Explanatory Sequential Mixed Methods Design Research Articles

Improving Argument-Based Explanation Writing in Inclusive High School Science Class for Students with and without Exceptionalities

ABSTRACT There have been many calls for the development of discipline-specific argument writing interventions to integrate science-specific and general literacy standards and goals. Yet, adolescents with and without exceptionalities struggle to meet existing writing demands. This explanatory sequential mixed methods design draws from the strengths of multiple baseline design and integrates rich qualitative data, from a student perspective, to better understand the elements that contribute to effective discipline-specific writing instruction. The study examined the effects of implementing Self-Regulated Strategy Development (SRSD) through a writing-to-learn sensemaking framework adapting the DEFEND strategy to improve students’ written argument-based explanations across inclusive science classrooms and focus learners with exceptionalities. A ninth-grade science teacher delivered science and writing instruction and collected quick writes before, during, and after SRSD implementation. Results indicated that students’ argument-based explanations improved in discipline-specific components (i.e. claim, evidence, reasoning, knowledge) and general components (i.e. organization and writing quality). Students discussed the challenges of using their developing knowledge to write argument-based explanations using the DEFEND strategy, with particular difficulties in expressing reasoning and an appropriate counterclaim. Issues of feasibility and usability are discussed.

To Improve Motivational Barriers to Retention in High Resolution Anoscopy, Patients and Providers Recommend Social and Environmental Changes: A Sequential Explanatory Mixed-Methods Pilot Study in a Federally Qualified Health Center.

Loss to follow-up (LTFU) in high-resolution anoscopy (HRA) programs jeopardizes the procedure's potential to help prevent anal cancer. We explored quality improvement factors to understand how to address this LTFU. Using the transtheoretical COM-B Model (Capability, Opportunity, Motivation, and Behavior) and a sequential explanatory mixed-methods design, we surveyed and interviewed 13 patients who remained engaged in HIV care but who delayed their HRA monitoring or treatment visits in the same community clinic, and 6 HRA clinicians and medical assistants. Analyses involved descriptive statistics and rapid qualitative analysis. Patients were racially, ethnically, and economically representative of the LTFU population, and were generally experienced with HRA (Mean HRA visits = 4.6, SD = 2.8, mdn = 3). Providers were experienced clinicians and medical assistants (Mean years providing HRA = 6.0, SD = 2.2). Analyses revealed two primary, related barriers: (A) motivational barriers such as physical pain, discomfort, embarrassment, and anxiety; which were largely borne from (B) opportunity barriers such as difficulties with scheduling, inconsistent after-care (particularly for pain and discomfort), anxiety-inducing exam rooms and equipment, and internalized and anticipated stigma. Capability barriers, such as limited health literacy about HRA, were less common and, like motivational barriers, linked to opportunity barriers. Participants recommended potential facilitators, including easier scheduling, standardization of pain management and after-care services, and examination room modifications to reduce anxiety. To retain HRA patients in community settings, interventions should address social and physical opportunity barriers that strongly determine motivational and capability barriers. Improving convenience, standardizing pain management, and introducing stigma interventions specific to HRA, could alleviate both motivational and capability barriers.

Stakeholders’ participation in decreasing wildfire risk in the context of natural resource management in the Podpoľanie region of Slovakia

Key MessageAs the number and extent of wildfires are increasing due to climate change and human impacts, the demand for effective risk reduction strategies is growing. Due to limited resources or management capabilities in Slovakia, appropriate multistakeholder participation could help decrease the risk of wildfires while continuing to implement the principles of sustainable forest management. Thus, we recommend improving relationships with responsible stakeholders and increasing their knowledge.ContextAlthough the frequency of wildfires has declined in Slovakia, the total burned area per year and the average burned area per fire have increased rapidly, mainly due to traditional land management and increasing numbers of natural disasters resulting from climate change.AimThe objective of this study is to assess the participation and management of stakeholders in the region of Podpoľanie, which is the region of Slovakia that is most prone to wildfires. In particular, this study investigates the questions of who is accountable, in what networks, and with regard to what issues with the goal of enhancing efforts to combat wildfires.MethodsThis single-country case study features an exploratory sequential mixed-methods design. While stakeholders’ participation was explored via face-to-face interviews and interest-influence matrices, stakeholders’ prioritization was assessed via an online survey and the quantitative mapping of stakeholders’ involvement, power, interest, and knowledge.ResultsWe separately identified primary stakeholders (e.g., fire departments and state-owned forest enterprises) and secondary stakeholders (e.g., municipalities and community members). Tasks related to efforts to combat wildfires were largely in compliance with legal regulations and other mandates. Nonetheless, some stakeholders (e.g., governmental organizations involved in nature protection or nonstate forest owners and the associated enterprises) lacked the knowledge, experience, or responsibility necessary to perform these tasks.ConclusionThese stakeholders should be informed and monitored closely to achieve outcomes that can benefit a variety of stakeholders. We recommend a plan that involves improving the relationships among primary and secondary stakeholders, increasing their knowledge, and promoting effective participation to decrease the risk of wildfires in the region.

