Cash outs during in-play sports betting: Who, why, and what it reveals

Cashing out is a popular feature of modern 'in-play' sports betting that allows sports bettors to withdraw a bet before the sporting event on which the bet was placed is finalized. Previous studies have shown that use of the cash out feature is positively related to problem gambling symptomatology. However, little is known about demographic and psychological characteristics of in-play sports bettors who use the cash out feature, or their motivations for use. To fill this knowledge gap, we recruited 224 adults (18 + years) from Ontario who engaged in in-play sports betting in the past three months. Participants completed self-report measures of psychological and gambling-related variables. Participants also provided qualitative responses for their motivations for using the cash out feature. Approximately half (51.8 %) of the participants reported using the cash out feature. No statistically significant demographic differences were found between participants who used and did not use the cash out feature. Participants who used the feature (compared to those who did not) reported higher problematic alcohol and cannabis use, feelings of depression, anxiety, and stress, and were motivated to gamble to make money. The primary reasons for cashing out were to access money immediately, to cut losses, and because cashing out felt like a less risky option. The current findings shed light on underlying psychological vulnerabilities associated with individuals who use the cash out feature, which can inform initiatives to reduce the harms associated with this popular feature of sports betting.

Experiences of Patients with Unilateral Vocal Fold Paralysis: A Mixed-Methods Study of the Insider's Perspective

OBJECTIVE

Unilateral vocal fold paralysis (UVFP) is often characterized by severe dysphonia and has a significant impact on a patient's communication in daily and vocational situations. Having a better understanding of how UVFP influences quality of life and patient experiences can help improve patient-centered care in this population. Therefore, the purpose of this study was to explore the lived experiences of patients with UVFP.

METHODS

Twenty-five adults with UVFP (age range: 39-84years) participated in the study. Quantitative data were collected from 22 participants, using the Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), and Acoustic Voice Quality Index (AVQI). Qualitative data were collected from 25 individual semistructured interviews, which were recorded, transcribed, and analyzed with the software program NVivo. The interviews were coded using an inductive thematic approach.

RESULTS

Quantitative results showed a mean DSI of - 1.6, mean AVQI of 3.80, and mean VHI of 45.8 in the participant group. A statistically significant, moderate (positive) correlation was found between VHI and time after onset (in years). From the qualitative analysis of the interviews, four main themes were identified: emotional impact, psychosocial impact, physical complaints, and coping strategies. Voice problems caused by UVFP generally had a negative impact on patients' emotional and psychological well-being, with considerable effects on participation, self-identity, and professional activity. Participants demonstrated a combination of problem-focused and emotion-focused coping strategies to accommodate to these issues. Half of the participant group also showed avoidance as a coping style. VHI scores were significantly higher in participants who reported experiencing current emotional and participation problems due to UVFP, and who had not yet accepted their new voice.

CONCLUSION

The themes from this study emphasize the importance of focused anamnesis and emotive counseling in practice, with specific attention to the psychosocial and emotional impact of UVFP.

Medication self-management among older adults with cognitive frailty

BACKGROUND

Independent and safe medication self-management is essential for successful aging. Nevertheless, how older adults with cognitive frailty (CF) self-manage medications at their own homes remain elusive.

OBJECTIVE

This study aimed at assessing the medication self-management capability of home-dwelling older adults with CF and exploring the ways, perceived challenges and barriers in medication self-management.

METHODS

A convergent mixed-method study design was used. The medication management capability of 16 CF individuals aged ≥ 60 years on ≥ 1 long-term prescription drugs were assessed using the Drug Regimen Unassisted Grading Scale (DRUGS). Virtual in-depth interviews were also performed between July-August 2022 using a semi-structured interview guide. All interviews were audio-recorded and transcribed verbatim. Qualitative data were analysed using a thematic analysis approach guided by Bailey and colleagues' model of medication self-management.

RESULTS

The mean DRUGS summary score was 96.86 [standard deviation (SD) 3.74] with highest performance scores observed in medication access (100 %) and lowest performance score in medication identification (91.46 %). Informants were able to independently take their medications and they tended to organise their medication intakes according to mealtime even though some admitted missing medication doses due to forgetfulness. Informants had difficulties with recalling drug names, with little awareness of self-monitoring their own health conditions and the effects of medications. Misconceptions towards medications, difficulties in accessing medications, reduced mobility and worsening health conditions could potentially deter informants from safe and independent medication self-management. In contrast, trust in doctors and a desire to achieve treatment goal could motivate medication self-management.

CONCLUSION

The findings revealed knowledge gaps among older adults with CF in identifying their medications and self-monitoring which warrant reinforcement by healthcare professionals to ensure chronic safe medication use. Future studies should evaluate strategies to enhance medication safety in terms of self-monitoring in individuals with CF.

Mixed-method study on the association between inclusion to conditional cash transfer program and the multiple faces of malnutrition in children and adolescents aged 3 to 19 years: a school-based evidence from Caraga Region, the Philippines

BACKGROUND

This study aimed to investigate the association between inclusion to Pantawid Pamilyang Pilipino Program (4Ps), a CCT program in the Philippines, and malnutrition in children and adolescents and examine the perceptions and experiences of parents and other stakeholders on how 4Ps influenced child nutrition.

METHODS

A concurrent mixed-method study was conducted in the Caraga Region, Philippines. Quantitative data from 5541 children and adolescents aged 3 to 19 were analyzed using multilevel mixed-effect logistic models. To allow in-depth understanding of the programmatic components that support the findings from the quantitative study, eight focused group discussions (FGDs) were concurrently conducted, cumulating 33 participants, including 4Ps parents, school coordinators/teachers, and school nurses. A constructivist grounded theory approach was used for analysis, and joint displays were employed to integrate quantitative and qualitative results.

RESULTS

Quantitative findings revealed high rates of malnutrition, with significant rates of stunting (12.0%), wasting/thinness (9.4%), and overweight/obesity (16.4%) among children and adolescents. 4Ps beneficiaries had higher odds of stunting and overweight/obesity compared to non-4Ps beneficiaries (AOR = 1.43, 95%CI: 1.08-1.91; AOR = 1.21, 95%CI: 1.01-1.45, respectively). However, no significant association was observed between inclusion to 4Ps and concurrent stunting and wasting/thinness or overweight/obesity (AOR = 1.05, 95%CI: 0.72-1.55). Geographic variations were observed, with 4Ps children in Agusan del Sur having lower odds of stunting than those in Agusan del Norte (AOR = 0.41, 95%CI: 0.23-0.71). Age and gender also showed significant associations with malnutrition. The qualitative analysis provided insights into the challenges contributing to malnutrition, including child labor, sickness, long distances to school, limited access to healthy food, and larger families. Unintended consequences such as cash card mismanagement, inappropriate cash grant allocation, and falsification of school attendance were identified. However, teachers and parents demonstrated resilience by implementing adaptive approaches to enhance child nutrition.

CONCLUSIONS

While 4Ps beneficiaries exhibit higher odds of stunting and overweight/obesity, the program's association with malnutrition was significantly influenced by geographic variations. It is crucial for social protection programs to prioritize comprehensive support strategies that effectively counter unintended consequences and challenges faced by beneficiaries and other stakeholders and address malnutrition in children and adolescents.

Application of case study research and ethnography methods: Lessons learned

While case studies can offer an in-depth investigation of a particular issue in healthcare, cultural context may be overlooked. Researchers may want to consider adding a cultural component to the design aimed at identifying and/or explaining values, beliefs, or traditions influencing the case. The addition of focused ethnography as a supplemental component to the research design is one strategy to examine cultural content. In this article, we provide insights gained from using case study research and focused ethnography in a qualitatively-driven mixed method design. Despite a detailed research plan, there were challenges that hindered the implementation of the design. To help prevent others from experiencing similar methodological challenges, we provide the following lessons learned and recommended strategies: discussion of structured procedures for intentional observations, reflexivity to guide decision-making, and refinement of processes using a pilot study.

