Explanatory Sequential Mixed Methods Design Research Articles

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.

Implementation of the Revitalized Tertiary Physical Education Program in a Higher Education Institution in Pampanga Grounded on the Statutory Policy of the Commission on Higher Education and UNESCO’s Quality Physical Education Model

The study aimed to evaluate the implementation of the revitalized tertiary physical education program known as the Physical Activity towards Health and Fitness (PATHFit) of a state university in Pampanga, Philippines relative to the statutory standard of the Commission on Higher Education and UNESCO’s Quality Physical Education (QPE) Model. A Mixed Methods Sequential Explanatory Design was utilized involving faculty members (n = 24) and a stratified sample of second-year college students (n = 114). Instrumentations were drafted based on the provisions of two standards considered in the study. The quantitative phase revealed that both the internal stakeholders evaluated the standards of the CMO 39, s. 2021 and the QPE standards and found them to be extremely evident and extremely effective. Additionally, t-tests revealed that there was a significant difference in the evaluation of the respondents. Regression analysis further identified that all five dimensions of the QPE which are assessed in concreteness are significant predictors of program effectiveness. The qualitative phase explored the two dimensions as actualized by the university in terms of notable practices and challenges encountered. It was suggested that the university may institutionalize mechanisms to foster quality physical education standards as embedded in the curriculum development cycle's planning, implementation, monitoring, and evaluation protocols.

Students’ peer feedback engagements in online English courses facilitated by a social network in Thailand

Despite the extensive research on peer feedback in recent years, there is limited understanding of how students engage in peer feedback activities within online English courses and their expectations during these activities. Hence, using a sequential explanatory mixed methods design with a phenomenological approach, this study integrated online peer feedback (OPF) activities into a 12-week online English writing course involving 30 second-year students (16.7% male, 83.3% female) facilitated by a Facebook group. Data were collected through survey questionnaires, written reflections, and task scores. Descriptive statistics and bivariate correlations were used to analyze the quantitative data, while thematic analysis was employed for the qualitative data. Three findings emerged: 1) EFL students exhibited positive engagements in OPF activities, 2) Students' engagements were not significantly correlated with their writing outcomes, and 3) Students provided recommendations for improving the quality and quantity of feedback, incorporating teacher feedback and guidance, and enhancing the overall process and experience. Based on these findings, integrating OPF activities into the academic curriculum is suggested, with a focus on providing guidance to students for delivering descriptive and constructive feedback, offering scaffolding to enhance their comprehension, and writing skills, and addressing concerns related to language proficiency and grammar.

Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study

BackgroundRisk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions.MethodsCase vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression.ResultsRisk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5–30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals’ willingness to intervene.ConclusionsThe results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians’ and midwives’ decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance.Trial registrationGerman Clinical Trials Register DRKS00017172 (18.06.2019).

Inequalities in Girls’ High School Sports Participation: How Social Class, Race/Ethnicity, and Gender Route Opportunities to Play and Persist in Athletics

ABSTRACT High school athletics are understudied sites for social and educational stratification. Participation can offer mental and physical health benefits, improved student retention and graduation rates, the encouragement of pro-social behaviors, resume building, and enhanced social statuses. Despite legal prohibitions against race and gender discrimination in schools, opportunities to play and persist in interscholastic athletics may reflect and amplify existing social and educational stratification processes. Using an exploratory sequential mixed-methods research design, this study centers on girls’ high school sports and considers how gender, race/ethnicity, and social class operate at the individual, interactional, cultural, and institutional levels and encourage proclivities, commitments, and support for participation. We combine qualitative (N = 28 women and 47 total college athletes) and quantitative (N = 4,271 high school students) studies to inquire about how, and to what extent, racial/ethnic and social-class dynamics affect girls playing any and specific high school sports and whether they play persistently. Findings suggest that schools co-construct unequal athletic opportunity structures by nurturing and rewarding a cultivated athletic habitus associated with masculinity, whiteness, and affluent dispositions. These processes disguise athletic advantages and successes as well-earned merit and restrict who is most likely to receive the individual and social benefits of high school sports participation.

