Explanatory Sequential Mixed Methods Research Articles

Why becoming a positive deviant for malaria prevention and control: a sequential explanatory mixed methods study in Bugesera district, Rwanda

BackgroundMalaria continues to be a significant global health challenge, particularly in sub-Saharan African regions. Effective prevention and control strategies are crucial in mitigating its impact. Therefore, assessing the use of malaria preventive measures, treatment-seeking behaviours, and understanding the motivating factors behind positive behaviours/practices and barriers to using malaria preventive and control measures is essential for designing successful intervention programs.MethodsUsing a sequential explanatory mixed methods design, a descriptive cross-sectional study was conducted among 382 heads of households in the Mareba sector, Bugesera district, Rwanda. A qualitative study followed with 30 in-depth interviews among the top performers and other community members to explore the motivations and barriers to performing positive behaviours. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used.ResultsThis study revealed that among those who own insecticide-treated nets, 234(89.3%) reported that they slept under the bed net the night preceding the survey; 256(67%) had fever cases in the last 24 months preceding the survey; and 214(87%) reported seeking care within 24 h. While almost all 243(98.8%) of participants who had fever case reported that they have taken all medicines as prescribed, however, a large number 263(68.8%) and 148(38.7%) still think that there are people in the community who do not take all malaria medications as prescribed and there are people who share malaria medications in the community, respectively. 82(65.1%) of those who never had a fever case believe that they have been using malaria preventive measures correctly and consistently. This study found that knowledge about malaria, family support, and community mobilization are the top motivating factors to practice positive behaviours while, lack of bet nets, poverty, and lack of time were reported as main barriers.ConclusionInterventions that target key motivating factors for adopting positive behaviours in malaria prevention and control should be prioritized. This, in turn, will reduce the disease burden on affected populations. Efforts to overcome barriers in malaria prevention and control should also be participatory. Community involvement should be at the centre of these interventions.

Addressing diversity, equity, and inclusion in library and information science curriculum: Looking back and to the future

This study emphasizes the importance of library and information science (LIS) educators drawing insights from practitioners’ lived experiences, particularly considering perspectives of former students’ experiences when navigating the Master of Library Science (MLS) curriculum. Acknowledging the constructivist underpinnings of learning, with a focus on Schema Theory, is imperative for LIS faculty to learn more about how students perceived their past curriculum. Challenges occur when students lack the necessary schemata to comprehend unfamiliar concepts, particularly in areas like diversity, equity, and inclusion (DEI). Given the lack of diversity amongst the faculty population in LIS, faculty must navigate this discrepancy, recognizing the potential mismatch between their own life experiences, those of their student body, and the diverse patrons of varying genders, races, sexualities, income levels, locations, and abilities that libraries and librarians aim to serve. To address this, educators should not only activate existing student schema but also guide them in constructing new schemas, especially when delving into unfamiliar DEI topics. This study employed an explanatory sequential mixed methods design, involving 190 participants who responded to a survey. Additionally, 26 participants completed interviews. Following Creswell and Plano Clark’s approach, this design allowed for a quantitative phase to gather data, followed by a qualitative phase to further contextualize the quantitative results. The findings offer valuable insights into DEI education and the challenges faced by LIS educators in promoting meaningful learning experiences to prepare students to work with all library patrons.

Validation of a Clinical Teaching Competency Framework for Physical Therapists: A Mixed-Methods Approach.

A competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the clinical teaching competency framework by gathering input specifically from clinical education faculty. This study used an explanatory sequential mixed methods approach to seek input from clinical instructors (CI) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom. Survey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and enhancement of quality of clinical education (94.1%). Concern regarding ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of Collective Impact, with 4 subthemes: Assessment, CI development, Implementation, and Guidelines. Clinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework into practice should be collaborative and consistent across academic and clinical education programs. This study moves the profession one step closer to use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.

