Explanatory Sequential Mixed Methods Design Research Articles

Post-16 students’ experience of practical science during the COVID-19 pandemic and the impact on students’ self-efficacy in practical work

This paper presents the findings from a detailed study investigating UK undergraduate students’ experience of practical science in their post-16 studies during the COVID-19 pandemic. It also examines their perceived confidence and preparedness in relation to areas of practical science skills at the start of their undergraduate courses. The study employed an exploratory sequential mixed methods design. Findings from student focus groups held at the end of their post-16 studies were used to support the development of a comprehensive skills audit and quantitative survey for incoming undergraduate students. Survey data were collected in September and October 2021 from 275 students commencing Biosciences, Chemistry, Physics and Natural Science degrees at two universities in England. The research is important because although almost all students had the opportunity to undertake practical work as part of their post-16 studies during the COVID-19 pandemic, there was considerable variation in students’ experiences. The data indicate that COVID-19-related closures of post-16 education establishments, ongoing social distancing requirements and the consequent removal of the assessment criteria for students to have ‘routinely and consistently’ undertaken each of the practical assessment requirements had implications for the development of students’ self-efficacy in relation to practical science. The research presents important considerations which are relevant for educators supporting students’ transition from post-16 to Higher Education and have the potential to impact on incoming students over many years to come.

Gendered responsibilities of household members in securing livelihoods through mat making in the Barak Valley, Assam

ABSTRACT Artisans face various obstacles owing to the lack of handicraft-related livelihood capital. This study highlights the significance of traditional skills and collaborative efforts of household members in ensuring a sustainable livelihood through mat making in the Barak Valley, Assam, India, despite facing multiple challenges. It employs a sequential exploratory mixed-method design and the Department for International Development’s sustainable livelihoods approach to examine the gendered responsibilities of household members earning a livelihood through mat making. The quantitative and qualitative findings reveal that the responsibilities of the women, men, and children in households are significant for earning their livelihoods from mat making. It recommends an immediate policy focus on bolstering the types of livelihood capital to sustain the livelihoods of mat makers and avoid decreasing their quality of life owing to the excessive utilisation of human capital.

The impact of resilience on academic performance with a focus on mature learners

BackgroundResilience is an essential psychological trait that empowers individuals to adapt and thrive in the face of challenges. Although it is acknowledged that health professionals need to possess high levels of resilience, there has been limited research comparing how different groups of health students, particularly school leaver undergraduates and mature age graduate entry students, develop resilience in their coursework.MethodsThis study combines both objective (academic grades with validated survey results) and subjective data (interviews) to compare how resilience is related to academic coursework performance for two groups of pharmacy students: the mature age graduate entry (GE, N = 64) learners and school leaver undergraduate (UG, N = 208) learners. We employed a sequential explanatory mixed methods design using surveys, academic performance data and semi-structured interviews. The survey tapped constructs related to resilience (burnout, stressors and coping methods) while the interviews elicited a more nuanced understanding of individual and environmental factors.ResultsAlthough there was no statistical difference in burnout experience between the two groups, GE students exhibited more positive resilience attitudes than UG when selecting resilience statements on the survey. Both cohorts indicated in the survey that engaging in distraction activities (physical exercise, sleeping, listening to music, anything other than the stressor) was their most preferred method of relieving stress. Within UG student survey responses, those who indicated support from partners, friends and family had better academic performance, while those who did not report coping methods did worse academically. The three key environmental factors we identified that contributed to both undergraduate and graduate entry resilience were workload, feedback provision and psychosocial support.ConclusionsCurrently, there is still a need for resilience programs geared at academic success to be implemented in higher education. This study provides objective evidence of academic success coupled with exploration into the nuances of resilience amongst different student groups. It not only highlights the differing resilience development strategies and burnout coping mechanisms in emerging health professionals, but showcases the juxtaposition of two different learner groups (UG and GE students) within a discipline. The cross-cohort facilitation of learning as in the discipline-specific strategies identified can help both groups develop resilience and inform future innovations. By comparing mature-age graduate students and younger-in-age undergraduate students, we identified a wider range of strategies and more positive attitudes to burnout in mature-age students. Health and clinical educators in university health degrees, clinical placements and clinical workplaces can develop effective training materials based on findings from this study to 1) assist undergraduate younger-age health students with developing resilience and 2) further refine mature-age health students’ and practicing health professionals’ resilience in today’s fast-paced clinical workplaces.

