Two-phase Mixed Methods Design Research Articles

Delivery and evaluation of simulations to promote authentic and meaningful engagement in childhood disability research

BackgroundIn 2019, our interdisciplinary team of researchers, family members, and youth co-designed four simulation training videos and accompanying facilitation resources to prepare youth, family members, trainees, and researchers to build the knowledge and skills to engage in patient-oriented research (POR) authentically and meaningfully. Videos covered challenges in aspects of the research process including (1) forming a project team; (2) identifying project objectives and priorities; (3) agreeing on results; and (4) carrying out knowledge translation.MethodsThe purpose of the study was to deliver four simulation training videos across 2 two-hour facilitated workshops with researchers, trainees, and family partners. We evaluated whether the training videos and facilitated discussion of the simulations helped to improve knowledge and attitudes about authentic and meaningful partnership in research and self-perceived ability to engage in POR. An explanatory sequential two-phase mixed methods design was used. Phase 1 (quantitative) included two training workshops and a pre/post-training survey. Phase 2 (qualitative) included two qualitative focus groups. Results of each phase were analyzed separately and then combined during interpretation.ResultsSixteen individuals (including researchers/research staff, trainees, family members, clinicians) took part in this research study. Overall, participants were highly receptive to the training, providing high scores on measures of acceptability, appropriateness, and feasibility. While the training videos and facilitated discussion of the simulations were found to increase participants’ knowledge and ability to engage in authentic and meaningful POR, we found no significant change in attitude or intent. Recommendations about the simulation content and delivery were provided to inform for future use.ConclusionsThe simulations were found to be a positive and impactful way for collaborative research teams to build knowledge and ability to engage in authentic and meaningful POR. Recommendations for future work include covering different content areas with varying levels of nuance; and offering the training to stakeholders in a variety of roles, such as those higher-ranked academic positions.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools.

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. https://doi.org/10.23641/asha.23661876.

Ride-sharing customers’ self-protection motivation in the post-COVID-19 world

PurposeThe COVID-19 pandemic has generated unprecedented public fear, impeding both individuals’ social life and the travel industry as a whole. China was one of the first major countries to experience the COVID-19 outbreaks and recovery from the pandemic. The demand for outings is increasing in the post-COVID-19 world, leading to the recovery of the ride-sharing industry. Integrating protection motivation theory and the theory of reasoned action, this study aims to investigate ride-sharing customers’ self-protection motivation to provide anti-pandemic measures and promote the resilience of ride-sharing industry.Design/methodology/approachThis study followed a two-phase mixed-methods design. In the first phase, the authors executed a qualitative study with 30 interviews. In the second phase, the authors used the results of the interviews to inform the design of a survey, with which 272 responses were collected. Both studies were conducted in China.FindingsThe present results indicate that customers’ perceived vulnerability of COVID-19 and perceived COVID protection efficacy (self-efficacy and response efficacy) are positively correlated with their attitude toward self-protection, thus leading to their self-protection motivation during the rides. Moreover, subjective norms and customers’ distrust appear to also impact their self-protection motivation during the ride-sharing service.Originality/valueThe present research provides one of the first in-depth studies, to the best of the authors’ knowledge, on customers’ protection motivation in ride-sharing services in the new normal. The empirical evidence provides important insights for ride-sharing service providers and managers in the post-pandemic world and promote the resilience of ride-sharing industry.

Uplifting Voices to Create New Alternatives

The present study used a structural social work theoretical lens to undertake a systematic mental health needs assessment. Using a community-based participatory research approach and a two-phase mixed methods design, the researchers assessed mental health needs and barriers to care among 2,556 adults of primarily Mexican background from ten economically marginalized communities in Chicago’s southwest side. Findings indicated that mental health concerns including depression, anxiety, and trauma-related symptoms were prevalent among community members and stemmed from the oppressive national and local level structural contexts in which they lived. Furthermore, data demonstrated that research participants overwhelmingly identified structural and programmatic barriers, rather than social barriers such as stigma, as posing the greatest challenges to mental health service access. Among the structural and programmatic barriers identified were service cost, lack of insurance coverage, and limited availability of services that were culturally affirming and responsive to context-specific service needs. This study has far-reaching implications for understanding the impact of structural factors on mental health. We recommend that social workers advocate for organizational and policy changes that address these structural barriers.

