Exploratory Sequential Mixed Methods Approach Research Articles

Teaching assistant roles in supporting students with intellectual and developmental disabilities in Chinese primary classrooms: divergent expectations among general education teachers and teaching assistants

Objectives Clarifying the roles of teaching assistants (TAs) is crucial for enhancing their support effectiveness. This study aimed to explore the differences in expectations regarding the roles of TAs between general education teachers and TAs in Chinese primary classrooms as well as the factors associated with these differences. Methods A sequential explanatory mixed-methods approach was employed. A total of 465 general education teachers and 400 TAs were surveyed to provide quantitative data, while five teachers and five TAs were interviewed to provide qualitative data. Results The quantitative survey revealed significant differences between teachers and TAs in terms of their overall expectations regarding TA roles as well as differences in the dimensions of personal care and classroom support. In particular, teachers scored significantly higher than TAs with regard to personal support; however, they scored significantly lower than TAs with respect to overall expectations and classroom support. The qualitative investigation revealed that these differences in role expectations were associated with internal (i.e., perceptions of the purpose of TA support and knowledge of student abilities) and external factors (i.e., professional training from schools and communication between teachers and TAs). Conclusions This study enriches the international literature on the role expectations of TAs in an inclusive education context and has important implications for their role clarification.

Challenges of proper disposal of old long-lasting insecticidal nets and its alternative uses in rural south-eastern Tanzania.

Insecticide-treated nets (ITNs), specifically long-lasting insecticidal nets (LLINs), are the most commonly used, scalable, and cost-effective tools for controlling malaria transmission in sub-Saharan Africa. However, the multiple alternative uses of retired LLINs have been associated with poor disposal practices. The World Health Organization (WHO) has provided guidelines and recommendations for the proper management of worn-out LLINs. This study assessed the existing alternative uses and disposal practices of old LLINs. An explanatory sequential mixed-methods approach was used to assess LLINs existing alternative uses, disposal practices, knowledge, and perceptions regarding WHO recommendations on proper disposal of old LLINs among stakeholders in Kilombero and Ulanga districts, south-eastern Tanzania. A survey questionnaire was administered to 384 participants. Furthermore, the study employed focus group discussions (FGD) and key informant interviews (KII) to elucidate responses regarding existing disposal practices, associated challenges, and alternative uses of LLINs. The insights derived from both study components were subsequently used for inferential analysis. The major challenge influencing the proper disposal of LLINs was limited awareness of how to properly dispose of them. Of the 384 people surveyed, 97.0% were not aware of the WHO recommendations for the proper disposal of old LLINs. All key informants were unaware of the WHO guidelines for proper disposal of old LLINs. The common methods used to dispose of LLINs were burning (30.7%), disposing them into garbage pits (14.8%), and alternative uses (12.2%). Of the 239 respondents with LLINs, 41.0% had alternative use, while 59.0% had no alternative use. The common alternative uses were ropes for tying or covering items (20.9%), garden fencing (7.5%), chicken coops (5.0%), and 7.5% for other minor alternative uses. Strengthening awareness and education on proper LLIN disposal practices among community members and key stakeholders is essential for enhancing malaria control efforts and preventing environmental pollution.

Design and Validation of Clinical Education Curriculum Pattern Based on Social Accountability for General Medicine Course: A Mixed Method Study

