Sequential Mixed Methods Study Research Articles

Preservice teachers’ cultural competence factors in teacher preparation programs: an explanatory sequential mixed methods study

ABSTRACT Cultural competence is a framework that develops preservice teachers’ self-awareness to confront their attitudes, beliefs, biases, and values, to learn and understand culturally diverse groups’ needs, and to translate such knowledge into culturally responsive professional practices and skills. Previous studies investigating teacher preparation programmes through the lens of cultural competence examined its application in early childhood and elementary undergraduate programmes, in an ESOL course, in a study abroad programme, and in a literacy method course. However, questions were left unanswered concerning the factors affecting preservice teachers’ perceptions of being culturally competent to teach culturally and linguistically diverse (CLD) students. The purpose of this study is to examine the factors that affect preservice teachers’ cultural competence development to teach CLD students using an explanatory sequential mixed-method design. The goal is to provide a holistic understanding of preservice teachers’ experiences with cultural competence in their teacher preparation programmes by integrating quantitative and qualitative data. The findings from this study highlight the need to implement intentional efforts to prepare preservice teachers to attend to the increasing demand for offering high-quality education to CLD students.

The indignities of shielding during the COVID-19 pandemic for people with sickle cell disorders: an interpretative phenomenological analysis.

This article seeks to understand the first-hand experiences of people with sickle cell, a recessively inherited blood disorder, who were identified as clinically extremely vulnerable during the COVID-19 pandemic. Part of a larger sequential mixed-methods study, this article uses a selective sample of eight qualitative semi-structured interviews, which were analysed using interpretative phenomenological analysis (IPA). The first stage of IPA focused on practical concerns participants had correlated to understanding shielding and their feelings about being identified as clinically extremely vulnerable. In a secondary stage of analysis, we examined the emotions that it brought forth and the foundations of those based on discriminations. This article adds to our theoretical understanding of embodiment and temporality with respect to chronicity and early ageing. It explains how people with sickle cell disorders have an embodied ethics of crisis and expertise. It also elucidates how people's experiences during the pandemic cannot be seen in void but illustrates ableism, racism, and ageism in society writ large.

Exploring workplace mental health: educator perspectives and factors in the medical education system – a mixed method study

IntroductionThe present study aimed to assess the status of workplace mental health from the viewpoints of educators, and explore their experiences concerning influential factors on occupational mental health at Shahid Sadoughi University of Medical Sciences.MethodsThe study was a sequential mixed-method study that was conducted in quantitative and qualitative phases. In the quantitative phase, the perception of educators (n = 205) was assessed by a Workplace Mental Health Questionnaire, including 37 items in 9 categories (including an opportunity to control, an opportunity to use skills, external goals created, environmental diversity, environmental clarity, access to money, physical security, opportunity to contact others, and valuable social status and position). In the qualitative phase, data were collected using semi-structured interviews (n = 21) and were analyzed based on the conventional content analysis approach.ResultsThe results showed that the status of workplace mental health of educators was at a moderate level (mean (± SD) = 115.87 (±3.21). The highest and lowest scores of the median were reported in the domains of “opportunity for control” (median = 4) and “opportunity to contact others” (median = 2.75), respectively. The theme of “contrast between preferences and disappointments in the development path” with two categories including “induced demotivation of system elements” and “tendencies of promotion” was explored from the educators’ perspective.ConclusionThe results indicated the moderate level of mental health of educators was influenced by the contrast between preferences and disappointments in the development path. The tendency of educators for promotion was explored as a positive factor in the mental health of educators in the academic environment. A growing desire for creative advancement among educators as a personal factor and a demand to stay updated with all developments as a system factor explained the positive experiences of educators in the university. The results showed the gap between the current situation and the desired state of occupational mental health may result from cultural challenges, lack of adherence to professionalism at the personal level (non-compliance with the principles of well-being and excellence), and interpersonal level (non-compliance with respect, justice, etc.). Moreover, factors disrupting occupational mental health at the system level explored in job stress, a resilient culture, lack of managerial support, ingratitude, lack of reward-effort matching mechanism, and lack of resources.