Understanding the developmental well-being of children from refugee backgrounds in British Columbia, Canada: A population-level mixed methods approach

Objectives and ApproachThis study utilized an explanatory sequential mixed methods approach to investigate the developmental well-being of children from refugee backgrounds in British Columbia (BC), Canada. Objective 1 (quantitative) leveraged population-level, government administrative data individually linked to a province-wide, routinely collected, teacher-reported measure of children’s development in kindergarten (the Early Development Instrument; EDI) to examine developmental outcomes across five domains for children identified as first-generation refugees (N=770), first-generation immigrants (N=7875), and non-migrants (N=199,186). In Objective 2 (qualitative), the population-level EDI results were brought to focus groups with BC educators and settlement workers (N=7) who work closely with children from refugee backgrounds to further corroborate, expand, and elaborate on the findings. ResultsA series of multiple linear regression models; adjusted for age, sex, and English Language Learner status showed that first-generation refugee status was significantly predictive of lower EDI scores in the areas of language & cognitive development, communication & generation knowledge, social competence, emotional maturity, and physical health & well-being. Focus group results corroborated the quantitative findings, added critical complexity/context (e.g., impacts of trauma), and identified important policy-oriented levers (e.g., early, accessible assessments and supports). ConclusionsThe study provided an understanding of the population-level developmental well-being of children from refugee backgrounds in BC, framed by rich, contextualized, and actionable knowledge from focus groups. ImplicationsShowcasing the combined breadth and depth of using a mixed methods approach, how we can best support the developmental challenges and build upon the strengths of children from refugee backgrounds will be discussed.

Understanding the behavioural determinants of active travel among older adults: A mixed methods study

IntroductionActive travel is an accessible form of physical activity, associated with physical and mental health benefits, particularly for older adults. This study aimed to identify the behavioural determinants that significantly impact older adults’ engagement in active travel as well as how and why these behavioural determinants occur. MethodsThis study employed an explanatory sequential mixed methods design informed by the Theoretical Domains Framework (TDF). The study focused on older adults in Scarborough, Canada. In the quantitative phase, a TDF-informed survey was distributed among Scarborough older adults and analyzed using descriptive statistics, Chi-squared tests, and generalized linear models. TDF determinants that significantly impacted older adult participants in active travel were identified. The qualitative phase followed up with select survey participants about their experiences with these TDF determinants. Semi-structured interviews were conducted, and data was analyzed using thematic codebook analysis. To integrate the quantitative and quantitative results, data were interpreted and integrated using a joint display matrix. ResultsThe survey results suggest that the TDF domains of motivation (i.e., feeling inspired to active travel) and skill (i.e., having the aptitude to active travel) were highly predictive of active travel behaviour among older adults in Scarborough, Canada. Beyond the TDF, the likelihood of active travel increased if participants reported being encouraged and satisfied with their health, fitness, exercise, and well-being in general. The interview results suggest that fostering motivation and skill require a network of interventions that address multiple TDF domains such as promoting action planning, creating commitment, building social connectedness, increasing awareness of active travel options, and building emotional and physical safety. By integrating the quantitative and qualitative results, three overarching themes were presented about older adults’ needs to engage in active travel: building reassurance (i.e., putting safety first); building meaningfulness (i.e., creating joy, fulfillment, and purpose); and building relatedness (i.e., creating awareness and connection). ConclusionsThis study suggests several important implications for future research and policy. The results of this study provide evidence to support investment in both built environment improvements (e.g., safer intersections, bike lanes, lower vehicle speed limits, public transit subsidies) as well as tailored activities to promote active travel (e.g., public awareness campaigns, skill development activities, organized walks). The mixed methods study design employed in this study in conjunction with a novel application of the TDF allowed for a more thorough understanding of behavioural determinants of active travel among older adults.

