Explanatory Sequential Mixed Methods Design Research Articles

Social support experiences of adolescents living with perinatal HIV in rural Limpopo, South Africa.

Adolescents with perinatal HIV (APHIV) experience emotional turmoil, which is worsened by real or perceived negative impacts on the adolescents' relationships, aspirations for their careers, and aspirations for their families. To explore the experiences of APHIV with regard to social support on their mental health and general well-being in the Vhembe District of Limpopo province. A mixed-methods sequential exploratory design was employed to conduct in-depth one-on-one interviews in the Vhembe District of the Limpopo province of South Africa. The interviews were conducted in selected community health centres and clinics over a period of four months (April 2019 - July 2019). This study included APHIV between the ages of 10 years and 19 years who had been initiated on antiretroviral therapy before the age of 10 years. Two major themes emerged. Theme 1 - Experiences within the family - included the sub-themes experience of positive social support within the family, and lack of support in the family. Theme 2 - Experiences outside the family - included the sub-themes experiences at the clinic, experiences at community level, and experiences at school and with friends. Adolescents with perinatal HIV are in need of social support from their loved ones as well as the community. Expansion of household programmes and intervention through integration of services by the multidisciplinary team might assist with alleviating the social support needs which will improve their mental health and adherence to treatment.

The effectiveness of a child and parent-oriented modular education program on the prevention of child sexual abuse knowledge and parental views: A mixed method study

This study evaluates the effectiveness of a modular training program on the prevention of child sexual abuse (CSA) on the level of sexual abuse knowledge of children and their parents and the views of parents. The study was conducted in a sequential explanatory mixed-methods design. In the quantitative part of the research, a randomized quasi-experimental method with a pre-test/post-test, and a control group was used, and in the qualitative phase, the descriptive phenomenological method was used. The quantitative phase was conducted with 122 children and 122 parents: those who participated in the modular training (intervention group) and those who did not (control group). The qualitative part of the study was completed with 15 parents. The modular training program was applied by the researchers to the children in the intervention group and their parents in sessions on different days. Children and their parents were measured 4 times in total: pre-test before modular training, post-test after training, 15 days after training, and 1-month follow-up test. The sexual abuse knowledge levels of children who received modular training were higher than those who did not (post-test, follow-up 1, and follow-up 2). Post-test scores related to child abuse knowledge and attitude levels of parents were higher in the intervention group (21.45) than in the control group (10.37). Qualitative findings were grouped under three main themes: “CSA risk factors”, “insecurity”, and “prevention methods”. The training program is effective in increasing the knowledge of children and parents.

Utilization and barriers of inclusive education resource centers: The case of Gamo zone primary schools

This study aimed to examine teachers’ utilization of Inclusive Education resource centers and identify the barriers that hinder the function of the centers in primary schools of Gamo Zone. For this purpose, the study employed a mixed methods explanatory sequential design. Primary data were collected from 95 teachers and 41 members of Resource Center Core Teams. Self-developed questionnaires, semi-structured interviews, and document analysis were used to gather data. Quantitative data analysis involved the use of percentage, mean, standard deviation, and independent sample t-tests, while qualitative data was analyzed through narrative and descriptive techniques. Results revealed that teachers did not adequately utilize the centers. Moreover, barriers such as shortage of specialized staff, inadequate training, lack of specialist support, limited resources, absence of qualified personnel, insufficient monitoring tools for students with special needs, and inadequate funding were identified. Finally, measures that aimed to enhance teachers’ utilization of the centers and address the barriers identified are forwarded.

Learning Style and English Argumentative Writing Proficiency – How They Complement Each Other

Argumentative writing in a foreign language is challenging for non-native speakers. The study was conducted in a China Normal University with 356 English major participators to uncover whether specific Learning Style (Converging. Diverging, Assimilating, Accommodating) has a higher significant impact on English Argumentative Writing Proficiency (EAWP). This study employed an explanatory sequential mixed-method research design. Findings showed that Convergers obtained the highest mean score in EAWP, while Divergers gained the lowest. The interviews revealed that students with different LS generally underwent four similar writing procedures. However, they differ concerning the strategies they employ in the writing process.