The self-efficacy of private school teachers toward the implementation of inclusive education in Ghana: A mixed-methods study

BackgroundAlthough efforts toward practicing inclusive education have stalled in countries such as Ghana, the available data have mainly centred on enacting inclusive education in public schools. With private schools being notable alternative service providers to public schools, understanding private school teachers’ perceived self-efficacy toward teaching students with disabilities in the classroom is essential.MethodTo develop insights into inclusive practices, a two-phase mixed-methods design was adopted for this study. In the first phase, 82 teachers from six private schools responded to the self-reported Teacher Efficacy for Inclusive Practice (TEIP) scale. In the second phase, there were 10 participants, including principals (n= 3), heads of department (n= 4) and teachers (n= 3). While the quantitative data were subjected to confirmatory factor analysis,t-tests, analysis of variance and linear regression, the qualitative data were analysed thematically using the components of the TEIP scale asa priorithemes.ResultThe study confirmed the structural validity of the TEIP scale in measuring teachers’ self-efficacy and the correlations and covariances between efficacy in managing behaviour and performing instruction and collaboration. There was divergence between the quantitative and qualitative data and background variables, such as educational qualifications, pre-service training in inclusive education and participation in professional development, which provided additional insights into the teachers’ self-efficacy.ConclusionThe findings show that some private school teachers teach students with disabilities despite having no confidence in their capabilities. The study findings underscore the need to create more training opportunities for private school teachers to enhance their confidence in practicing inclusive education in schools.

Contrapower Harassment in Paramedicine: Experiences of Academic Staff in Australian Universities

Background Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student-faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, on-demand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.

Factors Hampering the Participation of Nursing Staff in the Continuing Education Activities of Hospitals Centers in the Casablanca-Settat Region

Aim: This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca. Background: Continuing education (CE) for nursing staff represents a strategic asset for hospitals, identifying the constraints of nursing staff participation in continuing training could help improve the quality of care for patients and the population in general. Objective: This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca. Methods: The study used a two-phase mixed method design. First of all, a questionnaire was administered to 930 nurses belonging to 9 hospital centers in the Casablanca-Settat region in order to explore and estimate the frequencies of the factors hindering the participation of nurses in the activities of the FC sessions at the level of hospitals, and a semi-structured interview with 9 persons in charge of continuing education from these different hospitals to complete and explain the data collected by the questionnaire. Results: The data analysis confirmed that the work overload is the first individual difficulty hindering the participation of nurses in CE sessions, i.e., 85.4%. The most mentioned organizational difficulties are schedule recommended in the FC not encouraging and not suitable, i.e., 23%, non-targeted content (does not meet the needs of the nursing staff), i.e., 66.7%. Finally, the absence of support measures in terms of monitoring and evaluation to maintain the knowledge and skills acquired during FC sessions in real situations at the workstation occupied is the first institutional difficulty mentioned by the interviewed (88%). Conclusion: Those responsible for training should take into account the factors nurse’s face in participating in continuing education sessions when designing, developing, and implementing continuing education sessions.

Investigating Learning Challenges from the Perspective of Nursing Students and Educators at a University in Casablanca, Morocco

Background:Whether in an academic or clinical setting, many students often consider nursing studies to be difficult. Identifying learning challenges could help to improve the quality of the training and students’ skills.Objective:This study aimed to identify the main learning challenges of nursing students.Methods:The study utilised a two-phase mixed methods design. First, a focus group discussion with nine teachers and tutors was conducted to explore the learning challenges observed by staff. Then, based on the results, a questionnaire was developed for 54 students to explore and estimate the frequency of learning challenges perceived by them.Results:The data analysis confirmed 15 major learning challenges, including cognitive challenges, consisting of theoretical gaps, and challenges related to clinical reasoning, and non-cognitive procedural and behavioural challenges. Challenges related to clinical reasoning, such as the difficulty in developing care plans (100%) and choosing care actions (90.2%), remain the most frequent regardless of the level of study.Conclusion:Supervisors should consider students’ learning challenges when designing, developing and implementing their educational interventions.

