Explanatory Sequential Mixed Methods Research Articles

Experiences of gender-affirming healthcare among transgender and gender diverse (TGD) people during the COVID-19 pandemic: an explanatory sequential mixed methods study

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.

Challenges of mainstreaming institutional policy and frameworks of disaster risk management in Ethiopia

ABSTRACT This research examines the challenges of mainstreaming disaster risk management (DRM) policies and frameworks into the existing institutional structures in Ethiopia. Employing an exploratory sequential mixed method approach, incorporating qualitative and quantitative data collection and analysis, the study delves into the effectiveness of DRM implementation within the Ethiopian context. Primary data was mainly collected through a survey of 120 individuals and interviews with 18 experts. The findings showed that the Ethiopian sector encountered significant challenges in integrating DRM policies and frameworks due to limited resources and capacity. Implementation faced obstacles like insufficient data, coordination gaps between government agencies, and a lack of awareness among stakeholders. Additionally, frequent natural disasters exacerbate these challenges, demanding more robust and adaptive DRM strategies. The study underscores the necessity of enhancing the capacity of governmental institutions, civil society organisations, and local communities through targeted training programmes and knowledge-sharing platforms to facilitate effective DRM implementation. Moreover, the research emphasises the apparent gap related to the policies and frameworks and the imperative of strengthening institutional coordination and collaboration among relevant government ministries, agencies, and stakeholders, advocating for the establishment of inter-ministerial task forces or committees dedicated to DRM.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

Abstract 4112589: Typology of Self-Care in Adults with Type 1 Diabetes and Impaired Awareness of Hypoglycemia

Introduction: Individuals with type 1 diabetes (T1D) complicated by impaired awareness of hypoglycemia (IAH) are at significantly increased risk for severe hypoglycemia: a marker of high risk of CVD. Tailoring interventions to promote hypoglycemia avoidance is difficult due to self-care heterogeneity among those with T1D. Aims: Map self-care heterogeneity among adults with T1D into behavioral phenotypes and identify common barriers to hypoglycemia avoidance within each phenotype. Methods: An explanatory sequential mixed methods study was performed in 200 adults with T1D. Participants reported personal, clinical, and social determinants of health, hypoglycemia awareness, and self-care of diabetes (Self-Care of Diabetes Inventory, scored 0-100, adequate ≥70) . Cluster analysis was performed to identify self-care clusters. Then, directed content analysis was applied to individual, semi-structured interviews performed in a subsample from each cluster with IAH ( n =20). Findings were integrated to develop a typology of self-care and identify barriers to hypoglycemia avoidance within each phenotype. Results: Three self-care phenotypes were identified. Experts ( n =70; mean age: 45±17 years; 24% Black; T1D duration: 25±16 years; HbA 1c : 7.36±1.67%; IAH: 20%) performed all aspects of self-care adequately (Maintenance: 84.9±8.8; Monitoring: 85.1±8.8; Management: 72.5±10). Yet, Experts with IAH reported purposefully delaying treatment of hypoglycemia due to lack of concern. Those with Inconsistent self-care ( n = 112; mean age 37±14 years; 20% Black: T1D duration: 21±13 years; HbA 1c : 7.26±1.16%; IAH: 30%) performed only self-care maintenance adequately (Maintenance: 78.6±8.9; Monitoring: 65.6±9.8; Management: 56.8±10.1). Those with Inconsistent self-care and IAH reported passive self-care monitoring that inhibited effective hypoglycemic management. Novices ( n = 18; mean age 27±7 years; 50% Black: T1D duration: 16±8 years; HbA 1c : 8.97±2.80%; IAH: 28%) reported difficulty performing all aspects of self-care (Maintenance: 51.9±7.7, Monitoring: 56.9±12.9, Management: 44.5±6.3) due to economic and psychosocial barriers. Conclusions: Self-care heterogeneity mapped onto three phenotypes that can be used to better understand patient barriers to hypoglycemia avoidance and hypoglycemia awareness restoration. This typology provides a framework for investigating how best to tailor IAH treatment considerate of self-care.

