A mixed methods evaluation of the breastfeeding memory aide CHINS

Breastfeeding rates remain persistently low in the United Kingdom (UK) despite wide-scale rollout of UNICEF Baby Friendly Initiative training and accreditation. More must be done to ensure breastfeeding practitioners can provide effective support. The memory aide CHINS (Close, Head free, In-line, Nose to Nipple and Sustainable) could help practitioners remember, recall, and apply breastfeeding theory in practice and this paper presents a UK evaluation of its impact. A concurrent, convergent mixed methods approach was adopted using Normalisation Process Theory (NPT) as an overarching framework. An online survey targeted breastfeeding practitioners and academics from the UK (n = 115). A sub-set (n = 16) of respondents took part in qualitative focus groups. Survey data was subjected to descriptive and inferential statistical analysis, and the focus group data was analysed, using NPT. CHINS is widely used in breastfeeding education and practice largely because of its simplicity and ease of integration in everyday practice, as well as its sustained inclusion in UNICEF Baby Friendly Initiative training. CHINS has introduced a standardised approach to the principles of positioning for effective breastfeeding. Doing so has helped address inconsistencies and poor practice in this area, and CHINS plays a role in assisting practitioners in building confidence in their breastfeeding practice. More needs to be done to ensure the breastfeeding workforce develop and maintain the requisite skills to promote and support breastfeeding, including the role of memory aides such as CHINS in achieving this.

An exploration of organizational climate in community-based opiate prescribing services; a mixed methods study

INTRODUCTION

Assessing the internal dynamics of organizations has been shown to provide information that can help planners and policymakers improve service delivery. A good organizational climate, which in this study incorporates mission clarity, team cohesion, staff autonomy, communication, levels of stress, and openness to change has been shown to be of particular importance. Still, there is a dearth of evidence in this area, and while relationships between organizational factors have been identified, little is known about the mechanisms that might underpin these relationships, and there is little understanding of how to address deficits once they are identified. The objective of this study was to identify relationships between program factors that influence organizational climate and to explore which mechanisms might underpin these relationships.

METHODS

This paper reports on a cross-sectional, concurrent, mixed-methods study design, across twelve discrete community-based prescribing service providers (organizations) in Ireland. Data was obtained using a staff survey [n = 132] which utilized measurements of organizational readiness to change and one-to-one interviews [n = 12]. Quantitative data was analyzed using multivariate linear regression modeling which assessed relationships between variables, while interviews were analyzed using an abductive approach, both types of data were synthesized at the interpretation stage.

RESULTS

A range of interdependent factors were considered to affect the climate of organizations. Surveys identified that specific types of resources, such as physical infrastructure, training, and staffing resources were important for supporting a good organizational climate, while programs with greater needs had a poorer climate. Opportunities for professional growth, the skill sets of staff, and having access to e-communication were also significant. Interviewees reported that rigid organizational hierarchies and bureaucracy, philosophical views of addiction, stress, and staff turnover were influenced by the provision of fewer resources. Interdependent factors such as leadership, supervision, staff relationships, and collective training, also thought to be influenced by resources, were considered to positively influence programs. Resources were not the only challenge identified, and practices within programs and how existing resources are used were also thought to contribute both positively and negatively to the internal dynamics of services.

CONCLUSION

Key findings in this study identified that the organization of effective services is influenced by a range of specific factors, some of which can be addressed without additional resources. Overall, staff views of organizations can provide us with valuable information to support service improvement. Using a mixed methods approach can not only identify where relationships between organizational variables exist but can also help us to understand the mechanisms that underpin these relationships and, importantly, how to address deficits once they are identified. In order to improve how substance misuse services work, the need for a long-term systemic approach to program development, which incorporates some of the findings from this study, is required.

Feasibility, acceptability and equity of a mobile intervention for Upscaling Participatory Action and Videos for Agriculture and Nutrition (m-UPAVAN) in rural Odisha, India

Addressing undernutrition requires strategies that remove barriers to health for all. We adapted an intervention from the 'UPAVAN' trial to a mobile intervention (m-UPAVAN) during the COVID-19 pandemic in rural Odisha, India. In UPAVAN, women's groups viewed and discussed participatory videos on nutrition-specific and nutrition-sensitive agricultural (NSA) topics. In m-UPAVAN, weekly videos and audios on the same topics were disseminated via WhatsApp and an interactive voice response system. We assessed feasibility, acceptability, and equity of m-UPAVAN using a convergent parallel mixed-methods design. m-UPAVAN ran from Mar-Sept 2021 in 133 UPAVAN villages. In Feb-Mar 2021, we invited 1000 mothers of children aged 0-23 months to participate in a sociodemographic phone survey. Of those, we randomly sampled 200 mothers each month for five months for phone surveys to monitor progress against targets. Feasibility targets were met if >70% received videos/audios and >50% watched/listened at least once. Acceptability targets were met if >75% of those watching/listening liked the videos/audios and <20% opted out of the intervention. We investigated mothers' experiences of the intervention, including preferences for m-UPAVAN versus UPAVAN, using in-person, semi-structured interviews (n = 38). Of the 810 mothers we reached, 666 provided monitoring data at least once. Among these mothers, feasibility and acceptability targets were achieved. m-UPAVAN engaged whole families, which facilitated family-level discussions around promoted practices. Women valued the ability to access m-UPAVAN content on demand. This advantage did not apply to many mothers with limited phone access. Mothers highlighted that the UPAVAN interventions' in-person participatory approaches and longer videos were more conducive to learning and inclusive, and that mobile approaches provide important complementarity. We conclude that mobile NSA interventions are feasible and acceptable, can engage families, and reinforce learning. However, in-person participatory approaches remain essential for improving equity of NSA interventions. Investments are needed in developing and testing hybrid NSA interventions.

Cradling disparities: A descriptive qualitative study of maternal experiences of mothers from low-socioeconomic status in the first month postpartum

AIM

To explore the experiences, expectations and needs of mothers from low-socioeconomic status at 1 month postpartum.

DESIGN

Descriptive qualitative.

