Explanatory Sequential Mixed Methods Design Research Articles

Stripped of their professional status: overseas educated nurses working as unregistered practitioners in their host country

Background: Many of the overseas qualified nurses educated work as health care assistants and support workers for a decreased wage without scope for professional advancement. There is an imperative to ease their entry to the nursing register. Aim: To gather and provide evidence to the regulatory bodies regarding the demographics of this cohort of nurses and the challenges they face in attempting to register as a nurse. Design: This study used a mixed-method explanatory sequential design. The survey was completed by 857 unregistered nurses followed by five in-depth interviews. Results from both phases were triangulated. Results: The results signpost to the characteristics and challenges of these nurses working as unqualified grades of staff for a decreased wage without scope for professional advance. Discussion and conclusion: The downward occupational spiral of internationally educated nurses underscores the paradoxical nature of the pedagogical application of transition theory, as these nurses are compelled to revert to a novice status.

Why are Turkish nurses migrating? A mixed-methods study.

This study aimed to identify the factors influencing nurses' migration patterns in Turkey. The flow of nurse migration from developing countries to developed countries is steadily increasing. As a result, countries that are sources of migration tend to develop domestic inequities with respect to the population's ability to access health services. In particular, fragile economic conditions and the pandemic triggered the migration of nurses from Turkey, a developing country. This study employed a mixed-method explanatory sequential design and was conducted in Turkey between April and November 2022. The decision to migrate was the focus of both the quantitative aspect, involving 237 participants, and the qualitative aspect, with 20 participants. Quantitative data were gathered through a questionnaire, and qualitative data were obtained using open-ended questions during in-depth individual interviews. We followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist in the quantitative phase and the Consolidated Criteria for Reporting Qualitative Research checklist in the qualitative phase. Descriptive statistics and thematic analyses were used to analyze the data. In the quantitative stage of the study, nurses' reasons for deciding to migrate were identified as economic conditions, working conditions, society's outlook on the profession, political factors, and professional growth opportunities. In the qualitative stage, four major themes influencing nurse migration patterns emerged: devaluation and poor collegiality in nursing; inadequate management support; negative work environment; and health, social, and economic policies. The results of the study showed that the three factors most influential in the decision to migrate were economic issues, a negative work environment, and political climate. In developing countries, there is an urgent need for nurse administrators and health workforce decision-makers to create healthy working conditions and manage resources efficiently, focusing on improving nurses' economic situations while developing appropriate nationwide and international strategies.

Profil Habits of Mind Siswa SMA dalam Pemecahan Masalah Matematika

This study aims to describe the habits of mind possessed by high, medium, and low class XI high school students in solving mathematical problems on linear program material studied from persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. Habits of mind that are the focus of this study consist of four indicators, namely persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. The research subjects were students of class XI MIPA 4 SMAS Mujahidin Pontianak and the object of research was habits of mind in mathematics problem solving. Explanatory sequential mixed method design is the method of this research with its instruments, namely math problem solving test questions, habits of mind questionnaire, and interview guidelines. The results of the discussion show that the habits of mind possessed by high category students in solving mathematics are persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. Habits of mind owned by medium category students are persisting, thinking flexibly, and applying past knowledge to new situations. Habits of mind possessed by low category students are persisting.

Students’ affective engagements in peer feedback across offline and online English learning environments in Thai higher education

This study investigated the effectiveness and dynamics of peer feedback in online and offline learning environments, focusing on English as a Foreign Language (EFL) students’ affective engagement and its impact on learning outcomes. Utilizing an explanatory sequential mixed methods design, the research divided participants into groups that studied through Zoom and traditional classrooms over 12 weeks, analyzing their engagement with peer feedback. Data were gathered from Likert-scale and open-ended questionnaires, along with performance scores on key tasks, and analyzed using descriptive statistics, t-tests, linear regressions, and thematic analysis. The findings indicated that students valued peer feedback in both settings, with online learners showing higher engagement levels. However, this engagement did not translate into improved writing skills, highlighting the need for further research into other factors that could enhance EFL writing proficiency.

