Explanatory Sequential Mixed Methods Design Research Articles

Individual differences in learning agility at work: A mixed methods study to develop and validate a new scale

AbstractThe unprecedented complexity of today's business and working environment increases the need for leaders and employees to learn new skills, be adaptable, and open to embracing change. New abilities and mindsets emerge, and their evaluation is challenging. This research utilized an exploratory sequential mixed methods design to develop and provide a preliminary validation of a scale measuring individual differences in learning agility (LA) at work. The measure has been tested in Central‐Eastern European countries, Italy, and Egypt. Results showed satisfactory reliability and nomological validity. The final scale of 11 items provides HRD researchers and practitioners with a reliable and concise tool suitable for investigating individual differences in LA across different job roles and positions. The scale has been tested in a cross‐cultural setting and is available in English, making it especially appropriate for multinational contexts.

Patient Safety Culture: Nurses' Perspective in the Hospital Setting.

(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.

Time use of patients in a secure forensic hospital: A mixed methods study.

Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004. An explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey. Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use. Patient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems.

How does peer tutoring contribute to the development of reading comprehension? Evidence from ten years of practice

This study investigates the development of reading comprehension in primary school students who took part in a peer tutoring programme. Data were collected from 8,128 students (aged 6–12) from 58 schools that participated in the programme between 2012 and 2022. Adopting a mixed-methods sequential explanatory design, two research aims are addressed: (1) to detect changes in reading comprehension in a pretest-posttest, and (2) to analyse the interaction of a subsample of pairs to explain these changes. Pretest-posttest subgroup analyses show a significant improvement in reading comprehension for all levels, tutoring options, and roles (i.e., same-age tutors and tutees, same-age reciprocal role, cross-age tutors and tutees) (.43 ≤ ES ≤ .97). A linear mixed model shows that grade level and the interaction between this variable and tutoring option may moderate the increase in reading comprehension, after controlling for initial score. Interaction analysis points to key elements that can explain this improvement, mainly students’ explicit use of strategies for reading comprehension, repeated episodes of reading the text aloud, and joint construction of answers. Overall, these findings support the use of peer tutoring for the development of reading comprehension throughout primary education. Limitations of the study as well as implications for research and practice are discussed.

The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)-The Person-centred Practice Inventory-Care (PCPI-C). Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework-the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 -Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 -Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. This study investigated how social connectedness is associated with patient outcomes in a HaH program. The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. The quantitative phase included 100 patients (18years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Examining the Quality of Learning Environment of Sandwich Programmes in Ghana: A Case of Institute of Education

This paper reports on a study that examined the quality of the learning environment of sandwich programmes in Ghana. The study used a sequential explanatory mixed method design and focused on tutors and 400 students of the programme. The Total Quality Management Theory, Expectation Confirmation/Disconfirmation Theory, Context, Input, Process, and Product Evaluation Model underpined the study. A disproportional stratified selection method was used to select 1,000 students and 50 tutors from each of the four teaching centres. While a purposive sampling method was employed to select 12 students and eight tutors involved in sandwich programmes for follow-up interviews. The data were collected using a questionnaire and an interview guide. The quantitative data was analysed using means and standard deviation, while the qualitative data were subjected to thematic analysis. These findings revealed that the tutors show concern for the welfare of the students and offer chances for student-teacher contact. However, big class sizes limit how much faculty can customise the learning environment. Also, students were friendly, helpful, cooperative, and supported one another during activities. The study recommended that the management of the Institute of Education and centre coordinators make every effort to secure spacious classrooms to help reduce large class sizes and increase opportunities for student-teacher interactions, cohesiveness, and students' participation in the classroom. In addition, tutors should foster an atmosphere that invites student interaction and identify students' strengths and weaknesses.

Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.

Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic. The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management. A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management. Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Green brand identity and B2B channel partners' tactical green marketing orientation: Moderating effect of brand governance

Even though environmental values and sustainable branding have garnered much attention in the B2C context, B2B contexts remain relatively less explored. This study introduces a novel synthesis of Signaling theory and Stewardship theory and examines the moderating impact of brand governance on the relationship between green brand identity, consistent communication and channel partner commitment, leading to tactical green marketing orientation. Distinguishing itself from previous research, our approach embraces a multi-perspective lens, delving into the viewpoints of both channel partners and organizations (i.e., managers). Employing an explanatory sequential mixed method design, the first phase involved an empirical survey with 248 respondents (Study 1). Subsequently, the second phase (Study 2) comprised qualitative interviews with 41 respondents. The findings from both studies converged, revealing a positive association between “consistent communication” and “attitude,” a robust connection between “attitude” and “commitment,” and a favorable correlation between “green brand identity” and “attitude,” ultimately leading to a positive relationship between “attitude” and “green tactical marketing orientation". This research significantly contributes to the comprehension of B2B green brand positioning by demonstrating, that in the B2B context, brand governance influences channel partners' commitment and tactical green marketing orientation.

