Sequential Explanatory Mixed Methods Study Research Articles

Development and validation of care stress management scale in family caregivers for people with Alzheimer: a sequential-exploratory mixed-method study

BackgroundCaring for a person with Alzheimer’s disease is stressful for caregivers. So that, considering all the emotional and financial costs imposed on the families of Alzheimer’s patients, stress from caring is an issue that cannot be ignored and plans need to be developed to help these caregivers to manage the care properly. The current study was designed to develop a valid and reliable care stress management scale for family caregivers of patients with Alzheimer’s.MethodsThis study is a methodological study with a sequential-exploratory mixed-method approach that was performed in two-phase: develop the caring stress management scale and evaluate the psychometric properties of the scale. In the first phase, 14 semi-structured face-to-face interviews were performed with family caregivers of patients with Alzheimer’s. The interviews were transcribed immediately and an item pool with 275 items was prepared. After removing the duplicate or overlapping code, the initial format of the caring stress management scale (CSMS) was designed. In the second step, the items of the CSMS were evaluated using face and content validity. After that, the construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis, and convergent and divergent validity respectively. Finally, the reliability was assessed by stability and internal consistency. The sample size was 435 and data was gathered via an online form questionnaire.ResultsThis study designed the CSMS with two factors including emotional-focused coping (4 items) and problem-focused coping (4 items) that explained 51.00% of the total variance. The results of the confirmatory factor analysis showed a good model fit. Furthermore, the internal consistency and stability of this scale were acceptable.ConclusionThe results showed that the care stress management scale has two factors in Iranian family caregivers and it is valid and reliable and can be used by therapists and researchers.

Occupational Therapy for Poststroke Anxiety and Depressive Symptoms in Inpatient Rehabilitation.

Poststroke anxiety and depressive symptoms (P-SADS) affect one in three people and are associated with decreased participation in activities of daily living. This study sought to characterize occupational therapy (OT) P-SADS care practices and identify factors influencing P-SADS care provision in one U.S. inpatient rehabilitation (IRF) facility. An explanatory sequential mixed-methods study design was used by gathering data from electronic health records (from January 1, 2019 to December 31, 2019) as well as semi-structured interviews with OT practitioners in the IRF. No objective P-SADS screens were documented nor were any P-SADS-focused goals written. Minimal evidence-based P-SADS interventions were identified. Practitioners reported multi-level barriers to OT P-SADS care including limited time, pressure to prioritize physical recovery, and inadequate resources to guide practice. OT practitioner P-SADS care was inconsistent with established evidence-based practice. This research identifies gaps in comprehensive stroke recovery and informs implementation efforts to support evidence-based P-SADS care in IRFs.

Household Characteristics, Cost of Illness and Coping Mechanism of Families of Hospitalized Acute Encephalitis Syndrome Children: A Mix Method Study

Background: AES is responsible for causing high social and economic burden to the affected families. The study was conducted to know the household characteristics, cost of illness and coping strategy adopted by the family members of AES children admitted to a tertiary care facility in Assam, India. Methods: It was a sequential exploratory mixed method study, with a cross-sectional survey among AES children and their guardians, followed by In Depth interview. Results: Out of 51 cases 55% were male. The median age was 11 years. 53% of the families belonged to lower socioeconomic class. 96% of families reported to reside in rural areas. Commonly reported household assets were mobile phone 94%, bicycle 86%, television 31% and motorcycle 29%. Three major themes were emerged to contribute towards economic burden. The first major theme is “Direct cost” due to patient transportation cost (mean Rs 1161.00) and hospital costs: mostly due to medicinal cost (mean Rs1955.00), investigational cost (mean Rs 2920.00) and food cost (mean Rs 8375.00). The second theme “Indirect cost” is due to work days loss: 100% care providers had missed work days during hospital stay of their children and 84% had missed work days during post hospital care. The third theme is “Inherent cost spotted through coping mechanisms” which mostly 94% included borrowing money from the market and 31.4% selling household assets. Conclusion: Cost of illness is a huge burden to the AES afflicted families which demands reforms in health care financing and reimbursement in current context.