METHODS

Mothers from low-socioeconomic status and irrespective of their parity were invited to participate in one-to-one interviews at 1 month postpartum. Semi-structured interviews were conducted until data saturation. Interviews were audio recorded, transcribed verbatim and analysed thematically. Written informed consent was obtained.

RESULTS

Twenty mothers participated and six themes were identified: (1) No choice but to find meaning; (2) Father as a major pillar of support; (3) 'Kampung' Spirit; (4) Trials and Tribulations of Transition to Motherhood; (5) Shame, guilt and internalized stigma and (6) Reclaiming the power.

CONCLUSION

This study reflected the unique struggles of mothers from low-socioeconomic status with pregnancy, childbirth and early postpartum and the wider health inequities within Singapore's maternal health system. To provide much-needed support and improved care, the stakeholders within government, healthcare providers and social organizations should consider the niche needs of this community.

IMPLICATIONS FOR PATIENT CARE

Nurses need to reflect on their own biases and ensure consistent care delivery regardless of socioeconomic status. When delivering patient education, patient-centred and sincere advice rooted in personal experience can help to establish rapport.

IMPACT

This study is the first to explore the experiences of mothers from low-socioeconomic status in the Singapore context. Low-socioeconomic status mothers experienced less autonomy over their health, the care they received and their childcare options. As mothers adjusted to their new roles, they struggled to cope. However, as they were wary of the stigma surrounding poverty and their guilt of not being a 'good mother', they preferred to seek informal support from their family, friends and self-help through learning from social media, as compared to formal, external help.

REPORTING METHOD

COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Impact of COVID-19 on Grief: A Quantitative and Qualitative Analysis in Italy

This mixed-method research study delves into the repercussions of the COVID-19 pandemic on loss and mental health in Italy. The analysis uncovers a significant correlation between COVID-19 fear and heightened anxiety, depression, and stress, exacerbated by social isolation and misinformation. The loss of loved ones during the pandemic intensifies distress, with 28% showing signs of prolonged disorder and 22.8% displaying maladaptive grief symptoms. Distress persists across pandemic phases (59.3% critical, 54.9% intermediate, 48.4% less critical), attributed to grief, fear, uncertainty, and isolation. Qualitative analysis identifies two core themes: 'Death without Dying' and 'Online Grieving Practices and Coping Strategies,' elucidating disruptions to traditional grieving and the role of online coping strategies. Our findings underscore the pandemic's multifaceted impact on grief and mental health in Italy, highlighting the importance of addressing social and emotional needs during crises.

Mass media campaigns and the 'file drawer problem': A mixed methods study of how to avoid campaign failure

Mass media campaigns are frequently used to address public health issues. Considering the considerable cost, there has been little analysis of why campaigns sometimes fail. This study used a sequential mixed methods approach to explore the mechanisms that can lead to failure and to identify what can be done to avoid or overcome common mistakes in campaign planning, implementation, and evaluation. We conducted interviews and a survey with 28 public health social marketing and mass media campaign experts over three rounds of research and analysed the data thematically, generating themes inductively. We identified four systemic factors that drive success: long-term strategic thinking and commitment, understanding the campaign context, doing and learning from evaluation, and fostering strong relationships. The factors did not operate in isolation, rather good (or poor) execution in one area was likely to influence performance in another. The experts also emphasised that a change of political context could drastically affect one or more of the identified factors. Our analysis showed that campaign failures are not simply individuals making mistakes. Systemic issues throughout the planning, execution, and evaluation phases need to be addressed if campaign outcomes are to improve.

Undergraduate nursing students challenge misconceptions towards men in nursing: A mixed-method study

AIMS

To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing.

DESIGN

A convergent parallel mixed-method study.

METHODS

A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting.

RESULTS

Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'.

CONCLUSION

Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society.

IMPACT

Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study

BACKGROUND

Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population.

OBJECTIVE

This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD.

METHODS

We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis.

RESULTS

Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024.

CONCLUSIONS

This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52652.

Process evaluation of PsyCovidApp, a digital tool for mobile devices aimed at protecting the mental health of healthcare professionals during the COVID-19 pandemic: a mixed method study

Introduction

PsyCovidApp, a digital intervention aimed at safeguarding the mental health of healthcare workers during the COVID-19 pandemic, demonstrated in a randomized clinical trial to yield significant improvements solely among healthcare workers undergoing psychotherapy or receiving psychotropic medication.

Objectives

(1) To identify contextual factors and mechanisms of action that influenced the impact of PsyCovidApp during the aforementioned trial; (2) To pinpoint enhancements for optimizing its efficacy.

Materials and methods

For the first objective, a process evaluation was conducted, amalgamating quantitative techniques (surveying 216 healthcare professionals who had utilized PsyCovidApp during the trial) and qualitative methods (in-depth interviews with 16 healthcare workers). The second objective involved a panel of seven experts, utilizing the RAND-UCLA methodology.

Results

The quantitative study (response rate = 40%) revealed that 22% of respondents had not fully accessed the content of PsyCovidApp. The average usage time was 22.7 min/day, being higher (p < 0.05) among consumers of psychotropic medications. Contents related to relaxation and mindfulness were most highly rated. Acceptability and usefulness scores ranged between 7.3-7.5/10 points, with higher ratings (p < 0.05) among women and older healthcare workers. The qualitative study uncovered that the primary barriers to using PsyCovidApp were workload, lack of time, and exhaustion. Its primary mechanisms of action included emotion identification, mental health regulation (e.g., insomnia, intense emotions), and learning of techniques and skills. The expert panel reached a consensus on 29 proposals to optimize PsyCovidApp.

Conclusion

The knowledge derived from this study could inform the design and implementation of future similar digital tools.

Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking

BACKGROUND

Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field.

OBJECTIVE

A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app.

METHODS

A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data.

RESULTS

The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails.

CONCLUSIONS

The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy.

Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries

INTRODUCTION

Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability.

DESIGN

A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices.

METHODS

Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions.

RESULTS

Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs.

CONCLUSION

The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally.

CLINICAL RELEVANCE

The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.