Economics of Intergenerational Volunteering: A Mixed-Methods Study of Snow-Buddies Program in Niagara Region, Canada

ABSTRACT This study examines the financial costs and savings of a community-based intergenerational volunteer program (i.e. Snow-buddies) that pairs youth with older adults for snow removal. From March 2020 to May 2023, Snow-buddies completed 106 volunteer-matches and 486 snow removal events. Using a sequential exploratory mixed-method design, 14 semi-structured interviews were conducted with youth volunteers and older adults. The majority of participants revealed minimal out-of-pocket (OOP) expenses and time/productivity losses for snow removal. Increased mobility, fall prevention, and social connections were perceived benefits of the program. A survey (n = 55, 52% of matched participants) reported an average CAD$123 OOP spending per snow removal event. Applying the rate of fall injuries among older adults due to snow, an estimated 1.12 fall injuries per 486 person-events were prevented translating into a total of $81,398 financial savings from averted hospitalization (i.e. a benefit–cost ratio of ~$662 for every dollar spent on snow removal).

Experiences of cultural stress among U.S. citizen migrants: A mixed method approach.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico, devastating the archipelago and forcing thousands of Puerto Ricans to migrate to the U.S. mainland. Guided by a cultural stress theory framework, the present mixed method study examined how various cultural stressors impact participants' daily interactions and mental health outcomes. A total of 319 adult Hurricane Maria survivors residing on the U.S. mainland participated in the study. A mixed method sequential explanatory design was used. First, we used latent profile analysis (LPA) and multinomial logistic regression to identify the varied cultural stress experiences that participants had. Then we used data from semistructured interviews to better understand the experiences of participants classified into the different LPA profiles. Four profiles were identified: "moderate cultural stress" (35%), "overall low" (29%), "high cultural stress" (26%), and "low language stress" (10%). Multinomial regression indicated that members of the moderate cultural stress, high cultural stress, and low language stress profiles all reported significantly higher depressive and anxiety symptoms compared to members of the overall low profile. Qualitative data exemplified the daily experiences of participants placed into each profile, demonstrating that participants have rich and varied experiences that can contribute to their mental health symptoms. The present study documents the contributions of hurricane trauma and cultural stress vis-à-vis current mental health symptoms. Clinicians working with Hurricane Maria survivors should be cognizant of and inquire about migration-related cultural stressors including discrimination, feelings of being unwelcomed, and difficulty communicating in the destination community's dominant language. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Co-creation and evaluation of an algorithm for the development of a mobile application for wound care among new graduate nurses: A mixed methods study.

Chronic wounds are a growing concern due to aging populations, sedentary lifestyles and increasing rates of obesity and chronic diseases. The impact of such wounds is felt worldwide, posing a considerable clinical, environmental and socioeconomic challenge and impacting the quality of life. The increasing complexity of care requires a holistic approach, along with extensive knowledge and skills. The challenge experienced by health-care professionals is particularly significant for newly graduate nurses, who face a gap between theory and practice. Digital tools, such as mobile applications, can support wound care by facilitating more precise assessments, early treatment, complication prevention and better outcomes. They also aid in clinical decision-making and improve healthcare delivery in remote areas. Several mobile applications have emerged to enhance wound care. However, there are no applications dedicated to newly graduate nurses. The aim of this study was to co-create and evaluate an algorithm for the development of a wound care mobile application supporting clinical decisions for new graduate nurses. The development of this mobile application is envisioned to improve knowledge application and facilitate evidence-based practice. This study is part of a multiphase project that adopted a pragmatic epistemological approach, using the 'Knowledge-to-Action' conceptual model and Duchscher's Stages of Transition Theory. Following a scoping review, an expert consensus, and stakeholder meetings, this study was pursued through a sequential exploratory mixed methods design carried out in two phases. In the initial phase, 21 participants engaged in semi-structured focus groups to explore their needs regarding clinical decision support in wound care, explore their perceptions of the future mobile application's content and identify and categorize essential components. Through descriptive analysis, five overarching themes emerged, serving as guiding principles for conceptual data model development and refinement. These findings confirmed the significance of integrating a comprehensive glossary complemented by photos, ensuring compatibility between the mobile application and existing documentation systems, and providing quick access to information to avoid burdening work routines. Subsequently, the algorithm was created from the qualitative data collected. The second phase involved presenting an online SurveyMonkey® questionnaire to 34 participants who were not part of the initial phase to quantitatively measure the usability of this algorithm among future users. This phase revealed very positive feedback regarding the usability [score of 6.33 (±0.19) on a scale of 1-7], which reinforces its quality. The technology maturation process can now continue with the development of a prototype and subsequent validation in a laboratory setting.