Perception of caregivers on ITNs utilisation and its effectiveness among children under 5 years of age in Chikwawa district, Malawi

BackgroundIn 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017–2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers’ perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them.MethodsThis study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children’s caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran’s formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively.ResultsThe study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment.ConclusionThe study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

Assessment of Quality of Life and Determinants Among the Elderly Population in Rural Areas of Puducherry: A Mixed Method Study

Background: Elderly people living in rural areas often faces unique challenges that affect their quality of life (QOL), including limited access to healthcare and social support. Understanding the factors influencing their well-being is essential to improve the quality of life. The study aims to assess the QOL and its determinants among the elderly in rural areas of Puducherry. Methods: A community based sequential explanatory mixed method study was conducted among the elderly residing in the rural field practice area of a medical college in Puducherry district. 200 participants were recruited by simple random sampling from the family health records in the Rural Health Training Centre of a medical college. WHO QOL-BREF questionnaire was used to assess the Quality of Life quantitatively and an interview guide to explore its determinants. Data were entered in MS excel and analyzed using SPSS v16.0. Results: The mean age of the participants was 68.8± 2.5 years with majority being females. The environmental domain scored the highest mean QOL and psychological domain the lowest mean QOL. The overall mean QOL was 234.8 ± 65.4. The main determinants of poor QOL are age ≥ 75 years, lower socio-economic class, those who are widow/separated and presence of comorbid conditions. The binary logistic regression predicts the factor for poor QOL was age ≥ 75 years with OR (95% CI) as 6.23 (2.44-15.91). Conclusion: The overall mean QOL was moderate. The factors identified for poor QOL need to be addressed with key intervention strategies. Quality affordable medical services at door step to improve physical domain and targeted health education for family members and the community, who form the immediate environment around the elderly, can play a crucial role in enhancing the social domain.

A Mixed Methods Assessment of an Online Mental Health and Resilience Program for Agricultural Sector Students

ABSTRACT Financial, environmental, and socio-cultural challenges affect the mental health and wellbeing of those working and living on-farm. Education programs can help in improving mental health and overall wellbeing, but most of these programs are offered to established farmers in a face-to-face format, leading to a gap in offerings to many subgroups, including young agricultural entrants. To address these gaps, this paper assesses the value of an online mental health and resilience education program for young agricultural entrants. An explanatory sequential mixed methods approach was applied. Firstly, a quantitative survey was conducted with 172 first year agricultural tertiary students, aged 18–20, to assess the knowledge and skills gained due to program participation. Regressions and propensity score matching were used to determine the effect of program participation. Subsequently, seven interviews were conducted with program participants to provide insights into their experiences of the program. Thematic coding was applied to analyze the qualitative data. Findings from the quantitative survey show a significant increase in mental health knowledge and skills amongst program participants compared to participants in the control group. The qualitative interviews show the ability to work through the material in their own time and space, creates a safe environment for online students. Other mechanisms contributing to learning are using “normal language”, a peer voice in communicating wellbeing, and building on learnings in previous education. This paper addresses a gap in literature by being the first study to evaluate online mental health education for agricultural tertiary students. It provides educators and other program designers with valuable information for future program design to support the wellbeing of young agricultural workers.

Predictors of neonatal hypothermia within six hours of birth and exploring preventive practices among post-natal mothers in Kilimanjaro region: Explanatory sequential mixed method protocol.

Neonatal hypothermia is a worldwide problem that can lead to a high impact on neonatal health outcomes if appropriate thermal care measures are not implemented. Tackling neonatal hypothermia from the time of delivery with appropriate thermal care measures will increase neonatal survival and decrease complications related to hypothermia. The study aims to determine the predictors of neonatal hypothermia within six hours of birth and explore its preventive practices among postnatal mothers. This is a mixed-method sequential explanatory study. The first phase will be a quantitative study with a hospital-based analytical cross-sectional design. 325 neonates and their mothers will be randomly selected through a 4-stage sampling technique. The data will be collected using a structured questionnaire, checklist and documentary review. Descriptive and inferential statistics will be used to analyse the data. The second phase will be a descriptive qualitative study involving postnatal mothers who participated in a quantitative study. The data will be collected via in-depth interviews, and thematic analysis will be used to analyse the data. The findings of quantitative and qualitative studies will be triangulated in the discussion. This study will provide a wide understanding of neonatal hypothermia in the region which will help healthcare providers who are caring for neonates to be informed about the current situation, evaluate the care they provide, and find the best way to adhere to thermal care measures. Moreover, the practices of postnatal mothers will be known, which will help to develop tailored interactions to address this problem.