"Never Give Up. The Creator Has Good Things in Store for You": Risk Factors, Protective Factors, and Evidence of Resilience for Canadian Indigenous Women Abused by Intimate Partners

Canadian Indigenous women often experience severe partner violence and child abuse, but few studies holistically examine risk and protective factors and evidence of resilience that affect their well-being. This mixed-methods secondary analysis explored the experiences of 40 Canadian Indigenous abused women. Risk factors included intimate partner violence (IPV), childhood abuse, poverty, colonization, and disability. Protective factors included formal and informal support, community support, spirituality, and childhood residence. Evidence of resilience is from interview quotes and none of the measures of depression, mental distress, and posttraumatic stress disorder was in the clinical range. Despite significant IPV and childhood abuse, the women's resilience is highlighted.

"We Get Our Healing Through Traditional Ways": Canadian Indigenous Women's Use of Violence Against Women Shelters, Mainstream Counseling, and Traditional Healing

We know little about what services are accessed by Indigenous women abused by intimate partners (IPV). This mixed-methods secondary analysis examines the demographics and narratives of 40 Canadian Indigenous women regarding their use of violence against women (VAW) emergency shelters (55%), second-stage VAW shelters (7.5%), mainstream community counseling (70%), and Indigenous healing practices (42.5%). Five women who identified as LGBTQ or two-spirit accessed community services but not VAW shelters. The women had experienced severe IPV, but scored below clinical cut-offs for depression, psychological distress, and PTSD. They described strengths, concerns, and barriers in accessing services. Implications for counselors are presented.

Certified Registered Nurse Anaesthetists' and Critical Care Registered Nurses' perception of knowledge/power in teamwork with Anaesthesiologists in Sweden: a mixed-method study

Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists' (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES.Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23.Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR.Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes.

My Parents, My Grandparents Went Through Residential School, and All this Abuse has Come From it: Examining Intimate Partner Violence Against Canadian Indigenous Women in the Context of Colonialism

While the global rates of intimate partner violence (IPV) for Indigenous women have been acknowledged as substantial, few studies have incorporated an analysis of the impacts of colonization in the context of IPV. This secondary mixed-methods analysis explored the experiences of 40 Indigenous women from the Canadian prairie provinces who were abused by their intimate partners. The women discussed the impact of colonization, including the use of residential schools, to break down family life, spiritual beliefs, and languages, at times linking this to IPV. Of the 40 women, 38 described male partners as the abusers and two identified female abusive partners. Consistent with the literature, many of the male partners physically assaulted the respondents so severely that the women were injured and were at risk of death. Almost half of the men (47.4%) used sexually coercive strategies and/or sexually assaulted the women. Implications include the importance of professionals considering the broader historical experiences and possible trauma of Indigenous women who seek assistance for IPV from abusive partners.

"We just don't have the resources": Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa

BACKGROUND

South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context.

METHODS

This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively.

RESULTS

The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA.

CONCLUSIONS

Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

A scoping review on technology applications in agricultural extension

Agricultural extension plays a crucial role in disseminating knowledge, empowering farmers, and advancing agricultural development. The effectiveness of these roles can be greatly improved by integrating technology. These technologies, often grouped into two categories-agricultural technology and educational technology-work together to yield the best outcomes. While several studies have been conducted using technologies in agricultural extension programs, no previous reviews have solely examined the impact of these technologies in agricultural extension, and this leaves a significant knowledge gap especially for professionals in this field. For this scoping review, we searched the five most relevant, reliable, and comprehensive databases (CAB Abstracts (Ovid), AGRICOLA (EBSCO), ERIC (EBSCO), Education Source (EBSCO), and Web of Science Core Collection) for articles focused on the use of technology for training farmers in agricultural extension settings. Fifty-four studies published between 2000 and 2022 on the use of technology in agricultural extension programs were included in this review. Our findings show that: (1) most studies were conducted in the last seven years (2016-2022) in the field of agronomy, with India being the most frequent country and Africa being the most notable region for the studies; (2) the quantitative research method was the most employed, while most of the included studies used more than one data collection approach; (3) multimedia was the most widely used educational technology, while most of the studies combined more than one agricultural technology such as pest and disease control, crop cultivation and harvesting practices; (4) the impacts of technology in agricultural extension were mostly mixed, while only the educational technology type had a statistically significant effect or impact of the intervention outcome. From an analysis of the results, we identified potential limitations in included studies' methodology and reporting that should be considered in the future like the need to further analyze the specific interactions between the two technology types and their impacts of some aspects of agricultural extension. We also looked at the characteristics of interventions, the impact of technology on agricultural extension programs, and current and future trends. We emphasized the gaps in the literature that need to be addressed.

[Mixed Methods Studies in Health Services Research: Requirements, Challenges and the Question of Integration - a Discussion Paper from the Perspective of Qualitative Researchers]

With this discussion paper, the subgroup Mixed Methods of the working group Qualitative Research Methods in the non-profit organization German Network Health Services Research (DNVF) is taking up the topic of three previous discussion papers on the significance and potentials of qualitative research methods in health services research. Mixed methods are being increasingly used and demanded in health services research. However, there are also areas of conflict in the planning and implementation of mixed methods studies, and these are addressed in this paper from the perspective of qualitative research. Special attention is given to the aspect of integration as the fundamental signature of mixed methods research. With this discussion paper, our aim was to stimulate critical as well as constructive exchange of ideas on what constitutes high-quality health services research characterised by a diversity of methods and the framework conditions under which this can succeed.

Patients' experiences of using a mobile application-based rehabilitation programme after total hip or knee arthroplasty: a qualitative descriptive study

BACKGROUND

An increasing number of patients are discharged from a total hip or knee arthroplasty with a short length of hospital stay. Technologies, such as mobile applications, are used to provide remote support to patients' postoperative rehabilitation. Patients' experiences of receiving mobile application-based rehabilitation after total hip or knee arthroplasty have not been investigated extensively.