Development and testing of a videogame intervention for symptom management among 8–18 years old children with cancer: a study protocol

IntroductionEvidence shows that cancer treatment-related symptoms could be managed effectively in 8–18 years old children through Digital Health Interventions (DHIs), consequently improving their health-related quality of life (HRQOL). However, limited...

Are clinical decision support systems seen as helpful to First Contact Practitioners (FCPs) working in musculoskeletal health?

BackgroundThere is increasing burden on musculoskeletal (MSK) First Contact Practitioners (FCPs) working in primary care. One possible solution is to use digital technologies such as clinical decision support systems (CDSS). The primary objective of this study was to understand the potential for MSK FCPs to use a CDSS to support their practice in the United Kingdom. DesignAn exploratory sequential mixed methods design, using a cross sectional survey questionnaire and a subsequent focus group.Following ethical approval responders were recruited via professional networks to complete an online survey. A subsequent focus group enabled an in-depth exploration of survey results. Descriptive statistics were used to summarise survey data and thematic analysis with normalisation process theory used to describe findings. MethodsA snowball sampling method was used to invite MSK FCPs to complete the survey, using email, adverts and social media. The questionnaire captured responders’ demographic and professional practice characteristics, their knowledge and use of CDSS and their views and experiences regarding CDSS in MSK practice. ResultsThere were 75 responders to the survey and six participants in the focus group. The majority of responders 67% (n = 50/75) reported to be in favour of integrating a CDSS into their practice. Three themes were: 1) ensuring CDSS address efficiency concerns, 2) using CDSS to reduce unwarranted variation in practice, and 3) ensuring CDSS sustainability. ConclusionsCDSSs have potential value for FCPs working in MSK primary care settings. Eight summary recommendations advise future developments of CDSS for FCPs working in MSK primary care practice. Contribution of the Paper•This is the first known study evaluating the usefulness of clinical decision support systems (CDSS) for musculoskeletal (MSK) First Contact Practitioners (FCPs).•CDSS have potential value for MSK FCPs providing they are integrated into existing digital note systems and save clinic consultation time.•Eight recommendations advise future integration of CDSS into MSK FCP practice.

Barriers to reporting adverse events from the perspective of ICU nurses: A mixed-method study.

Nurses represent the largest group of healthcare professionals and are responsible for improving patient safety, including reporting adverse events. However, adverse events are underreported due to the many barriers that compromise patient safety in the hospital setting. The study aimed to investigate the barriers to reporting adverse events as perceived by nurses working in intensive care units (ICUs). The exploratory sequential mixed-method study design was used. Data were collected between January 2022 and March 2023 in intensive care units of one selected university hospital in the Slovak Republic. The quantitative phase was carried out using a specific instrument to explore barriers to reporting adverse events and included 111 nurses from the ICU. The qualitative phase was conducted using semi-structured face-to-face interviews and consisted of 10 nurses from the ICU. In terms of quantitative aspect, fear of liability, lawsuits, or sanctions was the most significant barrier to reporting adverse events among ICU nurses. As a result of qualitative thematic analysis, four significant barriers to reporting adverse events were identified: negative attitude toward reporting adverse events; lack of knowledge and experience in reporting adverse events; time scarcity; fear. Based on the results of the study, it is evident that only effective and regular reporting of adverse events leads to the minimization of adverse events. To improve patient safety in hospitals, education and management practices must be implemented to overcome barriers to reporting adverse events. The most important approach to overcoming barriers to reporting adverse events is to implement a culture of no blame and a positive culture of patient safety.