Values and preferences of medication use in patients for primary and secondary prevention of cardiovascular diseases: a mixed-methods exploratory study

BackgroundMedication therapy is a cornerstone for the primary and secondary prevention of cardiovascular diseases (CVD), yet values and preferences regarding medication use remain unclear. ObjectiveThis study aims to explore the values and preferences of medication use in patients for the primary and secondary prevention of CVD. MethodsThis study employed an explanatory sequential mixed methods design. From November 2021 to January 2022, patients meeting the criteria for primary and secondary prevention of CVD were screened at West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu, using stratified purposive sampling for interviews. Qualitative data were collected through focus group interviews to understand the behavior, values, and preferences related to medication use among the participants. The interview content was coded and categorized using MAXQDA 2020, then further sorted, analyzed, and themes were extracted using Colaizzi's seven-step analysis method. Following the qualitative research, a quantitative questionnaire was developed based on the themes identified from the interviews. From November 2022 to February 2023, patients meeting the criteria for primary and secondary prevention of CVD were conveniently sampled from the cardiology, endocrinology, nephrology, and neurology outpatient clinics at West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu. After signing informed consent, the participants' values and preferences regarding medication use were quantitatively analyzed. ResultsThe qualitative study included 21 participants for focus group interviews, yielding four themes: (1) cognition and behavior towards medication; (2) barriers to medication use; (3) facilitators of medication use; and (4) needs for medical services. In the quantitative study, 186 valid questionnaires were returned, yielding a 93.5% response rate. The results indicated common missed doses, and further confirmed the social stigmatization and the burden of medication use identified in the qualitative study. Despite the heterogeneity in medication preferences, participants generally preferred fewer types of drugs and lower frequencies of medication, and were averse to injectable formulations. ConclusionIn clinical practice for the primary and secondary prevention of CVD, the use of compound preparation could be increased, and medication regimens could be integrated with patients' daily lives and work to reduce the medication burden. Additionally, it is important to actively address patients' misconceptions and inappropriate behaviors regarding diseases and medications to improve medication compliance.

Nurse-Led Telehealth Oncology Clinic on ‘Home Management During Chemotherapy’ for Gastrointestinal Cancer Patients: Study Protocol of A Mixed Method Study

Introduction: Telehealth is increasingly being used for symptom management among cancer patients on chemotherapy. Objective of the study is to develop Nurse-led Tele-health Oncology Clinic for GI cancer patients regarding ‘Home Management during Chemotherapy’. Methods: The study will follow sequential explanatory mixed method design where during quantitative phase, using RCT (CTRI/2024/01/062028), GI cancer patients of age 18-65 years and undergoing 2nd or 3rd chemotherapy cycle will be randomised after obtaining consent to experimental (EG) & control (CG) groups. Ethical Clearance is already obtained. EG will be followed through Nurse-led Clinic which includes multiple virtual educational & counselling sessions, e-booklet on side effects management, PMRT, Support groups & telephonic follow ups. Effectiveness will be measured in terms of Quality of life, severity of side effects and Anxiety using FACT-G, CTCAE and DASS respectively. In qualitative phase, using extreme case sampling, in-depth interviews from consented participants will be conducted to explore experiences towards intervention. Analysis: Analysis of quantitative data will use descriptive and inferential statistics. This follows thematic analysis and integration of data. Conclusion: The study protocol will provide guidance to optimize utility of tele-medicine technology to improve healthcare outcomes especially for the GI cancer patients.

Investigating the effectiveness of web-based HIV self-test distribution and linkage to HIV treatment and PrEP among groups at elevated risk of HIV in Viet Nam provinces: a mixed-methods analysis of implementation from pilot to scale-up.

In Viet Nam, key populations (KPs) face barriers accessing HIV services. Virtual platforms can be leveraged to increase access for KPs, including for HIV self-testing (HIVST). This study compares reach and effectiveness of a web-based HIVST intervention from pilot to scale-up in Viet Nam. A mixed-methods explanatory sequential design used cross-sectional and thematic analysis. The pilot launched in Can Tho in November 2020, followed by Hanoi and Nghe An in April 2021. Scale-up included Can Tho and Nghe An, with 21 novel provinces from April to December 2022. After risk assessment, participants registered on the website, receiving HIVST (OraQuick®) by courier, peer educator or self-pick-up. Test result reporting and completing satisfaction surveys were encouraged. Intervention reach was measured through numbers accessing the testing, disaggregated by demographics, and proportion of individuals reporting self-testing post-registration. Effectiveness was measured through numbers reporting self-test results, testing positive and linking to care, and testing negative and using HIVST to manage pre-exposure prophylaxis (PrEP) use. Thematic content analysis of free-text responses from the satisfaction survey synthesized quantitative outcomes. In total, 17,589 participants registered on the HIVST website; 11,332 individuals ordered 13,334 tests. Participants were generally young, aged <25 years (4309/11,332, 38.0%), male (9418/11,332, 83.1%) and men who have sex with men (6437/11,332, 56.8%). Nearly half were first-time testers (5069/11,332, 44.9%). Scale-up participants were two times more likely to be assigned female at birth (scale-up; 1595/8436, 18.9% compared to pilot; 392/3727, 10.5%, p < 0.001). Fewer test results were reported in scale-up compared with pilot (pilot: 3129/4140, 75.6%, scale-up: 5811/9194, 63.2%, p < 0.001). 6.3% of all tests were reactive (pilot: 176/3129, 5.6% reactive compared to scale-up: 385/5811, 6.6% reactive, p = 0.063); of which most linked to care (509/522, 97.5%). One-fifth of participants with a negative test initiated or continued PrEP (pilot; 19.8%, scale-up; 18.5%, p = 0.124). Thematic analysis suggested that community delivery models increased programmatic reach. Live chat may also be a suitable proxy for staff support to increase result reporting. Web-based self-testing in Viet Nam reached people at elevated risk of HIV, facilitating uptake of anti-retroviral treatment and direct linkage to PrEP initiations. Further innovations such as the use of social-network testing services and incorporating features powered by artificial intelligence could increase the effectiveness and efficiency of the approach.