METHODS

This was a qualitative descriptive study. Twenty-five participants who had completed a mobile application-based rehabilitation programme for total hip or knee arthroplasty were recruited. Semi-structured interviews were conducted via telephone between July 2021 and January 2022 regarding the participants' experiences using the programme. All interviews were audio-recorded and verbatim transcribed. Data were analysed using inductive content analysis. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Data analysis revealed five categories: (a) improved access to health care, (b) encouraged postoperative recovery, (c) established supportive relationships, (d) facilitated learning, and (e) future directions.

CONCLUSION

The theory-underpinned mobile application-based rehabilitation programme demonstrated potential value in supporting patients' rehabilitation after arthroplasty. Nurses can consider using mobile technologies to expand their role in arthroplasty rehabilitation and improve the quality of rehabilitation care.

Exploring the Mechanisms of Well-Being Occurrence Among Event Tourists: Mixed Empirical Evidence from Positive Psychology

Introduction

This study explores the well-being dimensional components of event tourists and their identification processes in validating the well-being occurrence mechanism of event tourism and the correlation between the well-being of event tourists and the frequency and length of event tourism.

Methods

This study adopted a sequential mixed-methods design that followed a pragmatic paradigm through a photo interview with event tourists and festival travel organizers (N=16). The qualitative research method provided evidence to explore the framework of content and dimensional identification of event tourists' well-being according to Seligman's PERMA model. The quantitative research phase (N=475) focused on identifying and validating the PERMA model in the event tourist well-being dimension through descriptive statistical analysis and validated factor analysis, followed by a one-way analysis of covariance to explore the effects of the frequency and endurance of FSE tourism.

Results

The results show quantitative differences in the well-being dimensions and framework presentation of the PERMA model (Positive emotion, Engagement, Relationship, Meaning, and Achievement). R (relationship) and A (achievement) are identified and validated as dimensions of well-being outcomes for event tourists, while single-day or short trips of 2-3 days were most significant for event tourists' perceived well-being.

Conclusion

This study provides an empirical argument, thus providing an empirical argument for uncovering the deeper influencing and exhibiting factors of the PERMA theoretical framework and a research paradigm for PERMA theory in more tourism behaviors and psychology. Second, this study provides an in-depth explanation of the five dimensions of well-being in the PERMA model. The findings show the salience of the relationship and achievement in FSE tourism well-being, providing theoretical insight into existing studies integrating positive psychology models for in-depth tourism well-being research.

While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study

Introduction

Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting.

Aim

To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements.

Methods

Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach.

Results

49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements.

Conclusion

While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.

Development of eConsult reflective learning tools for healthcare providers: a pragmatic mixed methods approach

BACKGROUND

Electronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional development. However, tools that guide and document learning from eConsults are limited. The purpose of this study was to develop and pilot two eConsult reflective learning tools (RLTs), one for PCPs and one for specialists, for those participating in eConsults.

METHODS

We performed a four-phase pragmatic mixed methods study recruiting PCPs and specialists from two public health systems located in two countries: eConsult BASE in Canada and San Francisco Health Network eConsult in the United States. In phase 1, subject matter experts developed preliminary RLTs for PCPs and specialists. During phase 2, a Delphi survey among 20 PCPs and 16 specialists led to consensus on items for each RLT. In phase 3, we conducted cognitive interviews with three PCPs and five specialists as they applied the RLTs on previously completed consults. In phase 4, we piloted the RLTs with eConsult users.

RESULTS

The RLTs were perceived to elicit critical reflection among participants regarding their knowledge and practice habits and could be used for quality improvement and continuing professional development.

CONCLUSION

PCPs and specialists alike perceived that eConsult systems provided opportunities for self-directed learning wherein they were motivated to investigate topics further through the course of eConsult exchanges. We recommend the RLTs be subject to further evaluation through implementation studies at other sites.

Getting a grip on Safewards: The cross impact of clinical supervision and Safewards model on clinical practice

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients' experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy-in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed-method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP-S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale -26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP-S approach improves the implementation of Safewards and nurses' clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP-S pre-GRIP-S- 69.54 (SD 16.059); post-GRIP-S 71.47 (SD 13.978). The survey also identified nursing staff's perception of GRiP-S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre-GRiP-S was 28.43 (SD 5.988) and post-GRiP-S 29.29 (SD 3.951). The formative mean score pre-GRiP-S was 20.10 (SD 5.617) and post-GRiP-S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP-S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamwork, (iii) barriers to GRiP-S engagement, and (iv) assistance with the change process. The results indicate that the GRiP-S approach had a positive impact on Safewards delivery and supports ongoing change of practice.

The Role of Exercise Self-Efficacy in Exercise Participation Among Women With Persistent Fatigue After Breast Cancer: A Mixed-Methods Study

OBJECTIVE

Survivors of breast cancer with persistent cancer-related fatigue (CRF) report less exercise participation compared with survivors of breast cancer without CRF. Although CRF predicts other domains of self-efficacy among survivors, the effect of CRF on exercise self-efficacy (ESE)-an important predictor of exercise participation-has not been quantified. This study examined the relationship between CRF, ESE, and exercise participation and explored the lived experience of engaging in exercise among survivors of breast cancer with persistent CRF.

METHODS

Fifty-eight survivors of breast cancer (3.7 [SD = 2.4] years after primary treatment) self-reported CRF, ESE, and exercise participation (hours of moderate-intensity exercise per week). Regression and mediation analyses were conducted. Survivors who reported clinically significant CRF and weekly exercise were purposively sampled for 1-on-1 interviews (N = 11). Thematic analysis was performed across participants and within higher versus lower ESE subsets.

RESULTS

Greater CRF predicted lower ESE (β = -0.32) and less exercise participation (β = -0.08). ESE mediated the relationship between CRF and exercise participation (β = -0.05, 95% CI = -0.09 to -0.02). Qualitative data showed that survivors of breast cancer with higher ESE perceived exercise as a strategy to manage fatigue, described self-motivation and commitment to exercise, and had multiple sources of support. In contrast, survivors with lower ESE described less initiative to manage fatigue through exercise, greater difficulty staying committed to exercise, and less support.