Cardiogenic Shock Challenges and Priorities: A Clinician Survey

Cardiogenic shock (CS) is common and survival outcomes have not substantially improved. Australia's geography presents unique challenges in the management of CS. The challenges and research priorities for clinicians pertaining to CS identification and management have yet to be described. We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 10 clinicians (medical and nursing) to identify themes for quantitative evaluation. A total of 143 clinicians undertook quantitative evaluation through online survey. The interviews and surveys addressed current understanding of CS, status of cardiogenic systems and future research priorities. There were 143 respondents: 16 (11%) emergency, cardiology 22 (16%), 37 (26%) intensive care, 54 (38%) nursing. In total, 107 (75%) believe CS is under-recognised. Thirteen (13; 9%) of respondents indicated their hospital had existing CS teams, all from metropolitan hospitals, and 40% thought additional access to mechanical circulatory support devices was required. Five (5; 11%) non-tertiary hospital respondents had not experienced a delay in transfer of a patient in CS. All respondents felt additional research, particularly into the management of CS, was required. Clinicians report that CS is under-recognised and further research into CS management is required. Access to specialised CS services is still an issue and CS protocolised pathways may be of value.

Investigating the impact of technology-supported 3E learning model in disaster education

AbstractThis research aimed to investigate the effect of a technology-supported 3E learning model on middle school students’ knowledge of disasters and their attitudes towards disaster preparedness. To this end, it used an explanatory sequential mixed methods design. Quantitative and qualitative data were used to describe how the technology-supported 3E learning model changes the learning environment. A pretest-posttest control group quasi-experimental design was used in the quantitative part of the research, and a case study was used in the qualitative part. The experimental procedure lasted for six weeks. The sample consisted of 33 fifth-grade students attending a public school. The Disaster Preparedness Attitude Scale, an achievement test, and an interview form were used as data collection tools. The analysis results showed that the experimental group achieved statistically significantly higher scores in the posttest and the retention test of the Disaster Preparedness Attitude Scale, and the achievement test compared to the control group. Additionally, according to student views, the technology-supported 3E learning model is more helpful in acquiring skills and values, provides the opportunity to learn by experiencing, increases students’ motivation, and facilitates effective disaster education. These results indicate that conducting activities on a subject that concerns the whole society, such as disasters, using advancing and innovative technological devices, preparing lesson plans, and demonstrating their effectiveness in education will make a significant contribution to the literature.

Retrospective perceptions of support for career development among PhD graduates from US and New Zealand universities

PurposePhD graduates are entering an increasing range of careers, but past research has highlighted a lack of preparation for these careers. This study aims to explore the reflections of PhD graduates from science and humanities and social science disciplines regarding support for career development (CD) during their study.Design/methodology/approachThe authors used an explanatory sequential mixed-methods design and collected 136 survey responses and interviewed 21 PhD graduates from two US and one New Zealand universities to investigate their career readiness. Using the lens of Cognitive Information Processing theory, the authors explored the development of self-knowledge and career options-knowledge, and how support at the macro (institutional), meso (departmental) and micro (supervisors) levels influenced CD.FindingsDuring doctoral study, there was very poor engagement with CD activities. Graduates displayed limited self-knowledge and poor knowledge about career options. Graduates reported drawing mainly on their departments and supervisors for career guidance. Although there were pockets of good practice, some departments were perceived as promoting academia as the only successful outcome, neglecting to support other possible pathways. Some graduates reported excellent supervisor support for CD, but others described disinterest or a damaging response if students said they were not wanting to pursue academia.Originality/valueThe enabling aspects for developing self- and options-knowledge are collated into a conceptual model, which identifies key factors at institutional, departmental and supervisor levels, as well as for PhD students themselves.

Medical secretaries’ fears and opportunities in an increasingly digitalised workplace environment

PurposeThe purpose of this mixed-methods study was to explore how medical secretaries experience digital transformation in a Swedish healthcare organisation, with a focus on workplace climate and health.Design/methodology/approachData were collected using a sequential exploratory mixed-methods design based on grounded theory, with qualitative data collection (a Quality Café and individual interviews) followed by quantitative data collection (a questionnaire).FindingsFour categories with seven underlying factors were identified, emphasising the crucial need for effective organisation of digital transformation. This is vital due to the increased knowledge and skills in utilising technology. The evolving roles and responsibilities of medical secretaries in dynamic healthcare settings should be clearly defined and acknowledged, highlighting the importance of professionality. Ensuring proper training for medical secretaries and other occupations in emerging techniques is crucial, emphasising equal value and knowledge across each role. Associations were found between some factors and the health of medical secretaries.Research limitations/implicationsThis study adds to the knowledge on digital transformation in healthcare by examining an important occupation. Most data were collected online, which may be a limitation of this study.Practical implicationsSeveral aspects of the medical secretaries’ experiences were identified. Knowledge of these is valuable for healthcare managers to make digital transformation more effective while avoiding excessive strain on medical secretaries.Originality/valueMedical secretaries are expected to contribute to the digitalisation of healthcare. However, minimal research has been conducted on the role of medical secretaries in workplace digitalisation, focusing on workplace roles and its dynamics.

