The quantitative sampling method uses a non-probability sampling method. Results: There is a discrepancy in the suitability of treatment at the Puskesmas with management standards according to regulations, as well as the low number of people living with HIV who are monitored for viral load suppression. The inhibiting factor for implementing HIV management in Puskesmas is the attitude of health workers to delay treatment related to perceptions of HIV prevention policies that have not been well socialized. Not all service providers are trained,lack of viral load testing facilities in hospitals, inefficient HIV management records systems, and stigma are obstacles to implementing HIV management. The supporting factors for the implementation of PDP HIV are the attitude of the willingness of health workers to provide treatment related to the perception of peer support and the presence of trained officers in counseling and logisticalsupport for adequate drugs. Conclusion: Not all people living with HIV treated at the Puskesmas have received treatment according to regulations until viral load suppression is monitored. For this reason, it is necessary to increase the capacity of HIV counselingand management for all health workers involved in providing PDP services, adding viral load testing facilities at regional hospitals, and providing HIV stigma prevention programs for people living with HIV, families, communities and health services.

Use and adoption of digital educommunication media by university professors during the Covid-19 pandemic: cases of the National Autonomous University of Mexico and the Autonomous University of Chihuahua

This article analyzes the educational use of digital educommunication media (DEM) by four groups of professors working at the faculties of Philosophy and Letters and of Engineering at the Autonomous University of Chihuahua (UACH) and at the National Autonomous University of Mexico (UNAM). Seven hypotheses and three research questions were posed, which were related to the use of DEM (specifically: images, animations, and video; presentations (PowerPoint/Prezi); digital texts; the Cloud; social media/instant messaging; and email), their qualities and the differences regarding their use, among the different groups studied. A two-phase mixed-methods explanatory sequential approach was employed, with a first phase of quantitative data collection and a second qualitative phase. A stratified sample of 177 professors was selected, which was distributed proportionally between the two selected faculties and universities. All professors completed a 144-item questionnaire in the first phase, and on the basis of their answers, ten professors were selected to be interviewed in the second phase, to ensure the diversity of the interviewed group in terms of sex, age, faculty, and educational level at which they teach, as well as their teaching experience and experience in the use of DEM. Among the results, we found that: a) the choice between using DEM or traditional media in class was not determined by teachers’ perception about their students’ learning with technology; b) the characteristics of each DEM determined its use, but the use of a given DEM was not related to the activities that it could enable; c) the professors exclusively teaching in graduate programs, the younger ones, those from UNAM, or those of Engineering did not present significant differences to their counterparts in terms of their use and assessment of DEM; and d) the qualitative data reaffirmed these trends and helped typify the challenges and opportunities of using DEM, particularly those that arose from the period of the exclusively online education model that was adopted owing to the COVID-19 pandemic.

Regulations Governing Student Internship Programme in Ghana: A Sequential Explanatory Multi-Stakeholder Approach

Purpose: This paper seeks to ascertain the regulations governing students’ internship programmes in Selected Technical Universities in Ghana.
 Design/Methodology/Approach: The sequential explanatory mixed methods approach was utilised. Two separate structured questionnaires were administered to 481 students and 299 senior members (lecturers and administrators) of six selected technical universities (TUs); whereas members of industry, executives of business associations and government regulatory bodies in the tertiary sector of Ghana’s education system were interviewed, using an interview guide. Data was analysed through descriptive statistics (mean and standard deviation) and Constant Comparative Analysis.
 Findings: There was no well-defined enforceable law requiring TUs to secure internship placement for students, although, some regulatory bodies insisted that TUs showed evidence of their ability to secure placements for their students for industrial training before awarding programme accreditation.
 Research Limitation/Implication: The study focuses on regulations governing student internship programmes in Ghana. The study concentrated on selected Technical Universities in Ghana.
 Practical Implication: The knowledge advanced in this study underscores the need for proper synergy between Technical Universities regarding regulation governing student internship which should be spearheaded by the government of Ghana through the Ministry of Education, Ghana Tertiary Education Commission acting as a facilitator, creating interfaces and providing funding and incentives.
 Social Implication: The Government of Ghana can allow companies some tax exemptions or make the environment business-friendly for companies so that they can expand their operation to accept more interns.
 Originality/Value: This paper synchronises the perspectives of multiple actors on the regulations governing student internship programmes.