Introduction: In the social accountability of the curriculum, all medical education activities are aimed at training doctors who are able to meet the health needs of society. In Iran's medical education system, there is a weakness in responding to the needs of society, and the connection between students and society has gradually weakened. The purpose of this study was to design and validate a clinical education curriculum model based on social accountability for general medicine students. Methods: A sequential exploratory mixed-method approach was used to conduct this study at Tabriz University of Medical Sciences, combining qualitative and quantitative methods. The model was designed using the inductive content analysis method in the qualitative stage and validated through the descriptive-survey method in the quantitative stage. In order to collect data in the qualitative part, the method of studying previous documents, scientific texts and semi-structured interviews with experts and specialists was used, and in the quantitative part, a questionnaire prepared by the researcher was used. The model was developed using the views of 14 professors and 5 general practitioners, selected through purposive and sequential sampling until information saturation was reached. The model was validated by obtaining opinions from 15 experts using a purposeful and criteria-based method. The content validity ratio (CVR) was estimated using the Lawshe's formula. Results: In the qualitative phase, this study identified the characteristics of an ideal clinical education curriculum for a general medicine course based on a social responsibility approach. The characteristics identified were based on the four elements of Tyler's model. Based on the findings of this part of the research, the extracted codes in 114 subcategories and 13 main categories include goals: knowledge, attitude, and skills; Content: clinical sciences and skills, health sciences, behavioral sciences, social and professional ethics, communication and leadership skills, and content organization; Teaching-learning methods: educational strategies, and teaching-learning methods; Assessment methods: performance assessment in vivo, performance assessment in vitro, and essay assignments. In the quantitative phase, the designed model's components and elements underwent validation through expert agreement and received approval with a content validity ratio of CVR=0.81. Conclusion: In the proposed pattern, the clinical competencies required by general practitioners were the main focus of designing, explaining and describing curriculum elements. Also, this model is designed in such a way that it can meet the needs of society and medical students. It is suggested that medical school officials and curriculum planners use the proposed model in designing the curriculum of general medicine courses to enable medical students to respond to the needs of society.

Developing an observation protocol for online STEM courses.

The use of online instruction for undergraduate STEM courses is growing rapidly. While researchers and practitioners have access to validated instruments for studying the practice of teaching in face-to-face classrooms, analogous tools do not yet exist for online instruction. These tools are needed for quality design and control purposes. To meet this need, this project developed an observational protocol that can be used to collect non-evaluative data for the description, study, and improvement of online, undergraduate STEM courses. The development of this instrument used a sequential exploratory mixed methods approach to the research, design, pilot-testing, refinement and implementation of the protocol. Pairs of researchers tested the final version of this instrument, observing completed online undergraduate STEM courses. Across 2,394 pairs of observations, the observers recorded the same indication (yes or no to the presence of some course element) 1,853 times for an agreement rate of 77.4%, falling above the 75% threshold for an acceptable level of agreement. There was a wide range in the inter-rater reliability rates among items and further revisions were made to the instrument. This foundational work-in-progress instrument should be further developed and used by practitioners who are interested in learning about and reflecting on their online teaching practice.

Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study.

Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.

Development and psychometric evaluation of nurse’s intention to care for patients with infectious disease scale: an exploratory sequential mixed method study

AimsNurses who care for patients with infectious disease may experince significant stress and negative psychological reactions. The intention of nurses to care is a complex and multifaceted concept that is influenced by a range of factors. Therefore, this study was conducted to explain the concept of nurses’ intention to care for patients with infectious disease and then develop a reliable and valid scale to measure this concept accurately in Iranian nurses.DesignThis study is a cross-sectional study with a sequential-exploratory mixed-method approach from May 2022 to July 2023. The concept of nurses’ intent to care for patients with infectious disease was explain using deductive content analysis, and item pools were generated. In the sconed step the samples were 455 nurses. Data was collected by an online form questionnaire using a convenience sampling technique. In this step to determine the psychometric properties of nurse’s intention to care for patients with infectious disease scale (NICPS), face and content validity performed. Then construct validity was determined and confirmed using exploratory and confirmatory factor analysis followed by convergent and divergent validity respectively. Finally, scale reliability including stability and internal consistency were evaluated.ResultsThe finding showed that NICPS with seventeen items were classified into three factors namely “Social support” with seven items, “Spiritual motivation” with six items and “Job satisfaction” with four items. These three factors explained 56.14% of the total variance. The fit indices showed that the model has a fit and acceptable (TLI, CFI, IFI > 0.9; PNFI, PCFI > 0.5, REMSEA > 0.049, CMIN/DF = 2.477). Reliability revealed acceptable internal consistency and stability (> 0.7).ConclusionThe finding showed that NICPS has three factors in Iranian nurses. Nursing managers can use these results to provide training and support intervention for nurses in order to increase their intention to care for this patient. Also, the NICPS is a reliable and valid for evaluating this concept in future studies.

Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study.

Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975. DERR1-10.2196/56277.

The role of medicines and therapeutics committees structure in supporting optimal antibacterial use in hospitals in Uganda: A mixed method study.