Disrupted identities, invisibility and precarious support: a mixed methods study of LGBTQI adolescents and young adults with cancer

BACKGROUND

Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) adolescents and young adults (AYAs) with cancer report higher levels of depression and anxiety and lower health related quality of life than non-LGBTQI AYAs with cancer, and LGBTQI adults with cancer. This mixed methods study examined LGBTQI AYAs' experiences of cancer and cancer care, to understand these health disparities.

METHODS

Online surveys were completed by 95 LGBTQI AYAs with cancer (age 16-39 years); 19 AYAs took part in a one-to-one semi structured interview. Reflexive thematic analysis of interviews and open-ended survey responses facilitated in-depth examination of subjective experiences; descriptive statistics performed on individual closed-ended survey items identified the percentage of AYAs reporting experiences identified in the qualitative analysis.

RESULTS

63% of AYAs reported high or very high distress on the K10. Three themes were identified in the qualitative analysis: 1) "Identities in flux", included subthemes "Cancer disrupts developing identities, and involvement with LGBTQI communities"; "Internalized prejudice impacts identities"; and "Cancer facilitates identities and embodiment". 2) "Invisibility in cancer care", included subthemes "Navigating disclosure amongst cis-heteronormative assumptions", "Discrimination and paternalistic cancer care" and " Cis-heteronormativity within cancer information". 3) "Precarious social support for LGBTQI AYAs with cancer", included subthemes " Social support during cancer is helpful for LGBTQI AYAs", "LGBTQI AYAs navigate limited support", and" Finding cancer peer support networks is difficult for LGBTQI AYAs".

CONCLUSIONS

LGBTQI AYAs with cancer experience psychosocial vulnerabilities related to identity development, experiences of care, and social support networks. These factors likely contribute to their previously evidenced elevated risk of distress, relative to both non-LGBTQI AYAs and LGBTQI older adults. AYAs affected by cancer may require additional, tailored supportive care, including targeted information resources, LGBTQI AYA specific cancer support groups, or partnerships and referrals to LGBTQI community organisations. Additionally, it is evident that health care professionals and cancer services have much work to do in ensuring LGBTQI AYAs receive affirming and appropriate care across paediatric and adult clinical settings. They must move beyond assuming all patients are cisgender, heterosexual and do not have intersex variations unless otherwise stated; work to signal inclusivity and facilitate disclosure; and be able to respond appropriately with tailored information and care, which is inclusive of LGBTQI partners, chosen family, and support systems.

Patient communication and experiences in cancer clinical drug trials: a mixed-method study at a specialist clinical trials unit

BACKGROUND

As cancer therapies increase in their complexity, effective communication among patients, physicians, and research staff is critical for optimal clinical trial management. Currently, we understand little about on-trial communication practices and patient trial experiences over time. This mixed-method study explored patient experiences of participating in a clinical drug trial at different time points, focussing on patient communication with trial staff.

METHODS

Patients enrolled in clinical drug trials conducted at the Parkville Cancer Clinical Trials Unit were invited to complete a tailored online survey and/or a qualitative interview. Patients were recruited to three cohorts based on time since the first trial treatment: new (≥ 1 to ≤ 13 weeks), mid- (≥ 14 to ≤ 26 weeks), and long-term (≥ 52 weeks) trial patients. Descriptive statistics were calculated for survey responses. Interview data were analysed thematically with a team-based approach. Survey and interview data were integrated at the intepretation stage.

RESULTS

From May to June 2021, 210 patients completed a survey (response rate 64%, 60% male), 20 completed interviews (60% male), and 18 completed both. More long-term trial patients (46%) participated than new (29%) and mid-trial patients (26%). Survey data showed high (> 90%) patient satisfaction with the provision of trial information and communication with trial staff across trial stages, and many reported trial experiences as above and beyond standard care. Interview data indicated that written trial information could be overwhelming, and verbal communication with the staff and physicians was highly valued, especially for enrolment and side effect management among long-term patients. Patients described the key points along the clinical trial trajectory that merit close attention: clear and well-communicated randomisation practices, reliable pathways for side effect reporting and prompt response from the trial staff, and end-of-trial transition management to avoid a sense of abandonment.

CONCLUSION

Patients reported high overall satisfaction with trial management but outlined key pinch points requiring improved communication practices. Establishing a range of effective communication practices among trial staff and physicians with patients in cancer clinical trials may have a wide range of positive effects on patient accrual, retention, and satisfaction.

A call for qualitative and mixed-methods research on gambling and cannabis

Gambling disorder and cannabis use disorder are both considered major public health issues. Despite the well-documented frequency of substance use disorders among people with gambling disorder, little is known about the experiences of those who both engage with gambling and cannabis. A scoping review was undertaken to investigate studies focusing on the experiences of people who gamble and use cannabis. Unexpectedly, no qualitative or mixed-methods studies that included an in-depth qualitative component to study the lived experiences of this population were found. This absence highlights the critical need to diversify research methods and fill the gap in knowledge of the lived experiences of people who both gamble and consume cannabis.

Clinician acceptability of an antibiotic prescribing knowledge support system for primary care: a mixed-method evaluation of features and context

BACKGROUND

Overprescribing of antibiotics is a major concern as it contributes to antimicrobial resistance. Research has found highly variable antibiotic prescribing in (UK) primary care, and to support more effective stewardship, the BRIT Project (Building Rapid Interventions to optimise prescribing) is implementing an eHealth Knowledge Support System. This will provide unique individualised analytics information to clinicians and patients at the point of care. The objective of the current study was to gauge the acceptability of the system to prescribing healthcare professionals and highlight factors to maximise intervention uptake.

METHODS

Two mixed-method co-design workshops were held online with primary care prescribing healthcare professionals (n = 16). Usefulness ratings of example features were collected using online polls and online whiteboards. Verbal discussion and textual comments were analysed thematically using inductive (participant-centred) and deductive perspectives (using the Theoretical Framework of Acceptability).

RESULTS

Hierarchical thematic coding generated three overarching themes relevant to intervention use and development. Clinician concerns (focal issues) were safe prescribing, accessible information, autonomy, avoiding duplication, technical issues and time. Requirements were ease and efficiency of use, integration of systems, patient-centeredness, personalisation, and training. Important features of the system included extraction of pertinent information from patient records (such as antibiotic prescribing history), recommended actions, personalised treatment, risk indicators and electronic patient communication leaflets. Anticipated acceptability and intention to use the knowledge support system was moderate to high. Time was identified as a focal cost/ burden, but this would be outweighed if the system improved patient outcomes and increased prescribing confidence.

CONCLUSION

Clinicians anticipate that an eHealth knowledge support system will be a useful and acceptable way to optimise antibiotic prescribing at the point of care. The mixed method workshop highlighted issues to assist person-centred eHealth intervention development, such as the value of communicating patient outcomes. Important features were identified including the ability to efficiently extract and summarise pertinent information from the patient records, provide explainable and transparent risk information, and personalised information to support patient communication. The Theoretical Framework of Acceptability enabled structured, theoretically sound feedback and creation of a profile to benchmark future evaluations. This may encourage a consistent user-focused approach to guide future eHealth intervention development.

Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis

Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations.

Sharing decisions on reproductive goals: A mixed-methods study of the views of women who have cystic fibrosis

BACKGROUND

There are complex medical, psychological, social and economic aspects to becoming a parent with Cystic Fibrosis (CF). A shared decision-making (SDM) approach could help women with CF make informed decisions about their reproductive goals that are sensitive to their individual values and preferences. This study investigated capability, opportunity, and motivation to participate in SDM from the perspective of women with CF.

