Sequential Mixed Methods Design Research Articles

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

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

Students Attitudes on School Climate and Learning Engagement in Physics of Senior High School Students

This research aims to determine whether there is a substantial correlation between students' attitudes toward school climate and their learning engagement in Physics. It also aims to explore the impact of school climate on Grade 12 students' experiences in attending classes and how it affects learning engagement in Physics. The school climate has an impact on the interactions that exist between educators and students in the classroom. A positive school climate is created where relationships between teachers, students, and the environment are enhanced within the institution. Consequently, the researchers utilized an explanatory mixed-method sequential design. The data collection involved two adapted survey questionnaires, an in-depth interview, and a focus group discussion using simple random sampling with a 335-sample size for quantitative and 10 participants for qualitative. The students' attitudes on school climate acquired an overall mean of 3.89, otherwise described as high, and a 3.98 mean, also described as high, for learning engagement in Physics. The correlation between students' attitudes toward school climate and learning engagement is given by Pearson's correlation coefficient (r) of 0.810, and the associated p-value (P= 0.001), indicating a highly significant correlation. This suggests a comparable rise or fall in school climate as students' attitudes increase or decrease. In the qualitative phase of the study, five main themes emerged from the data which support the quantitative findings and further explain the result of the study.

Determinants of internal and external networking behaviours: insights into gender, education, political skills and mentoring

ABSTRACT Employee internal and external networking behaviours may drive different employee and organisational outcomes, which has implications for Human Resource Development professionals. However, little is known about how to develop internal and external networking behaviours. Using social role theory, social capital theory, and personal initiative theory, this study examines the impact of employee gender, education, political skills, and mentoring on internal and external networking behaviours. We utilised a mixed-method sequential research design comprising two studies. Study 1 survey data were collected from 372 middle managers from 10 Sri Lankan manufacturing and service organisations. The results indicate the higher external networking behaviours of men; the elevated internal and external networking behaviours of managers with a master’s degree; a positive relationship between political skills and both internal and external networking behaviours; and a positive relationship between mentoring and internal networking behaviours. Study 2 comprised 12 interviews of middle managers who had participated in Study 1. Thematic and content analyses explain, refine, and extend the results of Study 1. The findings have several implications for developing the networking behaviours of middle managers. Theoretical and research contributions are discussed.

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

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

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

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

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

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

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

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

Determinants of internal and external networking behaviours: insights into gender, education, political skills and mentoring

ABSTRACT Employee internal and external networking behaviours may drive different employee and organisational outcomes, which has implications for Human Resource Development professionals. However, little is known about how to develop internal and external networking behaviours. Using social role theory, social capital theory, and personal initiative theory, this study examines the impact of employee gender, education, political skills, and mentoring on internal and external networking behaviours. We utilised a mixed-method sequential research design comprising two studies. Study 1 survey data were collected from 372 middle managers from 10 Sri Lankan manufacturing and service organisations. The results indicate the higher external networking behaviours of men; the elevated internal and external networking behaviours of managers with a master’s degree; a positive relationship between political skills and both internal and external networking behaviours; and a positive relationship between mentoring and internal networking behaviours. Study 2 comprised 12 interviews of middle managers who had participated in Study 1. Thematic and content analyses explain, refine, and extend the results of Study 1. The findings have several implications for developing the networking behaviours of middle managers. Theoretical and research contributions are discussed.

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

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

Uncovering post-adoption usage of AI-based voice assistants: a technology affordance lens using a mixed-methods approach

ABSTRACT Despite the growing proliferation of AI-based voice assistants in our daily lives, how different functions of AI-based voice assistants affect users’ post-adoption usage behaviours remains an under-investigated research question. This study explores the nature and causation of post-adoption usage behaviours (effective utilisation after initial adoption or diffusion) within the context of AI-based voice assistants. Using a sequential mixed-methods research design, we first identify the post-adoption usage behaviours of AI-based voice assistants as a multidimensional concept comprised of routine use and extended use, then develop a contextualised model by revealing technology-specific antecedents, cognitive beliefs, and boundary conditions. By integrating results from the quantitative study and qualitative study, we find that three technology affordances (i.e., anthropomorphism affordance, interactivity affordance, and personalisation affordance) are salient antecedents of two cognitive beliefs, which further affect users’ routine use and extended use of AI-based voice assistants. Additionally, we uncover use frequency as a boundary condition and obtain a complementary view of post-adoption usage of AI-based voice assistants. The empirical research findings can extend the post-adoption IS usage literature and provide practical implications for crafting user-centred functionalities to facilitate effective human-AI interactions.

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

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

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

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

"There is No Help:" Caregiver Perspectives on Service Needs for Adolescents and Adults with Profound Autism.

The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.

Profil Habits of Mind Siswa SMA dalam Pemecahan Masalah Matematika

This study aims to describe the habits of mind possessed by high, medium, and low class XI high school students in solving mathematical problems on linear program material studied from persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. Habits of mind that are the focus of this study consist of four indicators, namely persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. The research subjects were students of class XI MIPA 4 SMAS Mujahidin Pontianak and the object of research was habits of mind in mathematics problem solving. Explanatory sequential mixed method design is the method of this research with its instruments, namely math problem solving test questions, habits of mind questionnaire, and interview guidelines. The results of the discussion show that the habits of mind possessed by high category students in solving mathematics are persisting, thinking flexibly, applying past knowledge to new situations, and metacognition. Habits of mind owned by medium category students are persisting, thinking flexibly, and applying past knowledge to new situations. Habits of mind possessed by low category students are persisting.