Patient experiences of a student-led physiotherapy neurological rehabilitation clinic: a mixed methods study

Background: Student-led clinics (SLCs) are becoming increasingly prevalent across allied health professions curricula; however, little is known about patient experiences of these clinics. This study explored the experiences of patients attending a physiotherapy neurological rehabilitation SLC. Methods: This study utilized a sequential explanatory mixed methods approach focusing on people with neurological conditions who voluntarily attended a SLC of 12 weeks duration. The data collection process was initiated following the conclusion of the final SLC session. The methodology employed a survey followed by semi-structured interviews to explore emerging areas in more depth. Interview data were descriptively analyzed, and reflexive thematic analysis guided the analysis of the interview data. Results: Twelve participants completed the survey, and seven also participated in a semi-structured interview. Overall, patients were very satisfied with the service received at the SLC. Three themes were identified from the interview data: patients’ perceptions of the benefits and impact of the SLC; the importance of individualized care, and patients' preferences for SLC delivery. Discussion: The findings of this study indicate that participants perceived this SLC positively in relation to care quality, student skills, and individualized rehabilitation. This suggests that SLCs of this type may potentially be acceptable and applicable across different settings, student groups, and possibly for those living with other health conditions. Future research should investigate patient experiences of SLCs with larger sample sizes, different student cohorts, stages, and patient groups and establish the effectiveness of patient clinical outcomes.

Development and Validation of Ikhlaas Scale for Pakistani Muslim Adults.

Ikhlaas refers to the capacity of having sincere intentions in both acts of worship (ibadah) dedicated to God and our dealings with others, as we strive to seek God's pleasure. The present research was primarily conducted to develop a psychometrically sound measure of ikhlaas and establish its construct validity. Using an exploratory sequential mixed methods design, it comprised two studies. Study 1 was conducted in three phases. In Phase 1, an initial set of 17 items for the Ikhlaas Scale (IS) was developed through the thematic analysis of Quranic verses, semi-structured interviews, and focus group discussions. Phase 2 was related to the translation and cross-language validation of scales. Phase 3 involved administering this item pool to a sample of Pakistani Muslim adults (N = 300) and conducting an exploratory factor analysis (EFA) that revealed a two-factor structure (item loading 0.45-0.89) for the 12-item IS, accounting for 43.65% of the variance. The first factor measured ikhlaas in worship (7 items), while the second factor measured ikhlaas in dealings with others (5 items). Ikhlaas had a significant positive correlation with taqwa and significant negative correlations with materialism, providing evidence for the convergent validity of the IS. In Study 2, confirmatory factor analysis (CFA) conducted on a sample of Muslim adults (N = 702) confirmed the 12-item, two-factor structure of the IS observed in the EFA. Ikhlas was positively related to religious commitment and religious emphasis. In the final measurement model, the average variance extracted (AVE) of all constructs (ikhlaas, religious emphasis, and religious commitment) was > 0.50, the values of maximum shared variance (MSV) were lower than those of AVE, and the diagonal values of the square root of the AVE were higher than the intercorrelations. The heterotrait-monotrait correlation ratio (HTMT) ranged from 0.51 to 0.61, which testified to the discriminant validity of IS. Overall, the IS is a robust measure of ikhlaas that needs to be further studied for developing its nomological network across global Muslim populations.

Exploring the barriers and enablers of industrial solutions in renovation projects: a mixed-methods study in the finnish AEC industry

Offsite construction is a major approach to promote industrialisation in construction. However, implementation of prevailing industrial solutions is often less adequate and unsatisfactory, especially in renovation projects. Thus, the overall objective of this study is to understand the reasons behind the poor performance in implementation of the industrial solutions. The specific objectives include identifying the prominent barriers and enablers of prefabricated products in renovation projects. This study employed exploratory sequential mixed method. The qualitative data were gathered via semi-structured interviews to collect experiences and perception of experts related to industrial solutions. This was followed by quantitative data collection via questionnaire survey using a seven-point Likert scale. The major barriers and enablers of industrial solutions in renovation projects have been ranked in this study. The findings reveal that immutability of heritage buildings, the tolerances of old buildings and insufficient spaces to ensure construction work ranked the top three barriers for implementing industrial solutions in renovation projects. Moreover, the study identifies the most significant enablers including shorter project schedules, quality improvement and work safety improvement. The novelty of the research lies in the comprehensive presentation of the barriers and enablers of industrial solutions in the renovation project context. Policymakers, designers, and contractors can utilize these findings as guiding principles to enhance decision-making processes and create viable solutions for the obstacles encountered in renovation projects. This study further represents a vital step towards the efficient and effective implementation of industrial solutions in renovation projects, resulting in more sustainable and cost-effective outcomes.