CONCLUSIONS

Survivors of breast cancer with persistent CRF may experience decreased ESE, which negatively influences exercise participation. Clinicians should screen for or discuss confidence as it relates to exercise and consider tailoring standardized exercise recommendations for this population to optimize ESE. This may facilitate more sustainable exercise participation and improve outcomes.

IMPACT

This study highlights the behavioral underpinnings of CRF as a barrier to exercise. Individualized exercise tailored to optimize ESE may facilitate sustainable exercise participation among survivors of breast cancer with CRF. Strategies for clinicians to address ESE are described and future research is suggested.

LAY SUMMARY

Women with fatigue after breast cancer treatment may have lower confidence about their ability to engage in exercise. Individually tailoring exercise to build confidence as it relates to exercise may result in more consistent exercise and better health-related outcomes.

Competencies and needs of nurse educators and clinical mentors for teaching in the digital age - a multi-institutional, cross-sectional study

BACKGROUND

The impact of technology and digitalization on health care systems will transform the nursing profession worldwide. Nurses need digital competencies to integrate new technology in their professional activities. Nurse educators play a crucial role in promoting the acquisition of digital competences and therefore need to be digitally competent themselves. Research on digital competencies of nursing educators is scarce but suggests lack of digital knowledge and skills and support needs. Although digitalization is to be seen as a global process, regional contexts need to be taken into account, such as pre-existing competencies, local conditions, and individual needs. Thus, it remains unclear which competencies nurse educators possess and which support needs they have. Aim of this study was to assess nurse educators' and clinical mentors' digital competencies and explore their needs and requirements concerning the digital aspects of their pedagogy and teaching activities in Germany.

METHODS

A descriptive exploratory study with a cross-sectional design was conducted. Participants were identified using a convenience sampling approach. Data were collected during July and September 2020 using a standardized self-reported questionnaire that was developed specifically for this study. The questionnaire was provided in a paper and online format and participants could decide which format to use. It contained open- and closed-ended questions. Data were analyzed using descriptive and content analysis. Additionally, explorative subgroup analyses based on job designation, age, and gender were performed. Reporting of this study adhered to the STROBE checklist.

RESULTS

A total of 169 educating nurses participated in the survey. The respondents considered themselves as digitally competent and showed a positive attitude towards the integration of digital technology in their teaching activities. Their perceived preparedness to integrate digital technology into teaching and training varied. Almost all respondents (98%) declared a need for further training and seemed motivated to participate in corresponding educational events. There were some indications for differences in competencies or needs between subgroups.

CONCLUSIONS

Educating nurses appear to possess basic digital competencies but there is a need to support their professional development in terms of new technologies. Findings can be used as a basis for developing supportive interventions. Further qualitative investigations could inform the design and content of such interventions.

Ostomy-related problems and their impact on quality of life of Saudi ostomate patients: A mixed-methods study

AIM AND OBJECTIVE

The aim of this study is to explore the health-related quality of life outcomes and ostomy-related obstacles among patients with ostomy in Saudi Arabia.

BACKGROUND

Negative effects on quality of life for patients following ostomy creation are a globally important health concern. Paucity of understanding factors that influenced quality of care after ostomy surgery hinders the ability of healthcare providers to offer appropriate care to improve patient's quality of care.

METHODS

This mixed-methods study was undertaken through survey (COHQOL-Q Arabic version) for collecting the quantitative data (n = 421) and semi-structured interview for collecting qualitative data (n = 12). This study employed STROBE and GRAMMS checklists.

RESULTS

Multiple health-related quality of life challenges was indicated by Saudi patients with intestinal stomas. Ostomy surgery interferes with religious practice in Muslim people, particularly obtaining Hajj worship and fasting for Ramadan. The overall QOL mean score was moderate level (M = 7.57) for ostomy patients in Saudi Arabia. The highest domain mean score was the social well-being (M = 7.84) and the lowest in the physical well-being (M = 7.18). Reshaping of religious practices, apprehension and adaptation to living with a stoma were the most common themes that participants discussed related to ostomy issues they experienced following ostomy surgery.

CONCLUSION

The study findings reported a greater understanding of challenges that patients with stoma experience in Saudi Arabia. The process of the adaptation and the change of their lifestyle also affects patient's quality of life. The healthcare providers can use the study results to create a supportive intervention strategy that needed for maximise QOL for people with stoma.

RELEVANCE TO CLINICAL PRACTICE

This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care which may support in the reduction of predictable problems. Recommendations for future studies related to nursing professional practice are indicated.

Long-Term Strategies for the Compatibility of the Aviation Industry with Climate Targets: An Industrial Survey and Agenda for Systems Thinkers

Aviation is responsible for nearly 2.5% of the world’s anthropogenic carbon emissions. Despite a commitment to reduce these emissions, it is a challenging industry to decarbonise. Very little is known about the attitudes of those working in aviation towards climate change and whether they are motivated to support decarbonisation initiatives. This uncertainty highlights several threats to the industry, with cascading impact on the economy and inequality. To deal with these challenges, this study explores long-term strategies to support compatibility between the evolution of the aviation industry and climate constraints. Using surveys, in-depth interviews, and thematic analysis, this research investigates the views of professionals towards climate change, and the role that they perceive aviation plays. The results of the interviews allow the development of a system map composed of ten self-reinforcing and three balancing loops, highlighting ten leverage points to inform strategies for the industry to respond to threats. This research concludes that the aviation industry should encourage a new generation of sustainability-aware innovators to decarbonise aviation. It also concludes that collaboration both internationally and within the industry is essential, as is the need to encourage an open-minded approach to solution development. It also presents the modelling results in terms of the multilevel perspective technological transition framework and suggests ways forward for modelling using the risk–opportunity analysis.

Development and evaluation of a patient education programme for children, adolescents, and young adults with differences of sex development (DSD) and their parents: study protocol of Empower-DSD

BACKGROUND

Differences in sexual development (DSD) are rare diseases, which affect the chromosomal, anatomical or gonadal sex differentiation. Although patient education is recommended as essential in a holistic care approach, standardised programmes are still lacking. The present protocol describes the aims, study design and methods of the Empower-DSD project, which developed an age-adapted multidisciplinary education programme to improve the diagnosis-specific knowledge, skills and empowerment of patients and their parents.

