ABSTRACT Student vocabulary size in preschool predicts later literacy outcomes. With many words to master, effective preschool teaching must not only focus on specific words but also on word-learning strategies, with metalinguistic awareness being one strategy. Research supports metalinguistic instruction in upper elementary grades, but few studies explore preschool metalinguistic teacher talk. Research Findings: This study analyzed nine teachers’ use of metalinguistic talk during storybook reading with their 67 preschoolers across 108 observations. Through a sequential explanatory mixed-method approach, we used quantitative methods to capture the frequency of metalinguistic talk types and multilevel models to explore associations between metalinguistic talk and standardized vocabulary scores. We then employed qualitative methods to understand how these talk moves enact affective messages about language awareness that signal dispositions toward word learning. Results revealed a typology of preschool metalinguistic talk, a positive association between metalinguistic talk and vocabulary, and teacher enactments that position words as powerful tools for expression or as markers of ability. Practice or Policy: These findings highlight metalinguistic talk as a promising approach for supporting preschool vocabulary development. They also reveal how teachers enact this talk in ways that may shape children’s sustained attention to and interest in words broadly.

Peer review serves as the structural foundation of scientific integrity, yet the system currently faces unprecedented strain. In response, AI tools are being deployed to assist human expert review, a development that has generated considerable debate. However, the psychological impact of this transition on the scientific community remains only partially understood. Our study utilises a sequential mixed-methods approach to examine the perceptions of AI-mediated feedback among a cohort of elite researchers (Nature and Science authors). Quantitative findings from our randomised experimental survey (N = 495) demonstrated that AI-assisted reviews were viewed as deficient in fairness, usefulness, and acceptance compared to human-led evaluations. Qualitative evidence from 47 in-depth interviews further identified a dual-layered aversion to AI-assisted feedback, concerning both the technology (AI use) and the agent (AI user). Specifically, scholars perceived AI-generated critiques as devoid of the necessary disciplinary nuance required for high-stakes evaluation. Moreover, a notable ‘AI user aversion’ emerged: reviewers who delegated tasks to AI were perceived as lacking the diligence and empathic engagement essential to the peer-review contract. Together, these finding suggest that the integration of AI into peer review may erode trust in the research evaluation process and journals should implement robust governance that preserves human oversight.

Experiencing weight stigma negatively impacts health yet remains present in healthcare environments. Hospital environments must be inclusive for people living with obesity (PLwO). The aim of this study was to develop and refine a checklist to increase obesity inclusivity in United Kingdom National Health Service (UK NHS) hospital environments, with input from healthcare professionals (HCPs), researchers, PLwO, and their carers and family members (C/FM). This study used a sequential mixed methods approach. Phase 1 used a converging coding matrix to integrate existing checklists and reviewed language for inclusivity. In phase 2, HCPs, researchers, PLwO and C/FM were recruited from professional and patient networks to provide feedback on the integrated checklist using a mixed-methods survey (February-March 2025) and qualitative semi-structured interviews (May-July 2025). Descriptive statistics and deductive and inductive framework analyses were used to identify patterns in the data to inform refinement of the checklist and implementation recommendations (Phase 3). Searches identified five checklists which were integrated, resulting in categories for reading materials, furniture, equipment, and access and infrastructure. Sixty-nine participants completed the survey, and eighteen were interviewed. Overall, participants considered the checklist comprehensive. Integration of the qualitative survey and interview data resulted in four themes: 1) recommendations and thoughts about checklist components, 2) wording, language, images and structure, 3) patient impact and care experiences, 4) implementation barriers and support. Primary implementation barriers related to funding, space, outdated infrastructure, and deep-rooted weight bias. Management buy-in, training, education, endorsement and accreditation schemes were considered facilitators. Twenty recommendations were developed to support hospitals with implementation. Findings indicate that a clear, practical, and inclusive checklist could support hospitals in reducing weight stigma and improving care experiences for PLwO. The collaboratively developed and refined checklist offers a practical tool for hospitals to use. However, support will be required for effective and complete implementation.