Increasing Production Capacity of Oil Country Tubular Goods Pipe Using Oee Methods

The effectiveness of production equipment is very important to pay attention to maintain competition, coupling pipe threading process there has been an imbalance in the threading process time resulting in decreased output due to the number of rejected products which is decreasing in production capacity. To overcome the problem, the data was processed using mixed methods with a sequential explanatory approach, and the overall equipment effectiveness measurement method to analyze the calculation of availability, performance, and quality rate. To determine the root cause of the problem using fishbone diagram analysis and six big losses. The results of the study stated that the overall equipment effectiveness was below the world-class standard, which was below 85% with a difference of 49.74% being the factor causing the failure to achieve the coupling pipe production capacity. The low overall equipment effectiveness is influenced by the engine performance which is a total average of 42.61%, due to failed products and reworked products and the breakdown time for 460 minutes impacting in losses on the engine productivity. These findings pursue the company to monitor, and implement the overall machine effectiveness system to optimize the capacity production.

An Assessment of the Impact of Mediating Variables on Knowledge, Attitudes and Practices of Ethics of War by the Officers and Soldiers of the Zambia Army

A study was conducted to establish levels of knowledge, attitudes and practices of ethics of war by officers and soldiers of the Zambia Army. A mixed method study using explanatory sequential approach was undertaken of a survey sample of 420 participants drawn from officers and soldiers serving in the Zambia Army. Questionnaires were used to collect quantitative data. Focus group discussions and interviews were also undertaken to collect qualitative data. The findings from focus group discussions and interviews provided greater depth and understanding as to how the officers and soldiers felt about ethics of war. The findings of focus group discussions and interviews also helped to explain the findings from quantitative data. The general objective of this study was to establish the knowledge, attitudes and practices of the ethics of war among Zambia Army personnel and examine how they related to age, rank, gender, level of education and years of service. In addition, it was hypothesized that mediating variables namely operational environment, organisational factors and administrative factors are critical in the Zambia Army in facilitating the existence of aforementioned relationships. Largely, it was concluded that, knowledge, attitudes and practice of ethics of war among Zambia Army officers and soldiers is influenced by gender, their level of education, type of service and length of service. Consequently, a model consisting of all recommendations made in the study was developed. This articles focuses on the impact of mediating variables and the degree to which they play a significant role in influencing the Knowledge, Attitudes and Practice of ethics of war as brought out by the Study. The article confirms that mediating variables play a significant role in that knowledge of ethics of war is acquired locally from the few available military schools, and training they undergo before being deployed for operations (pre-deployment training). As such, acquisition of this knowledge is heavily reliant on operational environment, organisational and administrative factors. Furthermore, the degree to which this knowledge shapes the attitudes of service personnel and how well they can be put in practice is equally dependent on how these and other mediating variables facilitate this process.

Adolescent Mental Health During Stay at Home of The Covid-19 Pandemic

This study aims to determine and describe the mental health impacts that arise in adolescents during the stay-at-home period of the COVID-19 pandemic. This type of research was a Mix Method with a Sequential Explanatory approach with a Participant Selection model. There were 12 informants in this study consisting of 6 primary informants, 3 key informants, and 3 additional informants. The population in this study amounted to 1000 people with a total sampling technique. The results showed that the highest frequency of each variable was very severe anxiety amounting to 313 people, Normal Stress was 511 people, and normal depression was 548 people. Loneliness, confinedness, academic pressure, parental pressure, family relationships, and fear of infection negatively affect adolescents' mental health. The impact of anxiety on adolescents during the Stay at the home period of the COVID-19 pandemic is feeling fear of contracting COVID-19 either themselves or those close to them. The impact of stress on adolescents during the stay at home period of the COVID-19 pandemic is that it is difficult to focus when online learning, feeling lonely being at home continuously, feel bored at home and feel like they are confined because they can't go anywhere during this pandemic. The impact of depression on adolescents during the stay at home period of the COVID-19 pandemic is that, overall, there are actually few teenagers who appear to be experiencing depression or symptoms of depression

An e-Mental Health Resource for COVID-19-Associated Stress Reduction: Mixed Methods Study of Reach, Usability, and User Perceptions.

