Sequential Mixed Methods Design Research Articles

Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR

IntroductionThe global COVID-19 vaccine rollout has been impacted by socioeconomic disparities and vaccine hesitancy, but few studies examine reasons for changed attitudes. In Lao People’s Democratic Republic (Lao PDR), a...

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

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

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

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

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

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

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

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

Constructing student agency: The nexus between classroom activities and engagement

Student agency refers to the quality of students’ self-reflective and intentional actions and interactions concerning their activities and engagements both inside and outside the classroom. The engagements and activities help to increase the level of personal agency. This study mainly aims to determine the nexus between constructing student agency and engagements and activities in higher education English as a Foreign Language (EFL) classrooms. This study adopted a sequential explanatory mixed method design. To collect quantitative data, a survey was conducted with a set of five-point Likert scale questionnaires among 107 students studying at bachelor’s level in Dhading district, Nepal. The students represent different years of the bachelor’s level. Semi-structured interviews were conducted among three teachers teaching at the same level to collect qualitative data. The findings of the study hold important insights for higher education teachers, emphasizing the significance of incorporating agency into classroom activities and fostering engagement. Additionally, this study contributes to the development of agency when students have opportunities to be selective in actions, engagements and interactions in classrooms. To effectively address this issue, the researcher strongly advocates highlighting the importance of classroom engagement and activities as essential components in enhancing student agency in EFL classrooms and beyond.

Effect of outdoor learning inquiry-based activities on learners performance in science: A sequential explanatory design

This study aimed to determine the effect of Outdoor Learning Inquiry-Based Activities (OLIBA) on the performance of grade 5 students in science. A sequential explanatory mixed methods design was used in the study. The respondents were the 180 grade 5 students from the representative divisions in Region XI. Sixty (60) grade 5 students from each division namely Davao Occidental, Tagum City, and Davao City were considered as respondents. The study utilized two instruments; the standardized test and the researcher-developed interview guide. The statistical tools employed were Mean and standard deviation and Independent Samples t-test. The results revealed the pretest performance of the students in the experimental and control groups in the three divisions was described as fairly satisfactory. Also, the students in the experimental group demonstrated an outstanding performance in the posttest due to the use of OLIBA while the control group registered a very satisfactory performance with the use of the traditional style of teaching. The result of qualitative analysis of participant's experiences in the pretest revealed similarities in content difficulty. After the implementation of OLIBA, both pupils and teachers revealed similarities in knowledge acquired and engagement due to OLIBA. Keywords: Inquiry-based; learners; outdoor learning; performance; sequential explanatory

Social Media Use Training for Adults with Intellectual Disabilities: A Pilot Study

Social Media Use Training for Adults with Intellectual Disabilities: A Pilot Study

Individual differences in learning agility at work: A mixed methods study to develop and validate a new scale

AbstractThe unprecedented complexity of today's business and working environment increases the need for leaders and employees to learn new skills, be adaptable, and open to embracing change. New abilities and mindsets emerge, and their evaluation is challenging. This research utilized an exploratory sequential mixed methods design to develop and provide a preliminary validation of a scale measuring individual differences in learning agility (LA) at work. The measure has been tested in Central‐Eastern European countries, Italy, and Egypt. Results showed satisfactory reliability and nomological validity. The final scale of 11 items provides HRD researchers and practitioners with a reliable and concise tool suitable for investigating individual differences in LA across different job roles and positions. The scale has been tested in a cross‐cultural setting and is available in English, making it especially appropriate for multinational contexts.

Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial.

Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention-Pregnancy Story I Didn't Know in Interactive Webtoon Series (PSIDK-iWebtoons)-designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn't Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857. DERR1-10.2196/58326.

Patient Safety Culture: Nurses' Perspective in the Hospital Setting.

(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.

Time use of patients in a secure forensic hospital: A mixed methods study.

Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004. An explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey. Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use. Patient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems.

The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)-The Person-centred Practice Inventory-Care (PCPI-C). Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework-the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 -Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 -Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. This study investigated how social connectedness is associated with patient outcomes in a HaH program. The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. The quantitative phase included 100 patients (18years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Examining the Quality of Learning Environment of Sandwich Programmes in Ghana: A Case of Institute of Education

This paper reports on a study that examined the quality of the learning environment of sandwich programmes in Ghana. The study used a sequential explanatory mixed method design and focused on tutors and 400 students of the programme. The Total Quality Management Theory, Expectation Confirmation/Disconfirmation Theory, Context, Input, Process, and Product Evaluation Model underpined the study. A disproportional stratified selection method was used to select 1,000 students and 50 tutors from each of the four teaching centres. While a purposive sampling method was employed to select 12 students and eight tutors involved in sandwich programmes for follow-up interviews. The data were collected using a questionnaire and an interview guide. The quantitative data was analysed using means and standard deviation, while the qualitative data were subjected to thematic analysis. These findings revealed that the tutors show concern for the welfare of the students and offer chances for student-teacher contact. However, big class sizes limit how much faculty can customise the learning environment. Also, students were friendly, helpful, cooperative, and supported one another during activities. The study recommended that the management of the Institute of Education and centre coordinators make every effort to secure spacious classrooms to help reduce large class sizes and increase opportunities for student-teacher interactions, cohesiveness, and students' participation in the classroom. In addition, tutors should foster an atmosphere that invites student interaction and identify students' strengths and weaknesses.