Helping Patients With Chronic Conditions Overcome Challenges of High-Deductible Health Plans: Mixed Methods Study.

A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population. This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care. In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants' health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care. Approximately half (11/20, 55%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year. Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending.

TRANSFORMATIONAL LEADERSHIP AND ADAPTIVE PERFORMANCE IN THE INTERNATIONAL SCHOOLS IN THE PHILIPPINES: A BASIS FOR AN ORGANIZATIONAL SUPPORT FRAMEWORK

Educational institutions have been drastically affected by the pandemic, especially in terms of human resources, specifically their well-being. In this study, transformational leadership practices are seen to be an agent that may support the teachers as they face the challenges in adapting to organizational changes. This study determined the relationship between the school administrators transformational leadership and teachers adaptive performance in providing organizational support to teachers. The study used the explanatory sequential mixed-methods study. It was participated by 36 school administrators and 137 teachers from the seven private international schools which are located in Las Piñas City, Muntinlupa City, Batangas City, and Lipa City, Philippines. Based on the summarized findings, the following are concluded. The school administrators extent of transformational leadership practice within its four dimensions is highly evident based on their self-assessment. The extent of transformational leadership practice within its four dimensions is highly evident according to teachers. The teachers level of adaptive performance within its eight dimensions is acceptable however, they need assistance in terms of dealing with uncertain or unpredictable work situations, demonstrating physically oriented adaptability, handling work stress, and handling emergencies or crisis situations. There is a significant difference in the mean transformational leadership ratings of the school administrators based on the description of the teachers. Moreover, there is no significant difference in the mean transformational leadership ratings of the school administrators as described by the teachers and school administrators. There is a positive strong relationship existing between transformational leadership and teachers adaptive performance. Furthermore, the proposed organizational support framework focuses on the implementation of transformational leadership framed within its four dimensions, which aims to develop trust, influence, and empowerment among the teachers.

Non-hospital healthcare center’s preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study

BackgroundBasic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs’ preparedness to provide initial emergency care.MethodsThis study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach’s alpha, Intra-class Correlation Coefficient, and Kendal’s Tau-b. All the statistical analyses were performed using Stata 14.ResultsIn the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: “Environmental Infrastructures of Centers”, “Protocols, Guidelines and Policies”, “Medical Supplies and Equipment”, “Emergency Medicines”, “Human Resources”, “Clinical Interventions”, “Maintenance of equipment”, “Medicine Storage Capability”, and “Management Process”. The toolbar had acceptable validity and reliability.ConclusionsThis study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.

A qualitative study of sleep in young breast cancer survivors: "No longer able to sleep through the night".

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep. IMPLICATIONS FOR CANCER SURVIVORS: Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for youngbreast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms,especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

Technology-Enabled Collaborative Care for Concurrent Diabetes and Distress Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Feasibility Study.