A Mixed-Methods Approach to Students’ Engagement in English Learning in the Chinese Context

Since language use is at the center of language learning, learners’ active engagement in learning activities is crucial for successful language learning. Answering the call for positive language education, the present study investigated the levels and influencing factors of engagement in English learning among 437 Chinese senior high school students. This study employed an explanatory sequential mixed-methods design, collecting data through questionnaires and semi-structured interviews. The results showed that students were generally well-engaged in English learning. Moreover, students were more inclined to engage in English learning behaviorally, emotionally, and cognitively. Students’ agentic engagement in English learning was relatively low and mainly reflected after English classes. The relatively low agentic engagement might be shaped by a series of personal and contextual factors, including the traditional Chinese concept of “honoring and respecting the teacher”, teachers’ teaching strategies, students’ learning strategies, English proficiency, learning climate, and teaching styles. Pedagogical implications for English teachers concerning enhancing students’ English learning engagement were provided.

Commodification of academic research in emerging countries

PurposeIn this paper we explore potential barriers for commodification of academic research in emerging countries.Design/methodology/approachWe carried out an exploratory study employing a mixed-method sequential exploratory design. Initially, qualitative interviews were performed to identify cognitive, structural, and ideological barriers associated with commodification. Subsequently, we administered a survey at three universities in Kazakhstan to gather quantitative data. The quantitative insights served to complement our qualitative findings and facilitate the interpretation of the observed patterns within the broader population.FindingsWe found that a too rapid shift toward commercialization exacerbated concerns among faculty members and created obstacles to commodification. The obstacles identified through inductive clustering of themes from exploratory qualitative interviews were grouped into three intentionally broad categories: cognitive, structural, and ideological barriers. We argue that in emerging economies, the path to commodifying academic research should start with developing local infrastructure to address identified structural, cognitive, and ideological barriers. This, in turn, will lead to more successful commercialization and redefine the role of academics in society.Research limitations/implicationsOur study has several limitations related to its empirical scope. We concentrated solely on one country, Kazakhstan. For future research, it is crucial to broaden the investigation to include more studies from the Central Asia region and other emerging economies. We believe that while there may be some minor institutional differences, the findings are generalizable to all post-socialist countries. However, incorporating a diverse range of institutions, particularly those with foreign ownership or private capital, would enhance the comprehensiveness of the findings. Furthermore, collecting a more extensive and balanced sample of responses from industry partners, academics, and students would have provided more valuable insights. By including a broader representation of stakeholders, we could have gained a more nuanced understanding of the complexities surrounding commodification in higher education. Given the exploratory nature of this study, it is essential to regard the findings as a source of inspiration rather than empirical confirmation.Practical implicationsOur research has practical implications for managing universities in emerging markets, as well as important policy implications, both for international actors and local governmental bodies.Social implicationsOur findings carry implications for policymakers. The focus that international institutions place on the matter of commodification and commercialization of knowledge is a positive step. Challenges emerge when this matter is approached with a narrow perspective. Drawing on the empirical context of the Republic of Kazakhstan, a country often overlooked in the literature on emerging markets, we find evidence that knowledge has indeed transformed into a commodity. The rapid shift toward commercialization, driven by substantial institutional pressures, may have occurred too precipitously in this particular context. In light of these findings, we advocate for a more balanced and contextually nuanced discourse concerning both the commodification and commercialization of knowledge.Originality/valueThis study represents one of the few endeavors into exploring commodification within the context of emerging economies. In recent decades, universities have faced substantial pressures to commodify academic research. While there has been a significant volume of research discussing and documenting the success of commodification in developed country universities, those in emerging economies have faced similar pressures without achieving comparable success. This paper delves into the reasons why.