“So, That Would Have Been Useful”: Curriculum in LIS in Support of Liaison Librarian Preparation

LIS education has historically come under fire for what some perceive as a disconnect between what is taught in the classroom and what the job really entails. This study is part of a larger research study that used a sequential explanatory mixed-methods design to investigate liaison librarians’ perceptions of their academic preparation to take on the liaison role, specifically whether and how their LIS program curriculum prepared them for this role. This qualitative strand of the study relied on in-depth semi-structured interviews of survey participants to explore two research questions: What are the perceptions of academic liaison librarians regarding the degree to which their programs prepared them for their current role? And which factors influenced these perceptions? This research identified the main reasons hindering the effectiveness of LIS education for preparing librarians for the liaison role to be a range of complex issues that LIS programs and educators should consider, such as changing career plans among students who did not initially plan to become liaison librarians, students not taking certain courses due to scheduling or course timing issues, and the abstract nature of some course content which obscures connections to real-world practice. Participants also identified courses in collection development, reference, instruction, and research methods as those that should take center stage when preparing liaison librarians. These results have the potential to inform various aspects of LIS program curriculum planning and design and provide course-selection guidance for LIS students considering a career in academic libraries.

Current application of ChatGPT in undergraduate nuclear medicine education: Taking Chongqing Medical University as an example

Background Nuclear Medicine(NM), as an inherently interdisciplinary field, integrates diverse scientific principles and advanced imaging techniques. The advent of ChatGPT, a large language model, opens new avenues for medical educational innovation. With its advanced natural language processing abilities and complex algorithms, ChatGPT holds the potential to substantially enrich medical education, particularly in NM. Objective To investigate the current application of ChatGPT in undergraduate Nuclear Medicine Education(NME). Methods Employing a mixed-methods sequential explanatory design, the research investigates the current status of NME, the use of ChatGPT and the attitude towards ChatGPT among teachers and students in the Second Clinical College of Chongqing Medical University. Results The investigation yields several salient findings: (1) Students and educators in NM face numerous challenges in the learning process; (2) ChatGPT is found to possess significant applicability and potential benefits in NME; (3) There is a pronounced inclination among respondents to adopt ChatGPT, with a keen interest in its diverse applications within the educational sphere. Conclusion ChatGPT has been utilized to address the difficulties faced by undergraduates at Chongqing Medical University in NME, and has been applied in various aspects to assist learning. The findings of this survey may offer some insights into how ChatGPT can be integrated into practical medical education.

Tourist experience and destination evangelism: the mediating role of inspiration

ABSTRACT Even though tourist experience (TX) and destination evangelism are crucial research priorities, a substantial paucity of empirically derived insights into these concepts and their relationships exists. Therefore, this study investigates the TX’s impact on tourist inspiration and destination evangelism by proposing and empirically validating a structural model by collecting data from 384 tourists and then validating it by conducting semi-structured interviews. The study also envisages tourist inspiration to mediate the proposed relationships, thereby contributing further to the tourism and travel literature. This study applies mixed-method explanatory sequential design that consists of two phases. In the first phase, proposed hypotheses were tested by applying the structural equation modelling technique and mediation analysis. The findings revealed that various dimensions of TX exert differential impacts on destination evangelism. The study also confirmed the partial mediation role of tourist inspiration between three dimensions of TX (sensory, cognitive and affective) and destination evangelism; however, the full mediation effect was observed between behavioural TX and destination evangelism. In the second phase, a qualitative study based on semi-structured interviews was conducted. These findings were found in alignment with the findings of the quantitative study. The study concludes by offering key implications and avenues for further research.

Mabrouk's Measure of Adolescent Optimism: Development and Validation of a New Scale of Adolescent Optimism.