METHODS

Mixed-methods design. An international online survey was completed by 182 women with CF, to investigate participation in SDM in relation to reproductive goals, and measures of capability (information needs), opportunity (social environment) and motivation (SDM attitudes and self-efficacy) to engage in SDM. Twenty-one women were interviewed using a visual timelines method to explore their SDM experiences and preferences. Qualitative data were analysed thematically.

RESULTS

Women with higher decision self-efficacy reported better experiences of SDM relating to their reproductive goals. Decision self-efficacy was positively associated with social support, age, and level of education, highlighting inequalities. Interviews indicated that women were highly motivated to engage in SDM, but their capability was compromised by lack of information, perception of insufficient opportunities for focused discussions about SDM.

CONCLUSIONS

Women with CF are keen to engage in SDM about reproductive health, but currently lack sufficient information and support to do so. Interventions at patient, clinician and system levels are needed to support capability, opportunity and motivation to engage equitably in SDM in relation to their reproductive goals.

Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies

BACKGROUND

The re-emerging dominance of the Taliban in Afghanistan in 2021 caused a new wave of Afghan refugees heading Iran and neighboring countries. Iran in the Middle East and Germany in Europe are two major host countries to the largest populations of Afghan refugees. In both countries, several studies have been done to assess the health condition of refugees.

OBJECTIVES

To systematically review the existing literature to identify similarities and differences of health conditions of Afghan refugees living in the two countries, and to synthesize evidence on the health status and health care access of these populations.

METHODS

Related electronic databases and grey literature of Iran and Germany on the health of Afghan refugees were scanned and searched up for the period 2000-2020. Key terms were formed by combining "Afghan refugees or immigrants or populations or asylum seekers", "Physical or mental health", "Healthcare service or access or use", "Iran or Germany". Empirical studies were considered if they contained samples of Afghan refugees with particular outcomes for Afghans. Results were categorized for both countries in the three main areas of physical health, mental health, and access/use of healthcare services.

RESULTS

Nine hundred twenty-two documents were extracted, of which 75 full-texts were finally reviewed. 60 documents belonged to the health condition of Afghan refugees residing in Iran including 43 in physical health, 6 in mental health, 8 in healthcare access and use, and 3 in multiple aspects of health, and 15 belonged to Germany including 7 in physical health, 4 in mental health, 2 in healthcare access and use, and 2 in multiple aspects of health. A less explicit evaluation of the overall health condition of Afghan refugees was observable, particularly for Germany. While matches on the study subject exist for both countries, in comparison to Germany, we extracted more quantitative and qualitative health studies on Afghan refugees of the mentioned areas from Iran. German health studies were rare, less qualitative, and more on the health condition of diverse refugee groups in general.

CONCLUSIONS

Wide gaps and unanswered questions related to mental health and overall health status of the Afghan refugee population are observable, especially in Germany. Our systematic review identified the gap in evidence, which we would recommend to bridge using a wider lens to comprehensively assess the overall condition of refugees considering associations between health and socio-economic and cultural determinants instead of a one-dimensional approach. Further, within health studies on refugee populations, we recommend stratification of results by the country of origin to capture the within-group diversity among refugees with different countries of origin.

Dataset for the Victorian energy transition including technical, social, economic, and environmental detail

This data relates to existing and planned electricity generation projects in Victoria, Australia. Planning Victoria, part of the Victorian Government, registered most projects. The technical performance data for the projects includes the electricity generated, input fuel, losses in the transmission of electricity, energy storage options, and transparency between grid operators and stakeholders. The social data related to the projects include health data for the effect of Victorian coal plant pollution, including a rich dataset on the health effects of a coal fire in (Jennens, 2021). A dataset for all the health effects of coal plants in Victoria was then compiled. The social data also includes a measure of customer engagement with electricity distribution companies in Victoria and public satisfaction with renewable projects in Victoria. The economic cost data includes capital costs, operation and maintenance costs, and externality costs related to greenhouse gasses emitted. The environmental data used a life cycle assessment and the critical materials needed for the electricity generation projects. The analysis performed was an nBL assessment (Foliente, 2007) which uses a comparative analysis of the four bottom lines (environmental, social, economic and technology). An nBL assessment is similar to a Triple Bottom Line assessment but includes additional parameters. The data used for this nBL analysis was for three scenarios (business as usual, a renewable generation future with electricity imported from other states and a renewable generation future with all electricity generated in Victoria). The first step in managing the raw data was to normalise, standardise and aggregate the data. These steps were done for the four bottom lines and the three scenarios. The reuse potential of this data is high as it is for a pipeline of projects that will continue to evolve. This data would also have the potential for other researchers to compare the Victorian electricity transition with other places internationally.

Three-in-1,000 and dynamic norms: A mixed-method investigation of novel appeals for influencing organ donor registration

The current research investigated two rarely used appeals for increasing organ donor registration-both with the potential to backfire. The three-in-1000 appeal explains that less than one percent of people will die in such a way that their organs can be donated. This appeal could heighten awareness that donor registration is needed, but it can also convey that registering is futile. The dynamic norms appeal emphasizes the increasing number of people who are becoming registered donors. This appeal could increase the perceived normative nature of registration, but doing so can also lead potential donors to conclude that enough people are already registered. In Studies 1 and 2, participants recruited from Amazon's Mechanical Turk were randomly assigned to either one of these appeals, and their attitudes toward donor registration and intentions to register as a donor were compared to participants in a no-message control group. Study 2 included a qualitative component where participants were asked to describe their perceptions as to why the message was or was not influential. In both experiments, intentions to register were higher for those in both messaging conditions compared to the control group. Positive attitudes toward organ donation were higher in the three-in-1000 condition compared to the control group for both studies. Those in the dynamic norms condition reported more positive attitudes than the control group in Study 1, but not Study 2. In both studies, there was scant evidence of the messages backfiring. In the qualitative component of Study 2, self-reported reasons for the influence of each method provided insight into how and why these appeals were influential, and indicated signs of underdetection for the dynamic norms message.

The Feasibility of Providing Remote Functional Family Therapy with Adolescents During the COVID-19 Pandemic: A Mixed-Method Study

Background

Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care.

Objective

This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach.

Method

Study 1 consisted of semi-structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M _age  = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA's and chi-square tests.

Results

In Study 1 two themes emerged around experienced challenges, namely 'Feeling in control' and 'Engagement and alliance'. Two other themes emerged around adaptations, namely 'Being more on top' and 'Connecting in different ways'. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy.

Conclusions

The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09692-y.

Developing a co-production strategy to facilitate the adoption and implementation of evidence-based colorectal cancer screening interventions for rural health systems: a pilot study

BACKGROUND

Evidence-based colorectal cancer screening (CRCS) interventions have not been broadly adopted in rural primary care settings. Co-production of implementation strategies through a bundled approach may be promising in closing this gap by helping rural healthcare practitioners select and implement the best fitting CRCS interventions to the local context. This paper describes the process and outcomes of co-development and delivery of the bundled implementation strategy to improve adoption and implementation of CRCS interventions with two rural clinics.

METHODS

We used a bundle of implementation strategies with a core focus on academic-clinical partnership development (strategy 1) and Plan-Do-Study-Act cycles (strategy 2) to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and implementation that improves CRCS. We also developed an implementation blueprint for each clinic (strategy 3) through an online blueprinting process based on adapted "Putting Public Health Evidence in Action" (PPHEA) training curriculum. Clinic physicians and staff (n = 7) were asked to evaluate the bundled approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the bundled approach, we collected implementation outcomes and limited intervention effectiveness of the CRCS evidence-based interventions (EBIs) developed through the process.