A Behavioral Economic Examination of Sexual Behaviors in the Era of Pre-exposure Prophylaxis via Explanatory Sequential Mixed Methods.

Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed.

The Visual Science Communication Toolkit: Responding to the Need for Visual Science Communication Training in Undergraduate Life Sciences Education

Visual representations are essential to scientific research and teaching, playing a role in conceptual understanding, knowledge generation, and the communication of discovery and change. Undergraduate students are expected to interpret, use, and create visual representations so they can make their thinking explicit when engaging in discourse with the scientific community. Despite the importance of visualization in the biosciences, students often learn visualization skills in an ad hoc fashion without a clear framework. We used a mixed-methods sequential explanatory study design to explore and assess the pedagogical needs of undergraduate biology students (n = 53), instructors (n = 13), and teaching assistants (n = 8) in visual science communication education. Key themes were identified using inductive grounded theory methods. We found that extrinsic motivations, namely time, financial resources, and grading practices, contribute to a lack of guidance, support, and structure as well as ambiguous expectations and standards perceived by students and instructors. Biology and science visualization instructors cite visual communication assessments as a way of developing and evaluating students’ higher-order thinking skills in addition to their communication competencies. An output of this research, the development of a learning module, the Visual Science Communication Toolkit, is discussed along with design considerations for developing resources for visual science communication education.

The evaluation of gamification implementation for adult learners: A scale development study based on andragogical principles

AbstractThis study utilised scale development analysis to evaluate the effectiveness of gamification based on Knowles' andragogical principle in facilitating online learning for adult students. An exploratory sequential mixed-method research design was employed, incorporating interviews and field notes to gather qualitative data for scale construction. The Gamification for Adult Questionnaires (GAQ) scale was developed via questionnaires and analysed quantitatively. The thematic analysis of qualitative interviews revealed 23 sub-themes based on the five main andragogical principles used as a foundation for the quantitative analysis scales. Initially, 47 items were constructed, but five items with low communalities were excluded and an EFA with varimax rotation was performed on the remaining 42 items. The KMO and Bartlett test yielded a satisfactory value of 0.90 Williams et al. (2010). The Chi-square test (Bartlett's method) resulted in a significant sphericity level of p < .01. The EFA results enabled the categorisation of the 42 items into four factors: independent learning (9 items), learning engagement (15 items), knowledge-experience sharing (7 items), and application to real-life situations (11 items). The high alpha coefficient of 0.97 suggests the scale is reliable, and the 42 items account for 81% of the variance. The results indicate that the GAQ scale is a valid and reliable tool for evaluating gamification based on andragogical principles in adult learning settings. This study provides a foundation for future researchers interested in exploring gamification with contemporary teaching methods and technology for adult learners using Knowles' andragogical principles.

Profiling the status of out-of-field teaching in Western Australia: graduate teacher and principal perspectives

ABSTRACT This paper shows how system-level data can generate useful insights into the profile of first-year graduates who are teaching out-of-field (OOF). Understanding in-school demand and impacts on first-year graduates teaching OOF is important, especially when the first years of teaching are complex, busy, and involve a steep learning curve. A mixed methods sequential explanatory design was used to generate qualitative and quantitative data collected from teacher and principal surveys. This study establishes the prevalence of OOF teaching amongst first-year graduates in Western Australian public schools and develops a profile of their OOF experiences and support needs based on their perceptions and their principals’ perceptions. This study details the supports that will make a difference to teachers’ capability, in particular a reduction in load where the OOF teaching workload is high, and access to formal subject-specific mentoring, both noted in research as important support mechanisms. This paper provokes new research questions, highlights areas for further research, and establishes the need for more large-scale datasets and longitudinal studies to examine change over time and the enduring effects of OOF teaching, both in relation to transitions into teaching, as teachers learn on-the-job, and when teachers undertake formal professional development programmes or courses.

Cardiovascular Health in Black and Latino Adults With Type 2 Diabetes.