Industry 4.0 Readiness and Roadmap in Food Industry: Insights from Indonesian Manufacturing Enterprises Using Explanatory Sequential Mixed-Method Design

The paper aims to understand the current readiness level of Industry 4.0 in the food industry. Furthermore, the study explores the prioritized Industry 4.0 dimensions and initiatives needed to improve the readiness level. The study uses an explanatory sequential mixed-method design. In the quantitative phase, the Industry 4.0 readiness assessment was conducted using the Smart Industry Readiness Index framework. The quantitative study further explores the prioritized dimensions using The Prioritization Matrix framework. In the qualitative phase, interviews with industry practitioners from the participating companies were conducted to gain more understanding and propose the conceptual roadmap. The study found that the Indonesian food industry has a better average readiness than the global average but significantly lower than the best-in-class manufacturers. Vertical Integration, Shop Floor Intelligence, Shop Floor Automation, and Workforce Learning &amp; Development are four priority dimensions to increase the readiness level in the food industry. A conceptual roadmap was proposed to improve the readiness index based on the strategic planning horizon, prioritized dimensions, and initiatives identified from interview results. The results of this study would provide an additional reference for applying explanatory sequential mixed-method design. The prioritized dimensions found would also benefit other researchers in the development of the readiness or maturity model. This paper provides a deeper understanding of Industry 4.0 readiness, the prioritized dimensions, and related improvement initiatives to propose the strategic roadmap for the food industry by utilizing explanatory sequential mixed-method design.

A step toward effective language learning: an insight into the impacts of feedback-supported tasks and peer-work activities on learners’ engagement, self-esteem, and language growth

This study explored the impact of feedback-supported tasks and peer-work activities on language learners’ engagement, self-esteem, and language growth in a university setting in Saudi Arabia. Employing a sequential explanatory mixed-methods design, 45 participants in the experimental group and 43 in the control group underwent 15 sessions of treatment, while traditional instruction was provided to the control group. Pre- and posttests and semi-structured interviews were employed for data collection. Results indicated a significant increase in engagement and self-esteem among experimental participants compared to the control group. Language growth, assessed through a teacher-made test, also demonstrated a significant improvement in the experimental group. The findings align with Vygotsky’s Socio-Cultural Theory and Long’s Interaction Hypothesis, emphasizing the pivotal role of collaboration in language learning. However, limitations include the specific context and the absence of a delayed posttest. Implications for educators, syllabus designers, curriculum developers, and policymakers underscore the importance of integrating collaborative and feedback-oriented strategies into language instruction for enhanced learning outcomes. This research contributes valuable insights for shaping effective language education practices, while suggestions for future research encourage a more comprehensive exploration of long-term effects and contextual variations.

How do patients with rheumatoid arthritis perceive their self-care and self-care support? A mixed-method study.

To explore self-care and needs and preferences towards tailored self-care support of patients with rheumatoid arthritis at the outpatient clinic. A sequential explanatory mixed method design. The Self-Care of Chronic Illness Inventory questionnaire, two focus groups and six semi-structured interviews were conducted between November 2021 and April 2023. Questionnaires of 107 patients were descriptively analysed. Subsequently, 11 patients and 2 healthcare professionals participated in the focus groups and 6 patients in the interviews, which were thematically analysed. Quantitative and qualitative data corresponded and showed that patients perform various self-care activities at an adequate level and have strategies to exert control and reduce symptoms. One key theme emerged: 'Not only being the person with rheumatoid arthritis' (RA) as patients primarily aim to get on with their lives. Nine subthemes covered self-care activities for maintaining health including staying physically active, finding the right medication and dose and adapting their diet. Patients differed in how they self-monitored their symptoms. Recognizing symptoms and finding strategies to manage symptoms included the process of body listening in which patient seek and try different strategies to find what works for them and incorporate routines. Patients experienced positive effects of a warm or cold environment. Patients felt the need for practical and emotional support from others and preferred having credible information. Patients perform adequate self-care including a diversity of self-care activities to get on with their lives and have strategies to reduce and control the symptoms and impact of RA. Tailoring self-care support to patients' individual needs and preferences is necessary to help patients cope with the erratic nature of the disease and maintain their quality of life. Healthcare providers need to provide practical and emotional support and use credible information to allow patients to make self-care decisions to manage their lives. Quantitative finding are reported according to the STROBE guidelines and qualitative finding are reported according to the COREQ guidelines. Patients perform various self-care activities at an adequate level and have strategies to exert control and reduce symptoms. Patients primarily aim to continue their lives and not being seen as the person with rheumatoid arthritis. Healthcare professionals need to provide practical and emotional support and use credible information to inform patients' self-care decision-making. No patient or public contribution.