Cultivating Esportspersonship: How Scholastic Esports Coaches Perceive Facilitating Positive Youth Development

Background Coaches may promote positive youth development (PYD) through youth sports programs, which can lead to outcomes, such as life skills and well-being. Scholastic esports programs, much like traditional school sports teams and clubs, have adult coaches who play a role in the development and success of teams. Purpose This study aims to explore the gap in research on scholastic esports coaches’ perspectives on their cultivation of PYD. Method This large-scale pilot study used a sequential explanatory mixed methods design. Quantitative rating responses to a coaching survey were collected and analyzed using an exploratory data analysis. Trends of interest were used to create interview questions that then informed and added context to the themes identified in the quantitative phase. Results Survey results revealed common trends in responses that highlighted the development of life skills, fostering a socially positive environment, and a genuine affinity for both coaching esports and working with young people. Interviews emphasized that coaches saw esports programs as a place for students to learn new skills, increase confidence, and benefit from being part of a social community. Discussion and Conclusion Findings suggest that scholastic esports programs afford PYD opportunities through coaches’ motivations, philosophies, and impacts. Coaches create conditions where youth can learn sportspersonship.

Development of a work systems stress questionnaire to predict job burnout: A mixed methods study based on a macroergonomics approach

Job burnout is a stress-related phenomenon that is a significant threat to the health and performance of organizations and employees. Interventions to ameliorate potentials for burnout have been limited by the lack of a comprehensive tool that considers work system stressors. Thus, the aim of this study was to develop a questionnaire for predicting job burnout based on the macroergonomics work system approach. The setting was a petrochemical company in South Iran. In the qualitative phase of this sequential exploratory mixed methods research, 971 meaning codes were extracted from fourteen one-to-one and seven focus group interviews (n = 59). The codes were subject to Directed Content Analysis, which yielded three themes and 15 dimensions, which were used to inform the development of reliable and valid questionnaire. Items for each of the dimensions were sourced from exiting scales. To test the developed Work System Stress Questionnaire (WSSQ) in terms of its ability to predict burnout, a survey which included demographic items, the WSSQ, and the Maslach Burnout Inventory was completed by 359 employees. Hierarchical linear regression modelling of the data indicated that Task Significance, Job Demands, Work-Life Conflict, and Work Schedule predicted Emotional Exhaustion, and altogether explained 58 % variance. Task Significance, Violence and Harassment, Work-Life Conflict, and Job Insecurity predicted the Depersonalization and explained 29 % variance. Decision Latitude, Welfare and Financial Facilities, Task Significance, and Structural Problems predicted Personal Accomplishment and explained 26 % variance. All 15 dimensions were valid (CVI range .73–.90) and reliable (Cronbach's alpha range .71–.93). The results confirm the ability of the WSSQ to explain more variance regarding job burnout than previous studies. In turn, the WSSQ will enable remedial actions to be put into place. It may also be useful for understanding the consequences associated with other organizational ergonomic variables that are related to job stress.

Comparing the psychological impact of the Shanghai lockdown on local and non-local college students: an explanatory sequential mixed method approach.

In 2022, the Shanghai municipal government enforced strict COVID-19 lockdown measures. Lockdown experiences for college students varied. Local students normally returned home and had familial support while non-local students relied more on institutional support when quarantining in dormitories. The difference could profoundly impact their access to necessary material resources and emotional support, affecting their mental health. This study compared the psychological effects of the Shanghai Lockdown on local and non-local college students using an explanatory-sequential mixed methods design. Quantitative analyses of data from 327 college students examined local and non-local students' mental health outcomes during the lockdown. Follow-up qualitative interviews (N = 12) contextualized their sources of stress and group differences. Higher prevalences of probable anxiety (34.6%), depression (45.1%), and poor subjective mental well-being (65.4%) are found among non-local students compared to local students (23.7% anxiety, 29.4% depressive symptoms, and 47.9% poor well-being). Suicidal ideation was higher among local students (8.6% prevalence difference). Being a non-local college student was associated with increased odds of probable anxiety, depression, and poor well-being. Interviews identified group differences such that non-local students received more school support (i.e., food and financial) and perceived emotional support but faced poorer quarantine living environments compared to local peers. Non-local college students were more vulnerable to the impact of lockdown. Our findings also provide insights into the impact of familial versus institutional support on student mental health during times of crisis.