Background: Despite the mandate of Presidential Regulation No. 78 of 2021, BRIDA establishment remains uneven across regions due to functional crises and limited innovation-support capacity, resulting in gradual implementation at provincial and local government levels. Objective: This study aims to assess civil servants’ (Aparatur Sipil Negara/ASN) perceptions of the urgency of BRIDAwithin research organizations and to develop a structured organizational framework for its formation. Methods: An exploratory sequential mixed-methods approach was used by distributing questionnaires through Google Forms to 67 ASN from various local governments. The findings show that 54 respondents (81%) acknowledged the urgency of BRIDA, 50 respondents (75%) supported its role in the innovation ecosystem, and 13 respondents (20%) had submitted proposals for BRIDA formation. Results: The formation process remains suboptimal due to incomplete regional participation, limited availability of academic manuscripts, and insufficient support from provincial governments. The recommendations include establishing data collection mechanisms for regions that have not yet implemented BRIDA, mapping functional needs, planning innovation programs, improving communication between central and regional governments, establishing discussion forums and laboratories, and conducting public outreach regarding BRIDA’s duties and functions. Conclusion: The majority of ASN support the establishment of BRIDA to strengthen the regional innovation ecosystem. Nevertheless, several barriers persist, including functional resource crises, insufficient academic manuscripts, and inadequate provincial guidance. The proposed organizational framework incorporates stages ranging from research and development restructuring, proposal preparation, innovation trials, and practical application to monitoring and evaluation mechanisms that ensure effective innovation implementation.

Increasingly, brief digital interventions are being implemented to combat alcohol misuse. While the utility of incorporating personalized feedback into these interventions has been explored, less work has concentrated on how consumer-driven research might be harnessed to better tailor personalized feedback. Critically, the relative efficacy of co-designed interventions vs those designed by research teams without stakeholder input has not typically been explored. This study aimed to use an exploratory sequential mixed methods approach to elicit user-designed personalized feedback to incorporate into an existing brief digital intervention developed to combat hazardous drinking; investigate differences in capacity, opportunity, and motivation (as per the Capacity, Opportunity, Motivation-Behavior model) to alter alcohol use behavior; examine whether participants prefer the co-designed product over those designed by research teams; and evaluate change in actual consumption over time as a function of co-designed (image-based) vs researcher-designed (image- or text-based) personalized feedback. Part 1 used an online co-design process involving a convenience sample of young adult focus group participants (N=40; mean age 21.87, SD 7.51 years). Part 2 surveyed a convenience sample of young adults who drank alcohol regularly (N=222; mean age 21.14, SD 4.69 years). Participants were assigned to 1 of 3 personalized feedback conditions (researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based) using block allocation with stratification based on alcohol intake and impulsivity level. Feedback was delivered via email, and impact on capacity, opportunity, and motivation to alter alcohol use behavior, plus preferred format of feedback, was examined (10.76, SD 14.05 days) via mixed and 1-way ANOVAs and post hoc tests. Change in alcohol consumption (89.70, SD 21.59 days) was investigated via a series of repeated-measures ANOVA and post hoc tests. In Part 1, qualitative thematic analysis of focus group data identified 6 overarching themes: visual representation, clarity, accessibility, brevity, peer comparison, and harm. Following this analysis, personalized feedback regarding alcohol intake and brain health was available in 3 formats: researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based. In Part 2, there were no differences in capacity, opportunity, and motivation to alter alcohol use behavior as a function of feedback format (ηp2=0.01). Participants preferred co-designed, image-based feedback over researcher-designed, image-based (d=0.55) or researcher designed, text-based (d=0.83) feedback. Regardless of feedback format, all participants significantly reduced total alcohol intake (ηp2=0.11) and alcohol-related harm (ηp2=0.05). Participants in image-based conditions (researcher-designed or co-designed) reduced frequency of drinking to a greater extent (d=0.56) than those in the researcher-designed, text-based feedback condition (d=0.39). Though the principles of co-design are undeniably valuable, the efficacy of co-designed interventions, over and above those designed by research teams without user input, requires further research. OSF Registries osf.io/rnbv8; https://osf.io/y4bhs.