Reconstruction of Caesarean Section Service Rates for National Health Insurance Patients

RSIA Permata Bunda as a JKN provider is paid according to the INA-CBG rate by BPJS Kesehatan, the amount of which does not match the costs incurred by the hospital so that there is a negative difference between the hospital section caesarea (SC) rate and the INA-CBG rate which reached 2 billion in 2021. The aim of this study was to reconstruct the SC service rate for JKN patients so that efficiency occurs. This study was an explanatory sequential mixed method design, preceded by quantitative research with unit cost calculation using the activity based costing (ABC) method and the average fee for service rate for hospital SC services and then qualitative research for interviews with informants. The unit cost calculated using the ABC method is lower than hospital package rates, fee for service rates but higher than INA-CBG rates for SC severity level I services in treatment classes I, II and III which causes losses for the hospital. Efficiency efforts that can be carried out by hospitals are through tariff reconstruction by adjusting LOS (length of stay), optimizing drug use and supporting examinations according to clinical pathways and changing the calculation of medical services from fee for service to a package system.

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

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

Errors and Misconceptions in Linear Inequalities Among Senior High Students in Mfantseman Municipality

This study aimed to investigate the different errors and misconceptions made by students when dealing with linear inequalities. The goal was to uncover the nature and causes of these errors and misconceptions among students in Senior High Schools within the Mfantseman Municipality in the Central Region of Ghana. The research employed an explanatory sequential mixed methods design and was conducted in two public Senior High Schools selected from the Municipality. A total of 180 Senior High School students and teachers participated in the study, including 10 teachers. The sample was selected using a random sampling technique, which yielded 170 students from the two chosen public Senior High Schools. Data collection encompassed results from students' tests on linear inequalities, interviews with students, and questionnaires given to mathematics teachers. The collected data was coded and analyzed using descriptive statistics. The study's findings revealed common errors made by students, such as multiplying/dividing by a negative number, substituting inequality symbols with "equal to" symbols, performing operations on only one side or different numbers on the two sides of a compound inequality, as well as errors in algebraic operations, simplification, and arithmetic. Misconceptions observed included confusion between equality and inequality, misconceptions when dividing or multiplying through an inequality by a negative number, and struggles with compound inequalities. Students' difficulties arose from an inadequate understanding of basic inequality concepts, overgeneralization, limited mastery of inequality rules, and insufficient exposure to compound inequalities. Translating word problems into algebraic symbols posed a significant challenge. The study also highlighted that mathematics teachers were aware of the errors made by students. Consequently, teachers made efforts to address these errors during linear inequality classes. The findings suggest that teachers not only need assistance in identifying errors but also in understanding how errors can emerge during the learning process. One of the recommendations is to enhance teacher education by emphasizing diverse teacher-student interactions that thoroughly consider students' mathematical ideas. This approach aims to support teachers in effectively utilizing students' experiences in the learning process.

Caregiver strategies supporting community participation among children and youth with or at risk for disabilities: a mixed-methods study.

