Explanatory Sequential Mixed Methods Design Research Articles

Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study

ObjectiveThis study aimed to develop and apply a nomogram with good accuracy to predict the risk of CRAB infections in neuro-critically ill patients. In addition, the difficulties and expectations of application such a tool in clinical practice was investigated.MethodsA mixed methods sequential explanatory study design was utilized. We first conducted a retrospective study to identify the risk factors for the development of CRAB infections in neuro-critically ill patients; and further develop and validate a nomogram predictive model. Then, based on the developed predictive tool, medical staff in the neuro-ICU were received an in-depth interview to investigate their opinions and barriers in using the prediction tool during clinical practice. The model development and validation is carried out by R. The transcripts of the interviews were analyzed by Maxqda.ResultsIn our cohort, the occurrence of CRAB infections was 8.63% (47/544). Multivariate regression analysis showed that the length of neuro-ICU stay, male, diabetes, low red blood cell (RBC) count, high levels of procalcitonin (PCT), and number of antibiotics ≥ 2 were independent risk factors for CRAB infections in neuro-ICU patients. Our nomogram model demonstrated a good calibration and discrimination in both training and validation sets, with AUC values of 0.816 and 0.875. Additionally, the model demonstrated good clinical utility. The significant barriers identified in the interview include “skepticism about the accuracy of the model”, “delay in early prediction by the indicator of length of neuro-ICU stay”, and “lack of a proper protocol for clinical application”.ConclusionsWe established and validated a nomogram incorporating six easily accessed indicators during clinical practice (the length of neuro-ICU stay, male, diabetes, RBC, PCT level, and the number of antibiotics used) to predict the risk of CRAB infections in neuro-ICU patients. Medical staff are generally interested in using the tool to predict the risk of CRAB, however delivering clinical prediction tools in routine clinical practice remains challenging.

Why don't all victims tell teachers about being bullied? A mixed methods study on how direct and indirect bullying and student-teacher relationship quality are linked with bullying disclosure

The study aimed to explore bullying disclosures to teachers from the victims’ point of view, with a special focus on the influence of direct and indirect bullying and student-teacher relationship quality. A sequential explanatory mixed methods design was adopted. First, 190 students with bullying experience completed a questionnaire. Second, 20 students were interviewed. One of several of the findings revealed that students were more inclined to tell a teacher about victimization when bullying was indirect. Bullying and how teachers managed it had an impact on the quality of the student-teacher relationship, but not solely dependent on whether the bullying ended.

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.

Intimate partner violence after childbirth: an explanatory sequential mixed-methods study protocol

BackgroundIntimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth.MethodsAn explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women’s experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data.DiscussionThis is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth.Ethical codeIR.TUMS.FNM.REC1400.200.

The Noteworthiness of Constructive Feedback and Student-Reflection to Approach Competence-Based Curriculum: An Explanatory Study of Medical Schools in Indonesia

Background: Competence-based medical curriculum requires the acquisition of complex abilities that should be assessed longitudinally. The programmatic assessment model can facilitate a complete picture of students' competencies. The five components of learning, assessment, supporting activities; and intermediate to final evaluation provide holistic learning experiences for students and mentors to participate in the learning strategies. We aim to assess the application of longitudinal components of the programmatic assessment model to the current assessment system based on student perceptions.Methods: This study used a cross-sectional mixed-method sequential explanatory design at six medical schools in Surabaya, East Java of Indonesia. The instrument was 43 items of validated questionnaire based on the five components and the focus group discussions. Results: This study obtained 442 respondents. The results reflected high reliability with a Cronbach alpha value of 0.969, and the validity test showed R arithmetic &gt; R table (R table 0.128 for n 442). The current assessment system was perceived as ‘good’, with 3.9 on 5 points Likert scale; but the ‘supporting activities’ where reflection and feedback lied; was at the lowest score although insignificant. Students underlined the lack of formative aspects (reflection, feedback, mentorship, and middle evaluation).Conclusion: The overall assessment system is well-perceived by the students; however, the 'supportive activities' component has been minimally applied. So the 'assessment of previous learning' is still prominent in the current assessment system.