The negative effects of perceived stress during pregnancy on mother-infant attachment and fetal health are well known. However, studies that comprehensively investigate this relationship using both quantitative and qualitative data, particularly in high-risk pregnancies, are limited. The aim of the study is to investigate the effects of perceived stress on the antenatal and fetal health in high-risk pregnancies. The study is designed as a sequential explanatory mixed-methods approach consisting of quantitative and qualitative stages. Pregnant women were selected from those who visited the hospital's maternity clinic using convenience sampling. The study was conducted between January 2024 and December 2024. In the first stage, quantitative data were collected using a descriptive information form, the Fetal Attachment Inventory (FAI), the Antenatal Perceived Stress Inventory (APSI), and a semi-structured interview form. In the second stage, open-ended questions were asked to investigate the emotional state of all pregnant women. The data obtained were analyzed using the descriptive phenomenological method. In quantitative analysis, responses were analyzed directly, whereas in qualitative analysis, inferences and interpretations were drawn from them. The study was completed with 81 high-risk pregnant women, with an average age of 28.9. The total APSI score was 13.4, and the FAI score was 82.2. A significant negative correlation was found between the inventories (r=-.965; p<.001), indicating a strong association between perceived stress and antenatal attachment, which should be interpreted with caution. Five main themes were identified in the analysis of the interviews: coping with stress, partner support, duration of partner support, sharing feelings and emotions about pregnancy with the partner, and postpartum fear. While physical or psychological support is often emphasized in partner support, the frequency of conversation is reported to be associated with emotional sharing. In general, mothers with low stress levels and high partner support had healthier pregnancy. The findings indicate that perceived stress during pregnancy is associated with adverse maternal and fetal outcomes, while partner support plays a protective role. Although the association between stress and attachment was strong, it should be interpreted cautiously and within the context of a single-center sample of primigravida women in late pregnancy. Strengthening psychosocial support during pregnancy remains essential.

ABSTRACT The Metaverse shows significant potential to support collaboration by enabling immersive virtual environments for collective work and learning. However, its effectiveness is often limited by a lack of user trust and engagement . By contextualizing and extending the interactionist theory of place attachment, this study theorizes spatial familiarity as a core feature of Metaverse, examining its mechanisms for fostering perceptions of virtual environments as reliable and engaging places for collaboration. With this end in view, this research followed a sequential mixed-methods approach, with the qualitative method first developing the context-specific research model by identifying key factors that enable Metaverse-based collaboration, and then the quantitative method validating the model. The results together indicate that the spatial familiarity of Metaverse enables individuals to engage in virtual environments for collaboration both directly and mediated by trust. Importantly, the efficacy of spatial familiarity is particularly pronounced when a person perceives a high level of avatar human-likeness but diminishes when her self-regulation is high. By uncovering the theoretical mechanisms through which spatial stimuli contribute to trust-building in collaborative Metaverse contexts, this study also offers practical implications for designing and managing virtual environments for collaborative purposes.

ABSTRACT The rise of artificial intelligence (AI) in education requires educators to move beyond basic literacy toward deeper and more practical competencies. However, limited research has examined how professional and institutional factors jointly influence educators’ ability to adopt AI effectively. Using a sequential mixed-methods approach, this study provides a context-sensitive refinement of AI competency by clarifying its relationship with adjacent constructs such as technological literacy and creativity. Qualitative data were collected through 37 semi-structured interviews and two focus groups, followed by a survey completed by 140 respondents. Structural Equation Modeling-Partial Least Squares (SEM-PLS) was employed to test and validate the proposed model. Results indicate that professional development, digital resources, technological literacy, creativity, and collaboration are significant predictors of AI competency, with creativity and technological literacy emerging as the strongest predictors. The model demonstrated strong explanatory power, emphasizing that effective AI competency extends beyond technical proficiency and requires creative thinking, digital fluency, and supportive institutional environments. The study offers practical implications for universities seeking to strengthen faculty readiness for AI-integrated teaching and learning.