Multiethnic Perspectives of Shared Decision-Making in Hypertension: A Mixed-Methods Study.

Shared decision-making (SDM) has the potential to improve hypertension care quality and equity. However, research lacks diverse representation and evidence about how race and ethnicity affect SDM. Therefore, this study aims to explore SDM in the context of hypertension management. Explanatory sequential mixed-methods design was used. Quantitative data were sourced at baseline and 12-month follow up from RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) participants (n=1212) with hypertension. Qualitative data were collected from semistructured individual interviews, at 12-month follow-up, with participants (n=36) selected based on their SDM scores and blood pressure outcome. Patients were cross- categorized based on high or low SDM scores and systolic blood pressure reduction of ≥10 or <10 mm Hg. Multinomial logistic regression analysis showed that predictors of SDM scores and blood pressure outcome were race and ethnicity (relative risk ratio [RRR], 1.64; P=0.029), age (RRR, 1.03; P=0.002), educational level (RRR, 1.87; P=0.016), patient activation (RRR, 0.98; P<0.001; RRR, 0.99; P=0.039), and hypertension knowledge (RRR, 2.2; P<0.001; and RRR, 1.57; P=0.045). Qualitative and mixed-methods findings highlight that provider-patient communication and relationship influenced SDM, being emphasized both as facilitators and barriers. Other facilitators were patients' understanding of hypertension; clinicians' interest in the patient, and clinicians' personality and attitudes; and barriers included perceived lack of compassion, relationship hierarchy, and time constraints. Participants with different SDM scores and blood pressure outcomes varied in determinants of decision and descriptions of contextual factors influencing SDM. Results provide actionable information, are novel, and expand our understanding of factors influencing SDM in hypertension.

Understanding the capacity development of faculty development programs: a sequential explanatory mixed methods study

BackgroundFaculty development programs can bring about both individual and organizational capacity development by enhancing individuals’ attitudes, values, and skillsto enable them to implement organizational change. Understanding how faculty development programs produce capacity development, and the influencing factors, requires further understanding. This study aimed to explore the perceptions of the participants of a faculty development program about the capacity development features of the program and the influencing factors.MethodsA sequential explanatory mixed methods design was used. Faculty members were surveyed about their perspectives on capacity development of faculty development. Subsequently, 22 interviews were conducted with the respondents to deepem understanding of the survey results. Interview transcripts underwent conventional content analysis.ResultsA total of 203 completed the questionnaire. Most of the faculty highly agreed that the faculty development programs had produced capacity development. The combined data identified (a) “quality of faculty development programs”, underscoring the significance of robust and comprehensive initiatives, (b) “development in instruction”, emphasizing the importance of continuous improvement in pedagogical approaches (c) “development in professionalism”, highlighting the necessity for cultivating a culture of professionalism among faculty members, (d) “development in attitude towards education”, emphasizing the role of mindset in fostering effective teaching practices, and (e) “supporting faculty development programs”, with fostering organizational growth and innovation. Important barriers and facilitators of the capacity development process included several organizational, interpersonal, and individual factors.ConclusionThe study identified specific features of the capacity development process in the context of a faculty development program and highlighted the importance of these programs in producing changes in both individuals and within the wider organizational system. Several factors that enabled and constrained the capacity development process were also identified. The findings of the study can inform future implementation of faculty development programs for capacity development.

Unpacking the role of motivation and enjoyment in AI-mediated informal digital learning of English (AI-IDLE): A mixed-method investigation in the Chinese context

This paper examines how Chinese university students negotiate their second language (L2) motivational dynamics, including their ideal and ought-to L2 selves, to participate in informal digital learning of English (IDLE) mediated by generative artificial intelligence (AI). It demonstrates the extent to which enjoyment, the most observable positive emotion in L2 learning, influences their involvement in AI-mediated IDLE (AI-IDLE) activities. Employing an explanatory sequential mixed-method design, this study surveyed 690 Chinese undergraduate students and conducted 12 post-survey interviews. Using a structural equation modeling approach, the quantitative analysis reveals that participants’ ideal L2 self can significantly predict both their sense of enjoyment and AI-IDLE, while the ought-to L2 self is only able to directly predict enjoyment. The quantitative results also demonstrate that enjoyment can partially mediate the relationship between the ideal L2 self and AI-IDLE and simultaneously fully channel the indirect impact of the ought-to L2 self on AI-IDLE. Supplementing these quantitative findings, the interview data provides a nuanced understanding of how motivation and enjoyment shift and interact with learning contexts as participants engage in AI-IDLE. Drawing on these quantitative and qualitative insights, this study identifies implications for pedagogy, particularly in terms of motivating Chinese university students to engage in IDLE while maintaining emotional well-being in the age of generative AI.