The development and validation of a conceptual definition of avoidable transitions from long-term care to the emergency department: A mixed methods study.

Transitions to and from Emergency Departments (EDs) can be detrimental to long-term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC-ED transitions and to verify the level of stakeholder agreement with this definition. The EXamining Aged Care Transitions study adopted an exploratory sequential mixed-method design. The study was conducted in 2015-2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.

Model pemberdayaan kelompok wanita tani (KWT) melalui modal sosial untuk menjaga kohesivitas kelompok

This research aims to analyze elements of social capital to maintain groups cohesiveness and designing an empowerment model for Women Farmer Groups (KWT). The research method used is explanatory sequential mixed methods design, a two-stage research process, quantitative descriptive analysis and qualitative analysis. Data collection used census techniques for 30 informants, namely all members of KWT Karya Tani , Katel Klawu Hamlet, Pengalusan Village, Mrebet District, Purbalingga Regency and conducted in-depth interviews with 7 key informants and the KWT chairman and management through Focus Group Discussion (FGD). The research results show that the elements of social capital consisting of strong networks; trust; compliance with norms; cooperation and social awareness for group members as well as involvement in group activities. are in the high category. The empowerment strategy at KWT Karya Tani to maintain cohesiveness is by integrating closed social capital and open social capital that accommodates the complex, heterogeneous social dynamics of society within the ties of social entities attached to KWT Karya Tani. The majority of KWT Karya Tani members are devout Christians and are bound by the religious norms and community organizations. Each member of KWT Karya Tani is a member of the Jamaat Women's Group as well as the wife of a member of the Karya Tani farmer group. This uniqueness presents empirical findings in the study of the empowerment model that will be implemented at KWT Karya Tani, namely a collaborative all aspect of empowerment model through a holistic, community-based approach.

Examining the relationship between electoral violence, State security and democratization in Ghana's Fourth Republic

Electoral violence has become a recurring challenge in Africa, posing a significant threat to democracy, political stability, and human security. This paper explores the relationship between state security and electoral violence in the African context and draws valuable lessons for Ghana. The objectives of this study include investigating the causes and dynamics of electoral violence in Africa, analyzing the role of state security agencies in preventing and mitigating electoral violence, assessing lessons that Ghana could learn from other African countries' experiences, and proposing recommendations to enhance state security and prevent electoral violence in Ghana's Fourth Republic. The paper adopted an explanatory sequential mixed method design. The approach combined the quantitative data analysis and qualitative data collection through literature reviews, interviews, and focus group discussions. By identifying causes and dynamics of electoral violence, assessing the performance of state security agencies, and drawing lessons from successful strategies employed in other African countries. The aim of the study is to add to the existing literature the development of effective measures for ensuring peaceful and fair elections in Ghana. The results reveal a positive and direct relationship between electoral violence and democratization. Furthermore, the research discloses a positive and direct relationship between electoral violence and state security. Finally, the results reveal that state security has an intermediating effect between electoral violence and democratization. The research findings will inform policymakers, election officials, and relevant stakeholders in designing strategies to reduce electoral violence and promote democratic processes in Ghana and across the African continent. Based on these, the study recommends the provision of trusted security, a constitutional review, and an increment of trust in the electoral space.