Towards an understanding of the digital transformation of facility management in healthcare: perspectives from practice

PurposeFacility management (FM) in healthcare is an organisational function that provides non-medical activities, ensuring operational functionality of critical health infrastructure. FM leaders are under pressure to implement the digital transformation, confronted with a highly complex and challenging operational environment. However, the current scope and understanding of the digital transformation in FM is rather limited, with a strong focus on technology. This perspective is inadequate to realise a digital transformation in healthcare organisations and requires a new framework. To ensure the practical applicability, a clearer depiction on how FM practitioners in the field, currently understand the digital transformation, is necessary.Design/methodology/approachA sequential exploratory mixed-methods design was chosen with a qualitative data collection and quantitative data analysis phase. A total of 23 semi-structured research interviews with professionals from FM in healthcare in Switzerland were carried out. Topic modeling was used to analyse, identify and cluster topics.FindingsIn total, nine distinct digital transformation topics were generated: ‘addressing future organisational and people needs’, ‘end-user-oriented processes’, ‘digitalisation management vs. digital tools’, ‘major organisational change’, ‘information exchange and work culture’, ‘digital systems’, ‘pressure’, ‘company-wide strategy’ and ‘management support and communication involving non-medical support services’. The findings indicate that FM practitioners perceive the digital transformation beyond the purely technological viewpoint, although they lack the know-how and instruments necessary to implement the digital transformation.Originality/valueThis study employs an innovative research design, resulting in foundational insights on how FM in healthcare perceives the digital transformation. As such, the study expands the notion on what the digital transformation means for the FM field.

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.

Transfer of training and learner attitude: a mixed-methods study on learner experience in an authentic learning program

ABSTRACT To understand the longstanding issue of low training transfer rates, in this study we explore the understudied role of trainee attitude in an authentic educational training programme comprising participants with diverse international backgrounds. We employed a sequential explanatory mixed-methods design and conceptualised attitude as a multi-dimensional construct (affective, cognitive, behavioural). The multiple regression analysis highlights the significant predictive role of learner attitude, when considering all three dimensions. Spearman’s Rank Correlation analysis underscores the significance of each attitudinal dimension, with varying significance across dimensions. Qualitatively, the cognitive-transfer link was confirmed while behavioural and affective domains had weaker links with transfer according to participants. Additionally, we identified constructs related to individual attitudes and transfer, including motivation, cultural diversity, and multiple situational conditions. Our findings have implications for international audiences and provide recommendations for designing effective training programmes to enhance transfer.

Evaluation of Internal Quality Assurance System in Defence Services Medical Academy: Moving Toward Quality Culture

The escalating number of higher education institutions globally has heightened the demand for credible education policies and quality assurance mechanisms. The establishment of organizations for quality assurance providers and accreditors has become widespread to meet this demand. The Myanmar Medical Council Accreditation Committee (MMCAC) was established in 2016 to ensure the quality and standard of medical practice in Myanmar. Defence Services Medical Academy (DSMA), one of Myanmar’s medical universities, transitioned to an outcome-based integrated program in line with the World Federation for Medical Education (WFME) Basic Medical Education Standards. To evaluate the effectiveness of DSMA’s internal quality assurance system and its progression towards a quality culture, this study explores faculty perceptions and practices regarding the internal quality assurance process. An explanatory sequential mixed method design was adopted, comprising quantitative surveys followed by qualitative in-depth interviews. Pre- and post-test surveys were administered to DSMA faculty members before and after an IQA training workshop. The surveys assessed knowledge, attitudes, and practices related to the internal quality assurance system. Qualitative data was collected through in-depth interviews with selected faculty members to delve deeper into their experiences and perceptions regarding the IQA process. Quantitative analysis revealed an improvement in faculty awareness and attitudes towards the IQA system post-training. However, challenges such as confusion about the functional place of the QA unit and concerns about disturbing academic freedom persisted. Qualitative findings highlighted varying levels of experience and awareness among faculty members, with unanimous recognition of the need to strengthen the IQA framework by adhering to international guidelines and fostering a culture of continuous improvement. Faculty attitudes towards the IQA process varied, with some viewing it as an extra burden and others recognizing its necessity for document organization and quality control. Faculty involvement in the IQA process varied, with departmental leadership playing a crucial role in promoting participation. While progress has been made in raising awareness and improving attitudes towards the IQA system at DSMA, challenges remain, indicating the need for ongoing efforts in awareness-building and perception management. Structural improvements, regular training programs, and ongoing evaluation are essential to strengthening the IQA framework and fostering a quality culture at DSMA. The successful implementation of quality assurance program depends on teamwork amongst leadership, academics, and all stakeholders.