An Explanatory Sequential Study of Public Elementary School Teachers on Deped Computerization Program (DCP)

The purpose of the study was to determine what personal information need further explanation on the utilization of DepEd computerization program in terms of; (1) purpose of computer usage, (2) indicated computer skills, (3) type of software for teaching and learning, (4) educational software by subject, (5) types of peripherals, (6) teaching and learning activities by subject and (7) internet usage of teachers and students. Further, to find out the significant difference between the utilization of DepEd computerization program when they are grouped according to their personal information variables. A total of 30 EPP/TLE teachers of Binugao District are the respondents were identified through purposive sampling technique. The study utilized explanatory sequential mixed method design. Two methods in collecting the data were utilized, for the quantitative phase the researcher used survey questionnaire in determining the personal information and utilization of DCP. Furthermore, in the qualitative phase the researcher used in-depth interview in gathering the data to identify what school program should be enhanced in utilizing DCP efficiently. On the quantitative analysis, there is no significant difference between the utilization of DepEd computerization program when they are grouped according to their personal information variables. In addition, the quantitative findings were follow-up by the qualitative findings. Thus, it was found that the school program to enhance the utilization of DCP efficiently of teachers revealed four major themes namely: (1) resiliency, (2) results-focus, (3) innovation and (4) receptiveness.

Protocol to develop strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery in a selected district of Zimbabwe

Village Health Workers (VHWs) in Zimbabwe complement the healthcare staff in primary health care delivery. In 2015 the Ministry of Health streamlined services offered by the VHWs with the VHW Strengthening Plan to improve the effectiveness of the program. However, these continue to offer services not addressing the current and emerging health problems. This three-phased study seeks to develop strategies to improve the effectiveness and efficiency of VHWs in service delivery. Systematic literature review shall be used to develop a conceptual framework to guide the development of VHWs service delivery strategies. Exploratory sequential mixed methods design shall explore VHWs roles in primary health care. A survey in the first stage shall collect qualitative data from 45 purposely selected healthcare workers and VHWs using interviews and then thematically analyzed with MAXQDA. The variables generated will have a cross-sectional survey used to collect quantitative data from 134 VHWs and analyzed on SPSS. The SWOT and basic logic models shall be used to develop strategies validated by the Delphi Technique and Key Stakeholders. Informed consent will be maintained in the study with findings published in journals and presentation symposiums. This protocol was approved by the University of Venda Research Ethics Committee (Registration FHS/23/pH/11/0709).

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BackgroundIn recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of “Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model”.Methods/designThe current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants’ attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants’ average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.DiscussionThis is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.Ethical codeIR.MUMS.NURSE.REC. 1403. 014.

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.

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) &amp; control (CG) groups. Ethical Clearance is already obtained. EG will be followed through Nurse-led Clinic which includes multiple virtual educational &amp; counselling sessions, e-booklet on side effects management, PMRT, Support groups &amp; 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.

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.

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.

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.

Achieving sufficient milk supply supports mothers to cope with premature birth.

To explore whether and how expressing breast milk is perceived as helpful in coping with negative emotions due to premature birth by mothers of very low birth weight (VLBW) infants. Qualitative interviews and a retrospective cross-sectional questionnaire with mothers of VLBW infants were conducted and analysed using an exploratory sequential mixed-method design. Hypotheses were built using qualitative content analysis and quantitatively tested using multivariate regression analysis. Interviews with 12 mothers and questionnaires of 518 mothers were analysed. Coping with prematurity by expressing milk was seen as a way to maintain the caregiving role for the mothers, where three relevant factors arouse: making up for what happened, providing the best for their infant and fear of low milk supply. Quantitative analysis showed that mothers with a high milk supply (Coef. = 1.1, p < 0.000) and more feelings of guilt due to premature birth (Coef. = -0.1; p = 0.015) perceived expressing breast milk significantly more as a resource for coping. This study adds knowledge on how expressing breast milk for their VLBW infant may support mothers in coping with premature birth, by revealing the association with milk supply and feelings of guilt due to premature birth.

THE USE OF TECHNOLOGY IN ENGLISH CLASSESS AT SMA NEGERI 1 GIANYAR: STUDENTS’ AND TEACHER’ PERCEPTION

The purpose of the study was to find out how instructors and students felt about using technology in English classes. A mixed method sequential exploratory design was used in the investigation. The subjects were 228 students in the tenth grade at SMA Negeri 1 Gianyar and one English teacher. The interview guide and questionnaire were used to gather respondents' perceptions in order to meet the research goal. A combination of quantitative and qualitative analysis was used to analyze the data. The results showed that: (1) English teachers saw the use of technology in language instruction favorably because it had a number of positive effects; and (2) students believed that using technology in the language learning process could improve their knowledge and proficiency in the language. It showed that incorporating technology into the English language learning process has several positive effects on EFL students as well as English teachers.