Child undernutrition remains a significant public health challenge in many low and middle-income countries (LMICs), including Lao PDR, where high levels persist even in urban areas with generally available and accessible food. This study aimed to explore factors underlying the persistently high rates of undernutrition among young children in urban (Saysetha) and peri-urban (Pakgneum) districts of the Vientiane Capital in Lao PDR. A cross-sectional survey employed a sequential explanatory mixed-methods approach, combining a structured questionnaire of 333 mother–child pairs for quantitative analysis with semi-structured interviews of 47 caregivers for qualitative insights. The prevalence of malnutrition among children under 24 months in Vientiane Capital was 27.3% for stunting, 4.2% for wasting, 14.4% for underweight, and 5.11% for overweight. Multiple logistic regression was applied to identify factors associated with malnutrition, while qualitative data were thematically analyzed. The principal findings revealed that, beyond food access, the quality of caregiving and, critically, caregivers’ capacity to translate nutrition knowledge into effective practices distinguished well-nourished from undernourished children. Caregivers of better-nourished children obtained health and nutrition information from diverse sources, whereas those of undernourished children relied mainly on health services. In conclusion, strengthening practical nutrition communication in various methods and channels, such as through videos and demonstrations, and enhancing caregivers’ ability to apply nutritional knowledge, are central to improving child nutritional outcomes in urban and peri-urban settings in Lao PDR.

ABSTRACT This study fills in significant voids in knowledge on how Nigeria’s Library and Information Science (LIS) education can adapt to technological disruptions and systematic inequalities. This adaption will affect sustainable development, digital inclusion, and young employability in Africa’s most populous country. Although current research on African LIS education mainly concentrates on South Africa and Kenya, Nigeria’s situation is understudied. Previous studies lack a strong theoretical basis in innovation diffusion and human capital systems models. The study examines how inclusive pedagogies and ICT are incorporated into Nigerian LIS curricula, analyses faculty preparedness for technology-driven teaching, and suggests ways to match programs with global standards while meeting local needs. Combining quantitative analysis of 15 accredited LIS programs (2018–2023) using a 25-item Digital Competency Index (DCI) and faculty surveys (n = 150) with qualitative case studies of the University of Nigeria, Nsukka, Bayero University, Kano, supplemented by interviews with 30 stakeholders, a sequential mixed-methods approach anchored in Rogers’s Diffusion of Innovations Theory and Becker’s Human Capital Theory, the study exposes a clear digital divide: rural universities scored 47% lower on ICT infrastructure (IIF = 2.1/5) than urban counterparts, while only 32% of programs teach linked data compared to 85% stressing outdated cataloguing. Though 29 million people in Nigeria have disabilities, just 18% of courses cover disability-inclusive methods. With 63% of professors noting perceived complexity (82%) and low trialability (67%), faculty unpreparedness became apparent as a significant challenge for teaching artificial intelligence applications. However, UNN’s 2021 curriculum overhaul, which combined IBM collaborations with Media and Information Literacy competencies, increased graduate employment rates from 58% to 79% (p < .001), proving the transforming power of strategic reforms. These results highlight the need to match LIS education with Nigeria’s digital economy ambitions using curriculum decolonisation, faculty upskilling, and ICT expenditure. The study offers concrete policies for legislators to advance Sustainable Development Goal 4 and Nigeria’s National Digital Economy Policy, emphasising infrastructural improvements, inclusive pedagogy, and industry engagement.

ObjectivesDespite adherence to guideline-based pharmacotherapy, many people with diabetic kidney disease (DKD) were unable to meet glycaemic and blood pressure targets. The purpose of this paper was to report the unmet needs of people with early-stage DKD.DesignA sequential mixed-methods approach was used, comprising a quantitative survey followed by an exploratory qualitative phase using nominal group technique (NGT) discussions with people with DKD.SettingPatients were recruited from 45 primary care clinics in Peninsular Malaysia from March to May 2024.ParticipantsSurvey data were collected from 131 adults with an estimated glomerular filtration rate between 30 and 89 mL/min/1.73 m2 and with suboptimal glycaemia and blood pressure outcomes. Exploratory NGT discussions were conducted with seven participants.Main outcome measuresThe online survey used the WHO definition of unmet healthcare need as the ‘failure to seek healthcare when needed during the past twelve months’ to assess the prevalence and associated factors. Qualitative data and ranking of other perceived unmet needs of these people with DKD and suboptimal clinical outcomes were collected through NGT discussions.ResultsThe prevalence of reported unmet healthcare needs per the WHO definition was 13%, with history of diabetic foot ulcer (adjusted OR (AOR) 6.67, 95% CI 1.22 to 37.25) and urban residence (AOR 3.70, 95% CI 1.26 to 12.89) reported as associated factors. NGT identified three patient-prioritised unmet needs: ‘dietary support’, ‘better medication’ and ‘mental health support’. Female participants prioritised obtaining medication and kidney health information, whereas male participants emphasised self-monitoring support.ConclusionThe low prevalence of WHO-defined unmet need, alongside patient-prioritised concerns extending beyond standard measures, suggests that current operational definitions may not fully capture patient-perceived unmet healthcare needs in DKD.