Several measures of adolescent optimism exist. However, none of these measures have been developed in the African setting, and only a few of the available measures have been validated for use in this setting. We aimed to develop and validate a culturally appropriate measure for this context. We employed an exploratory sequential mixed methods design using a five-step approach to tool development, comprising literature reviews, construct clarification, item development, piloting, and scale evaluation. We constructed a six-item scale, the Mabrouk's Measure of Adolescent Optimism (MMAO). In a sample of 1616 adolescents from Kenya, the MMAO demonstrated adequate internal consistency (both Cronbach's alpha and McDonald's Omega > 0.80) and test-retest reliability (ICC = 0.46). Factor analysis supported a unidimensional scale with adequate criterion and divergent validity as well as measurement invariance across sex, age (younger vs. older adolescents), residence (rural vs. urban), schooling status (in-school vs. out-of-school adolescents), and language of administration (Swahili vs. English). We report on the development and validation of a new scale of adolescent optimism that can be used to assess optimism among adolescents in Kenya and similar contexts. Preliminary evidence shows support for this new measure's reliability and validity, although additional tests are needed.

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

Assessing the mother tongue-based multilingual education policy in the Philippine mathematics education

The Philippine Department of Education developed and has been implementing the Mother Tongue-Based Multilingual Education (MTB-MLE) policy in response to encouraging findings from earlier research studies on using the mother tongue in early education. The purpose of this study is to evaluate how the MTB-MLE Policy is being implemented in terms of classroom instruction, teacher and school readiness, and student proficiency in their mother tongue, Kapampangan, and mathematics in the first five years of implementation in the Sasmuan District of Pampanga, Philippines, using an explanatory sequential mixed-methods research design. Teachers rated the implementation of the MTB-MLE policy positively but experienced some difficulties. Data analysis from interviews with teachers, school heads, district supervisors, and class observations revealed some issues, concerns, coping strategies, and best practices. The results of the two achievement exams students took were satisfactory, providing evidence of the value of using their native tongues in the classroom amidst challenges. Implications of the results were drawn for further improvement in the practice of the MTB-MLE policy in Mathematics Education.

Generative AI in student English learning in Thai higher education: More engagement, better outcomes?

Despite the growing body of research exploring artificial intelligence (AI) in educational contexts, there remains a critical gap in understanding the specific effects of generative AI (GAI) on English language learning, particularly within higher education in Thailand. This study addresses this gap by employing an explanatory sequential mixed-method design to explore both student and teacher perspectives. Quantitative data were analyzed using descriptive statistics, Mann-Whitney U tests, Spearman correlation analysis, and Kendall–Theil regression to examine students' acceptance, usage, and the relationship between GAI engagement and academic performance. Qualitative data, collected through structured written interviews, were analyzed using thematic analysis to uncover key themes from both student and teacher narratives. Quantitative findings reveal high student acceptance of GAI tools in terms of performance expectancy (M = 3.66, SD = .58), effort expectancy (M = 3.61, SD = .59), facilitating conditions (M = 3.51, SD = .59), and use behavior (M = 3.52, SD = .48), while social influence remained relatively lower (M = 3.31, SD = .54). Mann-Whitney U tests showed no statistically significant differences in GAI usage across high- and low-performing students (p > .05). Correlation analyses indicated strong associations between performance expectancy and other factors (ρ = .87, p < .001), yet no significant correlation with GPA (ρ = −.06, p = .76). Qualitative results from student reflections revealed improved efficiency, enhanced engagement, and increased linguistic confidence. Yet, concerns about overreliance on AI and the necessity for critical use were noted. Teacher narratives accentuated ethical concerns and the potential for GAI misuse, highlighting the need for balanced, responsible integration of AI into pedagogical practices. These findings underscore the potential of GAI to enhance learning experiences while emphasizing the importance of maintaining academic integrity and fostering critical thinking.

Family Structure and Female Enrollment into Engineering and Technology Programmes in English Speaking State Universities of Cameroon