The incidence of type 2 diabetes (T2DM) among U.S. adults has been rising annually, with a higher incidence rate in Black and Hispanic adults than in Whites. The American Heart Association (AHA) has defined cardiovascular health according to the achievement of seven health behaviors (smoking, body mass index [BMI], physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose). Optimal cardiovascular health has been associated with a lower risk of cardiovascular disease, and awareness of this risk may influence healthy behaviors. This study aimed to assess cardiovascular health in a sample of Black and Hispanic adults (age: 18-40 years) with T2DM and explore the barriers and facilitators to diabetes self-management and cardiovascular health. This was an explanatory sequential mixed-method design. The study staff recruited adults with T2DM for the quantitative data followed by qualitative interviews with a subsample of participants using maximum variation sampling. The seven indices of cardiovascular health as defined by the AHA's "Life's Simple 7" were assessed: health behaviors (smoking, BMI, physical activity, diet) and health factors (total cholesterol, blood pressure, A1C). Qualitative interviews were conducted to explore their results as well as the effects of the pandemic on diabetes self-management. Qualitative and quantitative data were integrated into the final analysis phase. The majority of the sample was female, with 63% identifying as Black and 47% as Hispanic. The factor with the lowest achievement of ideal levels was BMI, followed by a healthy diet. Less than half achieved ideal levels of blood pressure or physical activity. Themes that emerged from the qualitative data included the impact of social support, the effects of the pandemic on their lives, and educating themselves about T2DM. Achievement of ideal cardiovascular health factors varied, but the achievement of several health factors may be interrelated. Intervening on even one factor while providing social support may improve other areas of cardiovascular health in this population.

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Tuberculosis (TB) is a popular endemic disease in Indonesia with increased risk outcomes. The clinical pathway (CP) is crucial to enhancing healthcare services and resource efficiency despite discrepancies in service variability reduction, clinical outcomes improvement, and cost saving. Therefore, this study aimed to assess pulmonary TB CP and evaluate its impacts on clinical and financial results, as well as barriers to implementation at Tidar Hospital in Magelang, Indonesia. A sequential explanatory mixed-method design was used from July 2022 to January 2023. The study began with a retrospective analysis of medical records of TB patients (total sampling, n=92). In-depth interviews (IDIs) were conducted with healthcare workers including the quality and medical committee, case manager, CP team, inpatient and non-inpatient nursing sub-coordinators, and pulmonary specialists. In addition, eight multidiscipline healthcare professionals attended the focus group discussions (FGDs). The audio recordings were transcripted verbatim and subjected to thematic analysis. The results showed that the quality and content of CP based on TB evaluation using the Integrated Clinical Pathway Assessment Tool (ICPAT) was 62.6%. Four themes were obtained: 1) CP implementation techniques, 2) supportive factors in the success of CP, 3) organization support in CP implementation, and 4) TB patient outcomes. Furthermore, procedure compliance after CP implementation was 33%. There were no significant differences in the length of stay (p=0.77), diagnosis investigation and therapy appropriateness (100%), mortality (4 vs 3 patients; p=0.589), and cost efficiency with an average cost of care (Rp 6.994.508,- vs Rp 5.521.091,-; p=0.083) before and after CP implementation. Readmission rates were low before and after deployment (1 vs. 2 patients). This study found no significant clinical or financial benefits in TB CP implementation. These results imply the need for hospital leadership and a multidisciplinary team to overcome CP implementation hurdles.