RESULTS

Our co-production strategy yielded a prototype online blueprinting process consisting of 8 distance-learning PPHEA modules that guide selection and implementation of EBIs tailored to CRCS. Modules were delivered to clinic participants with minor adaptations, using PDSA cycle to improve quality of module contents and formats. Overall, participants in both clinics reported positive reactions toward the bundled approach. Both clinics reported improvements in how they perceived the characteristics of the innovation (the bundled approach) to tailor selected CRCS EBIs. As a result of the bundled strategies, each clinic selected and adopted specific EBI(s) with the varying degrees of implementation and CRCS outcomes.

CONCLUSIONS

The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of EBIs to improve CRCS.

Evaluation of the CNC® prosthetic system in recurrent breast cancer patients with chemotherapy-induced alopecia: a pilot study

BACKGROUND

Chemotherapy-induced alopecia (CIA), although generally reversible, is felt as extremely distressing by patients with breast cancer. A certified medical device (Capelli Naturali a Contatto^®-CNC^®) was produced to provide patients with a personalized scalp prosthesis, reproducing the patient's original hair, resistant to any type of everyday or sporting activity, and hairdressing.

AIMS

The present study aimed to evaluate the impact of the CNC^® device on the patient's perception of their body image, psychological wellbeing, satisfaction, strengths and weakness of the CNC^® device.

METHOD

A pilot study was carried out on 21 patients affected by CIA due to recurrent breast cancer. A mixed quantitative/qualitative method was used, including administering a questionnaire and a focus group.

RESULTS

Based on the Body Image Scale, body image perception improved after 3 and 6 months using the device in the 20 patients who answered the questionnaire. No significant change over time emerged for the six dimensions investigated by the Italian version of the Psychological Well-Being Scale. The thematic analysis of the focus groups showed six themes: definition of the prosthetic device, acceptance of the proposal, experience with the conventional wig, strengths, weaknesses, economic issues.

CONCLUSION

Compared to the previous experience of CIA and the standard wig, the use of the CNC^® device improved everyday life and may be proposed to women undergoing chemotherapy and expecting alopecia to prevent discomfort, social embarrassment, and compromised body image.

Intervening on impostor phenomenon: prospective evaluation of a workshop for health science students using a mixed-method design

BACKGROUND

Unaddressed impostor feelings that impede developing interest in science and self-efficacy in conducting research have a dispiriting effect that perpetuates unsatisfactory diversity in the health science workforce when such feelings are experienced more by those historically underrepresented in the workforce. This warrants effective interventions to reduce the impact of impostor feelings and related factors that diminish career resilience. We examined the effects of a 90-minute workshop on impostor perceptions and growth mindset to raise awareness of impostor phenomenon (IP) and develop skills to manage IP successfully for students attending a 10-week summer research experience program.

METHODS

Using a convergent mixed-methods design, data were analyzed from 51 racially and ethnically diverse students who participated in an interactive IP workshop. Using students' half-way and final progress reports about their summer experiences and pre- and post-summer online surveys, we identified how the workshop changed awareness of IP and helped students develop coping strategies.

RESULTS

Students strongly endorsed the workshop, remarking that its content and personal stories from peers validated their own IP experiences and relieved anxiety by revealing how common the experience was. Many reported applying mindset-changing solutions, including positive self-talk, focusing their thinking on facts about themselves and situation, and grounding themselves firmly against potentially persuasive and confidence-eroding impostor feelings. While students reported end-of-summer impostor feelings at levels similar to before the program, they described being able to manage their feelings better and persist towards goals and challenging tasks. One measure of IP appeared to be addressed through students' activation of a growth mindset, potentially explaining a specific mechanism for intervention. Discrepancies between qualitative responses and quantitative IP measures demand additional work on IP instruments.

CONCLUSIONS

A brief, theory-based IP workshop administered by research training programs, including those as short as 10-weeks, can have positive impact on subsequent IP experience and its successful management, with potential long-term impact on retention of a diverse biomedical research workforce.

Pedophile, Child Lover, or Minor-Attracted Person? Attitudes Toward Labels Among People Who are Sexually Attracted to Children

The primary label for people who are sexually attracted to children ("pedophile") is conflated with sexual offending behavior and tainted with stigma. In the present pre-registered mixed-method study, we therefore investigated attitudes and preferences regarding "pedophile/hebephile" and other labels among 286 people who report a stronger or equally strong sexual attraction to prepubescent and pubescent children than to adults. Overall, quantitative data showed acceptance of "pedophile/hebephile" as well as a range of alternative labels in a personal (Labeling Oneself) and a professional context (Being Labeled by Others). "Minor-attracted person" and "pedophile/hebephile" received generally higher support than other terms and appeared to be least divisive across three major online fora. Qualitative data revealed four themes: "Contested self-labels," "Person-first language and pathologizing sexuality/identity," "Stigma and shame," and "Reclaiming the pedophile label." Our results allow deeper insight into reasons for adopting certain labels over others, as well as difficulties of finding a non-stigmatizing label. We discuss limitations of the study and practical implications for clinical and research contexts.

Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework

BACKGROUND

Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes.

METHODS

We conducted a mixed-method consultation - a survey and semi-structured interviews during November-December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework.

RESULTS

The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants' concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised.

CONCLUSIONS

The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.

The benefits of Q + PPGIS for coupled human-natural systems research: A systematic review

Managing complex problems in socio-ecological systems (SES) requires innovative approaches, which account for multiple scales, large datasets, and diverse lived experiences. By combining two commonly utilized mixed-methods, public participation GIS (PPGIS) and Q-method (Q), Q + PPGIS has the potential to reveal competing agendas and reduce conflict, but its benefits and weaknesses are comparatively understudied. Using a systematic review, we evaluated how different studies have employed and implemented the Q + PPGIS method. We found 16 studies, comprising 30 publications, with considerable variation in their geographic foci, research disciplines, and addressed SES challenges. These studies exhibit a lack of cohesion between methodological design and implementation and the absence of a consistent application of the method. Nonetheless, Q + PPGIS offers a tool that can guide policy, better inform stakeholders, and reduce conflict based on misconceptions. Resolving the shortcomings identified here will broaden Q + PPGIS utility in geographically situating and representing multiple realities within complex socio-ecological systems challenges.

Evaluating students' experiences in self-regulated smart learning environment

The increasing development in smart and mobile technologies transforms a learning environment into a smart learning environment that can support diverse learning styles and skills development. An online learner needs to be supported for an engaging and active learning experience. Previously, this progressive research developed and implemented a self-regulated smart learning environment (mobile app) among final-year undergraduate students to support online learning experiences. To understand students' experiences, there is a need to evaluate the mobile app. However, there is a lack of a well-documented study investigating students' experiences in terms of usability, challenges, and factors influencing satisfaction to inform a decision regarding future implementation. This study attempts to fill these gaps by exploring these experiences for sustainable future implementation. The study used cyclical mixed-method evaluations to explore the experiences of 85 final-year undergraduate students. The quantitative data were collected using a survey on the constructs of the research model previously developed to evaluate factors influencing students' satisfaction, and the qualitative used focus group discussions to explore usability experiences and challenges of implementations. The quantitative data were analyzed using SPSS 25 to confirm the structural equation model's relationship. The qualitative data were analyzed using a thematic process to understand students' experiences. The findings from the first mixed-method evaluation show that students were able to follow the learning process, and the application supported their online learning experiences. However, a student expressed the need to improve user functionalities to motivate and engage them in the learning process. The suggestions were incorporated into the mobile app development for the second evaluation. The findings from the second evaluation revealed similar support. However, students suggested a web-based version to support different operating systems and improve interactions. Furthermore, the information system qualities and moderating factors investigated supported students' satisfaction. Future research could explore facilitators' experiences in the mobile app for sustainable development and implementation for engaging online learning experiences and skills development.

Stress and emotional arousal in urban environments: A biosocial study with persons having experienced a first-episode of psychosis and persons at risk

This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.