Many advances have been made to identify novel, effective orthopedic care practices. For all that is known about the comparative effectiveness of various clinical decisions in anterior cruciate ligament (ACL) injury care, surprisingly little is known about how surgeons approach decision-making in the face of this evidence. Implementation science models such as Capability, Opportunity, Motivation - Behavior (COM-B) offer a way to organize and comprehensively understand how clinicians make decisions. This evaluation aimed to understand and quantify the factors that influence orthopedic surgeons' decision-making in ACL injury care according to COM-B. This pragmatic evaluation used a sequential exploratory mixed-methods approach combining orthopedic leader discussions and qualitative semi-structured interviews, followed by four rounds of quantitative census surveys to understand the factors influencing four surgeon decision points related to ACL injury care. First, two authors (BN a practicing surgeon with a clinical and research leadership role and MR the director of the affiliated orthopedic research institute) participated in recurring in-person orthopedic leader discussions; then additional selected surgeons were invited to participate in one-time qualitative semi-structured phone interviews; and, finally all surgeons that perform ACL procedures in the health system were invited to participate in four quantitative web surveys. Results were summarized descriptively according to the COM-B model. Two co-authors (BN and MR) participated in the orthopedic leader discussions, five invited surgeons participated in qualitative interviews (100% response rate), and 10-11 surgeons participated in four survey rounds (83%-100% response rate). Factors influencing each of the four selected decision points were identified within each COM-B category. Clinical knowledge (capability) and social influence of patient preferences (opportunity) were identified as highly influential for all decisions. Automatic decision making or habit (motivation) was also highly important for most but not all decisions. Interviews and surveys with surgeons from one Midwest U.S. health system demonstrate the complexity of ACL injury care decision-making. Surgeons reported that capability, opportunity, and motivation were important in all four decisions. The most important factors influencing decisions ranged from their technical ability to perform one surgical technique over another (e.g., hamstring autograft) in selecting what type of surgical graft to use to their patients' preferences for having surgery in deciding whether to recommending surgery. Future research to identify and test intervention strategies like shared decision-making training in alignment with the identified factors like technical ability and social influences have the potential to lead to higher-value orthopedic care by supporting decisions like recommending longer pre-operative rehabilitation.

