Sequential Explanatory Design Research Articles

Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial.

Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention-Pregnancy Story I Didn't Know in Interactive Webtoon Series (PSIDK-iWebtoons)-designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn't Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857. DERR1-10.2196/58326.

Project ECHO Brain Health: Assessing the Impact of a Pilot Program to Promote Self-Efficacy Among Community Health Workers.

This mixed-methods study sought to examine the impact of the Project ECHO Brain Health program on participating community health workers' (CHWs') self-efficacy to address dementia, promote brain health, and advocate for research among Latinx South Texas communities. Using an explanatory sequential design, quantitative data collected from pre- and post-program surveys were analyzed to inform the collection of qualitative data, followed by an interpretation of all findings to better understand the impact of the program on self-efficacy. Pre- and post-surveys were collected from 25 CHWs, 13 of whom later participated in individual interviews. There was a statistically significant increase in mean self-efficacy scores between the pre- and post-surveys among participants. Three categories reflecting the experiences of participants were identified from the qualitative data: addressing training needs; impact on CHWs and their practice; and community of learning. The findings suggest that Project ECHO Brain Health program is a timely intervention that may facilitate increased self-efficacy among CHWs as they navigate the impacts of dementia in their communities.

Midday Meal Programs in Institutional and Community Schools of Nepal: A Comparative Analysis of Students’ Meal Choices

Midday meals play a crucial role in satisfying and motivating students during teaching-learning activities, ensuring that they receive their basic education rights. As food and nutrition are fundamental for every living being, and since students spend a significant portion of their day in school, they require snacks to sustain their energy levels. The study aimed to recognize modalities related to parents' education and evaluate school physical facilities associated with midday meals in institutional and community schools. The research, conducted with the participation of school principals and fifth-grade students, revealed significant disparities in providing midday meals and the quality of school facilities. The study employed an explanatory sequential design. Ten headteachers and 240 students were the samples for this research. The interview schedule and observing rating scale were used as data collection tools. The study explored how parents' education levels influence their choices regarding where to enroll their children. It also discovered that parents with lower qualifications prefer community schools, while those with graduate qualifications lean towards institutional schools. Additionally, snack consumption habits differ between institutional and community schools, reflecting potential socio-economic influences. It was found that over half of students in institutional schools brought homemade lunches, while community schools offered meals in canteens. The findings underscore the need for targeted interventions to enhance school facilities, particularly addressing identified shortcomings to ensure the well-being and safety of students participating in the midday meal program.

Bridging the divide: Exploring inequities between sworn and civilian leaders in a Canadian police service.

Policing in the 21st century has rapidly become more complex, accountable, and changeable. Concern has emerged across the globe over the sustainability of public policing. Empirical research has supported that effective leadership at all levels of an organization is necessary to achieve success. Much has been said about the importance of effective leadership in policing. This paper explores an unexpected key finding from a mixed-methods, explanatory sequential design doctoral study that examined the self-efficacy beliefs and the factors that have influenced the leader effectiveness of sworn and civilian police leaders in a major Canadian police organization.

Low selection of HIV PrEP refills at private pharmacies among clients who initiated PrEP at public clinics: findings from a mixed-methods study in Kenya

BackgroundIn Africa, the delivery of HIV pre-exposure prophylaxis (PrEP) at public healthcare clinics is challenged by understaffing, overcrowding, and HIV-associated stigma, often resulting in low PrEP uptake and continuation among clients. Giving clients the option to refill PrEP at nearby private pharmacies, which are often more convenient and have shorter wait times, may address these challenges and improve PrEP continuation.MethodsThis mixed methods study used an explanatory sequential design. At two public clinics in Kiambu County, Kenya, clients ≥ 18 years initiating PrEP were given the option to refill PrEP at the clinic where they initiated for free or at one of three nearby private pharmacies for 300 Kenyan Shillings (~ $3 US Dollars). The providers at these pharmacies (pharmacists and pharmaceutical technologists) were trained in PrEP service delivery using a prescribing checklist and provider-assisted HIV self-testing, both with remote clinician oversight. Clients were followed up to seven months, with scheduled refill visits at one, four, and seven months. The primary outcomes were selection of pharmacy-based PrEP refills and PrEP continuation. Following pilot completion, 15 in-depth interviews (IDIs) with clients who refilled PrEP were completed. We used descriptive statistics and thematic analysis to assess study outcomes.ResultsFrom November 2020 to November 2021, 125 PrEP clients were screened and 106 enrolled. The majority (59%, 63/106) of clients were women and the median age was 31 years (IQR 26–38 years). Over 292 client-months of follow-up, 41 clients (39%) refilled PrEP; only three (3%) at a participating pharmacy. All clients who completed IDIs refilled PrEP at clinics. The reasons why clients did not refill PrEP at pharmacies included: a preference for clinic-delivered PrEP services (i.e., pre-existing relationships, access to other services), concerns about pharmacy-delivered PrEP services (i.e., mistrust, lower quality care, costs), and lack of knowledge of this refill location.ConclusionsThese findings suggest that clients who initiate PrEP at public clinics in Kenya may have already overcome barriers to clinic-delivered PrEP services and prefer PrEP access there. To reach new populations that could benefit from PrEP, a stand-alone model of pharmacy-delivered PrEP services may be needed.Trial registrationClinicalTrials.gov: NCT04558554 [registered: June 5, 2020].