A study protocol for a mixed-method environmental scan of contextual factors that influence lung cancer screening adherence

BackgroundThe efficacy of lung cancer screening (LCS) to reduce lung cancer specific mortality is heavily dependent on adherence to recommended screening guidelines, with real-world adherence rates reported to be drastically lower than rates described in clinical trials. There is a dearth in the literature on reminder processes and clinical workflows used to address adherence and robust data is needed to fully understand which clinical set-ups, processes, and context enhance and increase continued LCS participation. This paper describes a protocol for an environmental scan of adherence and reminder processes that are currently used in LCS programs across the United States.MethodsThis study will triangulate data using a 3-step explanatory sequential mixed methods design to describe mechanisms of current adherence and reminder systems within academic and community LCS programs to pinpoint clinic or system barrier and facilitator combinations that contribute to increased adherence. In step 1, surveys from a nationally representative sample of LCS programs will yield quantitative data about program structure, volume, and tracking/reminder processes and messages. After completion of the survey, interested LCS program personnel will be invited to participate in an in-depth interview (step 2) to explore current processes and interventions used for adherence at the participant and program level. Finally, in step 3, triangulation of quantitative and qualitative data will be completed through qualitative comparative analysis to identify combinations of components that affect higher or lower adherence.DiscussionThis research advances the state of the science by filling a gap in knowledge about LCS program characteristics and processes associated with better adherence which can inform the development and implementation of interventions that are scalable and sustainable across a wide variety of clinical practice settings.

Approach to Weighting the Success Criteria of Toll Road Project of Government Cooperation with Business Entities Procurement Model

In providing funding for toll road development projects, many developing countries are im-plementing PPP pro-curement schemes including Indonesia. This funding scheme is believed to be an innovative procurement process model and has good prospects for the future of the construc-tion industry in the world. However, in its implementation, the Indonesian government is currently faced with various problems that have the potential to have a negative impact on the management and development of toll roads in Indo-nesia. Therefore, the main objective of this research is to develop a method of evaluating the success of PPP-themed toll road projects and determining the current and future strategy of PPP-themed toll road development projects. Methodology This research, using an exploratory sequential mixed methods approach, involves four stages of research. Through a Systematic Literature Review (SLR) of reputable scientific journals from various countries, a questionnaire survey was developed. The survey results were analyzed using multivariate statistical methods with the help of Par-tial Least square analysis software (PLS-SEM), analytical hierarchy process (AHP) and Relative Importance Index (RII) methods. The results of this research found 20 critical success indicators and four dimensions of project success. This study produces a new way to assess the success of PPP-themed toll road projects that is very important and can inspire the government in making policies, legislation and regulations as well as innovative strategies in develop-ing PPP-themed toll roads.

Immunosuppressive medication adherence and affecting factors in solid organ transplantation patients: a mixed-methods study

Objectives: Transplantation is a form of treatment that requires long-term pharmacotherapy. After transplantation, patients may have difficulty adapting to medication use for various reasons, and this may result in rejection. The aim of this study is to determine participants’ medication compliance and the factors affecting it. Methods: The research was conducted with a sequential explanatory mixed method. In the study, quantitative data were collected using the Turkish Immunosuppressive Medication Adherence Scale, and qualitative data were collected using the In-Depth Individual Interview Guide. Quantitative data were analyzed using statistical methods, and qualitative data were examined according to Braun and Clarke's thematic analysis framework. Results: In this study, 62.3% of the participants were male, 37.0% were 50 years old and over, 71.3% lived with their spouse, 54.0% had primary and secondary school education, and 42.0% could not work due to their current health condition. From a clinical perspective, it was determined that 78% of the transplants were kidney transplants, and 41.3% were more than 4 years after transplantation. 74.3% of the transplants were from living donors. The mean score of the immunosuppressive medication compliance scale was determined to be 40.91±4.09. In the qualitative data analysis of the study, factors affecting medication adherence were examined and the themes of "individual factors", "complexity of the regimen" and "social support resources" were obtained. The sub-themes of the individual factors theme are reluctance, hopelessness and addiction; Sub-themes of the complexity of the regimen theme are drug side effects and polypharmacy; The sub-themes of the social support resources theme are loneliness and family pressure. Conclusions: The factors influencing medication adherence among organ transplant recipients have been investigated, revealing that adherence levels vary significantly depending on various factors. These findings underscore the importance of tailored care strategies and individualized support approaches.