This study seeks to find out the influence of family structure composition and gender beliefs on female enrolment in to Engineering and Technology programmes in the English speaking state universities in Cameroon. The methodology used in this study was an explanatory sequential mixed method design where data were collected from 276 students from the two universities and an interview administered to 10 parents whose children are enrolled in any engineering or technology department within the two English speaking state universities in Cameroon. The data collection instrument was a structured questionnaire administered to the students and an interview guide administered to the parents. The data collected were analyzed descriptively and Point Biserial Correlation Analysis was also used to find the relationship between Family Structure Composition and Female Enrolment in Engineering and Technology Programmes. Paired Sample T-Test was also used to find out if gender within the family has an impact on enrolment in engineering and technology programmes and finally a Binary Logit Regression was used to show the impact of family structure on Female Enrolment in Engineering and technology Programmes. Findings from this study indicates that there is a weak relationship between family structure composition and female enrolment in engineering and technology. Indicating that performance in sciences and subsequent enrolment in engineering and technology by female students are supported by other factors other than the family structure. Paired sample T-Test and Binary logit regression analysis indicates a strong family belief system that female children should pursue the art discipline and this beliefs had a significant impact on female enrolment in engineering and technology fields. Parents should be encouraged to devote the same amount of their resources in educating their girl child as they do for the male children. House chaos and other constrains should be adequately managed within the family during school periods and negative family beliefs that have an impact on the schooling of the girl child should be avoided.

Factors Influencing the Participation of Shared Decision Making in Stable Coronary Artery Disease Patient: Protocol of a Mixed Methods Study.

The "paternalistic decision-making model" is no longer well suited to the modern clinical environment, and therefore, shared decision making (SDM) has emerged as a key approach. Although the benefits of SDM have been largely reported, several studies have reported low participation in SDM in coronary artery disease (CAD) patients. The theory of planned behavior (TPB) model is one of the most frequently employed theoretical frameworks for predicting human behaviors. According to the TPB, intention is influenced by attitude, subjective norm, and perceived behavioral control, while behavior is influenced by both intention and perceived behavioral control. Therefore, we propose a mixed methods study based on TPB to investigate the status of Chinese stable coronary artery disease (SCAD) patients' participation in SDM, understand their experiences of SDM, and explore the factors that influence their participation in SDM. An explanatory sequential mixed methods design will be used to explore the study aims, including a quantitative phase, a subsequent qualitative phase, and the final integration study. The quantitative study will use convenient sampling from the Affiliated Hospital of Hangzhou Normal University to conduct a cross-sectional survey (n ≥ 252). The qualitative study will be sampled using the maximum difference sampling method from the quantitative study results, and then the data will be collected through semi-structured interviews (n = 10-20). This study will use descriptive statistics and test hypotheses while considering a p-value of <0.05, which will be considered statistically significant. The study employs a mixed method approach with an explanatory sequential design, incorporating qualitative and quantitative methods to comprehensively understand the factors influencing SCAD patients' participation in SDM. Furthermore, these findings can inform the design of future intervention studies and provide healthcare providers with targeted information and communication to help SCAD patients make the most appropriate decisions. Study participants will be recruited using convenience sampling from just one single clinical setting, which may limit the findings' generalizability. This study has been approved by the Ethical Committee of the School of Nursing, Hangzhou Normal University (Approval No.: 2024013). All the participants will sign an informed consent form before participating in the survey. The corresponding results and conclusions will be disseminated in journals and conferences after the completion of the study.

International students' perceived quality of university health centre services: an exploratory sequential mixed methods study.

This study aims to investigate international students' perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students' requirements, including healthcare services, is essential. A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students' perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students' perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. The qualitative strand revealed five major themes representing the study participants' thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students' socio-demographic characteristics.

What Comes After the Algorithm? An Investigation of Journalists’ Post-editing of Automated News Text

ABSTRACT Journalists often perceive that automated journalism produces news texts that lack narrative and editorial quality. Therefore, they sometimes manually edit automated output before publication, creating so-called “post-edited” variants. Using an exploratory sequential mixed-methods design, this study aims to advance research on automated journalism by investigating the steps journalists say they take when post-editing and testing whether—and if so, how—these steps are reflected systematically on a larger scale in post-edited news texts. First, journalists’ statements about the post-editing process were gathered in semi-structured interviews. Then, qualitative content analysis of automated news stories and their post-edited offspring examined whether post-edited stories contain evidence of forms of editing not mentioned by the journalists. Second, the qualitative findings were investigated quantitatively using comparative content analysis (N = 282). The qualitative findings suggest that a range of editorial steps may be taken during post-editing. The quantitative analysis shows that some of these steps are reflected systematically in post-editing, resulting in significant differences between automated news stories and their post-edited offspring. However, findings also show differences between journalists’ reports and post-editing practice on a larger scale, including evidence that forms of editing were taking place that were not mentioned in the interviews.