Despite strong evidence supporting the maternal and fetal benefits of physical activity during pregnancy, many pregnant women fail to achieve the recommended levels of activity for various reasons. Previous studies have largely examined barriers to physical activity from a quantitative perspective, with limited attention to deeper social, interpersonal, intrapersonal, and environmental factors. Therefore, this study aimed to identify and explain barriers to physical activity among Iranian pregnant women using a sequential explanatory mixed-methods approach. This explanatory mixed-methods study was conducted in two sequential phases: quantitative, followed by qualitative. In the quantitative phase, 351 pregnant women aged 18-45 years who met the inclusion criteria were recruited using convenience sampling. Data collection tools included a socio-demographic and obstetric questionnaire and the Pregnancy Physical Activity Perceived Barriers Scale (BPAPS). Data were analyzed using descriptive statistics and univariate and multivariate linear regression in SPSS v.23. In the qualitative phase, women with high barrier scores (BPAPS ≥ 97) were purposively invited for semi-structured interviews. Data saturation was reached after 10 interviews. Qualitative data were analyzed using conventional content analysis. Finally, quantitative and qualitative data were integrated in the interpretation of the study results. A total of 351 pregnant women were included in the analysis. The mean age of participants was 29.06 ± 5.99 years, and the mean total barrier score was 78.07 ± 16.25. The mean standardized scores for subscales were: environmental barriers 43.67 ± 17.80, pregnancy-related intrapersonal barriers 43.16 ± 16.40, non-pregnancy-related intrapersonal barriers 41.68 ± 18.80, and interpersonal barriers 38.74 ± 17.93. Multivariate regression analysis indicated that older age, lower education, unemployment, and lack of pre-pregnancy physical activity were significantly associated with higher barriers to physical activity (P < 0.05). In the qualitative phase, one overarching theme, "Multidimensional Barriers to Physical Activity During Pregnancy," and four main categories were identified: intrapersonal barriers, knowledge and communication gaps, socio-cultural limitations, and structural/environmental barriers. The most frequently reported categories from women's lived experiences were related to intrapersonal barriers and knowledge/communication gaps. In the quantitative phase, environmental barriers had the highest mean score among the subscales. In the qualitative phase, intrapersonal barriers and knowledge/communication gaps emerged as key themes in women's lived experiences. This difference is not a contradiction but reflects the complementary nature of the two methods: quantitative data capture population-level frequency, while qualitative data provide deeper insight into barriers that are most personally impactful. Overall, the integrated findings suggest that barriers to physical activity during pregnancy are multidimensional. Based on these findings, we recommend three specific public health policy actions: (1) integrating self-efficacy and self-care training into preconception care programs, (2) establishing free or low-cost, female-only safe exercise spaces for pregnant women, and (3) mandating physical activity counseling during all routine antenatal visits.

HighlightsWhat are the main findings?Nurses working under closed-loop COVID-19 management experienced moderate sleep disturbances (PSQI score: 8.16 ± 4.25).Sleep quality was significantly associated with night shifts, work-related stress, and psychological capital (self-efficacy, resilience, hope, and optimism).What are the implications of the main findings?Targeted psychological support and stress management strategies may be beneficial for improving sleep quality among frontline nurses.Humanized and holistic management approaches may enhance mental well-being and healthcare workforce sustainability during public health crises.Background: During the COVID-19 pandemic, fever clinic nurses under closed-loop management faced high occupational stress and strict isolation, which may impair sleep quality. However, evidence in this population remains limited. This study investigated the sleep quality of fever clinic nurses during closed-loop COVID-19 management and identified associated factors. Methods: A sequential explanatory mixed-methods design approach was employed. Quantitative data were collected using the Pittsburgh Sleep Quality Index (PSQI) and Nurses’ Psychological Capital Scale from 33 front-line nurses, acknowledging the limited sample size. Semi-structured in-depth interviews were conducted with six nurses to provide qualitative insights. Results: The mean PSQI score was 8.16 ± 4.25, indicating moderate sleep disturbances among nurses. Factors associated with sleep quality included demographic and occupational factors (e.g., night shifts, work pressure) and psychological capital (self-efficacy, resilience, hope, and optimism). Qualitative analysis identified three themes: the impact of personal circumstances on sleep quality, psychological pressures during closed-loop management, and the role of self-regulation in coping. Conclusions: During the closed-loop management for COVID-19 pandemic prevention and control, the sleep quality of nurses in fever clinics was poor. This study identified personal circumstances, work pressure, and psychological capital as potential factors associated with sleep quality, suggesting that further research is needed to develop and test targeted interventions. These findings provide preliminary evidence that may inform future management strategies, but do not support definitive intervention recommendations.