Time use of patients in a secure forensic hospital: A mixed methods study.

Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004. An explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey. Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use. Patient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems.

The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)-The Person-centred Practice Inventory-Care (PCPI-C). Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework-the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 -Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 -Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. This study investigated how social connectedness is associated with patient outcomes in a HaH program. The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. The quantitative phase included 100 patients (18years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Rhetorical strategies in Chinese and English talk show humor: a comparative analysis

Humor is a kind of cognitive psychology activity, and it is diverse among individuals. One of the main characteristics of talk shows is to produce humorous discourse to make the audience laugh; however, rare studies have made a deeper comparative investigation on the rhetorical strategies in different language humorous utterances. Therefore, the current study adopted a mixed method of sequential explanatory design to identify the types of rhetorical strategies in the monolog verbal humor of Chinese and English talk shows, examine their similarities and differences. Two hundred monolog samples from 2016 to 2022, which consisted of 100 monologs of Chinese talk shows (CTS) and 100 monologs of English talk shows (ETS), were downloaded from the internet as language corpus. Berger’s theory was adopted to identify the types of rhetorical strategies. Based on the obtained findings, this study found that both language talk show hosts use a variety type of rhetorical strategies to produce humorous discourse. The comparison of similarities and differences revealed that the most frequently used rhetorical strategies in both talk shows were almost similar (e.g., satire, exaggeration, facetiousness, and ridicule), but the percentage of usage of these various rhetorical strategies in both talk shows was slightly different. Interestingly, misunderstanding occurred 20 times in CTS but was not found in ETS. Meanwhile, simile and personification were used more often in ETS. Conclusively, this study contributes valuable insights on the use of different types of rhetorical strategies to create verbal humor in different language contexts.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.

Exploring ICT professional development of experienced female EFL teachers

The integration of Information and Communications Technology (ICT) into language teaching and learning is mandated by the national policy in Indonesia. This study aims to describe 34 experienced female EFL teachers’ experiences ICT professional development.. This study reports on: 1) encouraging and discouraging factors of ICT use for participants, 2) solutions of ICT integration for participants’ professional development, and 3) peers’ perception on participants’ improvement of ICT competencies. In order to investigate the external and internal factors on the participants' ICT professional development experiences, a sequential explanatory design with mixed methods approach was used in the study. In the first phase, a questionnaire was used as the instrument to categorize participants into satisfactory ICT proficiency and less satisfactory ICT proficiency. The second phase was one-on-one interviews to find further information on the participants’ experiences on ICT professional development. The questionnaire was analyzed using SPSS, while interviews were analyzed using deductive content analysis which employs four stages in its process. Results show that all teachers with proper ICT proficiency and those who are less proficient in ICT have positive perceptions of the use of technology in education. However, there are differences in how they solve internal and external problems, and how they perceive guidance from peers and also support from the school environment. This study recommends universities and the government to develop programs of ICT professional development suitable for experienced female teachers.