METHODS

The new patient education programme was developed for children, adolescents and young adults with congenital adrenal hyperplasia, Turner syndrome, Klinefelter syndrome or XX-/or XY-DSD and their parents. The quantitative and qualitative evaluation methods include standardised questionnaires, semi-structured interviews, and participatory observation. The main outcomes (assessed three and six months after the end of the programme) are health-related quality of life, disease burden, coping, and diagnosis-specific knowledge. The qualitative evaluation examines individual expectations and perceptions of the programme. The results of the quantitative and qualitative evaluation will be triangulated.

DISCUSSION

The study Empower-DSD was designed to reduce knowledge gaps regarding the feasibility, acceptance and effects of standardised patient education programmes for children and youth with DSD and their parents. A modular structured patient education programme with four generic and three diagnosis-specific modules based on the ModuS concept previously established for other chronic diseases was developed. The topics, learning objectives and recommended teaching methods are summarised in the structured curricula, one for each diagnosis and age group. At five study centres, 56 trainers were qualified for the implementation of the training programmes. A total of 336 subjects have been already enrolled in the study. The recruitment will go on until August 2022, the last follow-up survey is scheduled for February 2023. The results will help improve multidisciplinary and integrated care for children and youth with DSD and their families.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00023096 . Registered 8 October 2020 - Retrospectively registered.

The effectiveness of social media intervention in people with diabetes: An integrative review

AIM

This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus.

BACKGROUND

DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME.

DESIGN

An integrative review was conducted based on Whittemore and Knafl's (2005) methodology.

METHODS

The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used.

RESULTS

A total of 13 studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression.

CONCLUSIONS

Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression.

RELEVANCE TO CLINICAL PRACTICE

This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.

Development and psychometric evaluation of the nurse behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale

There is a scarcity of literature discussing nurses’ behaviors toward caring for suspected or confirmed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. The development of a scale specific to measure nurses’ behaviors will allow health institutions to assess the disposition of their nurses in terms of HIV care. This study aims to present the rigors of developing and validating a reliable instrument to contextualize these nurses’ behaviors. This study utilized a sequential exploratory mixed method design to develop the NB-CSHAP scale. Thematic analysis was done on the qualitative data from the interviews with persons living with HIV/AIDS (PLHA) from which items were selected to be included in the scale. Exploratory factor analysis was utilized to extract the factors and Cronbach's alpha was used to assess the reliability of the instrument. Four factors were extracted and are categorized as either caring or discriminatory behaviors. These include: (1) service-oriented, (2) openhanded, (3) perceptive, and (4) discriminatory. The scale has an internal consistency of 0.73. The scale shows acceptable psychometric properties, hence can be used to assess the nurses’ behaviors in caring for confirmed or suspected HIV clients. The scale may be used by health institutions to determine the quality of the patient care provided by their nurses to clients with confirmed or suspected HIV.

Use of health parameter trends to communicate pet health information in companion animal practice: A mixed methods analysis

BACKGROUND

Reviewing patient health parameter trends can strengthen veterinarian-client-patient relationships. The objective of this study is to identify characteristics associated with veterinarians' communication of health parameter trends to companion animal clients.

METHODS

Using a sequential exploratory mixed methods design, independent pet owner (n = 27) and veterinarian (n = 24) focus groups were conducted and analysed via content analysis to assess perceptions of how health parameter trends are communicated by veterinarians. Subsequently, a quantitative assessment of video recorded veterinary appointments (n = 917) compared characteristics identified in focus groups with health parameter trend discussions in practice. A mixed logistic model was used to assess characteristics associated with the occurrence of weight trend discussions.

RESULTS

Fifteen characteristics relating to veterinarians' use of health parameter trends were identified across focus groups. Veterinarians discussed 77 health parameter trends in relation to bodyweight (57/77), blood work (15/77) and other health parameters (5/77), within 73 (73/917) appointments. The odds of a weight trend discussion were higher if the veterinarian identified the pet as overweight or obese compared to an ideal bodyweight (odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.15-4.09; p = 0.016).

CONCLUSION

Mention of a health parameter trend was uncommon and rarely included use of visual aids. Health parameter trends related to bodyweight were discussed reactively, rather than proactively.

Planning implementation and scale-up of physical activity interventions for people with walking difficulties: study protocol for the process evaluation of the ComeBACK trial

Background

There is currently little evidence of planning for real-world implementation of physical activity interventions. We are undertaking the ComeBACK (Coaching and Exercise for Better Walking) study, a 3-arm hybrid Type 1 randomised controlled trial evaluating a health coaching intervention and a text messaging intervention. We used an implementation planning framework, the PRACTical planning for Implementation and Scale-up (PRACTIS), to guide the process evaluation for the trial. The aim of this paper is to describe the protocol for the process evaluation of the ComeBACK trial using the framework of the PRACTIS guide.

Methods

A mixed methods process evaluation protocol was developed informed by the Medical Research Council (MRC) guidance on process evaluations for complex interventions and the PRACTIS guide. Quantitative data, including participant questionnaires, health coach and administrative logbooks, and website and text message usage data, is being collected over the trial period. Semi-structured interviews and focus groups with trial participants, health coaches and health service stakeholders will explore expectations, factors influencing the delivery of the ComeBACK interventions and potential scalability within existing health services. These data will be mapped against the steps of the PRACTIS guide, with reporting at the level of the individual, provider, organisational and community/systems. Quantitative and qualitative data will elicit potential contextual barriers and facilitators to implementation and scale-up. Quantitative data will be reported descriptively, and qualitative data analysed thematically.

Discussion

This process evaluation integrates an evaluation of prospective implementation and scale-up. It is envisaged this will inform barriers and enablers to future delivery, implementation and scale-up of physical activity interventions. To our knowledge, this is the first paper to describe the application of PRACTIS to guide the process evaluation of physical activity interventions.