Exploring the typology of reasoning influencing university teachers’ language teaching and learning strategies

Despite the critical role of reasoning in shaping language teaching and learning strategies in higher education, prior studies have either separately examined reasoning or focused on one specific type thereof and language teaching and learning strategies. To address this gap, this study took a comprehensive approach by examining various types of reasoning in language instruction and their alignment with language teaching strategies in higher education. It adopted a sequential mixed-methods design through two phases of data collection. The study instruments included a mixed-method questionnaire, interviews, classroom observations, and document analysis. The quantitative phase collected data from 357 university teachers of Arabic-language disciplines at the university level who completed a mixed-methods questionnaire using a 5-point Likert scale and brief written explanation. Exploratory factor analysis, descriptive and inferential analysis of variance and the Scheffé test were used to analyse the quantitative data. In the follow-up qualitative phase, 20 university teachers from the quantitative phase were observed in the classroom and interviewed, and their document tasks were analysed using thematic analysis. The results unveiled four distinct typologies of university teachers’ reasoning closely aligned with their language teaching and learning strategies: inductive, abductive, analogical, and deductive reasoning. Notably, these typologies were associated with cognitive, metacognitive, interactional, and Knowledge strategies. Furthermore, the findings highlighted the intricate interplay and mixture of these typologies, indicating that university teachers do not rely solely on one type or strategy. Finally, the conclusion section outlines critical areas for future research concerning reasoning and language teaching and learning strategies in higher education.

Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.

Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic. The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management. A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management. Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Covid-19 resilience journey of vulnerable young South Africans

AbstractResilience, the ability to adapt well to adversity, is a critical factor in the well-being and success of young individuals. This study explored the multifaceted nature of resilience among South African youth challenged by COVID-related stressors and structural disadvantage. Specifically, this paper reports a follow-up qualitative leg of a sequential mixed-method design. Thirty-eight young adults (average age 24), all of whom reported high risk exposure but low depression symptoms, took part in semi-structured interviews to learn more about their resilience journey. Qualitative content analysis was employed to identify prominent themes. The study’s findings emphasize the dynamic nature of youth resilience, with individuals being buoyed by social network support (especially family); personal agency, structural support, and resource combinations. The qualitative findings contribute to the growing attention to the need for comprehensive policies and programs that recognize and enhance multisystemic sources of support, enabling young individuals to navigate challenges and thrive in their transition into adulthood.

Cardiogenic Shock Challenges and Priorities: A Clinician Survey

Cardiogenic shock (CS) is common and survival outcomes have not substantially improved. Australia's geography presents unique challenges in the management of CS. The challenges and research priorities for clinicians pertaining to CS identification and management have yet to be described. We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 10 clinicians (medical and nursing) to identify themes for quantitative evaluation. A total of 143 clinicians undertook quantitative evaluation through online survey. The interviews and surveys addressed current understanding of CS, status of cardiogenic systems and future research priorities. There were 143 respondents: 16 (11%) emergency, cardiology 22 (16%), 37 (26%) intensive care, 54 (38%) nursing. In total, 107 (75%) believe CS is under-recognised. Thirteen (13; 9%) of respondents indicated their hospital had existing CS teams, all from metropolitan hospitals, and 40% thought additional access to mechanical circulatory support devices was required. Five (5; 11%) non-tertiary hospital respondents had not experienced a delay in transfer of a patient in CS. All respondents felt additional research, particularly into the management of CS, was required. Clinicians report that CS is under-recognised and further research into CS management is required. Access to specialised CS services is still an issue and CS protocolised pathways may be of value.

Green brand identity and B2B channel partners' tactical green marketing orientation: Moderating effect of brand governance

Even though environmental values and sustainable branding have garnered much attention in the B2C context, B2B contexts remain relatively less explored. This study introduces a novel synthesis of Signaling theory and Stewardship theory and examines the moderating impact of brand governance on the relationship between green brand identity, consistent communication and channel partner commitment, leading to tactical green marketing orientation. Distinguishing itself from previous research, our approach embraces a multi-perspective lens, delving into the viewpoints of both channel partners and organizations (i.e., managers). Employing an explanatory sequential mixed method design, the first phase involved an empirical survey with 248 respondents (Study 1). Subsequently, the second phase (Study 2) comprised qualitative interviews with 41 respondents. The findings from both studies converged, revealing a positive association between “consistent communication” and “attitude,” a robust connection between “attitude” and “commitment,” and a favorable correlation between “green brand identity” and “attitude,” ultimately leading to a positive relationship between “attitude” and “green tactical marketing orientation". This research significantly contributes to the comprehension of B2B green brand positioning by demonstrating, that in the B2B context, brand governance influences channel partners' commitment and tactical green marketing orientation.