BackgroundCOVID-19 and its public health response are having a profound effect on people’s mental health. To provide support during these times, Canada’s largest mental health and addiction teaching hospital (Centre for Addiction and Mental Health [CAMH]) launched the Mental Health and COVID-19 Pandemic website on March 18, 2020. This website was designed to be a nonstigmatizing psychoeducational resource for people experiencing mild to moderate distress due to COVID-19 and the public health response to the pandemic.ObjectiveThe aim of this study was to examine the reach, usability, and user perceptions of the CAMH Mental Health and COVID-19 Pandemic website.MethodsThis study used a mixed methods sequential explanatory design approach, which consisted of the following 2 distinct phases: (1) quantitative data collection and analysis and (2) qualitative semistructured interviews. In phase 1, we analyzed Google Analytics data to understand how many people visited the website and which were the most visited pages. We conducted a survey to identify users’ sociodemographic backgrounds, and assess the usability of the website using the System Usability Scale and users’ subjective stress levels using the Perceived Stress Scale (PSS-10). For phase 2, we conducted semistructured interviews to explore user experiences; user motivation, engagement, satisfaction, and perception of the stress reduction strategies; reflections of the website’s functionality, ease of use, navigation, and design; and recommendations for improvement.ResultsGoogle Analytics results showed 146,978 unique users from June 2020 to March 2021. Most users were from Canada (130,066, 88.5%). Between February 20, 2021, and June 4, 2021, 152 users completed the survey. Most users identified as white, female, and having at least a college degree. Based on the PSS-10 scores, most participants were experiencing moderate to high stress when they visited the website. Users rated the usability of the website as acceptable. Ten users completed in-depth interviews between May 2021 and June 2021. Positive feedback related to the content was that the website was a trustworthy source of mental health information with helpful evidence-based stress reduction strategies. Areas for improvement included the text heavy design of the website, wider dissemination/marketing, and greater accessibility of the website to meet the needs of diverse populations.ConclusionsAdding stress reduction resources to a website from a well-respected institution may be a practical method to increase awareness and access to evidence-based stress reduction resources during times of crisis, where there is severe disruption to usual health care contacts. Efforts to ensure that these resources are more widely accessed, especially by diverse populations, are needed.

Promoting East Java Culinary Practices in Webtoon From the Generation Z Perspective

The challenge of every industry today, including the culinary industry, is understanding the mindset and consumption patterns of Generation Z. They were born and raised side by side with the internet, social media, and technology. Their mindset and consumption patterns are different from the previous generation, especially in terms of mastery of technology and information. The aim of this study was to examine how Generation Z perceives new media of Webtoon as a medium of culinary promotion in East Java. This was mixed-methods research with an explanatory sequential approach. Data collection techniques included online questionnaires, interviews, and pre- and post-tests with 39 respondents. The results showed that there was a difference in the knowledge of Generation Z about East Java culinary practices after reading Webtoon, but the average difference between the pre- and post-test was low. This finding contradicts the perception that Generation Z favors Webtoon as a medium. The in-depth findings showed that this inconsistency is related to personal preferences in media selection. For Generation Z, although Webtoon is not a priority as a medium for the promotion of East Java culinary practices, Webtoon has three functions: a transmitter of information, disseminator of cultural values, and source of entertainment.
 Keywords: Generation Z, traditional food, East Java culinary, Webtoon, comic