Although the roles of Medicines and therapeutic committees (MTCs) have been expanding, there is limited information on the role of their structure in optimal antibacterial use in hospitals, especially in low-and-middle-income countries. Our study explored the structure and role of MTC in supporting antibacterial use in regional referral, general hospitals and tertiary private not-for-profit (PNFP) hospitals in Uganda. We conducted an explanatory sequential mixed-method approach with triangulation to explore the structure and functional role of MTCs from August 2019 to February 2020 in hospitals in Uganda. Quantitative data was collected using an interviewer-administered questionnaire among chairpersons or secretaries of MTCs and was analysed using descriptive statistics. We conducted key informant interviews using an interview guide among long-term serving members of MTCs to collect qualitative data which triangulated the quantitative data. The study revealed that sixteen hospitals had successfully established MTCs with an average duration of the MTCs' existence of 5.6 (+2.7) years. The membership of the MTCs varied between 7 and 14, with a median value of 10, and the majority of members in MTCs were pharmacists (15 out of 16) and clinical specialists (13 out of 16). The most frequent subcommittees of the 16 hospitals MTC were supply chain (n = 14), antimicrobial stewardship (n = 13), and infection control (n = 12). Majority (14 out of 16) of the MTCs supported availability and access of antibacterial use by selecting and evaluating antibacterials agents for their formulary lists using established criteria. Additionally, 15 out 16 MTCs conducted antimicrobial stewardship activities to support optimal antimicrobial use. In our study, MTC membership and subcommittees were critical structural components that aided the selection and evaluation antibacterials on hospital formulary lists and they supported optimal antibacterial use through implementing various antimicrobial stewardship activities. There is a need for the Ministry of Health to conduct more training on operationalising MTCs structures in all hospitals.

Delineating wine tourism experiences in Ningxia, China: a supply–demand perspective

PurposeThe purpose of this paper is to examine the relationship between wine tourism experiences (i.e. winescape, winery service quality, winery brand differentiation and tourist motivation) and tourist behavioral intentions (satisfaction, loyalty and revisit intention) from both demand and supply perspectives in Ningxia, China, by using the SERVQUAL model and the self-determination theory.Design/methodology/approachThe research comprises two studies with an exploratory sequential mixed-methods approach. Study 1 adopted semi-structured interviews with winery owners and managers to explore the factors related to wine tourism experiences that influence tourists’ tourism experience. The results from the Study 1 leads to Study 2, which used a survey to explore wine tourist experiences and their behavioral intentionsFindingsThis study provided important information regarding the factors that influence wine tourists experience in Ningxia wine region from the perspectives of supply and demands sides. Frist, this study confirmed the various factors influence wine tourism experiences in Ningxia based on the results from Study 1 (supply perspectives). Second, by further investigation in the Study 1, this study integrates the SERVQUAL model and the self-determination theory as fundamental theoretical frameworks in Study 2 to analysis the tourist perspectives. Third, as results, the authors finally confirmed the theoretical frameworks of wine tourism in Ningxia based on dual supply-demand perspectives.Originality/valueThe integration of multiple research approaches enriches the research findings and provides a more robust understanding of the wine tourism experiences in Ningxia.

Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management.

Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).

Influence of Democratic Leadership Style on the Performance of Agricultural Enterprises in Kenya

A performance evaluation of agricultural enterprises in Kenya was conducted to assess the influence of democratic leadership style. The assessment of agricultural enterprises’ performance in Kenya encompassed both financial and non-financial indicators. The overarching aim of the research was to assess the influence of democratic leadership style on the performance of agricultural enterprises in Kenya. The study was guided by the Systems Theory, Path Goal Theory, and Transformational Leadership Theory. The study evaluated the influence of Democratic leadership style on the Performance of Agricultural Enterprises in Kenya. Explanatory sequential mixed methods approach was adopted using cross-sectional survey design to collect quantitative and qualitative data. Quantitative data were gathered using closed-ended questionnaires, while qualitative data were gathered using interview guides and focused group discussion guides. A stratified random sample of 222 leaders and employees was selected from a population of 525 leaders and employees drawn from a census of 105 agricultural enterprises for the quantitative study. Qualitative data drew a sample of 40 participants. Quantitative data was analysed using descriptive and inferential statistics as provided for in Statistical Package for the Social Sciences (SPSS) Version 28.0.1. The overall findings of the study show that agricultural enterprises in Kenya perform better under democratic leadership style. The study recommends the implementation of Democratic Leadership Style by governments, donors, and capacity building organizations to enhance the performance of agricultural enterprises in Kenya.