Biology lecturers’ perceptions of genetics literacy in Indonesia: an explanatory sequential mixed methods study

ABSTRACT Given its impact on medicine, agriculture, and society, genetics literacy has attracted international interest. Biology lecturers play a crucial role in supporting students’ genetics literacy empowerment. However, research into biology lecturers’ perceptions of genetics literacy still needs to be undertaken. This study aimed to explore the understanding, perception, and awareness of genetics literacy among Indonesian biology lecturers. We performed an explanatory sequential mixed method study in two phases: online survey and semi-structured interviews. Results showed that (a) most biology lecturers agreed that genetics literacy was correlated with scientific literacy, information and communication technology literacy, reading literacy, and numerical literacy, and then genetics literacy is understood as consisting of genetics concepts and skills; (b) most biology lecturers agreed that argumentation, informal reasoning, and decision-making skills were appropriate for enhancing genetics literacy development; (c) despite less than half of the biology lecturers teaching skills related to genetics literacy and only a fourth assessing skills related to genetics literacy, most biology lecturers were willing to teach and assess skills related to genetics literacy comprehensively. The findings revealed that biology lecturers’ perceptions of genetics literacy must be explored, given their critical role in ensuring effective and successful genetics educational practice.

Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention.

Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions. A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization. Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas. Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.

Understanding “patient deterioration” in psychotherapy from depressed patients’ perspectives: A mixed methods multiple case study

Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment. Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre–post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients’ interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. Results: Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of “deterioration” not necessarily corresponds to a “deteriorated experience,” nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient’s (lack of) agency in the process, a discrepancy between patients’ expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences. Conclusion: The meaning of symptomatic deterioration should be interpreted within a patient’s idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.

Use of herbal medicine during pregnancy and associated factors among pregnant women with access to public healthcare in west Shewa zone, Central Ethiopia: sequential mixed-method study

ObjectiveThis study was aimed at assessing the prevalence of herbal drug use among pregnant women with access to modern medicine and associated factors in public health facilities in the west...

Acceptability to donate human milk among postnatal mothers at St. Francis hospital Nsambya, Uganda: a mixed method study

BackgroundThe World Health Organization recommends the use of donated human milk (HM) as the second-best option for mothers who are temporarily unable to provide sufficient breast milk to meet the needs of their infants. However, HM donation is yet to become an accepted practice in Uganda. We assessed the level of, and factors associated with acceptability to donate HM among postnatal mothers at St. Francis Hospital Nsambya (SFHN).MethodsA cross-sectional sequential explanatory mixed method study was conducted between October 2018 and March 2019. A questionnaire on sociodemography, awareness and likely acceptability to donate HM was administered to 410 postnatal mothers at SFHN. Multivariate logistic regression analysis was undertaken to determine factors associated with acceptance of HM donation. Focus Group Discussions (4) and Key Informants Interviews (4) were used to explore factors influencing behaviours to donate human milk. Qualitative data were analysed using a content thematic approach.ResultsOverall acceptance of donating the HM was 77.6%, and the significant factors were: willingness to express the HM (AOR 7.5; 95% CI 3.01, 18.68); wet-nursing knowledge (AOR 2.3; 95% CI 1.1, 5.0) and visit to under-5 years’ clinic (AOR 21.3; 95% CI 2.3, 196.9). The major themes in relation to accepting to donate HM were wet nursing experience, and confidence in donating the HM, and its perceived effectiveness. There were concerns about the safety and adequacy of HM and fear of transmitting criminal behaviours and mental illness through human milk.ConclusionsAcceptance to donate HM among postnatal mothers at St. Francis Hospital Nsambya was very high. Willingness to express and store human milk, prior knowledge about wet nursing and a visit to an under-five outpatient clinic were associated with acceptance. Thus, establishing a human milk bank is feasible in the study setting.

Development and psychometric properties evaluation of nurses’ innovative behaviours inventory in Iran: protocol for a sequential exploratory mixed-method study

IntroductionNurses’ innovative behaviours play a crucial role in addressing the challenges including adapting to emerging technologies, resource limitations and social realities such as population ageing that are intricately tied to...