Women's perspectives on the role and impact of Breastfeeding Support Groups in Ireland

BackgroundBreastfeeding Support Groups are deemed effective in promoting breastfeeding initiation and duration, but few studies have addressed the mothers’ perspectives. Research aimTo investigate the role and impact of Breastfeeding Support Groups on breastfeeding mothers in Ireland from the women's perspective. Specific objectives included the assessment over time of breastfeeding self-efficacy knowledge, use, and limitations of BSGs and whether they contributed towards women achieving their breastfeeding goals. MethodsAn online survey using an established, validated Breastfeeding Self-Efficacy tool and custom-designed questions was administered at two time points as part of a larger sequential explanatory mixed methods’ design. Cultural Historical Activity Theory was used as the theoretical framework. ResultsMajority of respondents at Phase 1 (N=978) were multiparous, urban dwellers, and breastfeeding more than twelve months. Mothers first attend Breastfeeding Support Groups primarily to meet other breastfeeding mothers with many attending multiple types of group formats weekly. Qualities considered extremely important in breastfeeding supporters were: personal breastfeeding experience breastfeeding knowledge empathy understanding and listening skills There was no statistical difference in breastfeeding self-efficacy over time (z=-1.296, p=.195, r=-0.06). ConclusionsParticipants attend Breastfeeding Support Groups to ‘meet other mothers’ in a convenient and local location, and not necessarily for a problem. Breastfeeding Support Groups normalise breastfeeding through social support, with breastfeeding supporters providing knowledge, empathy, understanding listening, and personal breastfeeding experience. Breastfeeding self-efficacy was high and did not increase over time, suggesting mothers need to be highly efficacious in this cohort to breastfeed.

Patients’ experiences with ‘sludge’ (administrative burden) in the cancer screening process and its relationship with screening completion, experience and health system distrust

Objective‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated...

Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study.

Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

Technology, Pedagogy and Knowledge Element (TPACK) in The Malaysian Automotive Industry In-House Training Framework

In order to ensure that the Malaysian automotive industry is able to compete with the world market, continuous workplace learning must be in place. This is to ensure existing employees in the automotive industry maintain productivity and competitiveness. This study is conducted to identify the element of TPACK to further explore the component of in-house training framework for the automotive industry. This study uses a sequential exploratory mixed method model as a research design. The components of TPACK for the in-house training framework have been identified through the use of expert interviews. The interview phase featured seven panels, including technical trainers and academics with expertise in automotive industry. Data on the suitability of the TPACK elements was gathered quantitatively using questionnaires. The survey included 114 automotive technical trainers in total as a sample. Pedagogical knowledge (PK) comprises 22 out of the 36 training elements that were found to be the majority. The findings of this study also suggest the importance for technical trainers to integrate the TPACK model in the development of in-house training in the automotive industry. By integrating the TPACK model, a comprehensive in-house training can be developed and implemented.

How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self-Management Solution.

Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app. (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.

The Somali Distress and Resilience Scale: Development of a novel measure for Somali adults.