Smart Living Housing Development in Malaysia: Debunking the Additional Cost Components from the Gross Development Cost Standpoint

The development of Smart Living housing in Malaysia necessitates a meticulous understanding of the Gross Development Cost (GDC) components to ensure project financial viability. Unlike conventional housing, Smart Living involves unique building elements such as polarised glass panels, occupancy sensors, wheelchair stair climbers, and rainwater harvesting systems. These features contribute to a holistically sustainable and convenient independent living environment but also present greater barriers with “extra work” that diverge from traditional houses. Given the nascent stage of Smart Living housing development in Malaysia, developers have often taken individual initiatives to constitute the concept due to the absence of established rules and regulations. This lack of standardisation has led to inconsistencies of cost and uncertainties in factual development cost components. Acknowledging these issues, this research necessitates an explanatory sequential mixed method approach; however, this paper presents only the initial phase of the research by exploring the perspectives of stakeholders. The study aims to clarify the additional cost components associated with the development, emphasizing their impact on the overall budgeting process through qualitative, semi-structured interviews with respondents selected through homogeneous purposive sampling. Findings from ten respondents were analysed narratively and revealed that the anticipated additional development cost components include one hard cost item for land acquisition, six soft cost items for social, environmental, and economic impact assessments, one soft cost item for the developer’s concern, and eleven hard cost items related to regulatory compliance. This paper addresses the gap in research regarding the uncertainties in determining feasible capital costs due to possibilities such as overestimating Smart Living feature expenses and underestimating preparation costs. By systematically examining these anticipated additional development cost components, this paper provides foundational guidance for better accuracy in estimating, managing costs, and conducting feasibility studies, thereby supporting the effective planning and execution of Smart Living housing developments in Malaysia.

Perspectives on childhood coronavirus disease vaccination in Japan and influencing factors.

To support parental decision-making it is important to understand parents' perspectives on vaccination for their children and the factors that contribute to their vaccine hesitancy. There have been relatively few studies in this area in Japan, particularly with longitudinal and mixed methodologies. We used an explanatory sequential mixed methods approach to describe longitudinal changes in vaccine acceptance and to explore factors associated with parental coronavirus 2019 (COVID-19) vaccine hesitancy. We recruited parents who had children aged 6 months to 11 years old from five facilities in Japan. Two cross-sectional online surveys and semi-structured online interviews were conducted. Logistic regression analysis was used to explore factors associated with parents' vaccine hesitancy for their children, and thematic analysis was used to analyze the interview data. In total, 134 parents responded to both online surveys and, of those, 10 participated in interviews. Acceptance rates of COVID-19 vaccination for their children were 19.4% (26/134) at the first survey and 11.2% (15/134) at the second survey. Integration of the data identified that the main factors for vaccine hesitancy included vaccine safety, vaccine effectiveness, government policy, and recommendations from people close to parents. Readily available and more balanced information, and community-wide support from people close to parents and familiar health-care providers are likely to provide better support for parents' decision-making. Further investigation is required on how to provide information in an easily understood manner.

The Effect of the COVID-19 Pandemic on the Family and Community Medicine Residency Training Program: The Philippine Experience.

The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs. The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs. A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions' residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data. There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value <0.05) in the average number of pediatric cases. For adult cases, significant differences (p-value <0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations. The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.

Evaluation of Blended Learning in Terms of the Perceptions of Medical Students: A Mixed Method Study.