The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use of communication technology could reduce these gaps in diabetes care created by the pandemic and also provide support for psychological distress. The purpose of this study is to test the feasibility of an innovative co-designed Technology-Enabled Collaborative Care (TECC) model for diabetes management and mental health support among adults with T2D. We will recruit 30 adults with T2D residing in Ontario, Canada, to participate in our sequential explanatory mixed methods study. They will participate in 8 weekly web-based health coaching sessions with a registered nurse, who is a certified diabetes educator, who will be supported by a digital care team (ie, a peer mentor, an addictions specialist, a dietitian, a psychiatrist, and a psychotherapist). Assessments will be completed at baseline, 4 weeks, and 8 weeks, with a 12-week follow-up. Our primary outcome is the feasibility and acceptability of the intervention, as evident by the participant recruitment and retention rates. Key secondary outcomes include assessment completion and delivery of the intervention. Exploratory outcomes consist of changes in mental health, substance use, and physical health behaviors. Stakeholder experience and satisfaction will be explored through a qualitative descriptive study using one-on-one interviews. This paper describes the protocol of the study. The recruitment commenced in June 2021. This study was registered on October 29, 2020, on ClinicalTrials.gov (Registry ID: NCT04607915). As of June 2022, all participants have been recruited. It is anticipated that data analysis will be complete by the end of 2022, with study findings available by the end of 2023. The development of an innovative, technology-enabled model will provide necessary support for individuals living with T2D and mental health challenges. This TECC program will determine the feasibility of TECC for patients with T2D and mental health issues. ClinicalTrials.gov NCT04607915; https://clinicaltrials.gov/ct2/show/NCT04607915. DERR1-10.2196/39724.

Participation and Persistence of Adult Basic Education Students at a Rural College Campus on Manitoulin Island

Little research has been conducted to examine the participation and persistence of adult basic education students in northern and rural Canada. This explanatory sequential mixed-methods study was conducted with adult learners to address this research deficit. The study consisted of questionnaire and interview phases. Using thematic analysis, five themes were identified from the participant responses: (a) positive, supportive, personal touch; (b) situational hardships; (c) friendships and community; (d) campus Indigeneity; and (e) program resources. Situational hardships directly affected students’ program participation and persistence. A positive, supportive environment contributed to participation and persistence, while friends, community, and program resources influenced student persistence in the program. Participants identified campus Indigeneity and promotion of the program as areas for improvement.

Making Desistance Recognizable: How Ex-Offenders Can Signal Their Desistance From Crime to Employers by Strategic Design

Abstract One of the primary concerns employers hold about hiring an ex-offender is the potential reoffending risk they pose. However, criminological literature shows that an ex-offender may be able to mitigate employers’ concerns by signalling their desistance from crime. Less understood is how ex-offenders can signal their desistance to (a) make desistance recognizable and (2) communicate desistance signals that employers value. This article draws on the results from the second phase of an Explanatory Sequential Mixed Methods study with a sample of Australian employers who participated in semi-structured interviews (n = 43). The findings show desistance signals can be communicated to employers via strategic design. These findings along with the theoretical and policy implications are then discussed.

Pan-Canadian caregiver experiences in accessing government disability programs: A mixed methods study

BackgroundAt present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada. AimUnderstand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs. Methods and ProceduresThis mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access. Outcomes and Results499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access. Conclusions and ImplicationsThe results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.

Implementation strategies to promote compassionate nursing care of complex patients: An exploratory sequential mixed methods study.

Individuals with multiple physical and, or, mental health issues and, or, drug-related problems are known as complex patients. These patients are often recipients of poor-quality care. Compassionate nursing care is valuable to promote better care experiences among this patient population. Implementation strategies should be designed to enhance compassionate nursing care delivery. The study aimed to gain understanding of barriers to compassionate care delivery to propose implementation to promote compassionate nursing care of complex patients. An exploratory sequential mixed methods study was conducted. Phase 1 was the qualitative component during which 23 individuals with multimorbidities were interviewed for exploring their perceptions of barriers to compassionate nursing care. The barriers were integrated with implementation science frameworks using the building technique during phase 2 to develop a Q-sort survey of implementation strategies for phase 3. Nurses, nurse managers, health care administrators, policymakers, and compassionate care experts responded to the survey by ranking the 21 implementation strategies, out of which five met the Q-factor analysis criteria. Participant-perceived barriers to nurse compassion could be categorized under knowledge, intentions, skills, social influences, behavioral regulation, reinforcement, emotion, and environmental context and resources. The five highest-ranked strategies included facilitation, consultation with stress experts, involvement of patients and families, modeling compassion through shadowing, and utilizing implementation teams. Enablement and modeling were the integration functions represented by the highest-ranked implementation strategies. Enabling nurses to provide compassionate care through emotional support and mental health counseling, and, modeling compassion and compassionate care through shadowing were recommended and rated as highly relevant by the majority of stakeholders. Enhancing nurses compassionate behaviors toward complex patients requires facilitating them in enacting compassion in practice through modeling and support from organizations and nurse managers.