Distance Education among Italian Teachers: Differences and Experiences

The successful integration of technology in teaching is a key component of education. Although prior research highlighted factors fostering the use of technology by teachers, few studies focused on whether these factors vary among teachers of different grade levels and subjects. Moreover, no studies have investigated personal experiences related to distance education among a large sample of teachers. To address these gaps, the present mixed-method study sought to examine whether factors promoting distance education varied among Italian teachers of different grade levels and subjects. A further aim was to explore experiences of teachers using distance education. The sample involved 357 Italian teachers and preservice teachers who completed an online questionnaire during the COVID-19 pandemic that also contained open-ended questions. Findings indicated that teaching self-efficacy was greater in pre-service and primary teachers, while facilitating conditions were greater in humanities and science secondary teachers. The perceived ease of use of technology and technology for pedagogy skills were more pronounced among science secondary teachers. Advanced technology skills were lower in humanities secondary teachers while the behavioural intention to use technology was greatest among pre-service teachers. Four themes emerged from the qualitative study of teachers' insights. These included positive and negative aspects of using technology, the relationship with students, the versatility of distance education, and the quality of lessons. This study underscores the need to address training based on different teachers' grade levels and subjects, and to focus on the emerging themes to better integrate the use of technology in schools.

Open-mindedness trait affects the development of intercultural communication competence in short-term overseas study programs: a mixed-method exploration

BACKGROUND

Overseas study trips can enhance healthcare students' intercultural communication competence. An opportunity to immerse in the new culture enables them to develop their ability to offer services to people from different countries. However, the role that open-mindedness (i.e., a personality trait) can play in this process has not been explored.

METHODS

The present study adopted a mixed-method design to identify how open-mindedness trait affected this overseas learning process. Thirty-two undergraduate healthcare students in Australia took part in the study. Questionnaires, which measured socio-demographic information, intercultural communication competence and open-mindedness trait were administered to the participants before and after their overseas trip. Half of the participants (n = 16) were interviewed after the overseas trip.

RESULTS

The correlational analysis showed that the open-mindedness trait was correlated with cultural skills, a component of intercultural communication competence, but not significant with the other three components. Three themes emerging from the qualitative data indicated that the open-mindedness trait affected students' cultural exposure. This trait enabled participants to be actively involved in the immersion in the local culture. They were willing to learn from peer fellows, and keen to embrace novel challenges.

CONCLUSION

It is concluded that open-mindedness trait is vital for increasing cultural immersion, and hence promote intercultural communication skills.

Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol

BACKGROUND

Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth.

METHODS

This is a mixed method cohort study on PPFP and is nested within an ongoing "Women and Infants Integrated Interventions for Growth Study" (WINGS). Married women aged 18-30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices.

DISCUSSION

The findings from the study will provide useful insights into couples' contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women.

TRIAL REGISTRATION

Trial registration number: CTRI/2020/03/023954 .

A mixed-method study of edible oil waste from farm to table in Iran: SWOT analysis

The increasing trend of food waste is one of the serious challenges throughout the world. The purpose of this study is to investigate the status of edible oil waste (EOW) from farm to table using the SWOT (strengths, weaknesses, opportunities, and threats) analysis in Iran (2021). First, semi-structured, interviews were conducted with 11 experts in the edible oil industry. Then a cross-sectional study was done on 40 restaurant managers through telephone interviews about the restaurant's discarded edible oils. Finally, an online study was undertaken among 121 households regarding their waste cooking oil at home. Two categories in five themes with 20 subthemes were explored based on the participant's perspectives. Lack of up-to-date knowledge and appropriate technology were the main reasons for making waste from farm to factory. EOW is used optimally in other industries. The results showed that 92% of the restaurants sell the EOW for poultry feeds without refinement. The majority of the households [52%] throw EOW in the garbage and 21% dump their discarded oils in the sewage. By SWOT analysis, the challenges of EOW from farm to table were identified. There is no specific policy plan for collecting and recycling EOW. The waste oil used in poultry feed without refinement can enter the human body and the possible oxidation toxicity of this waste can pose public health risks. Policymakers can use the SWOT analysis for setting laws and regulations for EOW to ensure its safe disposal and promote its use for biodiesel to provide a healthy community.

Developing an explanatory theoretical model for engagement with a web-based mental health platform: results of a mixed methods study

BACKGROUND

With the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW.

METHODS

In this paper we drew on BWW trial participants' usage data (number of logins) and the qualitative data from the process evaluation that explored participants' experiences, engagement with and reactions to BWW.

RESULTS

Our results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform.

CONCLUSIONS

Our findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.

Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study

BACKGROUND

Cervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention.

METHODS

Effectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women's satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes.

RESULTS

After a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women's satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers' workload.

CONCLUSION

Free HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence.

Beyond "Meat Free Monday": A mixed method study of giving up eating meat

Increasing numbers of people are vegan, vegetarian, or reducing meat consumption. There has also been growth in campaigns such as Meat Free Monday (MFM) that encourage and support reduced meat consumption. We conducted a mixed-method exploration of the behaviour and beliefs associated with reducing or eliminating meat consumption. An online questionnaire was completed by an opportunistic sample of 655 people aged 18-82 who were registered on the MFM website, and were meat eaters at the time of registering. The key focus of quantitative analyses was comparisons between three groups: those who described themselves as "omnivores" who ate all meat at the time of completing the survey, those who ate only some meat, and those who had stopped eating meat since registering for MFM. The qualitative component entailed Interpretative Phenomenological Analysis of in-depth interviews with 18 people who had completed the questionnaire. The quantitative data revealed that people who had stopped eating meat since engaging with the MFM campaign had more positive attitudes toward being vegetarian or vegan, had been engaged with MFM for a longer time, and had used more elements of the MFM website. The qualitative data illustrated that individuals understood and appreciated MFM's aim of supporting people to make an initial change and then considering expanding on this. Interviewees highlighted the value and importance of campaign materials that helped them to turn their beliefs and motivation into enduring behaviour change. The observed associations between longer engagement with the campaign and greater behaviour change suggest that MFM and similar campaigns will maximise their impact if they can maintain people's active engagement: that this will necessitate deeper understanding of the forms of support and advice are most wanted and most effective.

Mixed-Method Examination of Latinx Teachers' Perceptions of Daily Behavioral Report Card Interventions to Support Students with ADHD

Daily behavioral report cards (DRC) are an efficacious intervention for children with ADHD, yet there is little information on Latinx teachers' perceptions about ADHD and preferences related to behavioral treatment. The purpose of the current study was to examine the feasibility and acceptability of behavioral consultation with Latinx teachers and students, with a particular focus on the DRC. Participants (n = 23) included elementary school teachers (100% Hispanic/Latinx, 96% female) working with predominantly Hispanic/Latinx students. We leveraged a convergent, mixed-method design to evaluate feasibility, acceptability, as well as several potentially associated factors (i.e., perceptual, practical/logistical, individual, and cultural factors). Quantitative and qualitative measures and analyses were guided by the Consolidated Framework for Intervention Research. We found that Latinx teachers' Daily Report Card (DRC) completion rates (80%) were comparable to previous studies with predominantly non-Latinx white teachers and students. Quantitative indicators of acceptability were also similar to the prior literature. Few variables were associated with DRC completion rates, with the exception of teacher self-report of stress and satisfaction, which were both positively associated with completion rates. Qualitative findings expanded quantitative trends; thematic analyses revealed two overarching themes, that (1) teachers' attitudes toward behavioral interventions matter a great deal, and that (2) teachers' perceived behavioral control over DRC implementation depends a lot on the environment. Findings highlight the importance of stakeholders' perspectives, including teachers, in translating research to practice in real world settings.

Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study

BACKGROUND

Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis.

METHODS

This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively.

RESULTS

A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown.

CONCLUSION

A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.