The ongoing 4.0 industrial evolution, characterized by the rise of digital technology, has had a massive impact on human lifestyles worldwide. Faculty members in medical school are expected to respond to this industrial revolution by implementing teaching strategies, one of which is Blended learning as a suitable solution to overcome the limitations of space and time in the teaching process. For effective utilization of blended learning, it is important to conduct extensive studies on its implementation. The aim of this study was to assess the effectiveness and efficiency of implementing blended learning in the faculty of medicine in Hasanuddin University from the students' perspective. This study used a sequential explanatory mixed method approach, combining quantitative and qualitative methods. The quantitative part involved 782 undergraduate medical students from the first, second, and third years. Data were collected through a questionnaire survey distributed among the students. The qualitative part of the research was conducted through focus group discussions involving 13 students based on the questionnaire scores, representing both high and low scores. The results of the quantitative and qualitative research were collected and integrated. Based on the results, the majority of students agreed that blended learning provided many advantages to their learning (Mean±SD: 3.79±0.78). Also, they reported e-learning platform significantly contributed to their learning process (Mean±SD: 3.88±0.67). The workload of blended learning method was still considered quite heavy by students, and good time management was highly needed (Mean±SD: 3.45±0.84). As for qualitative part, some positive results were obtained; they reported that it increased motivation for learning, enhanced the efficiency of learning and gaining adaptability, while the negative opinions were the network error in e-learning, erratic e-learning display, and video quality problem. Most of the students expressed positive opinions about the advantages of blended learning; according to them, learning was more efficient and effective, it enhanced learning motivation, and it provided comprehensive accessible learning materials.

How Does a Junior Faculty Development Program Affect Burnout? A Mixed Methods Assessment.

Burnout is common among junior faculty. Professional development has been proposed as a method to improve engagement and reduce burnout among academic physicians. The Penn State College of Medicine Junior Faculty Development Program (JFDP) is a well-established, interdisciplinary program. However, an increase in burnout was noted among participants during the program. The authors sought to quantify the change in burnout seen among JFDP participants across 3 cohorts, and to explore sources of well-being and burnout among participants. Through a sequential explanatory mixed methods approach, participants in the 2018/19, 2019/20, and 2020/21 cohorts took a survey assessing burnout (Copenhagen Burnout Inventory), quality of life (QoL), job satisfaction, and work-home conflict at the start and end of the course. Descriptive statistics were generated as well as Pearson χ2 test/Fisher exact test for categorical variables and Wilcoxon rank sum tests for continuous variables for group comparisons. To better understand the outcome, past participants were invited to interviews regarding their experience of burnout during the course. Inductive thematic analysis (kappa = 0.86) was used to derive themes. Start- and end-of-course surveys were completed by 84 and 75 participants, respectively (response rates: 95.5% and 85.2%). Burnout associated with patient/learner/client/colleague increased (P = .005) and QoL decreased (P = .02) at the end compared with the start. Nonsignificant trends toward worsening in other burnout categories, work-home conflict, and job satisfaction were also observed. Nineteen interviews yielded themes related to risks and protective factors for burnout including competing demands, benefits of networking, professional growth, and challenges related to diverse faculty roles. Junior Faculty Development Program participants demonstrated worsening of burnout and QoL during the program while benefiting from opportunities including skill building and networking. The impact of Junior Faculty Development Programs on the well-being of participants should be considered as an element of their design, evaluation, and refinement over time.

Bridging the Policy Gap: Examining Physical Education in Colorado

Purpose: Using the social ecological model as a guiding framework, the purpose of this study was to examine the status of physical education in Colorado. Method: A sequential explanatory mixed-method approach was employed to acquire a snapshot of the status of physical education. Participants completed an initial survey followed by semistructured interviews. The quantitative survey data were analyzed with descriptive statistics, and the qualitative data were analyzed using open and axial coding. Results: The results of this study are presented in two parts: an overview of the status of physical education, followed by a detailed analysis of each component of physical education. Discussion/Conclusion: This study demonstrates a comprehensive approach to examining physical education, providing a holistic view of physical education, and serving as a valuable resource for policymakers and stakeholders.

Educating Hematology-Oncology Fellows About How to Communicate with Patients About Clinical Trials: A Needs Assessment.