Development of new training programmes for Thai community pharmacists using the theory of training needs analysis

Background: The study aimed to develop new training programmes for community pharmacists based on the theory of training needs analysis. Methods: Two phases were conducted. Phase 1 was the pharmacists’ needs analysis using the mixed method with an exploratory sequential design and the Hennessy-Hicks training needs analysis. Eligible pharmacists were requested to rate 44 task items on a 5-point Likert scale for task importance and perceived performance. All data were gathered and analysed using subgroup analysis and exploratory factor analysis for training needs. Phase 2 was the training programme development and verification by a focus group. Results: A total of 365 pharmacists completed the questionnaire, with a response rate of 28.3%. The 44 primary care tasks were grouped into seven main domains based on their importance. Three tasks with wide training gaps (mean gaps > 2.0), i.e., depression screening, home visits, and family planning, were selected for the programme development. The focus group agreed on the programme’s usefulness, practicality, and ease of implementation. Conclusion: The training needs of community pharmacists were evaluated, and three training programmes in primary care pharmacy were developed. The impacts of the training programmes merit further study.

Eco-Gender Gap Dalam Pemeliharaan Lingkungan di Desa Wisata (Kasus : Rumah Tangga Anggota Komunitas Pecinta Lingkungan di Desa Wisata Batulayang, Kecamatan Cisarua, Kabupaten Bogor)

Batulayang Tourism Village is one of West Java Province's sustainable tourism villages. Gender equality in environmental preservation are an important factor in efforts to preserve the ecological environment. Men and women share equal responsibility for environmental preservation. The purpose of this study is to examine the relationship between environmental preservation and the level of the gender gap. This study uses a mixed method exploratory sequential design approach, applying in-depth interviews for qualitative followed by questionnaires for quantitative data collection. The respondents in this research are 30 household members of the environmental community and 5 people research subjects who were in Ecovillage Program. The Spearman Rank Correlation and Chi-Square Test were utilised in this data processing for quantitative data. The research findings indicate that the Ecovillage Programe has sufficiently increased community participation to care more about the surrounding environment; however, in its implementation in the household sphere, the lack of gender-based environmental awareness causes there to still be a gap between husbands and wives in environmental management because environmental management is often associated with women's domestic role.

Can Socratic dialogue techniques be used to increase meaning of life for students with disabilities?

This research was motivated by the low meaningfulness of life among people with disabilities, especially those with autism spectrum disorder with visual impairment (ASDVI). The meaning of life greatly influences a person's quality of life, enthusiasm for living life, productivity, creativity, and happiness in living their own life. So, this research aims to determine the efficacy of individual counseling services using the cognitive behavior therapy (CBT) approach and Socratic dialogue techniques to increase the meaning of life in ASDVI students. The type of research that the researcher applied was a single-subject research experiment with the A-B-A pattern. The subject of this research was an ASDVI student at SLBN 001 Tanjungpinang. The instruments used in this research were observation and interviews. The data analysis method used is the explanatory sequential design. The results of the research showed that there was an increase in the meaning of life in ASDVI students, so the Socratic dialogue technique was considered effective in increasing the meaning of life in someone with disabilities, especially ASDVI specifications. The increasing meaningfulness of life for ASDVI students shows the difference between negative and positive thought patterns. This can be seen in changes in thinking patterns and behavior as well as independence, which shows that ASDVI students have the enthusiasm to live their lives and are independent, and can be active in seeking the views of the general public to achieve the ASDVI students' version of meaning itself and achieve a new, more positive perspective.

Examining the Quality of Learning Environment of Sandwich Programmes in Ghana: A Case of Institute of Education

This paper reports on a study that examined the quality of the learning environment of sandwich programmes in Ghana. The study used a sequential explanatory mixed method design and focused on tutors and 400 students of the programme. The Total Quality Management Theory, Expectation Confirmation/Disconfirmation Theory, Context, Input, Process, and Product Evaluation Model underpined the study. A disproportional stratified selection method was used to select 1,000 students and 50 tutors from each of the four teaching centres. While a purposive sampling method was employed to select 12 students and eight tutors involved in sandwich programmes for follow-up interviews. The data were collected using a questionnaire and an interview guide. The quantitative data was analysed using means and standard deviation, while the qualitative data were subjected to thematic analysis. These findings revealed that the tutors show concern for the welfare of the students and offer chances for student-teacher contact. However, big class sizes limit how much faculty can customise the learning environment. Also, students were friendly, helpful, cooperative, and supported one another during activities. The study recommended that the management of the Institute of Education and centre coordinators make every effort to secure spacious classrooms to help reduce large class sizes and increase opportunities for student-teacher interactions, cohesiveness, and students' participation in the classroom. In addition, tutors should foster an atmosphere that invites student interaction and identify students' strengths and weaknesses.