Nurse-Led Telehealth Oncology Clinic on ‘Home Management During Chemotherapy’ for Gastrointestinal Cancer Patients: Study Protocol of A Mixed Method Study

Introduction: Telehealth is increasingly being used for symptom management among cancer patients on chemotherapy. Objective of the study is to develop Nurse-led Tele-health Oncology Clinic for GI cancer patients regarding ‘Home Management during Chemotherapy’. Methods: The study will follow sequential explanatory mixed method design where during quantitative phase, using RCT (CTRI/2024/01/062028), GI cancer patients of age 18-65 years and undergoing 2nd or 3rd chemotherapy cycle will be randomised after obtaining consent to experimental (EG) &amp; control (CG) groups. Ethical Clearance is already obtained. EG will be followed through Nurse-led Clinic which includes multiple virtual educational &amp; counselling sessions, e-booklet on side effects management, PMRT, Support groups &amp; telephonic follow ups. Effectiveness will be measured in terms of Quality of life, severity of side effects and Anxiety using FACT-G, CTCAE and DASS respectively. In qualitative phase, using extreme case sampling, in-depth interviews from consented participants will be conducted to explore experiences towards intervention. Analysis: Analysis of quantitative data will use descriptive and inferential statistics. This follows thematic analysis and integration of data. Conclusion: The study protocol will provide guidance to optimize utility of tele-medicine technology to improve healthcare outcomes especially for the GI cancer patients.

The development and validation of a conceptual definition of avoidable transitions from long-term care to the emergency department: A mixed methods study.

Transitions to and from Emergency Departments (EDs) can be detrimental to long-term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC-ED transitions and to verify the level of stakeholder agreement with this definition. The EXamining Aged Care Transitions study adopted an exploratory sequential mixed-method design. The study was conducted in 2015-2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.

Examining the relationship between electoral violence, State security and democratization in Ghana's Fourth Republic

Electoral violence has become a recurring challenge in Africa, posing a significant threat to democracy, political stability, and human security. This paper explores the relationship between state security and electoral violence in the African context and draws valuable lessons for Ghana. The objectives of this study include investigating the causes and dynamics of electoral violence in Africa, analyzing the role of state security agencies in preventing and mitigating electoral violence, assessing lessons that Ghana could learn from other African countries' experiences, and proposing recommendations to enhance state security and prevent electoral violence in Ghana's Fourth Republic. The paper adopted an explanatory sequential mixed method design. The approach combined the quantitative data analysis and qualitative data collection through literature reviews, interviews, and focus group discussions. By identifying causes and dynamics of electoral violence, assessing the performance of state security agencies, and drawing lessons from successful strategies employed in other African countries. The aim of the study is to add to the existing literature the development of effective measures for ensuring peaceful and fair elections in Ghana. The results reveal a positive and direct relationship between electoral violence and democratization. Furthermore, the research discloses a positive and direct relationship between electoral violence and state security. Finally, the results reveal that state security has an intermediating effect between electoral violence and democratization. The research findings will inform policymakers, election officials, and relevant stakeholders in designing strategies to reduce electoral violence and promote democratic processes in Ghana and across the African continent. Based on these, the study recommends the provision of trusted security, a constitutional review, and an increment of trust in the electoral space.

Exploring Objective Simulation Competency Assessment Experience E-Learning Module Analytics: A Mixed-Methods Study to Improve Nursing Faculty Feedback.

Abnormal uterine bleeding is a common clinical concern for adolescent women. This research study aims to improve the clinical reasoning skills of advanced practice nursing students instructed in blended Objective Simulation Competency Assessment clinical experiences by enhancing feedback loops given to students during simulated experiences. A sequential explanatory mixed-methods study design was conducted with two cohorts of first-year women's health nurse practitioner graduate nursing students enrolled in the Women's Health Program at a large Midwestern university. Data were collected across 2 years from two separate cohorts, and analyses included data from 15 participants. The Abnormal Uterine Bleeding module designed with decision pathways was a worthy effort, and faculty value using data analytics from the e-learning module to evaluate student learning. This study describes how nursing faculty created abnormal uterine bleeding content in an online module format that can aid the diagnostic reasoning process and enable feedback to students.

EFL Students’ Online Learning Readiness: Performing Out the Basic Functions of Technology

This study aimed at investigating the 12th-grade students’ online learning readiness in utilizing basic technological functions in their English teaching and learning process. An explanatory sequential mixed-method design was employed, surveying 233 students from Hospitality and Culinary classes at a senior vocational high school in South Bali through a questionnaire. Interviews were further conducted via personal messages with two highest readiness level students and two lowest readiness levels to comprehensively study readiness. The questionnaire result indicated that students are prepared to use basic functions of technology for online learning, with a few necessary improvements. Interview findings revealed that highly prepared students are more motivated to engage in online learning, whereas less prepared students are more demotivated due to factors like online learning support, familiarity with tools, and supporting facilities. It is suggested to actively support the less-ready students with highly engaged learning activities, pedagogically empowered teachers, and supportive policies and facilities.

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

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