Exploring the effect of EFL students’ self-made digital stories on their vocabulary learning

In spite of the growing interest in digital storytelling (DST) in the English as a foreign language (EFL) context, there is a lacuna in research on the role it plays in learning vocabulary. This sequential explanatory mixed-methods study explored the potential of collaborative learner-generated digital stories (DSs) for vocabulary knowledge development and students’ attitudes towards DST-based vocabulary learning experiences. The primary data sources included pre/post-treatment vocabulary tests, collective reflection journals, weblog comments, and interviews. Two experimental groups of undergraduate EFL students were engaged in collaborative DST projects and their vocabulary test scores were compared with those of students in two control groups. The quantitative data were analyzed using independent and paired samples t-tests. Constant comparative method was employed to analyze the qualitative data. As the results showed, the students that were involved in learning the new words through collaborative DSs in the experimental groups outperformed the students in the control groups. The findings further demonstrated that DST empowers the students to integrate vocabulary learning into immediate daily contexts, experience peer-promoted vocabulary learning, contextualize vocabulary in multimodal stories, personalize the vocabulary knowledge development process, and enhance cognitive-affective engagement with stories to learn new words. The students also stated that DST is not a stand-alone pedagogical approach and recommended using animated, game-based, immersive, synchronous, social media-based, and micro DSs to facilitate vocabulary learning. The study promises implications for technology-assisted vocabulary instruction.

The Patients' Presupposed Distrust to Doctors in China: An Explanatory Sequential Mixed Methods Study.

The aim of this study was to investigate the current status of patients' presupposed distrust, and to clarify the causes of high presupposed distrust. An explanatory sequential mixed methods study was conducted using a two-stage design. The first phase was a quantitative cross-sectional survey, a total of 384 patients by convenience sampling completed the survey. Study instruments including demographic and clinical characteristics sheet, patients' presupposed distrust scale. In the qualitative phase, 16 patients on the basis of their mean score for all PPDS items were higher than 4 were identified as extreme cases participated in one-to-one semi-structured interviews. The total item mean score for all patients on PPDS was 3.59(3.18, 4.09), which above the median range of the PPDS (item mean score of 3). Personal income level and educational level were significant predictive influencing factors of patients' presupposed distrust, which could explain 17.347% of the variance. The reasons of high patients' presupposed distrust were as follows: moral character, health knowledge, patient perceptions, and the social circumstance. The level of patients' presupposed distrust was high, which needs to be further decreased. Demographic and clinical variables (personal income level, educational level) are identified to be the major contributing factors. The main causes for the formation of the high patients' presupposed distrust are patients internal factors and social circumstance.

User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study.

The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Most children were able to complete FoodBear's (11/14, 79%), myBear's (10/14, 71%), and FoodCam's (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children's autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children's dietary assessment and the provision of personalized dietary support.

Effective English teachers in online EFL learning: A post-pandemic reflection on students’ perspectives

In the framework of conventional academic settings, there have been a large number of studies on the qualities of effective teachers; however, studies in the context of online environments seem to be scarcely documented in the literature. This explanatory sequential mixed-method study of 224 secondary school students, 21 of whom were interviewed in detail, examined their perspectives on effective teacher characteristics in online EFL instruction. This study differed from earlier investigations of the qualities of effective teachers in terms of its research site and inquiry emphasis. The results of the surveys and interviews provided students’ judgments of effective teacher traits in terms of roles, professional abilities, personal qualities, and pedagogical expertise. According to the results of the polls, the most significant criteria for effective online learning management were instructors’ classroom management roles and their professional skills. The interviews stressed the importance of teachers’ qualities in managing classrooms and their pedagogical knowledge. In an online EFL instruction, students needed their teachers to scaffold them and explain what they should do with the lesson and the procedures they should follow for activities and assignments. In addition, the interviews validated teachers’ capacity to establish a favorable rapport with the students to facilitate their meaningful learning. As this study identified teachers’ professional abilities in managing online learning as a requirement, an online-learning-based professional development program for teachers is highly recommended as the most plausible alternative for the post-pandemic reflection of this current study.

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.