The purpose of this mixed-methods study is to examine the role of caregiver strategies to support community participation among children and youth with disabilities and those at risk, from the caregiver perspective. For the quantitative phase, we tested the hypothesized positive effect of participation-focused caregiver strategies on the relationship(s) between participation-related constructs and community participation attendance and involvement. For the qualitative phase, we solicited caregiver perspectives to explain the quantitative findings. An explanatory sequential mixed-methods design (QUAN > qual) was used. For the quantitative phase, we conducted secondary analyses of data collected during a second follow-up phase of a longitudinal cohort study, including 260 families of children and youth (mean age: 13.5 years) with disabilities and those at risk [i.e., 120 families of children and youth with craniofacial microsomia (CFM); 140 families of children and youth with other types of childhood-onset disabilities]. Data were collected through the Participation and Environment Measure-Children and Youth, the Pediatric Quality of Life Inventory, and the Child Behavior Checklist and analyzed using structural equation modeling. For the qualitative phase, we conducted semi-structured interviews with eight caregivers of children and youth with disabilities and those at risk (i.e., three caregivers of children and youth with CFM; five caregivers of children and youth with other childhood-onset disabilities). Interviews were transcribed verbatim and inductively content-analyzed. Our model reached acceptable to close model fit [CFI = 0.952; RMSEA = 0.068 (90% CI = 0.054-0.082); SRMR = 0.055; TLI = 0.936], revealing no significant effect of the number of participation-focused caregiver strategies on the relationships between participation-related constructs (e.g., activity competence, environment/context) and community participation in terms of attendance and involvement. The qualitative findings revealed three main categories for how caregivers explained these quantitative results: (1) caregiver workload and supports needed for implementing strategies; (2) caregivers careful strategy quality appraisal; and (3) community setting characteristics hindering successful strategy implementation. The findings suggest that the insignificant effect of the number of caregiver strategies may be explained by the intensified need for caregiver effort and support to develop and implement quality strategies that are responsive to community setting characteristics.

Investigating EFL teacher candidates’ acceptance and self-perceived self-efficacy of augmented reality

AbstractThe mixed-methods sequential explanatory design study presented here sought to investigate the acceptance and self-perceived self-efficacy of Augmented Reality technology among English as a Foreign Language teacher candidates. This study’s contribution to the field of AR as an instructional technology lies in that research on the using AR technology in language teacher education are particularly limited. To bridge this research gap, one-group pre-test-post-test design was used in this study, in which ten weeks of AR-enhanced English language teacher training treatment was carried out. To answer the research questions, quantitative data were gathered from 50 volunteers by using the Technology Acceptance Model survey and Self-Efficacy Scale. Qualitative data were received via semi-structured interviews carried out with 12 pre-service teachers. Findings revealed that there was a significant increase in EFL teacher candidates’ levels of AR technology acceptance whereas no significant difference was identified in their self-perceived self-efficacy. The interviewees proposed interpersonal, intrapersonal, technological, and technical factors to explain their low self-efficacy levels. Based on the findings, the paper offers implications and suggestions for researchers, teacher educators, and policymakers. The solutions to increase the level of acceptance and self-perceived self-efficacy levels to use AR among EFL Teacher Candidates include courses on Emergent Technologies (ICT, MALL, CALL, AR), training via seminars, workshops, input sessions through (inter)nationally funded projects, real-life examples, field-specific samples, and hands-on experiences.

Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study

BackgroundEthiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face.MethodsIn this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently.ResultsThis study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers.ConclusionThe level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers’ optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

Sexual and reproductive health (SRH) of women with mental illness (WMI) - An integrative mixed-method study.

Women with mental illness (WMI) are more likely to experience unreported sexual and reproductive health (SRH) problems. Mixed-method research studies with the strengths of quantitative and qualitative approaches provide deeper insight into SRH issues of WMI. A sequential explanatory mixed-method design was used to understand better the SRH problems of WMI attending tertiary care psychiatry hospital. In phase 1, a survey was conducted to identify if they have SRH problems. Women who were identified to have SRH problems were part of Phase II. In this phase, in-depth interview was conducted to explore their lived-in experiences. Integration at the method level was adopted by connection through sampling. Using a narrative approach, integration was accomplished at the level of interpretation and reporting. Among the users, 261 (64.6%) female sterilization, 244 (93%) was the most common, and the other methods like coitus interruptus, male condoms, and intrauterine devices were reported less. Of the non-users, 137 (33.9%) WMI 100 (73%) were unaware of the best family planning approach. Most of them, 377 (93.3%), were ignorant about sexually transmitted infection (STI) symptoms. WMI reported 62 (15.3%) unusual foul-smelling vaginal discharge and 58 (14.4%) genital ulcers, with poor treatment-seeking behavior. Sexual dysfunction in desire, arousal, lubrication, orgasm, satisfaction, and pain were also reported. The findings were described in a single report based on the quantitative data followed by themes obtained from qualitative interviews using weaving techniques under the headings of contraceptive use and its awareness, prevalence of STI symptoms and its treatment, and sexual health experiences. Data integration demonstrated that one-fourth of WMI had inadequate awareness of contraceptive use, were ignorant of STI symptoms, and experienced sexual dysfunction.