A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

Diabetes is one of the commonest morbidity among patients with tuberculosis (TB). We conducted this study to estimate the costs incurred by patients with TB comorbid with diabetes and to explore the perspectives of program managers as well as patients on the reasons and solutions for the costs incurred due to TB-diabetes. We conducted a descriptive cross-sectional study to estimate costs among 304 patients with TB-diabetes comorbidity registered in the public health system during 2017–2020 in the Bhavnagar region of western India, which was followed by in-depth interviews among program functionaries and patients to explore solutions for reducing the costs. Costs, when exceeded 20% of annual household income, were defined as catastrophic as this cut-off was most significantly related to adverse TB outcomes. Among the 304 patients with TB-diabetes comorbidity, 72% were male and the median (interquartile IQR) monthly family income was Indian rupees (INR) 9000 (8000–11,000) [~ US$ 132 (118–162)]. The median (IQR) total costs due to combined TB-diabetes were INR 1314 (788–3170) [~ US$ 19 (12–47)], while that due to TB were INR 618 (378–1933) [~ US$ 9 (6–28)]. Catastrophic costs due to TB were 4%, which increased to 5% on adding the costs due to diabetes. Health system strengthening, an increase in cash assistance, and other benefits such as a nutritious food kit were suggested for reducing the costs incurred. We conclude that, in addition to a marginal increase in the percentage of catastrophic costs, co-existent diabetes nearly doubled the median total costs incurred among patients with TB. Strengthening the TB-diabetes bi-directional activities, tailoring the cash transfer scheme for comorbid patients, and making the common two-drug combination diabetes tablets available at government drug stores would help TB-diabetes comorbid patients cope with the costs of care.

A mixed-methods approach to understand university students' perceived impact of returning to class during COVID-19 on their mental and general health.

This study investigated the prevalence and risk factors of mental and general health symptoms among university students attending in-person and online classes during COVID-19. We also explored their experiences returning to in-person classes and their views on the university's COVID-19-related policies. In this sequential explanatory mixed-methods study (2020-2021), U.S. university student respondents (N = 1030; 603 women [58.5%], 907 [88.1%] aged 18-24 years) completed a quantitative, cross-sectional survey assessing their mental and general health symptoms experienced while taking classes during the COVID-19 pandemic. The survey link was distributed through social media and email invitations. Three separate follow-up focus groups (n = 27), consisting of an average of nine focus group respondents who had completed the quantitative survey per group, were conducted using a semi-structured interview guide. Focus group respondents provided qualitative responses on their experiences returning to class during COVID-19 and adhering to COVID-19-related policies. The prevalence of mental health symptoms among survey respondents were 57.6% (n = 593) for depression, 41.5% (n = 427) for anxiety, and 40.8% (n = 420) for stress. Over 90% of respondents reported perceptions of good general health. Female respondents and respondents identified as non-binary gender had an increased risk for mental health symptoms compared to male respondents. Respondents with preexisting medical conditions had an increased risk for worse general health. Themes identified through qualitative analysis included (1) attending class during COVID-19 is associated with unhealthy behaviors, and poor health, (2) perceived challenges of online learning and increased feelings of isolation, (3) demand for COVID-19 policy reform and greater transparency of COVID-19 statistics; (4) difficulties in adhering to COVID-19 policies; and (5) concerns about acquiring and transmitting COVID-19. Our findings indicate that university students attending classes during the pandemic are experiencing negative mental health impacts. Although students were aware of COVID-19-related policies, many found it challenging to comply. Broad acceptance of COVID-19 policies will require greater transparency and information sharing.