Factors That Affect Spatial Data Sharing in Malaysia

This paper examines the phenomena of the local government’s inadequate reaction to the national programme of geographical infrastructure for the effective sharing of spatial data in Malaysia. We investigate the determinants of sharing data for Malaysia’s spatial data infrastructure (SDI) and aim to define the model for spatial data-sharing of Malaysia’s local SDI. The main contribution of this paper is an explanation of the novel methodology to study factors that affect spatial data sharing including a new qualitative analysis method through an interview with people concerned in this field, including engineers, technicians and academics, which was undertaken in Kuala Lumpur, and a new methodology to identify the necessary approach that affects spatial data sharing. An interview and a questionnaire were used in this study as part of a sequential exploratory approach. Among land use, Plan Malaysia, and Telekom Malaysia Berhad TMOne, 15 participants were interviewed in-depth to obtain their responses, and 83 individuals took part in the survey questionnaires. Interview data were measured by content analysis, while questionnaire data were measured by partial least squares analysis. In the structural model analysis, Smart PLS was used to choose the fit items based on validity and reliability measurements. According to the hypothesis measurement, technology and organisation both significantly affect the practice of spatial data sharing, but human resources and spatial data do not significantly affect it. All R-Squared values represent a value above 56 per cent for the human resource aspect, technology aspect and spatial data aspect. However, the R-Square value for spatial data sharing is 47%. Spatial data and human resources have a less substantial impact on spatial data sharing; hence, this study proposes a national awareness programme and mentoring to improve local SDI support for spatial data sharing.

Consumers’ experience with hospitality and tourism technologies: Measurement development and validation

As new and emerging technologies continue to transform hospitality and tourism operations and consumer environments, understanding consumers’ experience with hospitality and tourism technologies has become an urgent issue. This study aimed to develop a theoretically sound conceptualization of consumers’ experience with hospitality and tourism technologies. Employing a sequential exploratory approach and scale development procedures, this study theoretically defined and conceptualized consumers’ technology experience as a second-order formative construct consisting of nine dimensions (sensorial, cognitive, pragmatic, emotional, relational, unique, familiar, controllable, and economical experiences). This study also developed a set of scales to measure consumers’ experience with hospitality and tourism technologies, and empirically assessed and validated the developed scale. The results demonstrated that the developed scale exhibited robust psychometric properties. The developed scale is applicable to most hospitality and tourism technologies and various sectors of the hospitality and tourism industry.

The role of religion and culture on student attitudes in science learning

This research discusses the influence or role of religion and culture on students' attitudes in learning science. The mixed method used in this study is a sequential explanatory approach. The sample in this study used the purposive sampling technique and 6474 students were selected. The instruments in this study are attitude questionnaires and in-depth interviews on culture and religion. Data analysis was carried out in the form of descriptive statistical analysis. Then, the qualitative data were analysed in several stages, namely data reduction, data presentation, and drawing conclusions. Based on the results of interviews and data collection that has been carried out and the discussion described above, it can be concluded that students' attitudes towards science have relevance to cultural aspects that exist in their daily life environment and students' attitudes towards science also have a close relationship with religious aspects that was adopted them. This result is certainly very positive for the affective and religious development of students which of course has an impact on how they interact with fellow humans in the school environment and others.
 
 Keywords: Attitude; culture; religious

Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture.

BackgroundProfessional identity formation (PIF) has been recognized as an integral part of professional development in medical education. PIF is dynamic: it occurs longitudinally and requires immersion in the socialization process. Consequently, in the medical education context, it is vital to foster a nurturing learning environment that facilitates PIF.AimThis study assesses PIF among medical students in various stages of study and explores their perceptions of PIF, with its contributing and inhibiting factors.MethodThis mixed-methods study uses a sequential explanatory approach with undergraduate (years 2, 4, and 6) and postgraduate medical students in Indonesia. We examine the subjects by administering an adapted questionnaire on PIF. We completed a series of FGDs following questionnaire administration. Quantitative and thematic analyses were conducted sequentially.Results & DiscussionA total of 433 respondents completed the questionnaire. There were statistically significant differences among subjects on the subscales “Recognition and internalization of professional roles” and “Self-control in professional behavior”; the more senior students had higher scores. We conducted 6 FGDs in total. The results characterize PIF as a complex, dynamic, and longitudinal journey to becoming a medical doctor that is closely related to a student’s motivation. The FGDs also highlight the importance of both internal factors (students’ values, attributes, and personal circumstances) and external factors (curriculum, the learning environment, workplace-based learning, and external expectations) for PIF in medical education.ConclusionHigher-level students show higher scores in some aspects of PIF, which further validates the potential use of the questionnaire to monitor PIF, a dynamic process influenced by internal and external factors. Generating awareness among medical students and encouraging reflection on their PIF stage may be crucial for PIF processes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-022-03393-9.