Discovery awareness for staff supporting individuals with intellectual disabilities and challenging behaviour: is it helpful and does it increase self-efficacy?

Discovery awareness (DA) is an approach to using video within structured meetings to help staff become more mindful, aware and interested in a client they are supporting who has intellectual disabilities and challenging behaviour. The objective was to evaluate whether, and how, DA is helpful for staff in both inpatient and community settings, and whether it increases self-efficacy in working with people with challenging behaviour. A two-phase mixed method design was employed. For phase 1, forty staff who took part in one of seven single DA meetings completed the Challenging Behaviour Self-Efficacy Scale pre- and post-DA. In addition, post-DA, participants completed an Adapted Helpful Aspects of Therapy Scale (AHAT). For phase 2, six participants completed a follow-up Change Interview; 3–12 weeks after DA. Descriptive statistics reveal participants found events in the DA ‘greatly helpful’. The changes identified varied in whether they were expected or not, but were unlikely to occur without DA and ‘very important’. Statistical analysis showed no significant changes in self-efficacy following the DA. A thematic analysis on the qualitative data generated by the change interviews and AHAT identified three main themes: Impact on interaction; DA is unique and valuable; and the power of the process. The latter had three subthemes: a structure to facilitate change, making use of the content and reflective space to promote learning. Attendance at a single DA meeting does not increase staff perceptions of self-efficacy, however, staff find the process of DA helpful as it encourages reflection on their interactions with individuals with intellectual disability and challenging behaviour and attuning of their interactions, though further research is needed.

Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study

BackgroundEvaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis.MethodsThis study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way.ResultsThe results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study.ConclusionsThis evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity.Trial registrationClinicalTrials.gov, NCT02338869; registered 10/04/2014.

An investigation into specialty trainee engagement with e-learning.

The objectives of this study were to determine paediatric specialty trainees' engagement with e-learning in Health Education England North West and the characteristics of sites accessed by specialty trainees, and to assess the quality of web interfaces being used and whether this aligns with the best evidence for e-learning provision. A two-phase mixed methods design was used: a scoping exercise to elicit specialty trainees' preferred e-learning tools and a quality assessment of the named sites, and specialty trainee telephone interviews. A total of 135 respondents identified 86 sites. Quality assessment found considerable variation across sites and a number of barriers to access, one issue being uncertainty about quality and validity of sites. E-learning is viewed as an integral part of both mandatory and speciality training but there is considerable variation in access to and quality of sites. Specialty trainees value the convenience and breadth of e-learning available but express concerns about assessing the validity and legitimacy of such sites.

Developing Measures of Placement Quality in Allied Health, Dentistry, Medicine, and Pharmacy

As placement numbers expand, there is a concern that the quality of student experience and learning may diminish. Furthermore, there is a paucity of evidence for evaluation and quality improvement in clinical health placements and there have been few studies undertaken to assess quality. Valid and reliable measures of placement quality are needed to provide an evidence-base to guide decisions about the most efficient and effective placement models in health. A two-phase mixed methods design, using a modified Delphi process, focus groups, and surveys, developed and tested items to measure placement quality. Thematic analysis, descriptive statistics, and exploratory factor analysis (EFA) were used to analyse the data. Twenty-three participants took part in the Phase 1 stakeholder focus groups, and 150 useable surveys were returned by 161 who took part in Phase 2 to test validity and reliability of the student survey items. Results show broad agreement on the features of a quality clinical placement across allied health dentistry, medicine, and pharmacy professions. The student survey was found to be a valid and reliable measure of placement quality, with the EFA showing one component accounting for 58.5% of the variance in the survey data. The findings offer a framework and approach that others can adopt to measure placement quality in their setting. The measures may be adaptable to contexts outside health.