Ride-Hailing Drivers’ Preference for Fairwork Principles of Trustworthy Labour-Platform Management and Greater Worker-Autonomy and Willingness to Form and Join Worker-Platform Co-Operatives in Kenya

Ride-hailing worker-platform co-operatives had emerged as part of and for at least fairwork principles. Moreover, studies on e-drivers have recommended the formation of worker-platform co-operatives in Kenya. The actual worker-platform co-operatives by e-drivers are yet to be established. It was against this backdrop that a study was conducted to determine the extent of ride-hailing drivers’ preference for fairwork principles of trustworthy labour-platform management, greater worker-autonomy and willingness to form and join worker-platform co-operatives. The study was grounded in the social exchange theory, affective theory of social exchange, and utility theory. The researcher applied critical-realism research philosophy and multimethod research designs of discrete choice experiments and sequential explanatory mixed method research designs. Using the Yamane sampling formula, the study used quantitative data from 497 respondents from sampled 600 of the 20,000 e-drivers in the Nairobi Metropolitan Region. The quantitative data was analysed using multinominal logistic regression. Moreover, the study used qualitative data from 11 participants, analysed using thematic analysis. Results indicated that the two fairwork principles were statistically significant to e-drivers’ willingness to form and join worker-platform co-operatives. The trustworthy platform management (TPM) principle, in particular, was a highly preferred fairwork principle in terms of e-drivers’ willingness to form and join worker-platform co-operative model (Coeff=2.62; SE = 0.400, Z = 6.54, p&lt; .001), compared to the greater worker-autonomy contract (GAC) principle (Coeff=1.565, SE = 0.202, Z = 7.74, p&lt; .001). This study brings practical and theoretical contributions to improve the e-drivers’ benefits from the ride-hailing sector. Policymakers, promoters, and platform workers like e-drivers could understand how best to promote worker-platform co-operatives to succeed in the country’s societal context.

Preventive Practices of Hantavirus in a Rural Community in Panama: An Explanatory Sequential Mixed Methods Study.

Preventive care practices are a challenge in community care. This study examined hantavirus preventive practices and their relationship with personal and social factors, lifestyle, and cultural beliefs. An explanatory sequential mixed methods design, guided by Leininger's Theory of Culture Care Diversity and Universality, was used in two phases: (a) a cross-sectional relational design (n = 109) and (b) ethnonursing research (n = 30), in an endemic community in Panama. Univariate and bivariate analyses were used to analyze the quantitative data, whereas the Leininger's analysis model was used to analyze the qualitative data. In the quantitative phase, the most frequent preventive practice was household hygiene, and the least frequent was vector control. Two of the eight preventive practices were associated with personal factors and two were associated with social factors. In the qualitative phase, lifestyle, beliefs, and context were found to influence the adoption of hantavirus preventive practices and help explain the quantitative findings. Knowledge and understanding of the social and cultural contexts are essential for hantavirus prevention.

Development and Validation of the Decisions to use Opioids Measure

BackgroundMillions experience inadequately managed acute pain each year. Opioids are an important tool for managing pain; however, recent reductions in opioid prescriptions have exacerbated preexisting challenges in pain management. Moreover, patient expectations and desires for pain management may drive additional opioid use. There is an important need to characterize patient motivations for using opioids in order to develop promising interventions. The aim of this study was to develop the Decisions To use Opioids (DTO) measure. MethodsWe used an exploratory sequential mixed methods design to create items for the DTO measure. Qualitative data from patient interviews and focus groups informed the development of items for the DTO. We evaluated the content validity of candidate items with nine experts using the content validity index (CVI) and conceptual significance. Face validity was assessed via cognitive interviews with five emergency department (ED) participants who experienced acute pain. ResultsWe generated an initial pool of 52 items. Expert ratings provided evidence of content validity on 40 items, as indicated by an item CVI score of 0.83 or higher. Nine items with CVI scores of <0.83 were retained and revised due to the conceptual significance. The remaining three items were discarded. ConclusionsThis study provided evidence of content and face validity of the DTO measure for ED patients. Further psychometric evaluation is needed to gather data regarding the DTO's internal consistency, construct validity, and criterion validity.