Preferred Learning Model in Studying English as a Foreign Language During Post-Pandemic Period: Blended Learning, Online Learning, or Face to Face?

Objective: Before and During the Covid-19 pandemic, students in Indonesia experienced face to face learning, online learning, and blended learning. Since the students have experienced those three learning models, this study was conducted to investigate the learning model that is preferred by the students during post-pandemic period and identify the reasons why they chose a particular learning model in learning English as a foreign language context.   Method: To achieve that research objective, this study was conducted by following a mixed-methods study method, the sequential explanatory design. The researchers started this study by collecting the quantitative data to identify the learning models preferred by the university students in Bali when they have an English class during post-pandemic period. Then, it was followed by collecting qualitative data to explain why the students preferred a certain learning model for the English class. The respondents of the study were 100 lecturers and 200 university students. The researchers collected the study data through questionnaires and interviews. The questionnaires were delivered using Google Forms, and the interviews via Google Meet.   Results and Discussion: The study reveals that most lecturers and students preferred the blended learning model to teach and learn English. In general, the selection of the learning model preferred by the lecturers and students was influenced by educational and health factors. Therefore, it can be concluded that the students’ preference on selecting a learning model is not influence by the educational reasons only.   Research Implications: Face to face instruction is crucial in an education process, because a real teacher-student interaction will happen through face to face instruction. Thus, blended learning is more preferable by the students than e-learning.   Originality/Value: Previous studies on blended in Indonesia were conducted to reveal the effectiveness of blended learning education for the broader use of blended learning in modern learning. Only a few studies were conducted to reveal their effectiveness in limited face-to-face learning during the post-pandemic of Covid-19. Therefore, this study mainly focused on investigating the effectiveness of blended learning during the implementation of limited-face to-face learning in Indonesia during the post-pandemic of the covid-19 pandemic. This study was necessary because the findings can guide educators to develop a more effective learning environment.

Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study.

In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652.

Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.

Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic. The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management. A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management. Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cardiogenic Shock Challenges and Priorities: A Clinician Survey

Cardiogenic shock (CS) is common and survival outcomes have not substantially improved. Australia's geography presents unique challenges in the management of CS. The challenges and research priorities for clinicians pertaining to CS identification and management have yet to be described. We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 10 clinicians (medical and nursing) to identify themes for quantitative evaluation. A total of 143 clinicians undertook quantitative evaluation through online survey. The interviews and surveys addressed current understanding of CS, status of cardiogenic systems and future research priorities. There were 143 respondents: 16 (11%) emergency, cardiology 22 (16%), 37 (26%) intensive care, 54 (38%) nursing. In total, 107 (75%) believe CS is under-recognised. Thirteen (13; 9%) of respondents indicated their hospital had existing CS teams, all from metropolitan hospitals, and 40% thought additional access to mechanical circulatory support devices was required. Five (5; 11%) non-tertiary hospital respondents had not experienced a delay in transfer of a patient in CS. All respondents felt additional research, particularly into the management of CS, was required. Clinicians report that CS is under-recognised and further research into CS management is required. Access to specialised CS services is still an issue and CS protocolised pathways may be of value.

Green brand identity and B2B channel partners' tactical green marketing orientation: Moderating effect of brand governance

Even though environmental values and sustainable branding have garnered much attention in the B2C context, B2B contexts remain relatively less explored. This study introduces a novel synthesis of Signaling theory and Stewardship theory and examines the moderating impact of brand governance on the relationship between green brand identity, consistent communication and channel partner commitment, leading to tactical green marketing orientation. Distinguishing itself from previous research, our approach embraces a multi-perspective lens, delving into the viewpoints of both channel partners and organizations (i.e. managers). Employing an explanatory sequential mixed method design, the first phase involved an empirical survey with 248 respondents (Study 1). Subsequently, the second phase (Study 2) comprised qualitative interviews with 41 respondents. The findings from both studies converged, revealing a positive association between “consistent communication” and “attitude,” a robust connection between “attitude” and “commitment,” and a favorable correlation between “green brand identity” and “attitude,” ultimately leading to a positive relationship between “attitude” and “green tactical marketing orientation. This research significantly contributes to the comprehension of B2B green brand positioning by demonstrating, that in the B2B context, brand governance influences channel partners' commitment and tactical green marketing orientation.