The Effects of a Debate-Based Awareness Lecture on Cheating in Online Exams

Cheating in online exams has become an undeniable phenomenon throughout universities worldwide. This study examined the effect of a single factor on the scores and essay questions of online exams, helping the researcher identify cheating incidents. This factor was an awareness lecture, conducted in the form of a debate between the instructor and students, about the negative effects and ethics of cheating. The methodology of this study was based on the explanatory sequential approach, in which the researcher conducted the same online exam but with different treatments. Then, semi-structured interviews were conducted with certain students after the course had finished. The study consisted of two groups of students in the same course. Each group was given a different treatment: Group 1 consisted of 33 students who participated in an awareness debate lecture before the online exam, and Group 2 consisted of 31 students who did not participate in an awareness debate lecture. Then, 12 students were randomly recruited from Group 1 to participate in the interviews to explore more insights about the rationalization of cheating in online exams. The results showed that Group 1 had grades averaging (18.23 out of 30), and Group 2 had grades with a significantly higher average (22.1 out of 30). Conclusions and recommendations were presented to better shape the experience of online exams.

Management of literacy program implementation at elementary school post COVID-19 pandemic in Indonesia

This research is motivated by the low literacy management skills in elementary schools in the city of Padangsidimpuan, Indonesia. This makes it necessary to solve the problem by improving it through the management of literacy implementation programs. To achieve the objectives of this research, mix method with a sequential explanatory approach was adapted which begins with quantitative research and continues with qualitative research. The sampling technique used cluster random sampling method for quantitative research and snowball sampling for qualitative research. Quantitative research data were taken from five schools with a total of one hundred fifty students and eighteen teachers. Techniques Data collection were done through tests and distribution of questionnaires for quantitative research and in-depth interviews, documentation studies and observations for qualitative. The findings of this study indicate that was no conflict between the results of quantitative research and the results of qualitative research. The low literacy competence of students due to the management function has not followed the principles of planning, organizing, actuating, controlling, and evaluating.

Transformation of literacy program implementation based on digital learning platform in the era of disruption in Indonesia

The utilization of digital learning platforms is the real transformation of technology and information used in the era of disruption. This study aims to reveal how teachers and students respond to the use of digital learning palatform-based literacy programs at the elementary in Padangsidimpuan City, Indonesia. The research method applied was mix method with sequential exploratory approach which began qualitative and continued with quantitative research. The sampling technique used cluster random sampling method for quantitative and snowball sampling for qualitative research. Quantitative research data were taken from 5 schools with 150 students and 30 teachers. Techniques Data collection was carried out through the distribution of questionnaires for quantitative and in-depth interviews, documentation studies and observations for qualitative. The results shown that the results of quantitative research strengthen the results of qualitative research where the transformation of the use of online learning platforms gets good response from teachers and students. The use of online learning platforms consisting of whatsapp, drive, youtube, google classroom, and zoom via android could increase the effectiveness and efficiency of learning implementation.