Acculturation Motivation in International Student Adjustment and Permanent Residency Intentions

The present study uses a two-phase mixed-methods design to explore the role of motivation to acculturate within the international student experience. Hierarchical regression analyses were conducted to test acculturation motivation (AM) as a predictor of international student adjustment and permanent residency intentions, over and above age, gender, academic year, and English competence. Greater motivation to acculturate was indeed a significant predictor of international student adjustment and increased intentions of pursuing permanent host country residency. To better understand how international students’ experiences relate to levels of AM, qualitative analyses were employed. International students with low levels of AM were more likely to express negative feelings about cross-cultural adjustment, university perception, and peer relationships, compared to students with high levels of AM. Despite such differences, academic and developmental struggles as well as academic successes were similarly voiced across both comparison groups.

Development of clinical competence assessment tool for novice physical and occupational therapists-a mixed Delphi study.

[Purpose] The aim of this study was to clarify essential abilities of novice physical and occupational therapists for independent execution of their duties and to develop a clinical competence assessment tool. [Subjects] Forty-five experienced therapists participated in this study. [Methods] A two-phase mixed-methods design was used. First, semi structured interviews were conducted on 15 experienced therapists to create a comprehensive list of essential abilities that novice therapists need. Second, 30 experienced therapists participated in a two-round Delphi study to select items for the assessment tool being developed. [Results] Fifty-five items were extracted and classified into three categories: basic attitudes, therapeutic skills, and clinical practice-related thoughts. [Conclusion] Present results suggest that not only knowledge of execution of therapy-related duties and therapeutic skills is essential in novice therapist, but also appropriate abilities in social adjustment, self-management, and self-education. The newly developed tool might be useful for postgraduate education in clinical practice.

Factors Related to Engaging in Physical Activity: A Mixed Methods Study of Female University Students

Objective: As a needs assessment for intervention, quantitative and qualitative methods were used to examine attitude, subjective norms, perceived behavioral control, intention, knowledge, and weight control status related to physical activity in female university students within the Theory of Planned Behavior (TPB). Methods: A two-phase mixed method design was used. In Phase I, 362 students participated in an online survey, and in Phase II, 33 students participated in five focus group discussions. Ages of participants ranged from 18 to 45 years old, with 18 - 25 year olds making up over 74% of the sample. Results: Attitude, subjective norms, and perceived behavioral control, along with weight control status of trying to lose weight, were found to be significant predictors of intention to follow physical activity recommendations, which in turn were the strongest predictor of physical activity. Knowledge was not found to be significant. Group discussions revealed barriers to meeting physical activity recommendations, which included lack of companionship and social support, lack of motivation, time and cost restrictions, and lack of privacy in the gym. Social norms exerted both positive and negative influences. Conclusion: The mixed method approach provided a deeper insight into the influential factors pertaining to physical activity among female students, and results could be used in further research to develop effective interventions.

Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study

Background. Confidence in one's ability to perform a given task can be a stronger predictor of performance than skill itself. There are currently no measures to assess confidence with manual wheelchair use. The objective of this study was to develop and assess the content validity of the Wheelchair Use Confidence Scale (WheelCon-M).Method. A two-phase mixed-methods design was used. Semi-structured interviews were conducted to generate items, followed by a Delphi survey for item selection. Persons who use a wheelchair, health care professionals, and researchers participated in both phases of the study.Results. An 84-item WheelCon-M was developed based on the qualitative data. After the Delphi survey, a final 62-item WheelCon-M was composed of the following six areas (number of items per area): Negotiating the Physical Environment (33 items), Activities Performed using a Manual Wheelchair (11 items), Knowledge and Problem Solving (6 items), Advocacy (4 items), Managing Social Situations (5 items) and Managing Emotions (3 items).Conclusion. This article reports the development and content validation of the WheelCon-M. As a scale to measure confidence with wheelchair use was not available prior to this work, clinicians now have a method of identifying individuals who have low confidence with wheelchair use.