The Development of PJBL-STEAM Learning Design to Improve the Student Creativity in Handling Waste: Utilizing Used Cardboard in Making Simple Miniature ATMs

Students’ creativity in handling waste is important to help them solve mathematical and SBdP concepts, especially operational problems such as building simple miniature ATMs and reusing waste. Therefore, this research is motivated to develop a learning design that increases students’ creativity in handling waste, using the PJBL-STEAM approach as an effective method. The aim of this research is to increase students’ creativity in handling waste. Phase portraits are given using PJBL-STEAM learning. This research uses a sequential exploratory mixed method design, which is characterized by qualitative data collection and data analysis first, and the next stage is quantitative data collection and second data analysis. The research subjects were 28 experimental elementary school students and 26 control students. According to research by Smith and Jones (2018), the project-based learning approach is effective in increasing student engagement and problem-solving skills. They emphasized the importance of combining this approach with aspects of STEAM (Science, Technology, Engineering, Arts, and Mathematics) to increase students’ creativity in solving environmental problems, including waste management. The research method used in the research is the research and development method. This method will be used to develop and test the effectiveness of PJBL-STEAM learning designs that encourage student creativity in handling waste. The evaluation was carried out by observing student performance, evaluating simple miniature ATM products in the form of coins and paper made from used cardboard, and surveying student reactions to learning. The evaluation results will be used to measure the effectiveness of this learning design in increasing student creativity in waste management and recycling used cardboard. It is hoped that the development of the PJBL-STEAM learning design can help students improve their creative abilities in waste disposal and recycling used cardboard. It is hoped that the results of this research can become a reference for educators in the field of innovative learning which aims to develop 21st century skills.

Needs analysis of family caregivers of people living with dementia in Sleman Regency, Yogyakarta.

Without appropriate support, taking care of people living with dementia may become a burden for family caregivers. Identifying the needs for caregivers can help them minimise the burden of caring and meet quality care for people living with dementia. In the first phase, a content validity test was conducted on the Carers' Needs Assessment of Dementia (CNA-D) in the Indonesian version. The second phase, a sequential explanatory mixed-methods design, was conducted on 65 family caregivers in two stages. The first stage was a cross-sectional study. A correlation test between caregiver problems and caregiver burden was conducted. The caregiver problems that were statistically significant were analyzed to reveal the unmet needs. A needs analysis was also conducted on problems experienced by more than half of the caregivers. In the second stage, we conducted a semi-structured individual interview, and thematic analysis was used to analyze the data. The result of the validity test of the CNA-D instrument, Indonesian version, obtained a high value for content validity. The main problem of caregivers is a lack of information about dementia; however, it does not have a significant correlation with caregiver burden. The caregiver problem with the highest correlation to caregiver burden is burnout due to caring. More than 50% of caregivers' needs in Sleman Regency were not met in this research. The most essential needs that were not met were counselling and psychotherapy (83.3%-92%). The personal understanding of dementia, spiritual values in caring, cultural values in caring, barriers to accessing healthcare services, and self-care strategies should be considered in fulfilling family caregiver needs. Most of the needs of family caregivers of people living with dementia in Sleman Regency, Yogyakarta, have not been met. Therefore, it requires collaboration with multi-professionals and all stakeholders to fulfil these needs.

Health research evidence: its current usage in health planning, determinants and readiness to use knowledge translation tools among health planning teams in Tanzania—an exploratory mixed-methods study protocol

IntroductionAchieving universal health coverage requires using research evidence to inform decision-making. However, little information is available on the use of research evidence in planning in lower middle-income countries, including Tanzania....

Learners’ Perspectives on Support Services in Distance Learning at the Institute of Adult Education

This study sought to explore learners’ perspectives on support services in distance learning at the Institute of Adult Education in Tanzania. The study used the explanatory sequential mixed method design to capture respondents’ perspectives on quality of learner support services provided at the Institute. The target population was 350 distance learning diploma students. A sample of 83 students was drawn from the population through simple random sampling. The study employed a closed-ended questionnaire and an open-ended interview in data collection. Quantitative data was analysed through the thematic approach while quantitative data was analysed through descriptive statistics. The analysis led to the conclusion that learner support services existed but were inadequately provided. Most of the students were not satisfied with how face to face sessions were conducted. While the majority of respondents were satisfied with information about choosing courses of study, the majority were not satisfied with stress management services. The study recommends that the institute should develop strategies to ensure provision of quality student support services in terms of academic matters, guidance and counselling and stress management. Furthermore, students should be encouraged to report challenges experienced and propose the best way to improve the situations.