What can we learn from general practitioners who left Spain? A mixed methods international study

BackgroundInternational mobility of health workforce affects the performance of health systems and has major relevance in human resources for health policy and planning. To date, there has been little research exploring the reasons why general practitioners (GPs) migrate. This mixed methods study aimed to investigate the reasons why Spain-trained GPs migrate and develop GP retention and recruitment health policy recommendations relevant to Spanish primary care.MethodsThe study followed an explanatory sequential mixed methods study design combining surveys with semi-structured interviews and focus groups with GPs who qualified in Spain and were living overseas at the time of the study. The survey data examined the reasons why GPs left Spain and their intention to return and were analysed using quantitative methods. The transcripts from interviews and focus groups centred on GPs’ insights to enhance retention and recruitment in Spain and were analysed thematically.ResultsThe survey had 158 respondents with an estimated 25.4% response rate. Insufficient salary (75.3%), job insecurity and temporality (67.7%), excessive workload (67.7%), poor primary care governance (55.7%), lack of flexibility in the workplace (43.7%) and personal circumstances (43.7%) were the main reasons for leaving Spain. Almost half of the respondents (48.7%) would consider returning to Spanish general practice if their working conditions improved. Interviews and focus groups with respondents (n = 24) pointed towards the need to improve the quality of employment contracts, working conditions, opportunities for professional development, and governance in primary care for effective retention and recruitment.ConclusionEfforts to improve GP retention and recruitment in Spain should focus on salary, job security, flexibility, protected workload, professional development, and governance. We draw ten GP retention and recruitment recommendations expected to inform urgent policy action to tackle existing and predicted GP shortages in Spanish primary care.

Theory-based development of a tailored implementation strategy tool to promote Early Essential Newborn Care practice: A protocol

ObjectivesWe aimed to develop an implementation tool that could help healthcare professionals identify modifiable factors and develop tailored implementation strategies to promote the implementation of Early Essential Newborn Care (EENC) under the guidance of the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC). Methods and analysisThis theory-informed implementation study consists two phases. In Phase 1, an exploratory sequential design mixed-methods study will be used to explore the barriers and facilitators to implementing EENC. The qualitative results will be analyzed using NVivo 12.0, underpinned by the Consolidated Framework for Implementation Research (CFIR), whereas the quantitative results being achieved through questionnaires and analyzed using SPSS26.0. In Phase 2, based on the findings of Phase 1, a tailored EENC implementation strategies tool will be developed through iterative expert consultations utilizing the CFIR-ERIC tool and the Implementation Research Logic Model (IRLM).

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.

Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability.

To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.

Epidemiology and perceptions of non-fatal burns among select youth (15–24 years old) from Peshawar Pakistan; a sequential explanatory mixed methods study

PurposeBurns are among the top five cause of unintentional injuries among youth. We aimed to determine the incidence and risk factors of burns in select youth from Pakistan and also explored their perceptions about burns. MethodsA sequential explanatory mixed methods study was conducted which comprised of two phases. Phase 1 consisted of a cross-sectional quantitative survey (QUAN) in which 550 vocational school youth (15 to 24 years-olds) filled out the WHO community survey tool for injuries and violence and provided data on burns in previous 12 months (2021–22). Phase 2 consisted of qualitative (QUAL), in-depth interviews (IDIs) with participants selected from Phase 1 based on the occurrence of burns. STATA™ version 15.1 was used for Phase 1 data analysis and Zero-Inflated Negative Binomial regression was used for determining the Incidence Rate Ratio (IRR) of burns. Thematic analysis was performed for in-depth interviews from Phase 2. ResultsOut of 547 participants, 356 (65%) were males while 191 (35%) were females. Burns were reported by 85 participants (15%). A total of 137 counts of burns were reported showing multiple burns by some participants. The IRR for burns among young females was 2.89 (1.78–4.69) compared to males in the previous 12 months (2021–22). Age, sex, father’s education, and combined family income were significant risk factors for burns in youth. Six IDIs were conducted with burn victims, two were males while six were females. Four cooking-related burns, and two occupational burns during vocational training were reported. Themes that emerged from IDIs were internal and external factors, personal carelessness and lack of knowledge and safety about burns. Two sub-themes that were significant for recovery from burns were family support and access to healthcare. ConclusionYoung females are at a higher risk of burn injuries in Pakistan. Various social, demographic, and behavioral risk factors are associated with burns. Pre-burn and post-burn interventions are needed for prevention from burns in youth.

“If the food is finished after my brother eats then we (girls) sleep hungry.” Food insecurity and dietary diversity among slum-dwelling adolescent girls and boys in Pakistan: A mixed methods study

To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed methods study that included a survey of 391 girls and boys of 10–19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.