Although resilience has been identified as an important mediator of negative mental health outcomes among refugee populations, there are few culturally specific measures of resilience among such communities and no such measure among Somalis. In this study we aimed to develop a culturally appropriate measure of resilience specific to Somali adults in San Diego, as an example of a vulnerable refugee community. A community-based, exploratory sequential mixed method investigation was conducted via focus group discussions (n = 4), cognitive interviews (n = 4), and iterative survey adaptation. Somali refugee adults in San Diego (N = 183) were surveyed with this novel scale, a standardized measure of resilience, and assessments of depression, anxiety, and PTSD. Results were analyzed via correlation coefficients and multivariate linear regression modeling. Qualitative findings supported the inclusion of items addressing both barriers and facilitators of good mental health, which resulted in the development of the Somali Distress and Resilience Survey (SDRS). Linear regression analysis revealed that the SDRS demonstrated significant associations with symptoms of depression and PTSD, while the standardized measure of resilience did not demonstrate associations with any of the mental health outcomes assessed. The SDRS identified obstacles to resilience among Somali individuals, placing them at risk of developing negative mental health outcomes. Our novel measure also demonstrated more robust relationships with these outcomes than a standardized measure of resilience, suggesting greater utility of the adapted scale. However, the SDRS's development raises larger questions about the limitations of developing and comprehensively evaluating novel resilience measures in a community-based setting.

Digital Developmental Advising Systems for Engineering Students Based on Accreditation Board of Engineering and Technology Student Outcome Evaluations

The purpose of this research is to examine the benefits and limitations of the implementation of novel digital academic advising systems based on the principles of authentic outcome-based education (OBE) using automated collection and reporting processes for Accreditation Board for Engineering and Technology (ABET) student outcomes data for effective developmental advising. We examine digital developmental advising models of undergraduate engineering programs in two universities that employ customized features of the web-based software EvalTools®, including an advising module based on assessment methodology incorporating the faculty course assessment report, performance indicators, and hybrid rubrics classified according to the affective, cognitive, and psychomotor domains of Bloom’s learning model. A case study approach over a six-year period is adopted for this research. The two case studies present results of samples of developmental advising activity employing sequential explanatory mixed methods models using a combination of quantitative and qualitative analyses of a) detailed students’ outcomes and performance indicator information and b) self-evaluation of their professional development and lifelong learning skills. The findings of this study show that digital advising systems employing the faculty course assessment report using performance indicators and hybrid rubrics can provide comprehensive and realistic outcome data to help both developmental advisors and students easily identify the specific cause of performance failures, implement practical recommendations for remedial actions, and track improvements. Inherent strong skills can also be identified in academically weak students by observing patterns or trends of relatively better-performing outcomes to reinforce their natural affinity for learning specialized competencies to help them pursue related and successful career paths.

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

The influence of care home registration type and size on senior care leader’s confidence to provide palliative and end-of-life care: an explanatory sequential mixed methods study

BackgroundCare home staff are key providers of palliative and end-of-life care. Yet, little is known about how care home characteristics can influence care leader’s confidence in their ability to provide optimal palliative and end-of-life care.AimTo understand the influence of care home registration type (nursing, residential or dual registered) and size on senior care leader’s confidence to provide palliative and end-of-life care.DesignAn explanatory sequential mixed methods study comprising an online cross-sectional survey (including the Palliative Care Self-Efficacy Scale) and qualitative individual interviews. Analysis of survey data used a multivariate logistic regression and qualitative interview data used Framework Analysis. A ‘Following the Thread’ method was undertaken for data integration.Setting/participantsUK care home senior care leaders, purposively sampled by registration type, size and geographical location.ResultsThe online survey (N = 107) results indicated that nursing home senior care leaders had higher confidence scores on the Palliative Care Self-Efficacy Scale than residential care home leaders (aOR: 3.85, 95% CI 1.20-12.31, p = 0.02). Care home size did not show effect when adjusting for registration type (medium - aOR 1.71, 95% CI 0.59–4.97, p = 0.33; large – aOR 0.65, 95% CI 0.18–2.30, p = 0.5). Interviews (n = 27) identified three themes that promote confidence, (1) ‘feelings of preparedness’ stemming from staff expertise and experience and care home infrastructure, (2) ‘partnership working’ with external services as a valued member of the multidisciplinary team, and (3) a shared language developed from end-of-life care guidance.ConclusionCare home senior care leader’s confidence is influenced by care home characteristics, particularly availability of on-site registered nurses and the infrastructure of large care homes. All care home leaders benefit from training, working with external, multidisciplinary teams and use of guidance. However, mechanisms to achieve this differed by care home type and size. Further exploration is needed on successful integration of palliative care services and interventions to enhance confidence in residential care homes.

Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study.

Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments. This study aims to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies. This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions' programs.

Facilitators and barriers to evidence adoption for central venous catheters post-insertion maintenance in oncology nurses: a multi-center mixed methods study

BackgroundThe post-insertion maintenance of central venous catheters(CVCs)is a common, vital procedure undertaken by nurses. Existing literature lacks a comprehensive review of evidence adoption for CVCs post-insertion maintenance specifically within the oncology context. This investigation assessed evidence-based practice by oncology nurses in the care of CVCs, elucidating facilitators and obstacles to this adoption process.MethodsThis was a sequential explanatory mixed methods study, executed from May 2022 to April 2023, adhering to the GRAMMS checklist. The study commenced with a cross-sectional study through clinical observation that scrutinized the adoption of scientific evidence for CVC maintenance, analyzing 1314 records from five hospitals in China. Subsequently, a semi-structured, in-depth interview with nurses based on the i-PARIHS framework was conducted to ascertain facilitators and barriers to evidence adoption for CVCs post-insertion maintenance. Fifteen nurses were recruited through purposive sampling. Descriptive statistics were used to summarize quantitative data, while content analysis was used to analyze qualitative data.ResultsAn overall compliance rate of 90.0% was observed; however, two domains exhibited a lower adoption rate of less than 80%, namely disinfection of infusion connector and disinfection of skin and catheter. Three barriers and two facilitators were discerned from the interviews. Barriers encompassed (1) difficulty in accessing the evidence, (2) lack of involvement from nurse specialists, and (3) challenges from internal and external environments. Facilitators comprised (1) the positive attitudes of specialist nurses toward evidence application, and (2) the formation of a team specializing in intravenous therapy within hospitals.ConclusionThere exists a significant opportunity to improve the adoption of evidence-based practices for CVC maintenance. Considering the identified barriers and facilitators, targeted interventions should be conceived and implemented at the organizational level to augment oncology evidence-based practice, especially the clinical evidence pertinent to infection control protocols.Trial registrationThis investigation was sanctioned by the Medical Ethics Committee of Henan Cancer Hospital (Number 2023-KY-0014).

Rethinking the implications of sprawl for sustainable urban development: Insights from the Ejisu Municipality of Ghana between 2003 and 2023

Urban sprawl has been the focus of substantial academic discussion due to its intricate nature. The dominant narrative of this phenomenon, particularly in the global south, points to its adverse implications on cities, despite its positive outcomes. This study contributes to this discourse by examining the positive implications of sprawl — essentially spatial expansion and urban growth — from the perspectives of households and local planning officials within the Ejisu Municipality of Ghana. Employing an explanatory sequential mixed methods design, satellite images were used to assess the nature and spatial extent of Ejisu Municipality between 2003 and 2023. Additionally, 500 households and four relevant agencies were interviewed to discuss the positive implications of sprawl on the area's development and suggest measures to promote sustainable urban sprawl and development. The results showed significant horizontal expansion in the built-up areas over the period - from 34.51 km2 (16.6%) in 2003 to 44.92 km2 (21.61%) in 2013 and 76.46 km2 (36.78%) in 2023 with a projected increase to 100.80 km2 in 2033. Macroeconomic factors, demography, housing preferences, transportation, and regulatory frameworks were reported to influence the nature and extent of sprawl. Sprawl was reported to have resulted in economic diversification and viability, improved quality of life, improved access to public services, affordable housing, and expanded road networks, among others. The study proposes implementing sustainable measures for urban sprawl, and effective land-use planning, coupled with the enforcement of well-designed regulatory frameworks.