The use of household items to support online surgical knot-tying skills training: a mixed methods study

BackgroundThis study investigated the perceptions and performance of medical students regarding their engagement and learning of a knot-tying skill presented in an online demonstration format due to the emergency remote measures that accompanied COVID-19 restrictions.MethodsFinal-year undergraduate medical students were invited to view an online demonstration of a one-handed knot-tying skill and practice the skill using common household items. They recorded their attempts and uploaded them onto the Flipgrid application. Completed attempts were scored using an adapted Objective Structured Assessment of Technical Skill (OSATS) validated tool. We used a mixed-methods sequential explanatory design; data regarding students’ engagement was gathered via a short questionnaire, and a Focus Group Discussion (FGD) was conducted to understand their learning experiences better. Descriptive statistics such as proportions and percentages were used to summarize categorical variables and median for continuous variables. Each video attempt was scored independently by two surgeons; reliability was determined using intraclass correlation; statistical tests were conducted at a 5% level of significance. Responses to open-ended survey questions and qualitative data from the FGDs were analysed using thematic analysis.ResultsSeventy-one students participated in the exercise. Most students (91.5%) expressed confidence in their ability to perform the skill and were able to follow the steps in the video demonstration (83.1%). Median number of times needed to practice before video submission was 7.0 (Interquartile range [IQR] 5.0–10.0). Using the adapted OSATS tool; median scores on student attempts were 19.0 out of 21 (IQR: 17.0–20.0) for Assessor 1 and 18.0 out of 21 (IQR: 17.0–20.0) for Assessor 2, and overall scores showed good reliability between assessors based on intraclass correlation (0.86, 95% CI 0.79–0.90, p < 0.001). Qualitative insights from the students’ experiences in learning the skill were generally positive; it was a practical, experiential learning process and they valued the social aspects of learning via Flipgrid. Challenges expressed related to the need for in-person training and formal feedback on how to improve their technique. Suggestions to improve their learning included a request for an interactive session with immediate feedback on attempts, and being able to practice with a friend who would assist with videoing.ConclusionBasic knot-tying can be taught with acceptable efficiency and student satisfaction using online methods with items available at home.

Mixed-methods approach to investigating the diffusion of FinTech services: enriching the applicability of TOE and UTAUT models

PurposeThe rapid global use of Financial Technology (FinTech), an innovative and advanced technology, is leading to the replacement of traditional financial services. Despite this, consumers in the United Arab Emirates are still not accepting FinTech services as anticipated. This study aims to investigate the barriers preventing consumers from using FinTech services in the banking industry based on the technology-organisation-environment (TOE) framework and anchored by the unified theory of acceptance and use of technology (UTAUT).Design/methodology/approachThe current study used an exploratory sequential mixed-method design. A purposive sample was used to conduct preliminary semi-structured interviews with ten banking practitioners. These interviews aimed to explore the obstacles that hinder consumers from adopting FinTech services. To provide further empirical validation, the conceptual model has been systematically examined through a quantitative cross-sectional online survey encompassing a sample of 332 bank customers.FindingsThe qualitative investigation highlighted six new barriers to the usage of FinTech based on TOE’s model attributes. Through quantitative data analysis, the preliminary qualitative findings were primarily verified. It was discovered that self-efficacy, electronic word-of-mouth, system quality and bank image substantially influence consumers to use FinTech services, in addition to performance expectancy and facilitating conditions. Meanwhile, IT features and governmental support were found to have insignificant effects. Yet, government support was found to have a positive moderating role in strengthening social influence and system quality towards customer use of FinTech. Thus, the research supports the UTAUT and TOE models’ fitness for explaining FinTech usage with high predictive relevance.Originality/valueThis study is the authors’ pioneering effort to propose a comprehensive research framework that integrates the UTAUT and TOE models to tackle the limited adoption of FinTech services among consumers. Moreover, the study specifically examined the moderating influence of government support to propose an integrated model. Remarkably, this study is one of the initial attempts to investigate the adoption of FinTech using a mixed-methodology approach by incorporating quantitative and qualitative methods within a single inquiry to yield more comprehensive and insightful findings than research that relies on a single method.