Exploring patients' perspectives: a mixed methods study on Outpatient Parenteral Antimicrobial Therapy (OPAT) experiences.

Outpatient Parenteral Antimicrobial Therapy (OPAT), an alternative to inpatient intravenous antibiotic therapy, has shown benefits in international studies such as increased patient satisfaction. Because OPAT has been used only sporadically in Germany so far, no structured results on patients' experiences and concerns regarding OPAT have yet been available. This study therefore aims to explore the experiences of OPAT patients in a pilot region in Germany. This is an observational study in a German pilot region, including a survey of 58 patients on their experiences with OPAT, and in-depth interviews with 12 patients (explanatory-sequential mixed-methods design). Patients reported that they were satisfied with OPAT. That a hospital discharge was possible and anti-infective therapy could be continued in the home environment was rated as being particularly positive. In the beginning, many patients in the interviews were unsure about being able to administer the antibiotic therapy at home on their own. However, healthcare providers (doctors and pharmacy service provider staff) were able to allay these concerns. Patients appreciated regular contact with care providers. There were suggestions for improvement, particularly concerning the organization of the weekly check-up appointments and the provision of information about OPAT. Patients were generally satisfied with OPAT. However, the treatment structures in Germany still need to be expanded to ensure comprehensive and high-quality OPAT care. NCT04002453, https://www. gov/ , (registration date: 2019-06-21).

Recognizing the opportunity to directly de-label no-risk penicillin allergies in community pharmacy: a mystery shopper experience.

Incorrect labelling of a penicillin allergy can lead to unnecessary use of broad-spectrum, less effective, more harmful, or more costly antibiotics. Community pharmacists are well positioned to educate the public on penicillin allergies, prevent incorrect labelling persisting, and optimize prescribing of antibiotics. This study investigated community pharmacists' capacity to recognize an opportunity to directly de-label a no-risk penicillin allergy. A sequential explanatory mixed methods design using mystery shopping (quantitative) and postvisit reflections (qualitative). Mystery shoppers simulated a case of a previously dispensed prescription (involving nonimmune mediated intolerance 'thrush' as the reported allergy) that provided the opportunity for pharmacists to educate on incorrect penicillin allergy. The main outcomes were proportion of community pharmacists who ascertained the nature of the penicillin reaction, provided education on incorrect penicillin allergy labels and its consequences. Knowledge and practices regarding penicillin allergy were collected. Across two major states in Australia, 265 community pharmacists participated. Only 44.5% (118/265) of pharmacists asked about the nature of the reaction; of those, 91.52% (108/118) indicated that 'thrush' is not an allergic reaction. No pharmacists took the opportunity to educate on how an incorrect allergy label can impact antibiotic prescribing. Postvisit reflection data revealed five probable explanations for the observations viz. outdated knowledge, lack of knowledge, prioritizing management of adverse drug reaction (thrush), variations in duty of care and assumption of true allergy without an assessment. Our findings underscore a concerning knowledge and practice gap among community pharmacists regarding penicillin allergy assessment which warrants more support and education in the community pharmacy sector.

Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study

BackgroundIt is crucial to include a wide range of the population in clinical trials for the outcome to be applicable in real-world settings. Existing literature indicates that under-served groups, including disabled people, have been excluded from participating in clinical trials without justification. Exclusion from clinical trials exacerbates disparities in healthcare and diminishes the benefits for excluded populations. Therefore, this study was conducted to investigate potential obstacles that prevent disabled people from participating in clinical trials in the United Kingdom (UK).MethodsThe study was carried out through an explanatory sequential mixed methods design. The Imperial Clinical Trials Unit devised and implemented an online questionnaire-based survey (with open/closed-ended questions) and an online focus group discussion. The target population were disabled people, family members/carers of disabled people and staff involved in clinical trials, whereupon the sample was recruited by convenience sampling methods via posters and emails through various networks. The Qualtrics XM survey system was used as the host platform for the online survey, and Microsoft Teams was used for an online focus group discussion. The focus group discussion was conducted to gain a deeper understanding of the themes identified from the survey responses. We analysed responses to the survey via descriptive analysis and used thematic analysis to synthesise the free-text answers from the survey and focus group discussion.ResultsWe received 45 responses to the survey questionnaire and 5 disabled people took part in a focus group discussion. Our findings highlighted the differences between the perspectives of researchers and those “being researched” and different types of barriers experienced by disabled people: opportunity barriers (inadequate recruitment strategy and ambiguous eligibility criteria), awareness barriers (perception of disability) and acceptance/refusal barriers (available support and adjustment, and sharing of trial results).ConclusionOur findings support perspectives drawn from the Ford Framework regarding the need to consider all barriers, not just up to the point of enrolment into trials but also beyond the point of inclusion in clinical trials. We support calls for the introduction of legislation on including disabled people in clinical trials, implementation of industry/community-wide participatory approaches and the development of guidelines, a combined public–private approach.