Is knowledge hiding in higher education a political phenomenon? An explanatory sequential approach to explore non-linear and three-way interaction effects

PurposeThis study addresses a central research question: Is individuals’ propensity to hide knowledge a “political phenomenon” among researchers in the Indian higher education institutions? Drawing upon social exchange and uncertainty management theories, the authors examine how a three-way interaction effect of perceptions of organizational politics, political will and political skill contributes to knowledge hiding. In addition, this study aims to develop a nuanced understanding of the knowledge hiding phenomenon in the Indian higher education context.Design/methodology/approachThis study adopts a mixed-method study design with an explanatory sequential approach. The authors gathered data through a cross-sectional survey of 286 researchers (Study 1) followed by two focus group discussions (Study 2) involving 13 academic researchers from five Indian universities. The sample includes full-time faculty members, postgraduate and full-time doctoral students engaged in research.FindingsThe results of Study 1 indicate that researchers’ perceptions of organizational politics positively relate to their knowledge hiding. The findings of this study also suggest that the positive relationship between perceptions of organizational politics and knowledge hiding turns negative for individuals with high political will and high political skill. The focus group discussions (Study 2) explore significant predictors of knowledge hiding. This study unveils various characteristics of knowledge, knowledge hider, knowledge seeker and interpersonal dynamics as the key drivers of knowledge hiding in Indian academia.Originality/valueThe significant contributions of this study are to provide new insights into the relationship between organizational politics and knowledge hiding and to unravel the various factors that incite knowledge hiding among researchers in the Indian higher education context. This study is one among the few in the knowledge hiding literature to adopt a mixed-method research design with an explanatory sequential approach.

Higher-Order Models in the Theory of Planned Behavior to Predict Whistleblowing Intention

The low rank of Indonesia's Corruption Perception Index (CPI) 2021 indicates that government fraud is still a significant problem. One improvement in bureaucracy reform is the whistleblowing system to report wrongdoing. Although this system is applicable, the effectiveness of whistleblowing as a mechanism to detect fraud depends on the willingness of an employee to report misconduct. As a part of government management systems in local government, the internal auditor has a unique position to detect fraud as early as possible in their organization. They conduct regular monitoring of other agencies to know the fraud before. This research investigates internal auditors' intention to report fraud in the local government. By employing the theory of planned behavior, variables in this study were attitude toward whistleblowing, subjective norms, perceived whistleblowing control, and internal whistleblowing intention. This study was mixed-method research with a sequential explanatory design approach. Data were obtained from questionnaires of 201 internal auditors in local government and in-depth interviews to produce a complete study result. The researcher adopted a higher-order model in PLS-SEM to explain the relationship between components of the theoretical construct. Higher-order models facilitate a construct on a more abstract higher-level dimension and its more concrete lower-order subdimensions. The findings of this research revealed that attitude toward whistleblowing, subjective norms, and perceived whistleblowing control positively affected the intentions of the internal auditor to report wrongdoings internally. The result of this study can be implemented by the local government to effectively improve some policies related to moral education and whistleblowing systems.

Do multilingual employees better adjust to work environment changes? Examining the case of a credit union during the COVID-19 pandemic

PurposeOrganizations have been challenged to identify antecedents to improved employee adjustment to the work environment changes that arose in the wake of the COVID-19 global pandemic. This study aims to explore the effect of multilingualism on employee ability to adjust to workplace changes based on the concept that multilinguals have been found to switch between tasks more efficiently as compared to monolinguals.Design/methodology/approachApplying a sequential explanatory mixed methods research approach, quantitative performance evaluation data on 207 credit union employees is analyzed using hierarchical linear modeling to predict employee performance, and thematic analysis of qualitative data representing the adjustment narratives of six monolingual and six multilingual employees within the sample is conducted, corresponding to the period during which employees were adjusting to broad workplace changes after the onset of the global pandemic.FindingsThe results suggest greater predicted improvement in the performance of multilingual employees. Reliance on the task-switching ability associated with multilingualism is found to be the primary self-evaluative factor for successful change adjustment among multilingual employees.Practical implicationsIn light of work performance benefits identified in this study, organizations may consider multilingualism as a characteristic preceding better adjustment to organizational change, and not simply as a skill applicable to tasks requiring language proficiency, suggesting practical implications for human resource and organizational management.Originality/valueThis is the first sequential explanatory study focusing on the task-switching ability of multilinguals as an antecedent to change adjustment evidenced by improved work performance within an organizational context.

Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol

BackgroundSurgical site infections are common. Risk can be reduced substantially with appropriate preoperative antimicrobial administration. In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) in the setting of high rates of non-compliance with antimicrobial prophylaxis guidelines. SCIP included public reporting of evidenced-based antimicrobial guideline compliance metrics in high-risk surgeries. SCIP was highly successful and led to high rates of adoption of preoperative antimicrobials and early discontinuation of postoperative antimicrobials (>95%). The program was retired in 2015, as the manual measurement and reporting process was costly with limited expected additional benefit. To our knowledge, no studies have assessed whether the gains achieved by SCIP were sustained since active support for the program was discontinued. Furthermore, there has been no investigation of the spread of antimicrobial prophylaxis guideline adoption beyond the limited set of procedures that were included in the program.MethodsUsing a mixed methods sequential exploratory approach, this study will (1) quantitatively measure compliance with SCIP metrics over time and across all procedures in the five major surgical specialties targeted by SCIP and (2) collect qualitative data from stakeholders to identify strategies that were effective for sustaining compliance. Diffusion of Innovation Theory will guide assessment of whether improvements achieved spread to procedures not included under the umbrella of the program. Electronic algorithms to measure SCIP antimicrobial use will be adapted from previously developed methodology. These highly novel data mining algorithms leverage the rich VA electronic health record and capture structured and text data and represent a substantial technological advancement over resource-intensive manual chart review or incomplete electronic surveillance based on pharmacy data. An interrupted time series analysis will be used to assess whether SCIP compliance was sustained following program discontinuation. Generalized linear models will be used to assess whether compliance with appropriate prophylaxis increased in all SCIP targeted and non-targeted procedures by specialty over the duration the program’s active reporting. The Dynamic Sustainability Framework will guide the qualitative methods to assess intervention, provider, facility, specialty, and contextual factors associated with sustainability over time. Barriers and facilitators to sustainability will be mapped to implementation strategies and the study will yield an implementation playbook to guide future sustainment efforts.RelevanceSustainability of practice change has been described as one of the most important, but least studied areas of clinical medicine. Learning how practices spread is also a critically important area of investigation. This study will use novel informatics strategies to evaluate factors associated with sustainability following removal of active policy surveillance and advance our understanding about these important, yet understudied, areas.

Comparing the Experiences of Parturient Women With Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A Sequential Explanatory Mixed Method Study Protocol

Objectives: Women’s experience during childbirth can affect various aspects (psychological and physical), which has not yet been done accurately. The current study aimed to compare experiences of parturient women with remifentanil analgesia and elective cesarean section (C-section) and provide improver strategies for women living in Tabriz, Iran. Methods: This is a mixed-method study with an explanatory sequential approach. The first stage is quantitative and longitudinal. Participants will be divided into two groups of elective C-sections and parturient women who receive remifentanil. They will be matched concerning social class, type of provider, and birth rank. In the first stage, data will be collected using a socio-demographic questionnaire, Edinburgh’s Depression during pregnancy questionnaire, Labor Agentry Scale, and midwifery-neonatal outcomes checklist within 24 hours after delivery. Participants will be followed up to 30 days after delivery to complete the Edinburgh Postpartum Depression questionnaire. The second stage is a qualitative study to explain the perceptions of parturient women who had either elective C-section or painless delivery (using remifentanil), including factors related to labor experiences. In the third stage, a mixed study will be performed to provide strategies for improving labor experiences. Discussion: Women’s experiences during cesarean section can have different effects on maternal and neonatal outcomes; Following the use of two methods of continuous analgesia with remifentanil and spinal anesthesia and analgesia caused by these methods in cesarean section, women’s experiences may be different; The protocol presented in this study is a clinical guide to present this important issue (experiences of women during cesarean section looking for an appropriate method of analgesia). Ethical Code: IR.TBZMED.REC.1399.521, Pazhoohan Code: 65454.