Only 5-8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists' communication skills may enhance the frequency and quality of their discussions with patients about CCTs, consequently increasing participation. However, little is known about interest in or presence of CCT-related communication training during Hematology-Oncology (Hem-Onc) fellowships. This study aimed to describe, from the perspective of Hem-Onc fellowship program directors (PDs): (1) the current landscape of CCT education for Hem-Onc fellows; (2) the acceptability and feasibility of implementing a CCT communication skills workshop for Hem-Onc fellows. We used an explanatory sequential mixed-methods approach. PDs were surveyed and interviewed about their graduate medical education (GME) programs' current CCT curriculum, training challenges, fellows' CCT knowledge and CCT communication skills, and preferences for a CCT communication workshop. PDs were surveyed (n = 40) and interviewed (n = 12). PDs reported that their institutions prioritize CCT accrual (M = 4.58, SD = .78; 1-5 scale, 5 = "Strongly Agree") and clinical research training (M = 4.20, SD = .85). CCT skills that programs least often addressed were how to (1) discuss CCTs with newly diagnosed patients, (2) talk to patients about CCTs when none are available, and (3) help patients find CCTs at other institutions. PDs were interested in a CCT communication workshop for fellows ("yes" = 67.5%, "maybe" = 32.5%) and said training would be feasible (M = 4.28, SD = .78) and useful (M = 4.47, SD = .78). Qualitative results described programs' current approaches to CCT education and insights about developing and implementing CCT communication training. There is a clear need to improve CCT communication skills training in Hem-Onc fellowship programs and to implement and scale such training to increase CCT participation, especially among diverse patient populations. Furthermore, Hem-Onc GME PDs view such training as feasible and useful.

Health status and self-perception of health among homeless people in Spain: a mixed-methods study.

Homelessness is a phenomenon of social exclusion and poverty that has increased alarmingly during recent years. Homeless people (HP) experience violations of several basic human rights or needs that impact their well-being. Therefore, the aim of this research was to assess the health status and self-perceived health of HP and examining the impact of homelessness on their health. We used an explanatory sequential mixed-methods approach that integrated a quantitative cross-sectional study within critical social and ethno-sociological qualitative frameworks. Data were collected in Palma, Spain, from December 1, 2020, to January 1, 2023. A total of 198 HP were recruited from the streets and public areas. Basic human needs (Virginia Henderson model), medical diagnoses, substance abuse (DAST-10), diet quality (IASE), depression (PHQ-9), and social support (SSQ-6) were assessed. Then, 17 semi-structured interviews were conducted and were analyzed using thematic content and discourse analysis. Quantitative and qualitative data were integrated and jointly analyzed. The 79.3% of the participants were men, mean age of 47.8 ± 12.2 years. The 76.4% were Spanish. The participants reported severe difficulties in accessing the labor market, and that this greatly affected their self-esteem and mental health. The 48.9% of the participants suffered from one or more chronic diseases, and 50.3% were diagnosed with a mental health disorder. The participants generally did not consider health problems as a central concern. The health needs that most affected the participants were related to food, safety, and social support. HP frequently felt unsafe, fearfully, and anxious. Homelessness, unemployment, and social exclusion have significant negative impacts on the health and wellbeing of HP. Precarious work conditions and deficiencies in the welfare system contribute significantly to homelessness. These results highlight the need for systemic solutions that extend beyond short-term housing initiatives.

Design and Internal Validation of an Educational-Therapeutic Model for Addressing Co-Dependency Based on Perceived Lived Experiences of Adolescents

Purpose: Adolescence is the third developmental stage, beginning after the completion of childhood. This stage, influenced by developmental changes, exposes individuals to a higher risk of developmental dysfunctions and psychosocial harm compared to other life stages. The present study aimed to design and internally validate an educational-therapeutic model for addressing co-dependency based on the perceived lived experiences of co-dependent adolescents in the Khattam region. Methods and Materials: A sequential exploratory mixed-methods approach was employed. The qualitative part utilized inductive content analysis, while the quantitative part gathered opinions from professors and experts through a survey. In the qualitative section, the statistical sample for semi-structured interviews included 15 co-dependent adolescents from the Khattam region. In the quantitative section, 12 professors and specialists were selected as the sample. Based on the content analysis, 5 main themes and 12 sub-themes were extracted. Findings: The qualitative findings indicated that the themes and sub-themes were divided into two dimensions, individual and social. The individual dimension included reactivity with sub-components (denial, obsession, and anger), the need for control with sub-components (suppression of emotions and difficulty in establishing relationships), and alienation. The social dimension included interpersonal dependency with sub-components (controlling, distrust, abnormal relationships, weak boundaries), and external focus with sub-components (caring for others and being influenced by external factors). Conclusion: It can be concluded that educational system stakeholders should consider the proposed model of this research for designing and implementing effective education aimed at enhancing the self-efficacy of adolescents.