Enablers and inhibitors of digitalization as part of continuous improvement

PurposeTo deal with an increasingly competitive environment, organizations are combining continuous improvement (CI) practices with digitalization to accrue their benefits on operational performance and achieve operational excellence. The purpose of this study was to identify the enablers and inhibitors of digitalization as part of CI projects.Design/methodology/approachA mixed-methods sequential explanatory research design consisting of an online survey and semi-structured interviews was used to examine how digitalization technologies have been incorporated by organizations in their CI projects.FindingsKey enablers of digitalization were found to be leadership capabilities, strategic direction, stakeholder involvement, system compatibility, data quality and giving employees room to experiment. Knowledge of digitalization was found to affect all these enablers.Research limitations/implicationsThe empirical findings are based on a nonprobability sample of Dutch CI practitioners, limiting their generalizability.Practical implicationsThe empirical findings highlight the need for organizations to adopt a structured approach to implementing digitalization as part of their CI projects, starting by ensuring that the necessary knowledge and skills are either present or accessible to the organization.Originality/valueThe empirical findings show that enablers of digitalization in the context of CI are strongly interlinked, and thus require a holistic approach.

Exploring the Relationship between Spiritual Well-being and Psychological Well-being among Novice Clergy and Senior Priests in Myanmar: A Basis of Development and Implementation of a Psycho-Spiritual Intervention Program

The study explored the in-depth experiences of spiritual well-being and its role on psychological well-being among clergy towards development and implementation of a Psycho-Spiritual Intervention Program. In particular, the study looked into the lived-experiences of spiritual well-being through the quality of relationship that one has within each component of spiritual well-being and its role on psychological well-being among novice clergy and senior priests because novice clergy and senior priests are the most important stages in priestly life. There is a big difference between these two groups in terms of number of years in priestly life, year of ordination, age and occupation. In order to achieve breadth and depth in the understanding of this phenomenon, the researcher employed the explanatory sequential mixed-method design. A total of 271 clergy (135 novice clergy and 136 senior priests) completed questionnaires about spiritual well-being and psychological well-being, 10 novice clergy and 10 senior priests were then selected for in-depth interviews. The results of regression analyses showed that overall spiritual well-being is a significant predictor of psychological well-being among the clergy. Personal component of spiritual well-being alone and environmental component of spiritual well-being alone were significant predictors of psychological well-being among novice clergy and senior priests respectively. The interviews substantiated these results. It further revealed that transcendental and communal component of spiritual well-being still appear in the picture of the relationship between spiritual well-being and psychological well-being among the clergy. These components, however, were manifested in different ways among the novice clergy and the senior priests. The findings specifically showed that the experience of spiritual well-being within the personal component benefits personal growth, environmental control, self-acceptance, purpose in life and emotional stability among the novice clergy. The experience of spiritual well-being in environmental component, on the other hand, benefits peace of mind, self-acceptance and others-acceptance, increased ability of problem-solving skills, increased happiness and a better physical health among senior priests. The implications of the study for clergy, for counseling practice and for future research have discussed.

Service-Learning in Biochemstry Course: A Model to Improve the Problem-Solving Skills of Biology Education Students

Collaboration, communication, and problem-solving skills are becoming increasingly important in the modern workplace. Integration of learning activities, research, and community service was discovered to be an effective way to develop these abilities in students. The present study employed a mixed-methods sequential explanatory design to examine the effect of the service-learning model on seventeen college students. Observation, interview, and a problem-solving test were used to collect the data. The data were analyzed qualitatively and quantitatively. The quantitative data analysis was performed using the parametric pretest and post-test design. The results showed that participants’ problem-solving skills improved after being exposed to the service-learning model, indicated by the significance value of more than 0.05 in the non-parametric Wilcoxon test. Likewise, the qualitative analysis indicated that 95% of the participants considered the SL model effective in improving their problem-solving skills, especially the abilities to explore content, identify problems, solve the problems, and communicate scientific concepts.

Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana

IntroductionPeople with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana.MethodsA sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis.ResultsMost PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes.ConclusionThe study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs.

Establishing Faith – The Close Relationships, the Early Influences and the Aspect of Integrity and Trust

Abstract This study examines the establishment of Christian faith amongst Norwegians aged 30–40, with focus on the impact and nature of early religious influences. Employing an explanatory sequential mixed-methods design, the research synthesizes quantitative data from 585 participants, complemented by qualitative follow-ups with 10 respondents from the initial cohort. The tripartite investigation probes into the dynamics of Christian faith formation in this demographic. It particularly scrutinizes the synergy between personal relationships and engagement in Christian practices. The findings suggest a composite of activities that collectively underscore their significance. While youth ministry and parental influence during adolescence play notable roles, the qualities embodied in personal relationships – characterized by warmth, trustworthiness, and integrity – may be more crucial than the structural aspects of the relationships themselves. These insights contest conventional views of predominant influences on faith formation and religious acculturation, underscoring the salience of authentic interpersonal connections in navigating one’s spiritual trajectory.