Trial registration

Australian and New Zealand Clinical Trials Registry (ANZCTR) Registration date: 10/12/2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05990-3.

A philosophical perspective on the development and application of patient-reported outcomes measures (PROMs)

Questionnaires are a common method in healthcare and clinical research to collect self-reported data on patients' behaviour and outcomes rather than the clinician's perspective. As a consequence there is a plethora of questionnaires and rating forms developed to measure a range of concepts such as health-related quality of life and health status. Given that these measures have been developed within a nomothetic paradigm to enhance our understanding of peoples self-perceived health status by translating complex personal feelings and experiences into a simple numeric score, the patient's illness narrative is lost along the way. This commentary discusses the limitations of the nomothetic approach as completion of a questionnaire is a social and contextually orientated activity and that their development is best viewed within the philosophical tradition of pragmatism, based on sound qualitative methods and rigorous psychometric testing. The commentary discusses the philosophical orientation underpinning PROM development and argues the case for a pragmatic epistemology based on a mixed methods research paradigm which goes beyond the current practice of informing the content validity of a PROM in the early phase of its development but to work towards developing a more composite and holistic picture through mixed methods in the interpretation of a patient's PROM score. Therefore, it is argued that the quality of data obtained will be enhanced but, also importantly and rightly places the participant at the centre of the research.

What Impacts Perceived Stress among Canadian Farmers? A Mixed-Methods Analysis

Globally, farmers report high levels of occupational stress. The purpose of this study was to identify and explore factors associated with perceived stress among Canadian farmers. A sequential explanatory mixed-methods design was used. An online cross-sectional national survey of Canadian farmers (n = 1132) was conducted in 2015-2016 to collect data on mental health, demographic, lifestyle, and farming characteristics; stress was measured using the Perceived Stress Scale. A multivariable linear regression model was used to investigate the factors associated with perceived stress score. Qualitative interviews (n = 75) were conducted in 2017-2018 with farmers and agricultural sector workers in Ontario, Canada, to explore the lived experience of stress. The qualitative interview data were analyzed via thematic analysis and then used to explain and provide depth to the quantitative results. Financial stress (highest category-a lot: (B = 2.30; CI: 1.59, 3.00)), woman gender (B = 0.55; CI: 0.12, 0.99), pig farming (B = 1.07; CI: 0.45, 1.69), and perceived lack of support from family (B = 1.18; CI: 0.39, 1.98) and industry (B = 1.15; CI: 0.16-2.14) were positively associated with higher perceived stress scores, as were depression and anxiety (as part of an interaction). Resilience had a small negative association with perceived stress (B = -0.04; CI: -0.06, -0.03). Results from the qualitative analysis showed that the uncertainty around financial stress increased perceived stress. Women farmers described the unique demands and challenges they face that contributed to their overall stress. Results from this study can inform the development of mental health resources and research aimed at decreasing stress among Canadian farmers.

What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study

Background

High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda.

Methods

A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data.

Results

Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women’s personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15–8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04–1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery.

Conclusions

Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women’s readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.

Professional identity in nursing: A mixed method research study

Professional identity is developed through a self-understanding as a nurse along with experience in clinical practice and understanding of their role. Personal and professional factors can influence its development. A recent integrative literature review synthesised factors that influenced registered nurse's perceptions of their professional identity into three categories of the self, the role and the context of nursing practice. This review recommended that further research was needed into professional identity and how factors and perceptions changed over time. The aims of this study were to explore registered nurses' understanding of professional identity and establish if it changed over time. A mixed-methods study using a two-stage design with an on-line survey and focus groups was implemented with registered nurses who were studying nursing at a postgraduate level in Australia or Scotland. The reported influences on professional identity related to the nurse, the nursing role, patient care, the environment, the health care team and the perceptions of nursing. Professional development and time working in the profession were drivers of changes in thinking about nursing, their role and working context and their professional identity. Additionally, participants sought validation of their professional identity from others external to the profession.

A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education

BACKGROUND

The purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients' health.

METHODS

This was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement.

RESULTS

Greater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students' medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient's health nor did it clearly influence students' future practice goals.

CONCLUSIONS

The MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.

Pharmacy based surveillance for identifying missing tuberculosis cases: A mixed methods study from South India

BACKGROUND

No Indian studies have assessed the implementation of recent policy on pharmacy based surveillance and its contribution in TB notification. So, this study was conducted with objectives to describe: a) pharmacy based TB surveillance and TB notification, and b) experiences of pharmacy based surveillance implementation from the programme managers and pharmacists perspective.

METHODS

A mixed methods study-quantitative (cross-sectional) and qualitative (in-depth interviews) in two selected districts Dharmapuri and Salem districts of Tamil Nadu State, India.

RESULTS

In 2018, 45 (11%) of 397 pharmacies in Dharmapuri and 90 (6%) of 1457 pharmacies in Salem districts reported sale of anti-TB drugs to 1307 and 1673 persons respectively. Upon validation through direct patient contact 942 (72%) persons in Dharmapuri and 863 (52%) persons were identified as previously 'un-notified' TB patients. These patients constituted 20% and 29% of the total TB cases notified in Dharmapuri and Salem respectively. The enablers for implementing this activity were: understanding the importance of notification, availability of resources (manpower, computers) to record, report and validate the patient data, repeated trainings and partnerships. The barriers were: patients' hesitancy to share their details to pharmacists (confidentiality), cumbersome recording and reporting process, difficulties in recording patient details during high workload busy business hours.

CONCLUSION

This process contributed about one-fourth of the TB patients notified in these districts. Its implementation needs to be strengthened and should be scaled up in other parts of the country.