The Department of Veterans Affairs Cooperative Studies Program (CSP) added implementation science teams to select trials to accelerate the uptake of research evidence into practice. CSP study #2008, "Pentoxifylline in Diabetic Kidney Disease", evaluates whether adding pentoxifylline to usual care reduces the incidence of end-stage renal disease and mortality in patients with diabetic kidney disease. This implementation science sub-study aims to develop a VA-wide implementation plan by identifying key implementation outcomes, identifying and interviewing key stakeholders, and identifying critical barriers and facilitators to implementing findings. Using an exploratory sequential mixed methods approach in this hybrid type 1 design, we conducted semi-structured interviews with nephrologists, primary care physicians, and pharmacists from ten VA facilities that were enrolling Veterans in the CSP 2008 clinical trial. The interviews were analyzed using the Tailored Implementation in Chronic Disease (TICD) framework. Findings informed a web-based survey distributed to nephrologists, primary care physicians, and pharmacists from 15 additional participating facilities. Interviews identified five facilitators: 1) providers are willing to prescribe an older medication; 2) providers are not concerned about the side effects of pentoxifylline; 3) providers believe that pentoxifylline is inexpensive; 4) providers report widespread comfort with off-label prescribing; and 5) providers state they would be comfortable prescribing pentoxifylline if colleagues they trust recommend it. Survey data confirmed that providers are not concerned with prescribing an older medication, but there were mixed responses about off-label prescribing. Barriers included: 1) concerns about possible drug interactions; 2) providers self-identified as late adopters; 3) concerns about polypharmacy; 4) prescribers prefer newer drugs; and 5) providers want ample evidence that pentoxifylline works for this indication. Survey data confirmed all the identified barriers except for providers identifying as late adopters. Interview data provided early evidence of facilitators that may support pentoxifylline adoption if the trial shows positive results. Survey data reinforced and broadened these insights across a larger clinician sample. Together, these findings will guide development of targeted implementation strategies to support effective and timely dissemination of trial findings across the VA health system. The CSP 2008 study ClinicalTrials.gov ID is NCT03625648.

ABSTRACT This study aimed to assess a Middle Eastern maternity team’s perceptions and attitudes toward interprofessional education (IPE), examine factors that may influence these perceptions, and consider their potential implications. Within maternity multi-professional teams, IPE is an evidence-based, effective approach toward enhancing collaboration and quality of care. However, multiple factors that modulate the interactions of professionals, with each other and with the context, can influence its success. IPE has not been thoroughly researched in Middle Eastern healthcare settings which have distinct demographic, cultural, and legal characteristics that set them apart from those in the West, and therefore, available evidence may not be readily generalizable to these contexts. Given the paucity of evidence originating from these contexts, the present study was undertaken at a large new Middle Eastern hospital providing tertiary care through a multi-disciplinary maternity team. This study was conducted using a sequential mixed methods approach; an online survey offered to the entire team followed by a mixed focus group discussion. The survey incorporated a psychometric inventory IEPS (Interdisciplinary Education Perception scale) to assess participant perceptions and attitudes. The results showed IEPS scores favoring collaborative learning and that these scores did not differ significantly by participants’ length of clinical experience, type of profession, and previous IPE experience. However, scores on the IEPS ‘prestige subscale’ were significantly lower amongst western-trained participants compared to their non-western-trained colleagues. Qualitative results demonstrated that contextual factors acted as impediments to collaborative learning through changes to individual professional identity, which was impacted differentially within different professions.

Stigma remains a pervasive barrier to public health initiatives, which is often exacerbated by advertisements that, while raising awareness of risks and consequences, can also inadvertently stigmatize individuals based on their sexual health status. Transformative advertising offers a strategy to overcome this barrier; however, research is needed to uncover the pathways and mechanisms through which this can occur. Leveraging the Elaboration Likelihood Model and social identity theory, this study develops a process model to identify how advertising can strengthen Anti-stigma Perceptions towards people with sexually transmitted infections. Employing an explanatory sequential mixed-methods approach (i.e. survey and interviews), it identifies three distinct mediating pathways in which Executional Elements, Message Strategy and Perceived Relatability influence Anti-stigma Perceptions through Advertising Effectiveness. Furthermore, Perceived Risk moderates responses: Executional Elements affect high-risk individuals, whereas Message Strategies influence low-risk individuals. Practical implications highlight considerations for designing public health advertising that drive effectiveness and reshape societal issues.