An examination of peer recovery support specialist work roles and activities within the recovery ecosystems of Central Appalachia

Background Substance use/misuse is a leading public health concern in the United States. In the midst of the COVID-19 pandemic, drug-related deaths exceeded 100,000 in a 12-month period for the first time in history. There is currently an urgent need for empirical evidence to inform community leaders and policy makers on the benefits of recovery-informed approaches to SUD prevention and treatment. The peer recovery support specialist (PRSS) is a certified professional who self-identifies as being in recovery from a substance use disorder (SUD), mental illness, or co-occurring disorder and may play an important role in positively affecting outcomes for persons with SUD. However, the evidence for PRSS services is limited in part due to methods that are ill-fitted to measure the dynamic process of recovery across time and within a complex service continuum. Methods This sequential exploratory mixed-methods study queried PRSS in five Central Appalachian states regarding their work roles and activities within the context of regional service networks also known as ‘recovery ecosystems.’ Results 565 Central Appalachian PRSS respondents indicate that they frequently provide emotional support in a broad array of regional service settings but have few professional advancement opportunities. PRSS also report that their role is frequently misunderstood. Conclusions This study expands the existing literature providing information about training, remuneration, job satisfaction, work roles and activities within the context of existing recovery ecosystems. Inclusion of peer recovery support specialist’s perspectives improved measurement of peer service delivery and should be considered when working with this vital recovery-supporting workforce.

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses' Perspectives toward Nurse Practitioners' Roles in Saudi Arabia.

Nurse practitioners' roles need to be clearly defined in Saudi Arabia. Therefore, we aimed to explore potential factors that impact nurses' perspectives toward nurse practitioners' roles and whether they are interested in becoming nurse practitioners. A mixed-methods study design was employed using a questionnaire and focus groups. The survey was sent to nurses working at a public hospital in the Riyadh region. Participants (N = 77) reported that having more nurse practitioners would improve quality of care and patient safety. Additionally, most participants stated that an increased supply of nurse practitioners would have a positive impact on effectiveness, equity of care, and healthcare costs. In regression analysis, participants with favorable perspectives towards nurse practitioners were significantly more likely to have interest in becoming nurse practitioners (odds ratio [95% confidence interval]:1.04 [1.01-1.07]). In the qualitative domain, three positive factors were identified: effective collaboration with other staff, better contribution to quality care and patient safety, and better contribution to evidence-based practice. Two barriers were also determined: lack of motivation to become a nurse practitioner and unclear scope of practice. Results showed that nurse practitioners can provide quality healthcare services that meet patients' different needs. The growing role of this speciality warrants further research to show its value in daily practice.

Adherence to medical nutrition therapy and it's challenges among antenatal women with gestational diabetes mellitus in South India- A sequential explanatory mixed-method study.

Globally, one in ten pregnant women have diabetes; out of which, 90% contribute to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine the factors related toadherence among antenatal women with GDM. This study also explores the facilitators, barriers, and possible suggestions for improving adherence. This facility-based sequential explanatory mixed-method study was conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021. Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on the scores obtained they were selected for in-depth interviews to explore the facilitators and barriers. Collected data wereanalysed by Chi-square test using STATA version 16. Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%) with 95% CI of 34%-44%. Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI: 0.48-0.88) and good adherence was antenatal women in the 2nd trimester (PR: 1.541; 95%CI: 1.18-2.025). Barrierstonon-adherence were financial crisis, lack of awareness ofthe need for MNT, and joint family pressure. About two-thirds of antenatal women with GDM are non-adherent to MNT. Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has to be implemented for improving the adherence rate.

Development and psychometric properties of teamwork scale in resuscitation: A sequential exploratory mixed-method study.