Family satisfaction in Egyptian adult intensive care units: A mixed-method study

OBJECTIVES

To examine family members' satisfaction in adult intensive care units.

METHODOLOGY

This is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion.

SETTINGS

Six adult intensive care units in university hospitals in Egypt.

MAIN OUTCOME MEASURES

Family satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews.

RESULTS

The mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members' satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (-2.41 [-3.23 to -1.59]), low economic status (-1.57 [-2.47 to -0.67]), and perceiving patient condition to be deteriorating (-0.99 [-1.93 to -0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment.

CONCLUSIONS

In Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.

Developing leadership in postdoctoral nurses: A longitudinal mixed-methods study

BACKGROUND

Postdoctoral nurses have an important role in advancing nursing by generating knowledge and building networks in research, practice, and education which requires effective leadership. Therefore, the Leadership Mentoring in Nursing Research programme for postdoctoral nurses was developed.

PURPOSE

This study was to evaluate expectations, experiences, and perceived influence of the leadership mentoring programme on leadership and professional development, professional identity, and research productivity of postdoctoral nurses.

METHODS

A longitudinal mixed-method study with a concurrent triangulation design was used with data collected through semistructured interviews and online surveys.

FINDINGS

The leadership mentoring programme was found to be valuable by the participants who described strengthened leadership and professional development and development of professional identities. Participants showed increased research productivity and many moved to new/higher positions.

DISCUSSION

The leadership mentoring programme was found to enhance the leadership and professional development of postdoctoral nurses and support them in their academic careers.

Worker and perceived team climate factors influence the use of restraint and seclusion in youth residential treatment centers: Results from a mixed-method longitudinal study

BACKGROUND

Restraint and seclusion (R&S) are controversial methods of intervention aimed at protecting children from immediate harm in residential treatment centers (RTC). Previous studies have mainly focused on situational factors and youth characteristics to predict its use.

OBJECTIVES

This study sought to evaluate the role other potential predictors could play in the decision to use R&S, namely characteristics of residential workers and their perceived team climate.

METHODS

For two months, a total of 132 residential workers from different RTC in the greater Montreal area completed weekly diaries of standardized questionnaires. Using an explanatory sequential design (i.e., mixed methods), this study aimed at exploring the role of residential workers' characteristics (e.g., exposure to client aggression, stress and fatigue) and aspects of their perceived team climate (e.g., order and organization, communication and openness) as predictors of R&S use. Survey results were later also presented to four focus groups for discussion.

RESULTS

Results indicated that exposure to verbal violence from youths was associated with the increased use of R&S. Meanwhile, perceived communication and openness were associated with lower rates of R&S use. Participants shared that repeated exposure to verbal violence diminished their level of tolerance while teamwork provided them with the emotional space needed to focus on the needs of youths and find alternatives to R&S.

CONCLUSION

This study sheds light on the complex role of human emotions in the decision to use of R&S. Specifically, intense momentary emotions during crisis interventions had a greater influence on the use R&S than chronic states, such as fatigue.

The "Healthy Akame!" community - government - university collaboration for health: a community-based participatory mixed-method approach to address health issue in rural Japan

Background

Although Japan has a decentralized public health system, local governments have considered expert opinions over those of the community in decisions about public health programs. Differences in communities’ interests may create gaps between health program objectives and implementation. We hypothesized that community-based participatory research (CBPR), which involves the community at every step, promotes effective program implementation and community empowerment. This study addressed the first step of CBPR, assessing community needs and developing tailored health program for a rural community in Japan.

Methods

In this sequential exploratory mixed-method study (qualitative followed by quantitative), we first formed a community advisory board (CAB) representing community organizations, city officials, and university researchers. The CAB conducted group discussions with community residents to identify the community’s health issues and strengths. These group discussions were analyzed using thematic analysis, and the results were used to develop a questionnaire, which was subsequently sent to all households in the community to obtain priority scores for health issues and proposed action and to assess willingness to participate in community health program. The CAB then designed a program using the overall study results.

Results

Ten group discussions with 68 participants identified the following health issues: 1) diseases; 2) unhealthy behaviors; and 3) unsupportive environment. Nature, vacant lots, and local farms were considered local strengths. Of a total of 1470 households in the community, questionnaires were collected from 773 households. Cancer, lifestyle-related diseases, and cerebrovascular diseases were ranked as the most important health problems. Improving services and access to medical checkups, use of public space for exercise, local farming, and collaboration with the community health office were considered necessary to address these health problems. Considering feasibility and the availability of resources in the community, the CAB decided to focus on lifestyle-related diseases and designed activities centered on health awareness, nutrition, and exercise. These activities drew on community’s strengths and were adapted to Japanese culture.

Conclusions

The community’s priority health problem was closely related to the epidemiology of diseases. The CBPR approach was useful for identifying community’s needs and for designing a unique community health program that made use of local strengths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05916-w.

Case study research for better evaluations of complex interventions: rationale and challenges

BACKGROUND

The need for better methods for evaluation in health research has been widely recognised. The 'complexity turn' has drawn attention to the limitations of relying on causal inference from randomised controlled trials alone for understanding whether, and under which conditions, interventions in complex systems improve health services or the public health, and what mechanisms might link interventions and outcomes. We argue that case study research-currently denigrated as poor evidence-is an under-utilised resource for not only providing evidence about context and transferability, but also for helping strengthen causal inferences when pathways between intervention and effects are likely to be non-linear.

MAIN BODY

Case study research, as an overall approach, is based on in-depth explorations of complex phenomena in their natural, or real-life, settings. Empirical case studies typically enable dynamic understanding of complex challenges and provide evidence about causal mechanisms and the necessary and sufficient conditions (contexts) for intervention implementation and effects. This is essential evidence not just for researchers concerned about internal and external validity, but also research users in policy and practice who need to know what the likely effects of complex programmes or interventions will be in their settings. The health sciences have much to learn from scholarship on case study methodology in the social sciences. However, there are multiple challenges in fully exploiting the potential learning from case study research. First are misconceptions that case study research can only provide exploratory or descriptive evidence. Second, there is little consensus about what a case study is, and considerable diversity in how empirical case studies are conducted and reported. Finally, as case study researchers typically (and appropriately) focus on thick description (that captures contextual detail), it can be challenging to identify the key messages related to intervention evaluation from case study reports.

CONCLUSION

Whilst the diversity of published case studies in health services and public health research is rich and productive, we recommend further clarity and specific methodological guidance for those reporting case study research for evaluation audiences.

A mixed-methods approach to understanding overdose risk-management strategies among a nationwide convenience sample

BACKGROUND

This mixed-methods study compared drug use histories between individuals who had a reported non-fatal overdose to individuals who did not and described the overdose risk-management strategies as they were experienced by a sample of people who use drugs (PWUD). Shifts from non-medical prescription opioid use (NMPOU) to the use of heroin and synthetic opioids have been implicated in national increases in overdose incidences in the United States. However, relatively limited data exists regarding the narrative experiences of the evolving overdose risk management strategies among a nationwide sample of PWUD.

METHODS

Data recruitment was conducted via Amazon's mTurk crowdsourcing technology and was collected through semi-structured interviews that occurred in 2019. Participants (N = 60) with a history of NMPOU with transition to heroin or fentanyl use were recruited.

RESULTS

Participants reporting a previous non-fatal overdose were more likely to report a history of injection drug use, a history of heroin injection, greater overdose risk knowledge, and current medication for opioid use disorder (MOUD) use. Qualitative analysis revealed that participants attempted to mitigate overdose risk in primarily three ways: 1) self-regulation; 2) harm reduction; and 3) passive approach. Self-regulatory measures included administering small or incremental dosing, being mindful of personal tolerance limits, and avoiding the initiation of injection drug use. Harm reduction measures used to protect from overdose included carrying Narcan and relying on trusted drug-suppliers as references to drug purity. A passive approach indicated that participants relied on "luck" or divine support systems where religiosity and faith were endorsed as factors that mitigated personal overdose risk.