Unlocking the Puzzle: Investigating Problem-Solving Patterns in 2D and 3D Virtual Reality Environments Through Mixed Methods Analysis

This research investigates the intricate relationship between problem-solving patterns and various factors, including demographics, cognitive style, learning styles, puzzle completion, and emotional and behavioral responses in the context of 2D and 3D virtual reality (VR) puzzle-solving tasks. The study employed an explanatory sequential mixed methods design, where data were collected from 52 participants who voluntarily engaged in puzzle-solving activities in a VR environment. The first phase involved collecting quantitative data to determine the cognitive and learning styles of the participants. The second phase involved gathering qualitative data, including observations, audio, video, and screen recordings during puzzle-solving tasks. Findings revealed profound associations between problem-solving patterns and gender, education level, dominant hand, and previous VR experience. Notably, females tended to analyze puzzle pieces more thoroughly, and participants with higher education levels exhibited more remarkable analytical tendencies. The cognitive style also influenced problem-solving patterns for using two hands with a controller. Puzzle completion times were correlated with systematic/random arrangement, starting with big puzzle pieces and 3D localization skills. Emotional and behavioral responses were linked to problem-solving patterns, with systematic placement associated with lower negative emotions and higher joy, while random arrangement led to more negative emotions.

The Difference Between Internet and Social Networking Use among Ninth Graders

This study aims to dive into ninth-grade students' internet and social networking experiences, examining both intrapersonal and interpersonal components. The study used a mixed-method sequential explanatory design to incorporate quantitative and qualitative methodologies, with a strong emphasis on ethical considerations. In the quantitative phase, data is collected using standardized questionnaires, which were then analyzed and examined statistically to find occurring patterns and trends from the feedback given by the ninth graders. Following that, the qualitative phase includes in-depth interviews to contextualize and explain the quantitative results from the first phase of the study. The findings provide complex insights into the participants' attitudes and behaviors around internet usage and social networking. While most people believe that the internet is mostly entertaining and convenient, there are differing opinions regarding the presence of its impact on academic performance and mental well-being. This study concludes that there is no substantial difference in internal and social networking experiences between male and female students. The findings highlight the complex nature of ninth graders' Internet and social networking experiences, including knowledge acquisition, social communication, and emotional regulation. Recommendations include encouraging responsible and ethical digital citizenship and offering support tools to help students navigate the online environment securely and successfully, while also developing literacy. Overall, this study contributes to a better knowledge of how young individuals engage with and how significant individuals are influenced by the digital landscape, providing valuable information for educational institutions and policymakers looking to create positive internet experiences among night graders students.

Exploring Objective Simulation Competency Assessment Experience E-Learning Module Analytics: A Mixed-Methods Study to Improve Nursing Faculty Feedback.

Abnormal uterine bleeding is a common clinical concern for adolescent women. This research study aims to improve the clinical reasoning skills of advanced practice nursing students instructed in blended Objective Simulation Competency Assessment clinical experiences by enhancing feedback loops given to students during simulated experiences. A sequential explanatory mixed-methods study design was conducted with two cohorts of first-year women's health nurse practitioner graduate nursing students enrolled in the Women's Health Program at a large Midwestern university. Data were collected across 2 years from two separate cohorts, and analyses included data from 15 participants. The Abnormal Uterine Bleeding module designed with decision pathways was a worthy effort, and faculty value using data analytics from the e-learning module to evaluate student learning. This study describes how nursing faculty created abnormal uterine bleeding content in an online module format that can aid the diagnostic reasoning process and enable feedback to students.

Mental Health and Academic Performance of Private Senior High School Students in the Division of Zambales amid Pandemic

This study aimed to assess the mental health of private senior high school students and its effect on their academic performance during the fourth quarter of S.Y. 2020−2021 amid pandemic. It was conducted among grade 11 students enrolled in private schools in Zone I, Division of Zambales utilizing an explanatory sequential mixed methods design. The Mental Health Inventory or MHI-38 was used as the questionnaire for the quantitative part while online interviews were used for qualitative part. Findings revealed that students experienced anxiety during the pandemic. Despite being anxious, students were psychologically well and less distressed. Overall, they were in a positive state of mental health. The study also revealed that students' anxiety has significant difference with the modular distance learning delivery modality. The study has found no significant relationship between students' mental health and academic performance during the last quarter of S.Y. 2020-2021. Qualitative data analysis found that students experienced mental, academic, and social problems during the pandemic.