How sustainable is resilience? A mixed-methods study on the COVID-19-pandemic as a challenge to resilience resources of older adults who previously recovered from depression

Objectives Despite expanding knowledge about the internal and external resources that contribute to resilience among individuals who have experienced depression, the long-term accessibility and protectiveness of these resources across different stressors is unknown. We investigated whether and how the resilience resources of individuals who previously recovered from late-life depression remained protective during the COVID-19 pandemic. Methods We used a sequential explanatory mixed methods design. Quantitative data were derived from two psychiatric case-control cohorts and included twelve repeated measures during the COVID-19 pandemic (n = 465, aged ≥ 60). Qualitative data included two sequential interviews held in 2020 (n = 25) and 2021 (n = 19). We used thematic analysis to determine the protective resources after depression and during the COVID-19 pandemic and linear mixed models to examine the effect of these resources on change in depressive symptoms during the COVID-19 pandemic. Results While resources of ‘Taking agency’, ‘Need for rest’, ‘Managing thought processes’ and ‘Learning from depression’ remained accessible and protective during the pandemic, ‘Social support’ and ‘Engaging in activities’ did not. ‘Negotiating with lockdown measures’, ‘changing social contact’ and ‘changing activities’ were compensating strategies. Quantitative data confirmed the protectiveness of social contact, social cohesion, sense of mastery, physical activity, staying active and entertained and not following the media. Conclusion Many of the resources that previously helped to recover from depression also helped to maintain good mental health during the COVID-19 pandemic. Where accessibility and protectiveness declined, compensatory strategies or new resources were used. Hence, the sustainability of resilience is enabled through adaptation and compensation processes.

Self-help friendliness and cooperation with self-help groups among rehabilitation clinics in Germany (KoReS): a mixed-methods study protocol

IntroductionSelf-help is an important complement to medical rehabilitation for people with chronic diseases and disabilities. It contributes to stabilising rehabilitation success and further coping with disease and disability. Rehabilitation facilities...

Business peoples’ perceptions of English language use and its importance in the Chinese business world: a mixed-methods study

ABSTRACT This article presents the findings of a study measuring business people’s perceptions of English language use and its importance in the Chinese business community. Utilizing a mixed-methods sequential explanatory design, an analysis of cross-validated data from 1505 questionnaire participants and 30 interviewees revealed that business people in China do not use English as frequently as their national language, Mandarin Chinese, in their dealings. Nevertheless, the findings also indicated that business people are becoming increasingly aware of the importance of English as a medium of communication in the business world. The findings have meaningful implications for practitioners of English for specific purposes, policymakers, and materials developers.

Developing a reporting item checklist for studies of HIV drug resistance prevalence or incidence: a mixed methods study

BackgroundAdequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. To address this issue, we recently published reporting guidance documentation for studies of HIV drug...

Adopting the metaverse in the luxury hotel business: a cost–benefit perspective

Purpose This study aims to examine the perceived values of the metaverse when adopting it in the luxury hospitality business. Based on the cost–benefit perspective, this research provides solid theoretical contributions and actionable managerial recommendations. Design/methodology/approach An exploratory sequential mixed-method design was used. For the qualitative phase, 21 hotel managers and 24 hotel guests (who often stay in four-star and five-star hotels and resorts) were interviewed after showing them a series of videos about using the metaverse in the hotel business. Based on the results of the qualitative phase, the analytic hierarchy process method was used, and 476 valid questionnaires were analyzed. Findings The results highlight the perceived benefits (personalized services, immersive experience and positive brand image) and costs (lack of human touch, time and effort and security and privacy) of metaverse adoption for hotel managers and their guests. In addition, the study determines the weight of each value attribute of metaverse adoption for each travel stage (pre-travel, during travel and post-travel). Practical implications Regarding metaverse adoption, the research offers practical suggestions for luxury hotels. For instance, the cost of equipment and the time and effort required are perceived costs of metaverse adoption. To address these challenges, hotels may offer free equipment (e.g. VR headsets) and training to their guests to stimulate the use of the metaverse. Originality/value This study addresses a gap in the literature by presenting a conceptual framework for examining metaverse adoption in the luxury hotel scenario. Unlike using conventional models like the technology acceptance model or the unified theory of acceptance and use of technology to investigate a technology’s adoption, this study stands out by unraveling the topic through the lens of value proposition. The latter often comes from an efficient value co-creation process, which is indeed shaped by an adequate appreciation of the congruence of perceived values (i.e. perceived benefits and costs) of metaverse from hotel manager and guest perspectives.