CONCLUSION

Participants reported successful overdose mitigation via self-regulation, which may suggest that PWUDs were capable at managing their drug use amid the overdose crisis. The importance of the drug-supplier relationship was critical to many in reducing their overdose risk as formal harm reduction services (e.g., safe injection sites) remain inaccessible in the U.S. Implications for drug policy and harm reduction interventions are discussed.

Creating public value in the care at home sector: a mixed-method study about expectations of primary stakeholders using a social exchange perspective

PURPOSE

This mixed-method study aims to contribute to the scholarly debate by outlining an individual-level theoretical framework for public value creation and evaluation that builds upon a social exchange perspective. It provides insights into the normative frames of primary stakeholders in the Dutch care at home sector, that is professionals, managers, clients and informal care providers.

DESIGN/METHODOLOGY/APPROACH

A mixed-method design comprising a customized survey among 349 stakeholders, preceded by 31 in-depth interviews was used.

FINDINGS

This empirical work shows differences and similarities in the stakeholders' normative frames revealed via three dimensions of expectations regarding the process of care delivery: personal contact, impact of rules and procedures and communication.

SOCIAL IMPLICATIONS

These differences in interpretation have implications for the measurement and evaluation of public value creation.

ORIGINALITY/VALUE

By statistically and methodologically exploring the different expectations' scales that are developed, we intend to work toward a measure for public value creation, which can be used in future empirical work.

Effectiveness of simulation-based cardiopulmonary resuscitation training programs on fourth-year nursing students

BACKGROUND

Cardiopulmonary resuscitation (CPR) training for nursing students is important. The aim of study is to examine the effectiveness of a simulation-based CPR training program on the knowledge, practices, satisfaction, and self-confidence of nursing students.

METHODS

The study was conducted with a mixed-method design. The quantitative data were obtained by using the "CPR Knowledge Questionnaire," the "Students' Satisfaction and Self-Confidence Scale," and the "CPR Skills Observation Checklist", and the qualitative data were collected by using the "Semistructured Interview Form" in four focus group sessions, each consisting of six participants.

RESULTS

The mean pretest CPR knowledge score of the students before the simulation-based CPR training was 5.66 ± 1.97 out of 10.0. The mean posttest CPR knowledge score (8.38 ± 1.30) increased significantly after the simulation (p < 0.001). In addition, the mean posttest CPR skills score was significantly higher than the mean pretest CPR skills score (p < 0.001). Themes from the qualitative data revealed that the students considered the simulation to be an interesting and useful teaching method. These themes were "worries before simulation" and "satisfaction following simulation".

CONCLUSION

Simulation-based CPR training improved the levels of knowledge and skills of nursing students. In addition, after the simulation training, satisfaction and self-confidence scores were found to be high.

Evaluation of the birth plan implementation: a parallel convergent mixed study

BACKGROUND

Pregnancy, birth, and motherhood are among the most important events of every woman's life. Training and participation of mothers in the decision-making process of delivery play an essential role in physical as well as psychosocial preparation of the mother. The healthcare system can improve and enhance the level of care by involving the patient in their self-care process. The aim of the present study is to assess the implementation of the birth plan for the first time in Iran in Tabriz city.

METHODS/DESIGN

The present study uses a mixed-method with a parallel convergence approach, including both quantitative and qualitative phases. The quantitative phase is a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city. The participants will be assigned into intervention and control groups using a randomized block method. A training session will be held about the items of the birth plan checklist at weeks 32-36 of gestation for the participants in the intervention group, whereby a mother-requested birth plan will be developed. It will then be implemented by the researcher after admitting them to the delivery ward. Also, those in the control group will receive routine care. During and after the delivery, the questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) will be completed. Also, a partogram will be completed for all participants by the researcher. The participants in both groups will be followed up until six weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire (CEQ2.0), Edinburgh's Postpartum Depression Scale and PTSD Symptom Scale 1 (PSS-I) will be completed six weeks 4-6 weeks postpartum by the researcher through an interview with participants in Taleghani educational hospital. The general linear model and multivariate logistic regression model will be used while controlling the possible confounding variables. The qualitative phase will be performed to explore the women's perception of the effect of the birth plan on childbirth experience within 4-6 weeks postpartum. The sampling will be of a purposeful type on the women who would receive the birth plan and will continue until data saturation. In-depth, semi-structured individual interviews would be used for data collection. The data analysis will be done through content analysis with a conventional approach. The results of the quantitative and qualitative phases will be analyzed separately, and then combined in the interpretation stage.

DISCUSSION

By investigating the effect of implementing the birth plan on the childbirth experience of women as well as other maternal and neonatal outcomes, an evidence-based insight can be offered using a culturally sensitive approach. The presentation of the results obtained from this study using the mixed method may be effective in improving the quality of care provided for women during labor.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: July 7, 2020. URL: https://en.irct.ir/user/trial/47007/view.

Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.

Effectiveness and working mechanisms of the InConnection approach in multi-problem families: study protocol of a mixed-methods study

BACKGROUND

Multi-problem families face problems in several domains that are often found to be chronic and intergenerational. Effective mental health care for youth from these families is currently lacking, urging research on new methods. The InConnection approach is an integrated care program to improve resilience in multi-problem families by connecting the professional expertise from multiple disciplines with the informal social network of the youth. Specifically, youth are asked to nominate a youth initiated mentor (YIM) from among the supportive adults in their network. The aim of this protocol is to describe the design of a mixed-methods study to examine the effectiveness and working mechanisms of the InConnection approach.

METHOD/DESIGN

The effectiveness of the InConnection approach is studied in a quasi-experimental questionnaire study using propensity score matching, with N = 300 families with youth aged 10-23 years receiving treatment in either the intervention group (InConnection approach) or the control group (care as usual). The main outcome variables include youth resilience (primary), youth mental health, parental functioning, and the number, duration and types of out-of-home placements. Mediators, moderators, and predictors of effectiveness are examined. Assessments take place at the start of the care program and after three, nine and 15 months. Additionally, semi-structured interviews are conducted with families who have and have not nominated a YIM to understand why some families successfully nominate a YIM, whereas others do not.

DISCUSSION

Effective care for youth in multi-problem families is urgently needed. Given its flexibility and accessibility to suit all youth aged 10-23 years from multi-problem families, and its low costs compared to out-of-home placements, the InConnection approach seems an appealing approach to support these families. The current study will provide information on the effectiveness of the InConnection approach. Strengths of this study include its robust design, the ecological validity, and the inclusion of possible mediators, predictors, and moderators of treatment effects.

TRIAL REGISTRATION

Netherlands Trial Register NL7565 . Retrospectively registered on March 5, 2019.

Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country

Background

Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The aim of this study is to evaluate the impact of CareWell integrated care model for older patients with multimorbidity in the Basque Country.

Methods

The CareWell program for older patients with multimorbidity, based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The program was deployed in four healthcare areas in the Basque Country. The control group was formed by two organizations in which the program had not been deployed and regular care procedures were applied.

Participants, older patients (aged ≥65) with two or more chronic conditions (at least one being chronic obstructive pulmonary disease, chronic heart failure, or diabetes mellitus), categorized as complex according to a risk stratification algorithm, were followed up to 12 months. The impact of the program on the use of health resources, clinical effectiveness, and satisfaction was evaluated using a mixed-method approach.

Semi-structured interviews were performed to assess satisfaction with the newly deployed model and mixed regression models to measure the effect of the intervention throughout the follow-up period.