Parental Involvement in Curricular Performance of Students at Risk

Parental involvement plays an important role in the academic performance of at-risk learners facing educational challenges. However, many parents struggle to contribute effectively due to various challenges, such as limited educational backgrounds, busy schedules, and personal commitments. This study aims to describe the parental involvement in the academic performance of at-risk learners, specifically focusing on involvement, success, and support within the school. This study uses a Mixed-methods sequential explanatory design. The study involves quantitative analysis supplemented by qualitative insights obtained through standardized questionnaires and interviews. Purposive sampling was employed to select 50 parents as respondents, while 8 participants were chosen using a homogeneous sampling technique to represent outliers. Results indicate that active parental involvement positively improves academic outcomes, including behavior, attendance, and grades. Conversely, learners with less engaged parents tend to show limited progress in their academic performance. Lack of financial resources poses significant challenges, but scholarships lessen burdens, ensuring access to education for all. This study underscores the importance of parental support beyond academics, creating helpful learning environments, and fostering strong development. Understanding parental challenges can enhance strategies to improve learners’ behavior and academic performance. Overall, parental involvement is an important factor in promoting academic success and preparing learners for future opportunities.

EFL Students’ Online Learning Readiness: Performing Out the Basic Functions of Technology

This study aimed at investigating the 12th-grade students’ online learning readiness in utilizing basic technological functions in their English teaching and learning process. An explanatory sequential mixed-method design was employed, surveying 233 students from Hospitality and Culinary classes at a senior vocational high school in South Bali through a questionnaire. Interviews were further conducted via personal messages with two highest readiness level students and two lowest readiness levels to comprehensively study readiness. The questionnaire result indicated that students are prepared to use basic functions of technology for online learning, with a few necessary improvements. Interview findings revealed that highly prepared students are more motivated to engage in online learning, whereas less prepared students are more demotivated due to factors like online learning support, familiarity with tools, and supporting facilities. It is suggested to actively support the less-ready students with highly engaged learning activities, pedagogically empowered teachers, and supportive policies and facilities.

FACE AND POLITENESS IN JAVANESE MULTILINGUAL INTERACTION

Javanese culture is unique since its orientation is to group togetherness, but the language displays the social distance between the conversers. Using a sociolinguistic perspective, this study investigated how Javanese people manage their concerns about self-other and positive-negative face. Linguistic data from a Javanese culture webinar held by Yogyakarta Palace were analysed using the explanatory sequential mixed-method design. The results show that from the most frequent to the least frequent, Javanese people are concerned about enhancing other-positive face (44.34%), other-negative face (39.15%), self-negative face (11.32%), and self-positive face (5.19%). Complimenting, greeting, showing sympathy, and expressing gratitude are their ways to show their concern for the other-positive face. Meanwhile, employing indirect requests and honorifics in Javanese Krama are strategies to enhance the other-negative face. People’s tendency to please others, show respect, and avoid conflict is the underlying reason for their great concern for others’ positive and negative faces. Their reluctance to enhance their self-face is due to their inclination to shame and guilt. Such face management is highly influenced by the cultural norms and values upheld by society. In a forum delivered in Bahasa Indonesia, their strong Javanese identity is represented by the insertion of Javanese honorifics showing deference.

Exploring how Teachers’ Gender Biases and Students’ Self-Efficacy Beliefs Impact Mathematics Instruction

The issue of gender biases among mathematics teachers and the self-efficacy beliefs of students is an intriguing subject. This study sought to explore how teachers' gender biases and students' self-efficacy beliefs impact mathematics instruction in the Adenta Municipality of the Greater Accra Region of Ghana. A sequential explanatory mixed method design was utilized in collecting data from 100 Basic school mathematics teachers and four hundred (400) Junior High School students through a closed-ended questionnaire and semi-structured interview guide. The study discovered that gender-related stereotypes and biases among teachers perpetuated gender-based misconceptions, affecting the self-efficacy of female students who were perceived to be weaker in mathematics. The study recommended comprehensive teacher training and awareness programs to help address gender-related stereotypes and biases in mathematics instruction.

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.

Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana

BackgroundAlthough postgraduate studies have been shown to be associated with stressful experiences, students reading programmes through the distance and e-learning mode experience greater levels of stress due to several reasons. These stressful encounters might be heightened in female married postgraduates on distance education programmes due to other family-work-related engagements. This study investigated the stress-related experiences and intentions to quit studies among female married students on a distance education programme in Ghana.MethodsUsing a sequential explanatory mixed-methods design, 164 married postgraduate distance education students were sampled to participate by responding to a questionnaire. Follow-up interviews were conducted with 10 participants to offer insight into the quantitative findings. Quantitative data were analysed using descriptive statistics, including frequency and percentages, while the qualitative data were thematically analysed.ResultsStress was prevalent among the female married distance education students, with the majority having intentions of quitting their studies. The stressors identified ranged from personal (i.e., work and family demands) to institutional ones (i.e., academic load, unresolved complaints and high financial demands from the programme).ConclusionsKey findings suggest that female married postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can negatively impact their health and academic work. Implications and recommendations of the findings are discussed.