Exploring English for academic purposes instructors’ perceptions of speech fluency through developing and piloting a rating scale for a paired conversational task

Much research has explored how perceptions of speech fluency are influenced by a variety of temporal speech features (e.g. speech rate). However, less is known about the influence of non-temporal and conversational speech characteristics on fluency perceptions. To address this gap, this study explored English for Academic Purposes (EAP) instructors' perceptions of speech fluency through developing and piloting a rating scale for a paired conversational task for assessment for learning purposes. A two-phase mixed-methods sequential exploratory design (Creswell, 2009) was used. Seven trained EAP instructors watched videos of seven-minute conversations, elicited from 14 intermediate-to-advanced EAP learners. Afterwards, instructors were audio-recorded discussing their observations about learners' fluency. These recordings were transcribed and coded using in-vivo and pattern coding techniques (Saldaña, 2009). Six themes were identified: efficiency, smoothness, sophistication, clarity, facilitating topics and turns, and supporting the conversation partner. These themes informed the development of a multi-item fluency rating scale. 35 EAP instructors then used the scale to rate eight learners’ speeches. To investigate the construct-relevance of these scale items, a principal component analysis was conducted, producing two components - individual fluency and conversational fluency. Pedagogical activities aligned with the scale are provided.

Academic Stress Measurement and Management of Radiologic Technology Students

Academic stress among Radiologic Technology students in Iligan City, Philippines, significantly impacts their well-being and academic success. This research aims to measure and address this stress by developing tailored stress management activities. The study utilizes an exploratory sequential mixed-methods design, combining qualitative and quantitative approaches. Qualitative interviews with Radiologic Technology students identify the key stressors, including academic demands, interpersonal conflicts, and societal expectations. Based on the qualitative findings, a stress management program is developed, that incorporates self-awareness, self-care, and goal setting. Stress levels are measured using questionnaires before and after participating in stress management activities. Participants include second-, third-, and fourth-year Radiologic Technology students who have completed at least one semester in the Radiologic Technology program. Sampling methods include simple random and purposive sampling. Thematic analysis identifies coping mechanisms such as binge eating, exercise, and entertainment. Quantitative analysis shows a significant decrease in stress levels post-intervention, highlighting the effectiveness of stress management activities. Students express positive feedback, acknowledging the benefits of the stress management workshop. This study contributes to understanding academic stress among Radiologic Technology students and highlights the importance of tailored stress management strategies. It emphasizes the significance of self-awareness, self-care, and goal-setting, and emphasizes the need for targeted interventions.

Measures of retention in HIV care: A protocol for a mixed methods study.

Retention in HIV care is necessary to achieve adherence to antiretroviral therapy, viral load suppression, and optimal health outcomes. There is no standard definition for retention in HIV care, which compromises consistent and reliable reporting and comparison of retention across facilities, jurisdictions, and studies. The objective of this study is to explore how stakeholders involved in HIV care define retention in HIV care and their preferences on measuring retention. We will use an exploratory sequential mixed methods design involving HIV stakeholder groups such as people living with HIV, people involved in providing care for PLHIV, and people involved in decision-making about PLHIV. In the qualitative phase of the study, we will conduct 20-25 in-depth interviews to collect the perspectives of HIV stakeholders on using their preferred retention measures. The findings from the qualitative phase will inform the development of survey items for the quantitative phase. Survey participants (n = 385) will be invited to rate the importance of each approach to measuring retention on a seven-point Likert scale. We will merge the qualitative and quantitative findings phase findings to inform a consensus-building framework for a standard definition of retention in care. This study has received ethics approval from the Hamilton Integrated Research Ethics Board. The findings will be disseminated through peer-reviewed publications, conference presentations, and among stakeholder groups. This study has limitations; we won't be able to arrive at a standard definition; a Delphi technique amongst the stakeholders will be utilized using the framework to reach a consensus globally accepted definition.