Chinese and non-Chinese parents’ perceptions of school counselling in Hong Kong: a mixed-methods cross-cultural comparison

ABSTRACT Little is known about parents’ perceptions of school counselling in Hong Kong. We adopted an explanatory sequential mixed methods design to investigate Chinese and non-Chinese parents’ perceptions. In phase one, 287 parents in Hong Kong were surveyed. Results suggested that Chinese parents had a poorer understanding of counsellors’ roles, more negative perceptions of counselling, and were less likely to perceive counselling as beneficial than did non-Chinese parents. In phase two, we interviewed 27 parents. Our findings suggested that cultural stigma and school-related factors accounted for the findings of the phase one study. Schools may consider proactive engagement with parents, and establishing communication which is sensitive to cultural norms to promote a better understanding of and willingness to participate in counselling.

"There's room to do more": a mixed-methods study of the Temporary Assistance for Needy Families (TANF) diversion program and intimate partner violence in Georgia.

Intimate partner violence (IPV) is a risk factor for homicides and suicides. As poverty is both a predictor and a consequence of IPV, interventions that alleviate poverty-related stressors could mitigate IPV-related harms. Temporary Assistance for Needy Families (TANF), a monthly cash assistance program, is one such potential intervention. In the state of Georgia, the TANF diversion program, which provides a non-recurrent lump-sum payment to deter individuals from monthly TANF benefits, is an understudied component of TANF that may influence the effectiveness of state TANF programs in supporting IPV survivors. This study quantifies and qualifies the role of Georgia's TANF diversion program in shaping IPV-related mortality. This study relies on a mixed-methods sequential explanatory design. Using data from the Georgia Violent Death Reporting System (GA-VDRS), an interrupted time series analysis was conducted to estimate the effect of TANF diversion on IPV-related homicides and suicides. Semi-structured interviews were then administered with TANF policy experts and advocates, welfare caseworkers, and benefit recipients (n = 20) to contextualize the quantitative findings. The interrupted time series analysis revealed three fewer IPV-related deaths per month after implementing TANF diversion, compared to pre-diversion forecasts (coefficient = -3.003, 95%CI [-5.474, -0.532]). However, the qualitative interviews illustrated three themes regarding TANF diversion: (1) it is a "band-aid" solution to the access barriers associated with TANF, (2) it provides short-term relief to recipients making hard choices, and (3) its limitations reveal avenues for policy change. While diversion has the potential to reduce deaths from IPV, it may be an insufficient means of mitigating the poverty-related contributors to IPV harms. Its limitations unveil the need for improved programs to better support IPV survivors.

Learning Pronunciation Using Record, Listen, Revise (RLR) Method in Dictionary Speech Assistant–ELSA Speak Application: How the Flow of Thinking Goes

Dictionary Speech Assistant is a combination of Record, Listen, Revise (RLR) method of ELSA Speak Application to help students improve their pronunciation. The aims of the research were to describe the effectiveness as well as to explore how the flow of thinking of the junior high students in improving their pronunciation using RLR method in ELSA Speak Application. An explanatory sequential mixed-method design was utilized to collect quantitative and qualitative data. The data gained from pre-test, post-test, and documentation of single words which were collected from 34 students of SMA N 6 Semarang. Then, they were analyzed using SPSS program quantitatively and descriptive qualitative. The quantitative result outlined that there was significant difference on students’ pronunciation skill with t-test value was higher than t-table (9.117>2.035). The effectiveness was qualitatively proven using RLR method; Record phase with the score of 23%, Listening phase which was followed by imitating process. In the Revise phase, after two to five attempts the students got the score of 96%, which was an increase from the first attempt. It is concluded that Dictionary Speech Assistant is beneficial for students in learning pronunciation. The majority of students believed that Dictionary Speech Assistant creates a new environment to help students improve their pronunciation skills.

A mixed methods study on continuity and care coordination based on the obstetric near miss approach.

The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. To investigate elements of continuity and coordination leading to obstetric near misses. A major referral hospital and its referral pathway in Kenya. Explanatory sequential mixed-methods design. Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.