Ethnic differences in pre-hospital ambulance care in the UK: a mixed method study

BackgroundThe Equality Act 2010 ensures fair access to healthcare services by eliminating discrimination. Previous research indicates that ethnic minority communities are more likely to face significant disparities in prehospital ambulance care. The aim of this study was to identify barriers and facilitators associated with ambulance response in ethnic minority communities in the East Midlands region in the UK. MethodsWe used an explanatory sequential mixed methods design. First, in a cross-sectional design, we analysed retrospective electronic clinical data from East Midlands Ambulance Service NHS Trust (EMAS). Multivariable logistic regression analysis was used to identify ethnic differences in ambulance transportation whilst accounting for confounders including age, gender, ethnicity, NEWS2 score, socio-economic deprivation, and urban or rural place of attendance. Second, a qualitative study used online semi-structured interviews with purposive sample of ethnic minority patients who used EMAS. Thematic analysis was used to explore barriers and facilitators. FindingsThe observational study included 2 324 439 clinical records from Jan 1, 2018 to Dec 31, 2021. After adjusting for confounders, Asian (odds ratio [OR] 0·81, 95% confidence interval [CI] 0·80, 0·82), Black (OR 0·90, 95% CI 0·88, 0·93), and Mixed ethnicity patients (OR 0·92, 95% CI 0·89, 0·95) were significantly less likely than White British patients to be conveyed to hospital. The qualitative study included 11 individuals from mainland European countries, Asian, Black, and Mixed ethnicities. We identified five main barriers including delays in ambulance arrival, high costs for uninsured, language barriers, racism, and trust issues with ambulance staff. We also found that cultural and communication training for ambulance staff, and better-equipped ambulances were key facilitators for ensuring effective ambulance care. InterpretationProviding financial support and promoting awareness of available resources for transportation costs, along with implementing cultural competency training for ambulance staff, are steps that will help to eliminate ethnic minority disparities. Further research is needed given the varying requirements of heterogeneous and diverse ethnic minority communities. FundingThe Türkiye Ministry of National Education supported this research.

Are the mothers admitted for childbirth in a tertiary care hospital satisfied with the health care services? A mixed methods study from Mangaluru, Karnataka state, India

ContextPatient Satisfaction is the strongest determinant of hospital functioning and is an indirect or proxy indicator of the quality of doctor. AimsThe study aims to assess maternal satisfaction with healthcare services during childbirth during hospital stay, explore factors influencing satisfaction, and assess the perceptions of both mothers and their bystanders regarding the healthcare services provided. Methods and materialIt is a sequential explanatory mixed method study conducted in the Obstetrics and Gynaecology department in a tertiary college hospital among 291 pregnant women admitted for childbirth. Quantitative data obtained using expert validated questionnaire was entered in an Excel sheet and analyzed using IBM SPSS Version 23. Descriptive statistics were reported as median (IQR) for continuous variables and as frequencies and proportions for categorical variables. Normality was tested using Shapiro Wilk test and to test significant difference in satisfaction scores across the variables Mann Whitney U test was used. For the qualitative phase, in-depth interview was conducted to explore factors determining patient satisfaction in healthcare services. ResultsQuantitative results showed that mothers were satisfied with the admission process, support given during breastfeeding, immunization and vaccination, health education and very satisfied with the privacy, doctors and nursing services, overall cleanliness. Qualitative results revealed the admission process was time consuming, overall cleanliness was poor, guidance on breast feeding and immunization and service provided by doctors and nurses are good. ConclusionThe study concluded that while mothers were generally satisfied with healthcare services, particularly with support during breastfeeding, immunization, and doctor and nursing services, there were concerns about the admission process and overall cleanliness.