Effects of Simulation on Nursing Students' Dementia Knowledge and Empathy: A Mixed Method Study

The experience of living with dementia is multifaceted while unique to the individual. Dementia education must empower nursing students to recognize the complexity of the experience while also emphasizing the need for person centered care. Participation in Dementia Live^® provides nursing students a glimpse into the life of a person living with dementia incorporating common symptoms associated with dementia and time for reflection regarding the experience. The purpose of the study was to determine the effects of dementia simulation on nursing students' dementia knowledge and empathy for people living with dementia. This convergent mixed methods study involved a convenience sample of 65 undergraduate nursing students. A pretest/posttest design was used to collect quantitative data while thematic analysis of focus group discussions was used for qualitative data collection. Quantitative results reported a significant increase in empathy. Qualitative findings supported the quantitative findings with themes identifying four of the six components of empathy. This study adds to the understanding of teaching and learning about dementia care and highlights the contributions a seven-minute simulation made to improve empathy.

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

AIMS AND OBJECTIVES

To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices.

BACKGROUND

High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors.

DESIGN

Observational mixed methods convergent design.

METHODS

Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research.

RESULTS

Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team.

CONCLUSIONS

The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality.

RELEVANCE TO CLINICAL PRACTICE

It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, Puducherry: A mixed-methods study

Background:

Iron-deficiency anemia in pregnancy is a major public health problem despite the efforts taken by the Ministry of Health and Family Welfare for the past five decades. Adherence to iron and folic acid supplementation (IFAS) is the key factor for the prevention and management of nutrition anemia.

Aim:

The aim of this study was to assess the adherence to its associated factors and to explore the reasons for the non-adherenc among pregnant women attending a tertiary care center.

Materials and Methods:

It is an explanatory mixed-methods design (quantitative cross-sectional analytical design and qualitative descriptive design).

Statistical Analysis Used:

Results presented as proportion with 95% confidence interval (CI). Chi-square test was done to assess the association of the factors to adherence. Qualitative data were transcribed verbatim, translated to English, and analyzed by manual content analysis.

Results:

A total of 340 pregnant women were included, and the adherence to IFAS among the antenatal mothers was 63.8 (95% CI [58.61–68.6]). The factors associated with adherence to IFAS (prevalence ratio with 95% CI) were primigravida status [1.22 [1.02–1.45]), nonanemic in the first trimester (1.27 [1.09–1.49]), and absence of side effects (3.16 [1.95–5.12]). Conceptual framework was constructed using the emerging themes: (i) knowledge-related factors, (ii) behavior-related factors, and (iii) facilitating factors.

Conclusion:

About three-fourth of the participants were adherent to IFAS. Compliance is directly influenced by the gravida status, anemic status, and absence of side effects. Based on qualitative results, measures to improve palatability and the quality of IFAS are recommended.

Determinants of nurse job dissatisfaction - findings from a cross-sectional survey analysis in the UK

Background

A lower recruitment and high turnover rate of registered nurses have resulted in a global shortage of nurses. In the UK, prior to the COVID-19 epidemic, nurses’ intention to leave rates were between 30 and 50% suggesting a high level of job dissatisfaction.

Methods

In this study, we analysed data from a cross-sectional mixed-methods survey developed by the Royal College of Nursing and administered to the nursing workforce across all four UK nations, to explore the levels of dissatisfaction and demoralisation- one of the predictors of nurses’ intention to leave. We carried out logistic regression analysis on available data in order to determine what impacts job dissatisfaction.

Results

In total, 1742 nurses responded to questions about working conditions on their last shift. We found that nearly two-thirds of respondents were demoralised. Nurses were five times more likely (OR 5.08, 95% CI: 3.82–6.60) to feel demoralised if they reported missed care. A perceived lack of support had nearly the same impact on the level of demoralisation (OR 4.8, 95% CI: 3.67–6.38). These findings were reflected in the qualitative findings where RNs reported how staffing issues and failures in leadership, left them feeling disempowered and demoralised.

Conclusion

A large proportion of nurses reported feeling dissatisfied and demoralised. In order to reduce the negative impact of dissatisfaction and improve retention, more research needs to investigate the relationship dynamics within healthcare teams and how the burden experienced by RNs when unsupported by managers impacts on their ability to provide safe, good-quality care. These findings predate the current Covid-19 pandemic outbreak which may have had a further detrimental effect on job satisfaction in the UK and other nation’s nursing workforce.

Preliminary report of a simulation community of practice needs analysis

Aim

To understand the current needs related to education and training, and other investment priorities, in simulated learning environments in Australia following a significant period of government funding for simulation-based learning.

Methods

A mixed methods study, comprising qualitative focus groups and individual interviews, followed by a quantitative cross-sectional survey informed by themes emerging from the qualitative data.

Findings

Two focus groups and 22 individual interviews were conducted. Participants included simulation educators, technical users and new adopters. Survey data were collected from 152 responses. Barriers at the introduction and maintenance stages of simulated learning included irregular staff training resulting in inconsistent practice, and lack of onsite technical support. Educators lacked skills in some simulation and debriefing techniques, and basic education and research skills were limited, while technicians raised concerns regarding the maintenance of equipment and managing budgets.

Discussion and conclusion

Despite its effectiveness as an education tool, barriers remain at the introduction and maintenance stages of simulated learning environments. Efforts to improve the integrity and sustainability of simulation training should be informed by a comprehensive needs analysis. The resulting data should be used to address barriers in a way that maximises the limited resources and funding available for this important learning tool.

An overview of the qualitative descriptive design within nursing research

Background

Qualitative descriptive designs are common in nursing and healthcare research due to their inherent simplicity, flexibility and utility in diverse healthcare contexts. However, the application of descriptive research is sometimes critiqued in terms of scientific rigor. Inconsistency in decision making within the research process coupled with a lack of transparency has created issues of credibility for this type of approach. It can be difficult to clearly differentiate what constitutes a descriptive research design from the range of other methodologies at the disposal of qualitative researchers.

Aims

This paper provides an overview of qualitative descriptive research, orientates to the underlying philosophical perspectives and key characteristics that define this approach and identifies the implications for healthcare practice and policy.

Methods and results

Using real-world examples from healthcare research, the paper provides insight to the practical application of descriptive research at all stages of the design process and identifies the critical elements that should be explicit when applying this approach.

Conclusions

By adding to the existing knowledge base, this paper enhances the information available to researchers who wish to use the qualitative descriptive approach, influencing the standard of how this approach is employed in healthcare research.