This research aims to develop and evaluate an automated English paragraph scoring system using the Gemini API aligned with the Thai upper secondary curriculum's writing indicators, to address issues related to teacher workload and delayed feedback in writing assessments. The system integrates the Gemini 2.5 Pro API with a prompt-engineering framework designed to simulate expert EFL assessors. This research employs a sequential mixed-methods research approach. For the quantitative component, 160 upper secondary EFL students in Thailand were sampled from their written assignments, consisting of three expository paragraph assignments aligned with the Thai core curriculum. Cluster sampling was used to select participants. The students' writings were assessed using a validated analytical evaluation criterion comprising four aspects. The essays were independently scored by three evaluators, and the results were compared to automated scores generated by a Gemini-based system. Reliability between human evaluators was first checked using the Intraclass Correlation Coefficient (ICC), and the agreement between human and AI scores was measured using the Quadratic Weighted Kappa (QWK). The results showed a high level of agreement between the Gemini-generated scores and the human evaluators (QWK = 0.82), indicating that the system can approximate human judgment in evaluating English as a Foreign Language writing. Qualitative analysis of the AI-generated feedback further revealed that the system could provide diagnostic recommendations related to grammar, vocabulary, and sentence structure. These findings suggest that the system can support teachers in reducing grading workload while providing timely, criteria-based feedback to enhance students’ writing development.

ABSTRACT Teachers’ perceptions play a pivotal role in the successful inclusion of students in mainstream classrooms. This article explores Maltese primary teachers’ views on including students with autism and examines key factors influencing these perspectives through a Critical Disability Theory lens. Using an explanatory sequential mixed-methods approach, the research initially focused on four influential factors, derived from the aforementioned theory, as potentially affecting teachers’ perceptions: power and support, curriculum, labelling, and training and resources. Additional themes also emerged during the study. Findings from the larger doctoral research reveal an overall optimistic attitude towards inclusion in principle, though this is often tempered by heavy workloads, personal and professional experiences, insufficient training, and the issue of responsibilisation. The study concludes that wider contextual and structural factors, which tend to perpetuate ableist practices, heavily influence perceptions more than individual teachers themselves. Recommendations are proposed to better align support, policies, and training to foster sustainable inclusion.

The western existing scales to measure employee burnout are often critiqued in relation to cultural sensitivity and early stage job frustration experience while being implemented in non-western settings as evidenced within the limitations of the local study findings. Therefore, since Omani society values social stability while being integrated with employment, there is a demanding necessity for developing a culture-sensitive scale to measure job frustration among healthcare workers (HCWs). This study aimed to develop and psychometrically validate the Omani Job Frustration Questionnaire (OJFQ), a culturally grounded instrument designed to assess early-stage occupational frustration among healthcare workers in Oman. The development of the scale was considered following a sequential mixed-methods approach. Set of six focus group discussions (FGDs) with 42 nurses in the mental health setting steered initial item generation guided by conceptual frameworks from the MARS model, and CBI. Expert reviews involving 16 professionals from Oman and Malaysia were conducted to refine the item pool ending up with a 45-item OJFQ initially. The newly developed scale was surveyed on 139 participants working in a mental health setting, primarily involving nursing professionals, getting a response rate of 99.3%. The data analysis was conducted in presenting details of descriptive statistics, Cronbach's alpha, exploratory factor analysis (EFA), item analysis and confirmatory factor analysis (CFA) to assess scale validity. The final scale included 37-item across five constructs after conducting EFA: (1) management and role clarity, (2) emotional regulation and professional coping strategies, (3) career development and engagement, (4) workplace bureaucracy and social challenges, and (5) workplace resources and stability. The scale demonstrated acceptable internal consistency (Cronbach's α = 0.774 for the final 37-item version), and all constructs were significantly correlated with the total score. CFA showed an acceptable chi-square ratio but suboptimal fit across most indices, providing preliminary support for the proposed factor structure. Both EFA and CFA were conducted on the same sample. In addition, there was no significant correlation (r = 0.032, p = 0.709) was found with the CBI, suggesting that the scale may capture a related but distinct construct. The OJFQ represents a culturally tailored instrument with preliminary psychometric support for assessing job frustration among healthcare workers with initial validation in a mental health nursing context in Oman. Its development may support early identification of occupational strain within culturally specific healthcare environments. Further refinement across diverse healthcare settings and populations are warranted.