Results

Two hundred patients were recruited (101 intervention and 99 control), mostly males (63%) with a mean age of 79 years and age-adjusted Charlson Comorbidity Index of 9.7 on average. Relevant differences between the groups were observed for all dimensions. In the intervention group, the number of hospitalizations and visits to emergency centers was reduced, and the number of primary care contacts increased. Clinical changes were also observed, such as a decrease in the body mass index and blood glucose levels. The satisfaction level was high for all stakeholders.

Conclusion

The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations. The satisfaction with this model of care was high.

Trial registration

ClinicalTrials.gov, NCT03042039. Registered 3 February 2017 - Retrospectively registered.

Exploring student perceptions and attitude towards various aspects of peer feedback in a pharmacotherapy course

BACKGROUND

The purpose of this study is to gauge pharmacy students' perceptions and attitude towards peer feedback in a pharmacotherapy course.

METHODS

An explanatory sequential mixed-method approach with a 20-item electronic survey and semi-structured interviews were used to collect data from students enrolled in a required pharmacotherapy course at a major public university in the southeast United States. A survey design with descriptive statistics were used for the quantitative part and constant comparative approach was used to analyze qualitative data.

RESULTS

Seventy-three completed surveys (53%) were received (n = 73). Majority of the students (90%) believed that they will be using peer feedback in their future pharmacy careers. Most students (90%) agreed that their peers are competent enough to provide constructive feedback, whereas only 78% believed in their own competency to provide feedback to their peers. Over 81% of students preferred receiving feedback from a peer they have previously worked with. Interviews with five second-year pharmacy students (n = 5) revealed three major themes regarding PharmD students' perception of peer feedback activity, namely, (1) participants' perspectives about the value of peer feedback, (2) learning from peer feedback, and (3) significance of the individuals participating in the peer feedback activities.

CONCLUSIONS

Perceptions of competency, the perceived value of peer feedback and interrelationship among peers are important determinants of effective peer feedback practices. Education and training in techniques and benefits of peer feedback, as well as opportunity to practice the skill can help students promote a positive attitude towards peer feedback.

Exploring barriers to meeting recommendations for fruit and vegetable intake among adults in regional areas: A mixed-methods analysis of variations across socio-demographics

Fruit and vegetable consumption is low compared to recommendations worldwide. Few studies have investigated intakes of fruit and vegetables and barriers to meeting recommendations in a mixed-method design. Moreover, there is a need to better understand differences in these barriers by population subgroups. This study aimed to examine fruit and vegetable intake and barriers to meeting recommendations and differences by sex, age and socio-economic groups. Data on adults from the cross-sectional Greater Bendigo Active Living Census 2014 were used. Participants self-reported intake of fruit and vegetables and completed an open-ended question on barriers to meeting recommended intakes. Logistic regression analyses were used to examine odds of meeting recommended intakes. Leximancer was used for thematic analyses of barriers. A total of 13,788 individuals (54% female, 52.1 (SD 17.7) years) were included in the quantitative analyses. Qualitative data were available for 5649 of these individuals. Only seven percent of participants met recommended intakes for fruit and vegetables. Barriers were lack of time, that guidelines were perceived as unachievable, the wide variety of other foods available and the high cost and limited availability of fresh fruit and vegetables. The most relevant barriers by subgroups were: taste (12%) and lack of appetite (18%) for males and females, respectively; lack of time (26-28%) and lack of appetite (70%) for young to middle aged adults and older adults, respectively and cost (35%) and availability of fresh fruits and vegetables (22%) for rural and disadvantaged groups. Findings have implications for the design of healthy eating strategies, which may benefit from being tailored to key population groups.

Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study

PURPOSE

We conducted a feasibility study to investigate the use of ketogenic diets (KDs) as an adjuvant therapy for patients with glioblastoma (GBM), investigating (i) trial feasibility; (ii) potential impacts of the trial on patients' quality of life and health; (iii) patients' perspectives of their decision-making when invited to participate in the trial and (iv) recommending improvements to optimize future phase III trials.

METHODS

A single-center, prospective, randomized, pilot study (KEATING), with an embedded qualitative design. Twelve newly diagnosed patients with GBM were randomized 1:1 to modified ketogenic diet (MKD) or medium chain triglyceride ketogenic diet (MCTKD). Primary outcome was retention at three months. Semi-structured interviews were conducted with a purposive sample of patients and caregivers (n = 15). Descriptive statistics were used for quantitative outcomes and qualitative data were analyzed thematically aided by NVivo.

RESULTS

KEATING achieved recruitment targets, but the recruitment rate was low (28.6%). Retention was poor; only four of 12 patients completed the three-month diet (MCTKD n = 3; MKD n = 1). Participants' decisions were intuitive and emotional; caregivers supported diet implementation and influenced the patients' decision to participate. Those who declined made a deliberative and considered decision factoring diet burden and quality of life. A three-month diet was undesirable to patients who declined and withdrew.

CONCLUSION

Recruitment to a KD trial for patients with GBM is possible. A six-week intervention period is proposed for a phase III trial. The role of caregivers should not be underestimated. Future trials should optimize and adequately support the decision-making of patients.

A nurse-led self-management support intervention for patients and informal caregivers facing incurable cancer: A feasibility study from the perspective of nurses

PURPOSE

Investigation of the feasibility of recruitment through nurses of patients with incurable cancer, and the feasibility (adoption, usage) and nurses' evaluation of a nurse-led self-management support intervention, integrated in continuity home visits and based on the 5 A's Behavior Change Model.

METHOD

Questionnaire, registrations, evaluation forms, and interviews.

RESULTS

Recruitment was complicated; many patients were ineligible for participation, nurses appeared protective of their patients (gatekeeping), and recruitment during the first continuity home visit appeared to be a barrier as a lot of other issues had to be discussed. The adoption rate was 81%, meaning that 18 out of 22 nurses recruited were willing to use the intervention. The usage rate at the nurse level was 56%, meaning that 10 nurses applied the intervention in full (having applied all five A's) in at least one patient. Nurses used the intervention in full in 21 out of the 36 patients included, implying a usage rate at the patient level of 58%. Nurses' mean general satisfaction score for the intervention was 7.57 (range 0-10). Nurse were especially positive about the 5 A's model, and considered the continuity home visits to be an appropriate setting for the intervention.

CONCLUSIONS

Timing of recruitment and gatekeeping complicated recruitment of patients through nurses. Although nurses were positive about the intervention, nurses often did not fully apply the intervention. To improve its usage, it is suggested that nurses should first be trained in using the 5 A's model.

Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth

ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.

Community-dwelling older adults' needs and acceptance regarding the use of robot technology to assist with daily living performance

BACKGROUND

The rate of aging in Korea is extremely fast compared to major countries. We examined the key demands of community-dwelling older adults with regard to Connected Active Space technology, which provides tailored assistance with daily living performance through robotic services.

METHODS

This study is based on a mixed-method design, through a quantitative survey (n = 234) first phase, followed by a qualitative study with focus group interviews (n = 23) to explore the needs and acceptance of community-dwelling aged people concerning the application of robot technology in their daily lives.

RESULTS

The scores concerning the need for and acceptance of robot services to assist daily living performance were high, at 7.2 and 7.9 out of 10 points, respectively. Further, for both needs and acceptance, timely reaction to emergency situations, early detection of emergency situations, help to locate objects, assistance with mobility, and assistance in memory recall were prioritized (in that order). In a thematic analysis of qualitative data from three focus-group interviews, a 'mismatch between desires and functional capacity' was the core characteristic of living as an older person and 'being a friend and helper' was the most desired trait of a robot service.

CONCLUSION

Although most of the participants lived independently, they regularly experienced difficulties regarding buying products, transportation, using phones, and preparing meals. If appropriate assistance technology is developed, this population can maintain its independence. Thus, it is necessary to address main needs, including detecting and addressing emergency situations, locating objects, assisting mobility and memory recall, and assisting with daily living performance. New robot services that can be tailored to the functions or abilities of the elderly must be developed based on individually collected information.