Non-technical skills as a complement to technical skills have become increasingly important in cardio-pulmonary resuscitation, and teamwork is one of the most prominent of these skills. Because of the limited number of tools introduced and validated for measuring teamwork in resuscitation, this study was conducted to develop and evaluate the psychometric properties of the Teamwork Scale in Resuscitation (TSR). This study was a sequential exploratory mixed-method study and was conducted between March 2020 and April 2021 and in two phases. In the first phase (qualitative), semi-structured interviews were performed with resuscitation team members who were selected using a purposeful sampling method with maximum variation in terms of experience, level of education, age, and gender. Using directed qualitative content analysis, the data were analyzed and the primary item pool was developed. In the second phase (quantitative), assessing face, content, and construct validity as well as reliability via the internal consistency and stability, the psychometric properties of the instrument are evaluated. The initial tool consisted of 54 items; after assessing the face validity, ten items were removed during content validity, and the final tool consisted of 44 items and three main categories including the essential prerequisites for resuscitation, leadership, and teamwork, which was scored based on a 5-point Likert scale from strongly disagree to strongly agree. The convergent validity and concurrent validity of the tool were confirmed. The reliability of the instrument was also confirmed using Cronbach's alpha test and re-test and the intra-class correlation coefficient (ICC) between raters. The validity and reliability of TSR for measuring teamwork in resuscitation in a simulated environment are approved. Further studies are suggested for different contexts of resuscitation and with trained raters to evaluate its use in real resuscitation situations.

A Mixed Methods Study on Goal Pursuit, Goal Attainment and Subjective Well-Being during Adolescence and Young Adulthood

The purpose of this mixed methods sequential explanatory study was to investigate the effects of independent goal pursuit, interdependent goal pursuit, independent goal attainment, and interdependent goal attainment on subjective well-being among Filipinos and the moderation interaction of developmental levels (e.g., adolescence and young adulthood) in these effects. In the quantitative study, four measures: SWLS, PANAS-X, Goal Motivation Scale, and Goal Progress Scale were administered to 218 adolescents and young adults from Mindanao. The Path analysis technique was used to test the effects of independent goal pursuit, interdependent goal pursuit, independent goal attainment and interdependent goal attainment on subjective well- being, and the moderation interaction of developmental levels on these effects. Subjective well- being was measured in terms of satisfaction with life (SWLS), positive affect (PA) and negative affect (NA). Results of the study indicated that the moderation model of developmental levels on goal pursuit and goal attainment with SWLS tested attained a good and perfect fit (x2/df = 2.34; RMSEA = .044; GFI =0.920; SRMR = 0.06); the moderation model of developmental levels on goal pursuit and goal attainment on PA tested attained a good and perfect fit (x2/df = 2.75; RMSEA = .051; GFI =0.915; SRMR = 0.08); and the moderation model of developmental levels on goal pursuit and goal attainment on NA tested attained a good and perfect fit (x2/df = 2.91; RMSEA = .054; GFI =0.912; SRMR = 0.09). Independent goal pursuit predicted SWL, PA and NA; interdependent goal pursuit predicted SWL; independent goal attainment predicted SWL, PA, and NA; and interdependent goal attainment predicted NA. Findings revealed significant moderation interactions on the following: effect of independent goal pursuit on SWL, PA, and NA among Filipino adolescents; effect of interdependent goal pursuit on SWL among Filipino young adults; effect of independent goal attainment on SWL, PA, and NA among Filipino young adults; and effect of interdependent goal attainment on NA among Filipino adolescents. In the qualitative study, 10 Filipino adolescents and 10 Filipino young adults selected by a purposive sampling were included in the multiple case studies to explore their personal views, experiences, and goals in goal pursuit and goal attainment in relation to happiness. Convergences and divergences of goals, goal pursuits, and goal attainment linked with happiness were found among Filipinos during adolescence and young adulthood. The quantitative and qualitative findings of the study are discussed with reference to prior research. Implications for counseling practice and recommendations are provided.

Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study.

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.